chapter 1 - brands delmar - cengage learning · web vieworientation to surgical technology ch. 1...

AST. Surgical Technology, 2E. Phillips. Berry & Kohn’s Operating Room Delmar Learning Technique, 10E. Elsevier

CHAPTER 1ORIENTATION TO SURGICAL TECHNOLOGY

CH. 1 PERIOPERTIVE EDUCATIONCH. 2 FOUNDATIONS OF PERIOPERATIVE PATIENT CARE STANDARDSCH. 4 THE PERIOPERATIVE PATIENT CARE TEAMCH. 6 ADMINISTRATION OF PERIOPERATIVE PATIENT CARESERVICES

HISTORY OF SURGERY 3 Historical Background sections are found at the beginning of each chapter.

SURGERY TODAY 4Surgical Specialties 5HISTORY OF SURGICAL TECHNOLOGY

6

FIELD OF SURGICAL TECHNOLOGY 8 Surgical Technology (Ch. 2) 23 Working Conditions 8 Personal Characteristics 8 Expected Behaviors of Perioperative

Caregivers (Ch. 1)8

Surgical Team Members 8 CH. 4 THE PERIOPERATIVE PATIENT CARE TEAM

56

Surgical Technology Education and Certification

10 Credentialing of Caregivers (Ch. 2) 25

THE SURGICAL TECHNOLOGISTAS A PROFESSIONAL

11

Professionalism 11Surgical Technologist’s Lifestyle 12Job Descriptions for the Surgical Technologist

13

Career Opportunities 13HEALTH CARE FACILITIES 14Hospital Organization 15 Establishing Administrative Roles (Ch. 6) 73Hospital Departments and Interdepartmental Communication

17 Patient Care Departments (Ch. 6) 77

Financial Considerations and Reimbursement

19

Organizations Related to Hospitals, Health Care, and Surgical Services

20

CHAPTER 2STANDARDS OF CONDUCT

CH. 3 LEGAL AND ETHICAL ISSUESCH. 2 FOUNDATIONS OF PERIOPERATIVE PATIENT CARE STANDARDS

LEGAL ISSUES 23Definitions of General Legal Terms 23 Box 3-1 23Definitions of Traditional Principles 24Torts 25Consent for Surgery: A Basic Right 27 Consent 33Documentation 29 Documentation of Perioperative Patient

Care35

Event/Incident Reports 30 Incident Report 37Advance Directives 30 Advance Directives 35ETHICAL AND MORAL ISSUES 30 Ethical Issues 44


Moral Principles 31 Ethical Issues 44Bioethics 31 Bioethical Situations 45AHA Patient’s Bill of Rights 31Elements of Ethical Decision Making 32 Ethical Issues 44Professional Codes of Conduct 34 Box 3-4 44Surgical Conscience 34 Surgical Conscience 48SCOPE OF PRACTICE 34Job Descriptions and Competencies 35 Credentialing of Caregivers (Ch. 2) 25Credentialing 36 Accreditation (Ch. 2) 25Accreditation 36Core Curricula for Surgical Technology and Surgical Assisting

36

Career Development 36Clinical Ladder Program 37RISK MANAGEMENT AND LIABILITY 38 Liability 30Medical Errors 38Safe Medical Device Act 39Malpractice Insurance 39 Liability Insurance 31

CHAPTER 3THE SURGICAL PATIENT.

CH. 7 THE PATIENT: THE REASON FOR YOUR EXISTENCE

THE STSR AND THE SURGICAL PATIENT

43 Patient-Centered Care 88

PHYSICAL, PSYCHOLOGICAL, SOCIAL, AND SPIRITUAL NEEDS OF THE SURGICAL PATIENT

43 Patient-Centered Care 89

Understanding the Surgical Patient 44Causes of Surgical Intervention 44The Surgical Patient, a Human Being 44 Patient-Centered Care 88Prioritizing Needs-Maslow’s Hierachy 45 Hierarchy of Needs 89Life Stage Development: Select Basic Concepts

46

Cultural and Religious Influences 49 Patient’s Reactions to Illness 91

CHAPTER 4SPECIAL POPULATIONS

CH. 7 THE PATIENT: THE REASON FOR YOUR EXISTENCECH. 8 PERIOPERATIVE PEDIATRICSCH. 9 PERIOPERATIVE GERIATRICSCH. 34 GYNECOLOGIC AND OBSTETRIC SURGERY

INTRODUCTION 57 Patients With Special Needs (Ch. 7) 92PEDIATRIC PATIENTS 57 Indications for Surgery (Ch. 8)

Considerations in Perioperative PediatricsPreoperative Psychologic Preparation of Pediatric Patients

119121126

Monitoring the Pediatric Patient 59 Intraoperative Pediatric Patient Care Considerations (Ch. 8)Body Temperature Considerations

132

123Shock 60Fluids and Electrolytes 60 Fluids and Electrolyte Balance

Considerations (Ch. 8)123

Infection 61 Pediatric Infection Risk Considerations(Ch. 8)

125

Metabolic and Nutritional Responses 61 Metabolism and Nutritional 122


Considerations (Ch. 8)

