8/6/2019 1 Surgery

1/39

SURGERYSURGERY

The etymology of the word surgeryThe etymology of the word surgery

Chiron = handChiron = handErgon = workErgon = work

8/6/2019 1 Surgery

2/39

SURGERYSURGERY

Branch of medicineBranch of medicine-- surgical proceduressurgical procedures

Under the protection of asepsia andUnder the protection of asepsia andantisepsia, anesthesia, hemostasis,antisepsia, anesthesia, hemostasis,antibioticsantibiotics

A good surgeonA good surgeon--3H3H-- HEAD, HAND, HEARTHEAD, HAND, HEART Surgery is science and artSurgery is science and art

8/6/2019 1 Surgery

3/39

POSSIBLE SURGICALPOSSIBLE SURGICAL

OUTCOMESOUTCOMES

THE RIGHT OPERATION PERFORMED WELLTHE RIGHT OPERATION PERFORMED WELL

THE RIGHT OPERATION PERFORMED BADLYTHE RIGHT OPERATION PERFORMED BADLY

THE WRONG OPERATION PERFORMED WELLTHE WRONG OPERATION PERFORMED WELL

THE WRONG OPERATION PERFORMED BADLYTHE WRONG OPERATION PERFORMED BADLY

8/6/2019 1 Surgery

4/39

SURGERYSURGERY

THE SURGEON GIVES LIFE FROM HIS OWNTHE SURGEON GIVES LIFE FROM HIS OWN

8/6/2019 1 Surgery

5/39

SHORT HISTORY OF SURGERYSHORT HISTORY OF SURGERY

HIPOCRAT (KOS, 460HIPOCRAT (KOS, 460--377 BC)377 BC)

TREAT THE PATIENT NOT THE DISEASETREAT THE PATIENT NOT THE DISEASE

FIRST OF ALL, DO NOT DO ANY HARMFIRST OF ALL, DO NOT DO ANY HARM

OBSERVATION= FIRST STAGE OFOBSERVATION= FIRST STAGE OFPHYSICAL EXAMINATIONPHYSICAL EXAMINATION

8/6/2019 1 Surgery

6/39

SHORT HISTORY OF SURGERYSHORT HISTORY OF SURGERY

CELSUSCELSUS Of the numerous volumes of his encyclopedia, only one remains intact, hisOf the numerous volumes of his encyclopedia, only one remains intact, his

celebrated treatisecelebrated treatise On MedicineOn Medicine ((De MedicinaDe Medicina), which is divided into eight), which is divided into eightbooks.books.

In the "Prooemium" or introduction toIn the "Prooemium" or introduction to De MedicinaDe Medicina there is an earlythere is an earlydiscussion of the relevance of theory to medical practice and the pros anddiscussion of the relevance of theory to medical practice and the pros andcons of bothcons of both animal experimentationanimal experimentation andand human experimentationhuman experimentation..

In the treatment of disease, Celsus' principal method was to observe andIn the treatment of disease, Celsus' principal method was to observe andwatch over the operations ofwatch over the operations ofNatureNature, and to regulate rather than oppose, and to regulate rather than opposethem, conceiving that fever consisted essentially in an effort of the body tothem, conceiving that fever consisted essentially in an effort of the body tothrow off some morbid cause, and that, if not unduly interfered with, thethrow off some morbid cause, and that, if not unduly interfered with, theprocess would terminate in a state of health. On occasions, however, heprocess would terminate in a state of health. On occasions, however, heboldly recommends the use of theboldly recommends the use of the scalpelscalpel; his rules for; his rules for blood lettingblood letting andand

purgativespurgatives are laid down with detail and precision;are laid down with detail and precision;[6][6] and many of the rulesand many of the ruleshe prescribes were not very different from those still in use at the beginninghe prescribes were not very different from those still in use at the beginningof the 19th century. His work contains detailed descriptions of theof the 19th century. His work contains detailed descriptions of thesymptoms and different varieties ofsymptoms and different varieties offeverfever,,[7][7] and he is credited withand he is credited withrecording the cardinal signs ofrecording the cardinal signs ofinflammationinflammation:: calorcalor (warmth),(warmth), dolordolor (pain),(pain),tumortumor (swelling) and(swelling) and ruborrubor (redness and(redness and hyperaemiahyperaemia).).

