— lesson 1—

INTRODUCTION TO OPERATIVE
SURGERY

Prof.: MD, Nikita Klyshko

 — TOPIC —
Equipment of typical operating
room, tools, modern methods of
surgical interventions. Modern
methods of anesthesia.
• Structure of the standard operating room
• Surgical instruments (5 groups) & suture materials
• Modern methods of surgical interventions & anesthesia
• Operational access
• Seams
• Practical part
Structure of operation theatre
 The modern operating room is equipped with
high-tech equipment and devices that meets the
modern requirements of both surgery and
anesthesiology
There are 4 zones in the Operation Theatre Complex
 The Operation Theatre Complexes are organized
on the principle of "clean rooms" with separation
on "dirty" and "clean" areas in order to prevent
infectious complications
Zoning of the Operation Theatre Complex
Scheme of Operating Theater Complex
 Sterile Zone (zone 1)

This zone includes:

• Operating rooms
• Closet for anesthesia equipment
 Sterile Zone (zone 1)
In this zone all kinds of operation are conducted:
1. Transplantation of tissues and organs
2. Joint prosthesis
3. Herniaplastic (operation to close a hernia defect)
4. Reconstruction of large vessels, operations on heart
and another organs
5. Microsurgical operations
6. Neurosurgical, open thoracoabdominal, combined
operations (removing of tumors of different
localization)
7. and another interventions
 Sterile Zone

Operating room
 Clean Zone contains (zone 2)

1. Clean-up zone
2. Scrub zone
3. Storage space for sterile surgical supplies
4. Storage rooms for solutions for parenteral
treatment and surgical instruments
5. Anaesthesia induction rooms
6. Staff room
 Clean Zone

Scrub zone with entrance to operating room

 Protective zone (zone 3)

There are:
1. Rooms for preparation of surgical instruments
2. Rooms for disinfection of anaesthesiological and respiratory
devices.
3. Protocol rooms
4. Medical staff rooms
5. Stores for suture material, blood, mobile X-ray equipment
6. Shower room (to wash body and change their clothes)
 Protective zone

Stores for suture material, blood, mobile X-ray equipment

 Disposal zone of the Operating Theater
Complex ( zone 4)

Allowed free coming medical staff of the hospital.

There are offices of medical staff working in the

operating unit, stores of medical equipment and
material supplies.
 Disposal zone

Office of Operating Sisters Store of medical equipment and material supplies

Basic surgical instruments
 Classification of instruments by purpose (5 groups)

1. tools for tissue separation (knives, scissors, saws, etc.)

2. hemostatic instruments (clamps, ligature needles)
3. tools for fixing tissues (tweezers, hooks, probes,
retractors, etc.)
4. tools for connecting tissues (needle holders with
needles, suture material, staplers, etc.)
5. special tools
 1. Tools for tissue separation
Resection knife

Scalpels Amputation Surgical scissors

knives
 Electrosurgery device
(for disconnecting tissues and hemostasis)

Electrosurgery is based on the

transformation of electrical
energy into thermal energy.
For dissection and coagulation
of tissue using high frequency
electric current
Cryosurgical instruments and apparatuses

Cryosurgery (from the Greek - "cold" and

"work by hands") is a kind of surgical
treatment through low-temperature
exposure to abnormal or diseased biological
tissues with the purpose of destroying,
reducing, removing any part of tissue or
organ.

There are used liquid nitrogen, carbon

dioxide, argon, etc. in apparatuses for
cryosurgery
Ultrasonic devices for tissue separation

The ultrasonic knife is used for separating and

excising scars, removing tumors, opening
inflammatory foci, and performing plastic surgeries.

The ultrasonic knife

 2. Hemostatic instruments

Kocher's clamp (forceps)

Hemostatic clamps

Deshan’s ligature needle

 3. Tools for fixing tissues

hooks (1,2,3,4)
retractors (5)
Tweezers:
1. surgical
2. anatomical
 4. Tools for connecting tissues

Surgical needles (reusable)

Mathieu needle holder Surgical

needles
Mathieu needle holder disposable
(atraumatic)

Hegard needle holder

 Stitching surgical apparatuses
Intestinal stitching apparatus Metal clips are used in
stitching apparatuses

Stitching apparatus
cassettes with metal clips for endoscopic
operations

cassettes with
metal clips
 5. Special surgical instruments are used only in certain operations