Trauma 61 Trauma (Ch. 8) 119PATIENTS WITH OBESITY 62 Obese Patients (Ch. 7) 98Review of Surgical Considerations 64 Obese Patients (Ch. 7) 98Specific Considerations of Bariatric Surgery 64 Obese Patients (Ch. 7) 98PATIENTS WITH DIABETES 64 Patients with Diabetes Mellitus (Ch. 7) 96Complications Associated with Diabetes 65 Common Complications of Diabetes

Mellitus (Ch. 7)96

Care of the Patient with Diabetes in Surgery 66 Special Considerations (Ch. 7) 97PREGNANT PATIENTS 66 Perioperative Obstetrics (Ch. 24) 691Considerations when Caring for Pregnant Patients

67 Considerations for the Care of the Pregnant Patient (Ch. 24)

691

Anesthesia 67 Anesthesia (Ch. 24) 692Intraoperative Considerations for the Surgical Technologist

67 Considerations for the Care of the Pregnant Patient (Ch. 24)

691

IMMUNOCOMPROMISED PATIENTS 68 Immunocompromised Patients (Ch. 7) 99Acquired Immunodeficiency Syndrome 68 Acquired Immunodeficiency Syndrome

(Ch. 7)100

Considerations for the Surgical Team Members

68 Acquired Immunodeficiency Syndrome (Ch. 7)

100

PATIENTS WITH DISABILITIES 69 Patients with Sensory Impairment or Physical Challenges (Ch. 7)

92

GERIATRIC PATIENTS 69 CH. 9 PERIOPERATIVE GERIATRICS 155TRAUMA PATIENTS 71THE “GOLDEN HOUR” AND TRAUMA PATIENTS

71

KINEMATICS 71Blunt Trauma 71Penetrating Trauma 72TRAUMA SCORING 72CONSIDERATIONS FOR THE SURGICAL TECHNOLOGIST

72

Preservation of Evidence 72Hypothermia 73Infection 73PREPARATION OF THE CASE 73

CHAPTER 5PHYSICAL ENVIRONMENT AND SAFETY STANDARDS

CH. 10 PHYSICAL FACILITIESCH. 13 POTENTIAL SOURCES OF INJURY TO THE CAREGIVER AND THE PATIENTCH. 15 PRINCIPLES OF ASEPSIS AND STERILE TECHNIQUE

PHYSICAL DESIGN OF THE SURGERY DEPARTMENT

77 Physical Layout of the Surgical Suite(Ch. 10)

177

Areas of the OR 78 Space Allocation and Traffic Patterns(Ch. 10)

181

Physical Components of the Operative Suite 79 Operating Room (Ch. 10) 185Substerile Area 83 Substerile Room (Ch. 10) 185Direct Support Services 83 Peripheral Support Areas (Ch. 10) 183HAZARDS AND REGULATORY AGENCIES

85 Environmental Hazards (Ch. 13) 211

SAFETY CONSIDERATIONS 86 Opening paragraphs (Ch. 13) 211


Air-Handling System 86 Ventilation (Ch. 10)Environmental Factors (Ch. 13)

186214

Surgical Lights 86 Lighting (Ch. 10)Environmental Factors (Ch. 13)

188214

Noise in the Operating Room 86 Environmental Factors (Ch. 13) 214Ergonomics and Safety Considerations 86 Body Mechanics (Ch. 13) 215Fire Hazards and Safety 87 Fire and Explosion (Ch. 13) 220Electrical Hazards 88 Electricity (Ch. 13) 218Ionizing Radiation 89 Ionizing Radiation (Ch. 13) 215BIOLOGICAL HAZARDS AND SAFETY CONSIDERATIONS

90 Biological Hazards ad Safeguards (Ch. 13)

224

Universal Precautions 90 Standard Precautions (Ch. 15) 254Standard Precautions 90 Standard Precautions (Ch. 15) 254Laser and Electrosurgical Plume 93 Surgical Plume (Ch. 13) 225Latex Allergy 94 Latex Sensitivity/Allergy (Ch. 13) 226CHEMICAL HAZARDS AND SAFETY CONSIDERATIONS

94 Chemical Hazards and Safeguards (Ch.13)

222

Waste Anesthetic Gases 94 Anesthetic Gases (Ch. 13) 222Methyl Methacrylate 95 Methyl Methacrylate (Ch 13) 224Formalin 95 Sterilizing Agents (Ch. 13) 223Ethylene Oxide 95 Sterilizing Agents (Ch. 13) 223Glutaraldehyde 95 Sterilizing Agents (Ch. 13) 223CHAPTER 6BIOMEDICAL SCIENCE

NO CHAPTER ON THIS TOPIC

INTRODUCTION 99COMPUTERS 99Surgical Applications 99Hardware 100Software 103Word Processing 104Graphics 105Internet Basics 106ELECTRICITY 107Surgical Applications 107Basic Principles of Electricity 108PHYSICS 112Medical and Surgical Applications 112Mechanics 113Nuclear Physics 122Gravity 122SURGICAL ROBOTS 122Terminology 123Design 123Remote Manipulation 124Geometry 124Hearing and Vision 125Decontamination and Sterilization of Robotic Components

125

Clinical Applications 125THE OR OF THE FUTURE 125Surgical Planning and Rehearsal 125Surface-Based Registration 126ROLE OF THE SURGICAL TECHNOLOGIST