8/6/2019 1 Surgery

7/39

HippocratesHippocrates used the Greek wordused the Greek word carcinoscarcinos,,

meaning crab or crayfish, to refer to malignantmeaning crab or crayfish, to refer to malignanttumors. It was Celsus who translated the Greektumors. It was Celsus who translated the Greekterm into the Latinterm into the Latin cancercancer, also meaning crab, also meaning crab

He goes into great detail regarding theHe goes into great detail regarding thepreparation of numerous ancient medicinalpreparation of numerous ancient medicinalremedies including the preparation ofremedies including the preparation ofopioidsopioids. In. Inaddition, he describes many 1st century Romanaddition, he describes many 1st century Romansurgical procedures which included removal of asurgical procedures which included removal of acataractcataract, treatment for, treatment for bladder stonesbladder stones, and the, and the

setting ofsetting offracturesfractures..

8/6/2019 1 Surgery

8/39

SHORT HISTORY OF SURGERYSHORT HISTORY OF SURGERY

GALENUSGALENUS-- TOPOGRAPHICTOPOGRAPHIC

ANATOMYANATOMY THE DEVELOPMENT OFTHE DEVELOPMENT OF

SURGERY WAS IMPAIRED DUESURGERY WAS IMPAIRED DUETO THE FAILURE TO ACTTO THE FAILURE TO ACT

AGAINST BLEEDING,AGAINST BLEEDING,INFECTION, PAININFECTION, PAIN

8/6/2019 1 Surgery

9/39

AMBROISE PARE (1510AMBROISE PARE (1510--1590)1590)= FATHER OF SURGERY= FATHER OF SURGERY -- HeHewas the great official royalwas the great official royalsurgeon for the kingssurgeon for the kings Henry IIHenry II,,Francis IIFrancis II,, Charles IXCharles IXandand

Henry IIIHenry III and is considered asand is considered asone of the fathers of surgery.one of the fathers of surgery.He was a leader in surgicalHe was a leader in surgicaltechniques andtechniques and battlefieldbattlefieldmedicinemedicine, especially the, especially thetreatment of wounds. He wastreatment of wounds. He was

also an anatomist and thealso an anatomist and theinventor of several surgicalinventor of several surgicalinstruments.instruments.

8/6/2019 1 Surgery

10/39

SHORT HISTORY OF SURGERYSHORT HISTORY OF SURGERY

WILLIAM MORTON,WILLIAM MORTON,

1846, ETHER1846, ETHER

8/6/2019 1 Surgery

11/39

JOSEPH LISTERJOSEPH LISTER--

FATHER OF ANTISEPSIAFATHER OF ANTISEPSIA

carbolic acid's antiseptic propertiescarbolic acid's antiseptic properties

LOUIS PASTEURLOUIS PASTEUR--

FATHER OF ASEPSIAFATHER OF ASEPSIA

8/6/2019 1 Surgery

12/39

SHORT HISTORY OF SURGERYSHORT HISTORY OF SURGERY

JOSEPH LISTERJOSEPH LISTER(1827(1827--1912)1912)

STERILE SURGERYSTERILE SURGERY

CARBOLIC ACIDCARBOLIC ACIDSOLUTIONSOLUTION-- WOUNDSWOUNDS

HANDS WASH ANDHANDS WASH ANDSTERILE GLOVESSTERILE GLOVES

INSTRUMENTSINSTRUMENTSWASHED WITH SOL.WASHED WITH SOL.