Tools for the skull trepanation Special tools for amputation

Set for tracheostomy
1. Blunt hook for thyroid
isthmus
2. Single-toothed pointed
hook for holding the larynx
and trachea
3. Trousseau trachea
retractor
4. Tracheostomy cannula (in
assembled and
disassembled form)
 Terminology

• Absorbable (e.g. Vicryl (polygalactin 910), chromic gut)   

• Degraded in tissue in less than 60 days
• Traditionally used for closure of subcutaneous tissues or injuries to the
tongue or nailbed

• Non-absorbable (e.g. Ethilon (nylon), silk, Prolene (polypropylene)

• Lasts longer than 60 days
• Traditionally used for skin closure
 Terminology

• Monofilament (e.g. Prolene (polypropylene), plain gut)

• Made of one strand of material

• Multifilament (e.g. Vicryl Rapide (polygalactin 910), silk)

• Made of multiple strands woven together in a braid
• More friction when pulled through tissues, however this adds greater security
to knots than monofilament
• Greater risk for inflammation and infection than monofilament
 Terminology

• Natural (e.g. silk, chromic gut)

• Made of organic materials
• Traditionally more inflammatory than synthetic materials

• Synthetic (e.g. Ethilon (nylon), Vicryl (polyglactin 910))

• Made of laboratory manufactured material
 Gauge: Size of suture
• Strength of suture proportional to square of the diameter of the thread
• Usually best to select smallest suture that provides adequate tensile
strength as more material increases tissue reaction
• Standardized by United States Pharmacopedia
• Scale runs from 11-0 (smallest) to 7 (largest)
• Sizes are a number or a zero
• #2>#1>0>2-0 (00)
• Zero sizes are pronounced with the number of zeros first
• Eg. 7-0 is pronounced “seven-oh”
• Metric system used in other parts of the world
• Sized in tenths of a millimeter
• Eg. 5-0 is 0.1mm in diameter and size 1 metric
 Needles
Types
• Cutting and reverse cutting most common for skin closure
• Cutting: sharp edge of needle on inside of curve
• Reverse cutting
• Sharp edge of needle on outside of curve
• Theoretically reduces chances of suture pulling through tissue
• Taper point: used for surgical applications in soft tissue
 Needles

• Size
• Measured from thread attachment to needle tip in mm
• Usually sized to correspond with suture gauge
• Shape
• eg. Straight, sections of a circle, double curved
• 3/8ths and 1/2 circle are most common for skin closure
 Types of anesthesia

1.General anesthesia - narcosis

2.Local anesthesia:
• Contact anesthesia (application)
• Infiltrative anesthesia
• Conduction Anesthesia
• Epidural anesthesia
• Spinal anesthesia (subdural anesthesia)
 Types of anesthesia

General anesthesia, or narcosis is a complete loss of all

sensitivity, often with different levels of the consciousness
depression

Local anesthesia – local insensibility to pain without the loss of

consciousness , induced with anesthetics:
 General anesthesia
Inhalation narcosis: inhalation of vapor or Intravenous narcosis: the introduction of the
gaseous narcotic substances anesthetic solutions into veins, muscles, etc.
Anesthesia machine
 Local anesthesia

• Contact anesthesia (application) - anesthesia by applying

anesthetics to mucous membranes.

• Infiltrative anesthesia - blocking the transduction of impulse at

the level of pain receptors and small nerve branches
• Conduction Anesthesia - blocking the transmission of impulse at the
level of the nerve trunk or nerve plexuses.

• Epidural anesthesia - blocking the transmission of impulse at the

level of the spinal nerve roots by introducing an anesthetic into the
epidural space.

• Spinal anesthesia - blocking the transmission of impulse at the level

of the spinal nerve roots by introducing an anesthetic into the
subdural space.
 Local anesthesia

Conduction anesthesia (blocking

Infiltrative anesthesia (blockage of the transmission of impulse at the
impulse transmission at the level of level of the nerve trunk or nerve
small nervous branches) plexuses)

Application anesthesia
Best incisions
How to make best
incision?
Types of seams
Simple interrupted suture
Adopted interrupted suture (Donati
stitch)
Uninterrupted intradermal suture
Uninterrupted 2 layers suture
Surgical
skill