126


CHAPTER 7ASEPSIS AND STERILE TECHNIQUE

CH 12 CARE OF THE PERIOPERATIVE ENVIRONMENTCH. 14 MICROBIOLOGIC CONSIDERATIONSCH. 15 PRINCIPLES OF ASEPSIS AND STERILE TECHNIQUECH. 17 DECONTAMINATION AND DISINFECTIONCH. 18 STERILIZATION

HISTORY OF STERILIZATION 130 Historical Background (Ch. 15) 248BASIC TERMINOLOGY 131PATHOGENS AND INFECTION 131 Microorganisms: Nonpathogens versus

Pathogens (Ch. 14)230

Infection 131 Pathogenic Invasion (Ch. 14)Infectious Processes in the Body

232

Pathogens Associated with Surgical Site Infection

132 Types of Pathogenic Microorganisms(Ch. 14)

233

Methods of Transmission 135 Transmission of Microorganisms (Ch. 15) 249PRINCIPLES OF ASEPSIS 138 Principles of Sterile Technique (Ch. 15) 257Principle 1: Sterile Field 138 Principles of Sterile Technique (Ch. 15) 257Principle 2: Sterile Team Member Attire 139 Principles of Sterile Technique (Ch. 15) 257Principle 3: Movement in and around Sterile Field

140 Principles of Sterile Technique (Ch. 15) 258

SURGICAL CONSCIENCE 140 Surgical Conscience (Ch. 3)No Compromise of Sterility (Ch. 15)

49262

CLEANING, DISINFECTION, AND STERILIZATION

141 Instrument Cleaning and Disinfection (Ch. 17)

281

Cleaning and Disinfection 142 Instrument Cleaning and Disinfection (Ch. 17)

281

Disinfectant and Disinfectant/Sterilant Agents

147 Methods of Disinfection (Ch. 17) 287

INSTRUMENT PREPARATION AND WRAPPING FOR STERILIZATION

151

Instruments 151 Inspecting and Testing (Ch. 17) 284Specific Procedural Trays 151Instrument Sets 151 Assembly of Instrument Sets (Ch. 18) 299PACKAGING FOR STERILIZATION AND STORAGE

152 Packaging Instruments and other Items for Sterilization (Ch. 18)

301

Performance Standards of Packaging Material

152 Packaging Instruments and other Items for Sterilization (Ch. 18)

301

Performance Characteristics 152 Packaging Instruments and other Items for Sterilization (Ch. 18)

301

Types of Packaging Materials 153 Packaging Materials and Methods (Ch. 18)

302

General Principles of Packaging 155 Packaging Instruments and other Items for Sterilization (Ch. 18)

301

Sterilization 158 Thermal Sterilization (Ch. 18) 304Requirements and Essential Factors 159 Reliability Parameters for Sterilization

(Ch. 18)298

Basic Components of a Steam Sterilizer 160 Thermal Sterilization (Ch. 18) 305GAS STERILIZATION 163 Chemical Sterilization (Ch. 18) 312Ethylene Oxide 163 Ethylene Oxide Gas Sterilization (Ch. 18) 312


Alternative Gas Sterilization Methods 164 Hydrogen Peroxide Plasma Sterilization(Ch. 18) Ozone Gas Sterilization

316

LIQUID CHEMICAL STERILIZATION PROCESSES

165 Chemical Sterilants in Solution (Ch. 18) 317

IONIZING RADIATION 165 Radiation Sterilization (Ch. 18) 319METHODS OF MONITORING THE STERILIZATION PROCESS

165 Monitoring the Sterilization Cycle (Ch. 18)

298

Mechanical Methods of Monitoring the Sterilization Process

165 Mechanical Indicators (Ch. 18) 299

Chemical Methods of Monitoring the Sterilization Process

166 Chemical Indicators (Ch. 18) 299

Biological Methods of Monitoring the Sterilization Process

166 Biologic Indicators (Ch. 18) 299

Bowie-Dick Test 167EVENT-RELATED STERILITY 167 Shelf Life (Ch.18) 320Environmental Decontamination 168 Establishing the Perioperative

Environment (Ch.12)204

Environmental Services 168 Daily Terminal Cleaning (Ch. 12) 208Case by Case 168 Room Turnover Between Patients

(Ch. 12)205

Daily 168 Daily Terminal Cleaning (Ch. 12) 208CHAPTER 8GENERAL PATIENT CARE AND SAFETY

CH. 21 PREOPERATIVE PREPARATION OF THE PATIENTCH. 26 POSITIONING, PREPPING, AND DRAPING THE PATIENTCH. 28 HEMOSTASIS AND WOUND CLOSURECH. 31 POTENTIAL PERIOPERATIVE COMPLICATIONS

PREOPERATIVE PATIENT ROUTINES 172 Preoperative Preparation of All Patients (Ch 21)

365

Surgical Consent 173 Preoperative Preparation of All Patients (Ch 21)

367

Preoperative Education 175 Preoperative Teaching (Ch. 21) 371Patient Possessions 175 Preoperative Preparation of All Patients

(Ch 21)367

Evening/Morning before Surgery 176 Evening before an Elective Surgical Procedure (Ch. 21)

367

Diet 177 Preoperative Preparation of All Patients (Ch 21)

366

Makeup and Dress 177 Preoperative Preparation of All Patients (Ch 21)

367

Call to Operating Room 177 Before Leaving for the Operating Room (Ch. 21)

374

Family Visit 177 Before Leaving for the Operating Room (Ch. 21)

375

Patient Identification 177 Before Leaving for the Operating Room (Ch. 21)

375

Transportation 178 Transportation to the Operating Room Suite (Ch. 21)

375

TRANSFER AND POSITIONING 179 Admission to the Operating Room Suite (Ch. 21)

376

BASIC POSITIONING FOR SURGERY 180 Preliminary Considerations (Ch. 26) 470


Supine Position 181 Supine (Dorsal) Position (Ch. 26) 483Trendelenburg Position 183 Trendelenburg’s Position (Ch. 26) 487Reverse Trendelenburg Position 184 Reverse Trendelenburg’s Position (Ch.