8/6/2019 1 Surgery

13/39

SHORT HISTORY OF SURGERYSHORT HISTORY OF SURGERY

LOUIS PASTEUR,LOUIS PASTEUR,

1860, germ theory of1860, germ theory ofdiseasedisease

CHEMICAL ANDCHEMICAL ANDPHYSICAL AGENTSPHYSICAL AGENTS

KILL BACTERIASKILL BACTERIAS STERILE SURGERYSTERILE SURGERY

8/6/2019 1 Surgery

14/39

SHORT HISTORY OF SURGERYSHORT HISTORY OF SURGERY

THEODOR KOCHERTHEODOR KOCHER(1841(1841--1917)1917)

19091909-- Nobel Prize forNobel Prize forhis work on thehis work on thethyroid glandthyroid gland

8/6/2019 1 Surgery

15/39

HISTORYHISTORY

THEODOR BILLROTHTHEODOR BILLROTH(1829(1829--1894)1894)

Two types of partialTwo types of partial

gastrectomies aregastrectomies arenamed after himnamed after him

FirstBillroth I partialFirstBillroth I partial

gastrectomygastrectomy-- 1881 for1881 forpyloric gastric cancerpyloric gastric cancer

8/6/2019 1 Surgery

16/39

HISTORYHISTORY

WILLIAM STEWART HALSTEDWILLIAM STEWART HALSTED(1852(1852--1922)1922)

High repute as a surgeon andHigh repute as a surgeon anddiagnosticiandiagnostician

18901890--introduced the use ofintroduced the use ofrubber glovesrubber gloves

Halsted radical mastectomyHalsted radical mastectomy

Developed methodsDeveloped methods

Strict aseptic techniqueStrict aseptic technique Gentle handling of tissueGentle handling of tissue

Low tension on the tissueLow tension on the tissue

Use of fine silk suture materialUse of fine silk suture material

8/6/2019 1 Surgery

17/39

8/6/2019 1 Surgery

18/39

HISTORYHISTORY

ALEXANDERALEXANDERFLEMING,1881FLEMING,1881--19551955

19451945--The Nobel PrizeThe Nobel Prizefor discovery offor discovery of

PENICILLINPENICILLIN

8/6/2019 1 Surgery

19/39

HISTORYHISTORY

WILHELM CONRADWILHELM CONRADROENTGEN, 1845ROENTGEN, 1845--

19231923

1895, discovery1895, discovery

of the raysof the rays-- X RAYX RAY

8/6/2019 1 Surgery

20/39

ASEPSISASEPSIS

ABSENCE OF ANY INFECTIOUS AGENTSABSENCE OF ANY INFECTIOUS AGENTS

PROCEDURES FOR ASEPSISPROCEDURES FOR ASEPSIS

STERILIZATION OF GOODS AND SUPPLIESSTERILIZATION OF GOODS AND SUPPLIES DISINFECTION OF THE HOSPITALDISINFECTION OF THE HOSPITAL

ENVIRONMENTENVIRONMENT

ANTISEPSIS OF LIVING TISSUESANTISEPSIS OF LIVING TISSUES

ENVIRONMENTAL CONTROL OF THEENVIRONMENTAL CONTROL OF THEOPERATING ROOMOPERATING ROOM

8/6/2019 1 Surgery

21/39

STERILIZATIONSTERILIZATION

IS THE PROCESS THAT KILLS ALL FORMSIS THE PROCESS THAT KILLS ALL FORMSOF LIVING MATTER: BACTERIA, VIRUSES,OF LIVING MATTER: BACTERIA, VIRUSES,MOULDSMOULDS

SPECIAL EQUIPMENTSPECIAL EQUIPMENT-- PHYSICAL ORPHYSICAL ORCHEMICAL AGENTSCHEMICAL AGENTS

PRACTICAL CRITERION OF STERILITY ISPRACTICAL CRITERION OF STERILITY ISTHE FAILURE OF MICROBIAL GROWTHTHE FAILURE OF MICROBIAL GROWTH