26)487

Fowler’s Position and Sitting Position 184 Fowler’s Position (Ch. 26) 487Lithotomy Position 185 Lithotomy Position (Ch. 26) 487Prone Position 186 Prone Position (Ch. 26) 488Kraske (Jackknife Position) 188 Kraske (Jackknife) Position (Ch. 26) 489Lateral Position 189 Lateral Positions (Ch. 26) 489Kidney Position 190 Kidney Position (Ch. 26) 490Sim’s Position 191 Sim’s Position (Ch. 26) 490THERMOREGULATORY DEVICES 191VITAL SIGNS 192 Monitoring Physiologic Functions

(Ch. 27)513

Temperature 192 Metabolic Crises (Ch. 31) 617Pulse 193Respiration 194 Physiologic Parameters Monitored

(Ch. 27)519

Blood Pressure 196 Physiologic Parameters Monitored (Ch. 27)

519

URINARY CATHETERIZATION 199 Urinary Catheterization (Ch. 26) 491Indications 200 Urinary Catheterization (Ch. 26) 492Procedure 200 Urinary Catheterization (Ch. 26) 492Considerations 200 Urinary Catheterization (Ch. 26) 492SKIN PREPARATION 202 Principles of Patient Skin Preparation

(Ch. 26)494

Skin Preparation Setup 203 Antiseptic Skin Cleansing Fundamentals (h. 26)

495

Skin Marking 206HEMOSTASIS AND BLOOD REPLACEMENT

206 Hemostasis (Ch. 28) 529

Factors Affecting Hemostasis 207 Hemotologic disorders (Ch. 31) 611Control of Bleeding during Surgery 207 Methods of Hemostasis (Ch. 28) 530Mechanical Methods 207 External Mechanical Methods (Ch. 28)

Internal Mechanical Methods531534

THERMAL HEMOSTASIS 209 Thermal Methods (Ch. 28) 535PHARMACOLOGICAL AGENTS 209 Chemical Methods (Ch. 28) 530Blood Loss 210 Blood Volume Complications (Ch. 31) 608Blood Replacement 210 Blood Loss Replacement (Ch. 31) 612Hemolytic Transfusion Reactions 211CARDIOPULMONARY RESUSCITATION

211 Cardiopulmonary Resuscitation (Ch. 31) 602

Cardiac Arrest in the Surgical Setting 212 Cardiac Arrest (Ch. 31) 597MALIGNANT HYPERTHERMIA 213 Malignant Hyperthermia (Ch. 31) 617Prevention 213 Malignant Hyperthermia (Ch. 31) 617Treatment 213 Malignant Hyperthermia (Ch. 31) 618EMERGENCY MEDICAL SERVICES 213INDICATIONS OF EMERGENCY SITUATIONS

214

OBJECTIVES AND PRIORITIES IN ERMERGENCY SITUATIONS

214

Syncope 214Convulsions/Seizures 215 Convulsions (Ch. 31) 616Anaphalactic Reactions 211 Drug Interactions (Ch. 31) 598


Clinical Manifestations of Impending Cardiac Arrest

216 Cardiac Arrest (Ch. 31) 597

CHAPTER 9SURGICAL PHARMACOLOGY AND ANESTHESIA

CH. 21 PREOPERATIVE PREPARATION OF THE PATIENTCH. 23 SURGICAL PHARMACOLOGYCH. 24 ANESTHESIA: TECHNIQUES AND AGENTSCH. 31 POTENTIAL PERIOPERATIVE COMPLICATIONSCH. 31 POSTOPERATIVE PATIENT CARE

PHARMACOLOGY 219 CH. 23 SURGICAL PHARMACOLOGY 394Drug Sources 219 Surgical Drug and Pharmaceutical

Sources (Ch. 23)398

Drug Forms 220 Pharmacologic Forms Used in Surgery (Ch. 23)

398

Drug Nomenclature 220 Drug Names (Ch. 23) 395Route of Administration 221Drug Classifications 221Pharmacokinetics 221Pharmacodynamics 222DRUG-HANDLING TECHNIQUES 223 Handling Drugs and Pharmacologic

Materials in Surgery (Ch. 23)397

Medication Identification 223Supplies for Medication Handling 225 Handling Drugs and Pharmacologic

Materials in Surgery (Ch. 23)397

Transfer of a Medication to the Sterile Field 225 Handling Drugs and Pharmacologic Materials in Surgery (Ch. 23)

397

Medications Commonly Used in the Operating Room

226 Box 23-4 (Ch. 23) 399

HISTORY OF MODERN ANESTHESIA 229 Historical Background (Ch. 24) 401METHODS AND TECHNIQUES OF ANESTHETIC ADMINISTRATION

231 Types of Anesthesia (Ch. 24)Choice of Anesthesia

402403

GENERAL ANESTHESIA 231 General Anesthesia (Ch. 24) 404Depth of General Anesthesia 231 General Anesthesia (Ch. 24) 404Phases of General Anesthesia 232 Balanced Anesthesia (Ch. 24) 418Advantages of General Anesthesia 232 General Anesthesia (Ch. 24) 404Risks and Complications Associated with General Anesthesia

232 CH. 31 POTENTIAL PERIOPERATIVE COMPLICATIONS

588

Anesthetic Agents 235 Inhalation Anesthetic agents and Intravenous Anesthetic Agents (Ch. 24)

410

Adjuncts to General Anesthesia 240 Controlled Homeostasis (Ch. 24) 418Anesthesia Equipment 241 Anesthesia Machine (Ch. 24)

Monitoring Depth of Anesthesia (Ch. 24)Monitoring Physiologic Function (Ch. 27)

407417513

NERVE CONDUCTION BLOCKADE 244 Local and Regional Anesthesia (Ch. 24) 423Nerve Conduction Blocking Agents 244 Table 24-4 429Topical Anesthesia 246 Topical Application (Ch. 24) 433Local Anesthesia 246 Local Anesthesia (Ch. 24) 425Regional Anesthesia 246 Spinal and Epidural Anesthesia (Ch. 24) 427NONTRADITIONAL ANESTHESIA OPTIONS

249 Alternatives to Conventional Anesthesia(Ch. 24)

440

TEAM MEMBER ROLES DURING 249


ANESTHESIA ADMINISTRATIONPreoperative Visits 250 PreoperativeVisit by the

Perioperative/Perianesthesia Nurse (Ch. 21)PreoperativeVisit by the Anesthesia Provider (Ch. 21)

368

372

Preoperative Routine-All Types of Anesthesia

250 CH. 21 PREOPERATIVE PREPARATION OF THE PATIENT

364

Postanesthesia Care 253 CH. 31 POSTOPERATIVE PATIENT CARE

581

CHAPTER 10INSTRUMENTATION, EQUIPMENT, AND SUPPLIES

CH. 19 SURGICAL INSTRUMENTATIONAlso found in various other chapters throughout the book.

INSTRUMENTATION 259 Fabrication of Metal Instruments (Ch. 19) 324Classifications 259 Classification of Instruments (Ch. 19) 326Instrument Care and Handling 264 Handling Instruments (Ch. 19) 339Types of Instrument Sets 265SPECIALTY EQUIPMENT 269Endoscopes 269 Endoscopes (Ch. 19) 334Power Tools 270 Powered Surgical Instruments (Ch. 19) 33Lasers 270 Laser Surgery (Ch. 19) 270Microscopes 273 Operating Microscope (Ch.20) 357Video Monitors, Recorders, and Cameras 273 Vision within the Working Space

(Ch. 32)627

Fiber-optic Headlamps and Light Sources 274Irrigation/Aspiration Units 274Cryotherapy Units 274 Thermal Methods (Ch. 28) 535Insufflators 274Nerve Stimulators 274 Nerve Stimulator (Ch. 36) 749ACCESSORY EQUIPMENT 275Suction Systems 275 Suction and Aspirating (Ch. 19) 334Electrosurgical Unit 275 Electrosurgical Unit (Ch. 20) 344Lights 278 Lighting (Ch. 10) 188Pneumatic Tourniquets 279 Pneumatic Tourniquet (Ch. 28) 532Sequential Compression Devices 280 Sequential Compression Device (Ch. 28) 531SUPPLIES 280Drapes 280 Draping Materials (Ch. 26) 502Sterile Packs 282Sponges and Dressings 282 Sponges (Ch. 25)

Dressings (Ch. 29)462574

Catheters, Tubes, and Drains 285 Drains (Ch. 29) 571Nonsuture Needles 288 Preparation of the Sterile Field (Ch. 25)

Angiography and Arteriography (Ch. 22)450387

Irrigators and Syringes 289 Preparation of the Sterile Field (Ch. 25) 450CHAPTER 11WOUND HEALING, SUTURES, NEEDLES, AND STAPLING DEVICES

CH. 28 HEMOSTASIS AND WOUND CLOSURECH. 29 WOUND HEALING

INTRODUCTION 292TYPES OF WOUNDS 292 Types of Wounds (Ch. 29) 565Surgical Wound 292 Intentional Wounds (Ch. 29) 565Traumatic Wound 293 Unintentional Wounds; Traumatic

Injuries (Ch. 29)566


Chronic Wound 294 Incidental and Chronic Wounds (Ch. 29) 566INFLAMMATORY PROCESS 294 Inflammatory and Immune Responses

(Ch. 29)569

TYPES OF WOUND HEALING 294First Intention (Primary Union) 294 First Intention/Primary Union (Ch. 29) 564Phases of Wound Healing by First Intention 295 First Intention/Primary Union (Ch. 29) 564Second Intention (Granulation) 295 Second Intention (Ch. 29) 565Third Intention (Delayed Primary Closure) 295 Third Intention /Delayed Primary Closure