8/6/2019 1 Surgery

22/39

STERILE= WITHOUT LIVING ORGANISMSSTERILE= WITHOUT LIVING ORGANISMS

STERILIZATION= THE PROCESS OFSTERILIZATION= THE PROCESS OF

OBTAINING STERILE OBJECTS THROUGHOBTAINING STERILE OBJECTS THROUGHCHEMICAL OR PHYSICAL TREATMENTSCHEMICAL OR PHYSICAL TREATMENTS

8/6/2019 1 Surgery

23/39

MOIST HEAT ORMOIST HEAT OR

STEAM UNDER PRESSURESTEAM UNDER PRESSURE

DESTROYS ALL MICROBIAL LIFEDESTROYS ALL MICROBIAL LIFEINCLUDING SPORESINCLUDING SPORES-- denaturation ofdenaturation ofintracellular proteins.intracellular proteins.

THE PARAMETERS OF EFFICACYTHE PARAMETERS OF EFFICACY Temp. 140* CTemp. 140* CAtmospheric pressure 2,5Atmospheric pressure 2,5

Time of sterilization 30 min.Time of sterilization 30 min.

8/6/2019 1 Surgery

24/39

MOIST HEATMOIST HEAT

SOFT SURGICAL SUPPLIESSOFT SURGICAL SUPPLIES

GOWNSGOWNS

MASKSMASKS

DRAPESDRAPES

SHEETSSHEETS

DRESSINGSDRESSINGS

SWABSSWABS

8/6/2019 1 Surgery

25/39

DRY HEAT STERILIZATIONDRY HEAT STERILIZATION

THE PARAMETERS OF EFFICACYTHE PARAMETERS OF EFFICACY

Temp. 180* CTemp. 180* C Time of sterilization 1 h.Time of sterilization 1 h.

FOR METALIC INSTRUMENTS ANDFOR METALIC INSTRUMENTS AND

GLASS MEDICAL ARTICLESGLASS MEDICAL ARTICLES

8/6/2019 1 Surgery

26/39

ETHYLENE OXIDE GASETHYLENE OXIDE GAS

STERILIZATIONSTERILIZATION

FOR HEAT SENSITIVE OR MOISTUREFOR HEAT SENSITIVE OR MOISTURESENSITIVE ITEMS:SENSITIVE ITEMS:

LENSED INSTRUMENTSLENSED INSTRUMENTS

RUBBER GOODSRUBBER GOODS

SHARP AND DELICATE INSTRUMENTSSHARP AND DELICATE INSTRUMENTS

PREPACKED COMMERCIAL MEDICALPREPACKED COMMERCIAL MEDICALPRODUCTS: syringes, suture materials,PRODUCTS: syringes, suture materials,drainage tubesdrainage tubes

8/6/2019 1 Surgery

27/39

PACKED ITEM THAT ISPACKED ITEM THAT IS

OUTDATED,OUTDATED, EXPOSED TO MOISTURE,EXPOSED TO MOISTURE,

DROPPED ON THE FLOOR ORDROPPED ON THE FLOOR OR

PUNCTUREDPUNCTURED

IS CONSIDERED CONTAMINATEDIS CONSIDERED CONTAMINATED

8/6/2019 1 Surgery

28/39

OTHER METHODS OFOTHER METHODS OF

STERILIZATIONSTERILIZATION

RADIATION STERILIZATIONRADIATION STERILIZATION IONISING RADIATION BY COBALTIONISING RADIATION BY COBALT

FOR DISPOSABLE HOSPITAL SUPPLIESFOR DISPOSABLE HOSPITAL SUPPLIES

CHEMICAL STERILIZATIONCHEMICAL STERILIZATION 2% aqueous solution of GLUTARALDEHYDE2% aqueous solution of GLUTARALDEHYDE