(Ch. 29)565

FACTORS INFLUENCING WOUND HEALING

295 Factors Influencing Wound Healing (Ch. 29)

568

COMPLICATIONS OF THE HEALING WOUND

296 Complications of Wound Healing (Ch. 29)

576

Intraoperative Wound Care 297 Surgical Technique (Ch. 29)Wound Management

570571

Postoperative Wound Care 298 Drains (Ch. 29)Dressings

571574

SUTURE 298 Sutures (Ch. 28) 537History 298 Historical Background (Ch. 28) 528Types of Suture Material 299 Specifications for Suture Material

(Ch. 28)540

Suture Sizes 300 Specifications for Suture Material (Ch. 28)

541

General Factors Affecting Choice of Suture 300 Choice of Suture Material (Ch. 28) 541Characteristics of Common Sutures 300 Specifications for Suture Material

(Ch. 28)Absorbable SuturesNon absorbable Suture

540

541543

Packaging of Suture 303 Suture and Needles: Packaging and Preparation (Ch. 28)

549

Ligatures 303 Internal Mechanical Methods (Ch. 28) 534Ligating Methods 303 Internal Mechanical Methods (Ch. 28) 534Suture for the Procedure 304 Considerations in the Choice of Needle

and Suture (Ch. 28)549

Layer Closure 305Endoscopic Suture 307 Endoscopic Suturing (Ch. 28) 540Suturing Techniques 307 Suturing Techniques (Ch. 28) 537Accessory Devices 309 Retention Bridges, Bolsters, and Bumpers

(Ch. 28)Tissue Adhesives

539

552STAPLING DEVICES 310 Surgical Staples (Ch. 28) 551Types of Staplers 312 Stapling Instruments (Ch. 28) 551Meshes or Fabrics 313 Synthetic Meshes (Ch. 28) 554NEEDLES 314 Surgical Needles (Ch. 28) 545Needle Eye 314 Eye of the Needle (Ch. 28) 547Needle Point 315 Point of the Needle (Ch. 28) 546Needle Bodies 315 Body of the Needle (Ch. 28) 546CHAPTER 12 SURGICAL CASE MANAGEMENT

Topics are found in various chapters throughout the book.

INTRODUCTION 318Applied Theory 319 Aseptic Technique and Environmental

Controls (Ch. 15)251

PREOPERATIVE CASE MANAGEMENT 323Attire 323 Appropriate Operating Room Attire 264


(Ch. 16)Preparing the OR 327 Principles of Sterile Technique (Ch. 15)

Surgical Scrub and Hand Cleansing (Ch. 16)

257271

ORGANIZING THE BACK TABLE 341 Preparation of Sterile Field (Ch. 25) 446Organizing the Mayo Stand 346 Preparation of Sterile Field (Ch. 25) 447Assisting a Team Member 346 Assisted Gowning and Gloving of a Team

Member (Ch. 16)277

Draping the Surgical Patient 346 Principles of Draping (Ch. 26) 505Positioning of the Sterile Team Members and the Furniture

353

INTRAOPERATIVE CASE MANAGEMENT

353

General Principles 353 During the Surgical Procedure (Ch. 25)Counting Procedures (Ch. 25)Dismantling the Instrument Table (Ch. 19)

451461342

Progression of the Surgical Procedure 361POSTOPERATIVE CASE MANAGEMENT

363

Preservation of the Sterile Field 363Drape Removal 363 After the Surgical Procedure is Complete

(Ch. 25)459

Gown and Glove Removal 364 After the Surgical Procedure is Complete (Ch. 25)Removing or Changing Contaminated Gown or Gloves (Ch. 16)

460

278

Immediate Postoperative Care 364 After the Surgical Procedure is Complete (Ch. 25)

460

Patient Transfer and Transportation 364 Patient Transfer from the Operating Room (Ch. 25)

460

Breakdown of the Setup 365 Room Turnover Activities by the Scrub Person (Ch. 12)

206

The Operating Room Cycle 365 Establishing the Perioperative Environment (Ch. 12)Room Turnover Between Patients

204

205The Instrument Cycle 366 Handling Instruments (Ch. 19) 339

CHAPTER 13DIAGNOSTIC PROCEDURES

CH. 21PREOPERATIVE PATIENT CARECH. 22 DIAGNOSTIC POCEDURES

SOURCES OF PATIENT DATA 371History and Physical Examination 371 Preoperative Preparation of all Patients

(Ch. 21)365

Diagnostic Imaging 371 Diagnostic Imaging (Ch. 22) 383Laboratory Reports 378 Preadmission Procedures (Ch. 21) 365Electrodiagnostic Studies 381 Preadmission Procedures (Ch. 21) 365Pulmonary Diagnosis 382 Blood Gases and pH (Ch. 27) 519Endoscopy 383 Endoscopy (Ch. 22) 392Plethysmography and Phleborheography 383 Plethysmography (Ch. 22) 392INDICATIONS FOR SURGERY 383


CHAPTER 14GENERAL SURGERY

CH. 33 GENERAL SURGERYCH. 40 OTORHINOLAYNGOLOGIC AND HEAD AND NECK SURGERY

ANATOMY 386Abdominal Cavity: General Dimensions 386Surface Features 386Abdominal Musculature 387Peritoneum 387Retroperitoneum 388Alimentary Canal 388Esophagus 388 Esophageal procedures 652Stomach 389 Gastric Procedures 654Small Intestine 390 Intestinal Procedures 659Mesentery 391 Intestinal Procedures 659Colon 391 Intestinal Procedures 659Rectum 393Anus 393Omenta 394Pancreas 394 Pancreatic Procedures 651Spleen 395 Splenic Procedures 651Liver 395 Liver Procedures 649Biliary Tract 396 Biliary Tract Procedures 644GENERAL SURGERY INSTRUMENTATION

397

Major Set 397Minor Set 397Local Excision Instruments 399Biliary Instruments 399Intestinal Instruments 400Other General Instruments 400ROOM SETUP 400POSITIONING 400 Special Considerations for General

Surgery636

DRAPING 400 Special Considerations for General Surgery

636

INCISIONS 402 Types of Abdominal Incisions 642SURGERY OF THE ABDOMINAL WALL: HERNIAS

404 Hernia Procedures 668

Specific Anatomic Features of the Groin Area

404

Hernias 405 Hernia Procedures 668Hernia Repair 405 Hernia Procedures 668SURGERY OF THE ALIMENTARY CANAL

407

Surgery of the Esophagus 408 Esophageal procedures 652Gastric Surgery 408Pathological Conditions of the Stomach 408 Gastric Procedures 654Procedures Related to Gastric Secretion, Ulcers, and Neoplasm

416 Gastric Procedures 655

Procedures for Morbid Obesity 416 Bariatric Surgery 657Surgery of the Small Bowel 416 Intestinal Procedures 658Appendectomy 420 Appendectomy 663Colon Surgery 425 Intestinal Procedures 659STOMAS 427 Intestinal Stomas 660


Anorectal Surgery 427 Anorectal Procedures 666Hemorrhoid Ligation and Excision 430 Hemorrhoidectomy 666Surgery of the Liver and Biliary Tract 430 Biliary Tract Procedures

Liver Procedures644649

Common Bile Duct Exploration 439 Common Bile Duct Exploration 646SURGERY OF THE PANCREAS AND SPLEEN

447 Pancreatic ProceduresSplenic Procedures

651651

Select Pathology of the Pancreas 447 Pancreatic Procedures 651Draining Pancreatic Cysts 448 Pancreaticojejunostomy 651Pancreatic Resection 448 Pancreatectomy 652Whipple Pancreaticoduodenectomy 448 Pancreaticoduodenectomy (Whipple

Proceure651

Surgery of the Spleen 452 Splenic Procedures 651VASCULAR AND OTHER PROCEDURES

454

Varicose Veins 454 Ligation and Stripping of Varicose Veins(Ch. 43)

919

Vascular Access Procedures 455Muscle and Nerve Biopsies 456Incision and Drainage 456Excision of Lesion 456Endoscopy 457 CH. 32 ENDOSCOPIC SURGERY 622BREAST SURGERY 457 Breast Procedures 637Breast Anatomy 457 Breast Procedures 637Breast and Axilla: Pathology and Diagnosis 457 Breast Procedures 637Breast Surgery (Noncosmetic) 457 Breast Procedures 637SURGERY OF THE THYROID AND PARATHYROID

461 Surgical Procedures of the Anterior Neck(Ch. 40)

858

Anatomy of the Thyroid and Parathyroid 461 Surgical Procedures of the Anterior Neck(Ch. 40)

858

Pathological Conditions of the Thyroid and Parathyroid Glands

461 Surgical Procedures of the Anterior Neck(Ch. 40)

858

Thyroidectomy 461 Surgical Procedures of the Anterior Neck(Ch. 40)

858

TRACHEOTOMY 461 Surgical Procedures of the Trachea(Ch. 40)

856

Indications for a Tracheotomy 461 Surgical Procedures of the Trachea(Ch. 40)

856

Illustrative Procedure: Tracheotomy 467CHAPTER 15OBSTETRIC AND GYNOCOLOGIC SURGERY

CH. 34 GYNECOLOGIC AND OBSTETRIC SURGERY

INTRODUCTION TO OBSTETRIC AND GYNOCOLOGICAL SURGERY

478 CH. 34 GYNECOLOGIC AND OBSTETRIC SURGERY

672

ANATOMY 478 Anatomy and Physiology of the Female Reproductive System

673

The Pelvis 478External Genitalia 481 Female External Genitalia 673Vagina 481 Internal Female Reproductive Organs 674Uterus 482 Internal Female Reproductive Organs 674Fallopian Tubes 483 Internal Female Reproductive Organs 675Ovaries 483 Internal Female Reproductive Organs 675PREGNANCY-A SPECIAL CONDITION 485 Perioperative Obstetrics 691Select Key Terms in Labor and Delivery 486


Labor 486SPECIAL INSTRUMENTATION, DRUGS, EQUIPMENT, AND SUPPLIES IN OBSTETRIC AND GYNOCOLOGICAL SURGERY

487

Instrumentation 487 Drugs 487Equipment 494Supplies 494OR SETUP AND BASIC PATIENT POSITIONING AND DRAPING

494 Gynecology: General ConsiderationsPosition

676692

SURGICAL PROCEDURES: OBSTETRICS AND FERTILITY RELATED

494

Pathology and Surgical Conditions: Obstetrics and Fertility Related

494

Vaginal Delivery 495Cesarean Section 497 Cesarean Birth 694Tubal Occlusion (Sterilization) Procedures 503 Tubal Ligation 689Tuboplasty 504 TuboplastyLaproscopic Resection of Unruptured Tubal Pregnancy