FOR HEATFOR HEAT--SENSITIVE EQUIPMENTSENSITIVE EQUIPMENT BEFORE USE, the instruments must beBEFORE USE, the instruments must be

washed up with sterile waterwashed up with sterile water

8/6/2019 1 Surgery

29/39

DISINFECTIONDISINFECTION

DISINFECTANT IS A CHEMICALDISINFECTANT IS A CHEMICALSUBSTANCESUBSTANCE-- ON THE SURFACE OFON THE SURFACE OFINANIMATE OBJECTSINANIMATE OBJECTS

Disinfectant at a low concentration can beDisinfectant at a low concentration can beused as an antisepticused as an antiseptic

OPERATING TABLE, INSTRUMENT TABLEOPERATING TABLE, INSTRUMENT TABLE

FLOORS ARE CLEANED WITHFLOORS ARE CLEANED WITHDISINFECTANTSDISINFECTANTS

8/6/2019 1 Surgery

30/39

ANTISEPSISANTISEPSIS

CHEMICAL AGENTS ON ANIMATECHEMICAL AGENTS ON ANIMATESURFACES DESTROYBACTERIASURFACES DESTROYBACTERIA

A GOOD ANTISEPTIC:A GOOD ANTISEPTIC: TO KILL AT LOW CONCENTRATIONTO KILL AT LOW CONCENTRATION

NO TOXICITY FOR LIVING TISSUESNO TOXICITY FOR LIVING TISSUES

TO ACT FOR A LONG TIMETO ACT FOR A LONG TIME

NOT TO STAIN OR HAVE A BAD SMELLNOT TO STAIN OR HAVE A BAD SMELL

TO BE ECONOMICTO BE ECONOMIC

8/6/2019 1 Surgery

31/39

ANTISEPSISANTISEPSIS

SURGICAL SCRUB ON HANDSSURGICAL SCRUB ON HANDS

PREOP.PREPARATION OF THE PS SKINPREOP.PREPARATION OF THE PS SKIN

WOUNDS TREATMENTWOUNDS TREATMENT

8/6/2019 1 Surgery

32/39

ANTISEPTICSANTISEPTICS

70% ALCOHOL70% ALCOHOL

2% IODINE2% IODINE

BETADINEBETADINE HYDROGEN PEROXIDEHYDROGEN PEROXIDE

CHLORIDECHLORIDE

SILVER NITRATESILVER NITRATE

BORIC ACIDBORIC ACID

IODOFORMIODOFORM

8/6/2019 1 Surgery

33/39

SURGICAL SCRUBSURGICAL SCRUB

PROCESS OF MECHANICAL SCRUBBINGPROCESS OF MECHANICAL SCRUBBING

WITH AN ANTISEPTIC SOLUTIONWITH AN ANTISEPTIC SOLUTION

IMAGINED BY IGNAZ SEMMELWEISS,IMAGINED BY IGNAZ SEMMELWEISS,

WIEN, 1846WIEN, 1846

8/6/2019 1 Surgery

34/39

SKINFLORASKINFLORA

RESIDENT FLORARESIDENT FLORA

TRANSIENT FLORATRANSIENT FLORA ON HANDS DEPENDS ON PERSONALON HANDS DEPENDS ON PERSONAL

HYGIENEHYGIENE HOSPITAL FLORA RESISTANT TOHOSPITAL FLORA RESISTANT TOANTIBIOTICSANTIBIOTICS

8/6/2019 1 Surgery

35/39

PREPARATIONOF THE PS SKINPREPARATIONOF THE PS SKIN

SHAVINGSHAVING

SCRUBBINGSCRUBBING

DRAPINGDRAPING

8/6/2019 1 Surgery

36/39

THE STERILE FIELDTHE STERILE FIELD

The area of the operating room thatThe area of the operating room thatsurrounds the site of incisionsurrounds the site of incision

All items needed for the operation areAll items needed for the operation aresterile and are used within the sterile fieldsterile and are used within the sterile field

It is created by the placement of sterileIt is created by the placement of sterilesheets and towels around the site ofsheets and towels around the site ofincisionincision

8/6/2019 1 Surgery

37/39

8/6/2019 1 Surgery

38/39

8/6/2019 1 Surgery

39/39