507

SURGICAL PROCEDURES: GYNECOLOGICAL PROCEDURES

510

Gynecological Pathology 510SURGICAL INTERVENTION OVERVIEW

510

Abdominal Incisions for Gynecological Surgery

510

Surgical Intervention: Laparoscopy 515 Laparoscopy 681Basic Colposcopy 518 Colposcopy 679Hysteroscopy 518 Hysteroscopy 681Marsupialization of Bartholin’s Gland Cyst 521 Bartholin Glands 683Simple Vulvectomy 521 Vulvectomy 682Anterior and Posterior Repair (Colporrhaphy)

524 Procedures for Repair of the Pelvic Outlet 684

Cervical Biopsy, Cryotherapy, Laser Treatment, LEEP, and Conization

533 Biopsy of the Cervix 678

Dilation and Curettage 535 Dilation and Curettage 686Myomectomy 538 Myomectomy 689Total Abdominal Hysterectomy and Bilateral Salpingo-oophorectomy (TAH-BSO)

542 Abdominal Hysterectomy 689

Vaginal and Laparoscopically Assisted Vaginal Hysterectomy (LAVH)

546 Vaginal Hysterectomy 687

Radical Cancer Surgery: Total Pelvic Exenteration

547

CHAPTER 16OPHTHALMIC SURGERY

CHAPTER 38OPHTHALMIC SURGERY

ANATOMY OF THE EYE 554 Anatomy and Physiology of the Eye 794Orbit 554 Anatomy and Physiology of the Eye 794Extrinsic Muscles 555Lacrimal System 555Globe 556 Anatomy and Physiology of the Eye 794


Cavities and Chambers of the Eye 558 Anatomy and Physiology of the Eye 794OPHTHALMIC SURGICAL PATHOLOGY

558

Glaucoma 558 Iris 801Cataract 558 Cataract 803Small Retinal Detachment 558 Retina 805Large Retinal Detachment 558 Retina 805Vitreous Hemorrhage 558 Vitrectomy 807Proliferative Vitreoretinopathy (PVR) 559 Retina 806Traction Retinal Detachment 559 Vitrectomy 807Epiretinal Membarane 559Corneal Pathology 559Chalazion 559Pterygium 559 Pterygium 799Dacryocystitis 559 Lacrimal Apparatus 799Strabismus 559OPTHALMIC MEDICATIONS 560 Ophthalmic Drugs 796SPECIAL CONSIDERATIONS IN OPHTHALMIC SURGERY

560

Special Equipment 560 Operating MicroscopeOphthalmic Lasers

796811

Instruments 561SURGICAL INTERVENTION 562 Ocular Surgical Procedures 797Surgical Repair of Ptosis 562 Eyelid 798Iridectomy 563 Iris 801Trabeculoplasty 563 Iris 802Strabismus Correction: Recession/Resection

563

Adjustable Suture Surgery 566Scleral Buckle 567 Retina 806Enucleation and Evisceration of the Eye (Traditional Approach)

571 Surgical Removal of the Eye 798

Keratoplasty (Corneal Transplant) 573 Intraocular Procedures 799Cataract Extraction 577 Cataract 803Phacoemulsification 580 Cataract 804Vitrectomy 580 Vitrectomy 807

CHAPTER 17OTORHINOLARYNGOLOGIC SURGERY

CH. 40OTORHINOLARYNGOLOGIC AND HEAD AND NECK SURGERYCH. 41 THORACIC SURGERY

ANATOMY OF THE EAR 587 Anatomy of the Ear 839Outer Ear 587 External Ear 839Middle Ear 588 Middle Ear 839Inner Ear 588 Inner Ear 839PATHOLOGY OF THE EAR 589 Pathology of Hearing 840Pathology Affecting the Outer Ear 589Pathology Affecting the Middle Ear 589Pathology Affecting the Inner Ear 590Diagnostic Procedures/Tests for the Ear 590PREOPERATIVE CONSIDERATIONS 591 General Considerations in Ear, Nose, and

Throat ProceduresGeneral Considerations

837

841SPECIAL INSTRUMENTS, SUPPLIES, 592 General Considerations in Ear, Nose, and 838


DRUGS Throat ProceduresGeneral Considerations 841

EAR PROCEDURES 592 Surgical Procedures of the Ear 841Myringotomy 592 Myringotomy (Ch. 8) 143Myringoplasty/Tympanoplasty 596 Tympanoplasty 842Mastoidectomy 600 Mastoidectomy 842Stapedectomy 600 Stapedectomy and Stapedotomy 842Stapedotomy 600 Stapedectomy and Stapedotomy 842Cochlear Implants 601 Implantation of a Cochlear Prosthesis 843ANATOMY OF THE NOSE AND SINUSES

601 Anatomy of the Nose 844

External Nose 601 Anatomy of the Nose 844Internal Nose 601 Anatomy of the Nose 844Paranasal Sinuses 602 Anatomy of the Nose 844Blood Supply to the Nose 602 Anatomy of the Nose 844Olfaction 603 Physiology of the Nose 844PATHOLOGY OF THE NOSE AND PARANASAL SINUSES

603

Rhinitis/Sinusitis 603 Turbinectomy 846Nasal Polyps 604 Polypectomy 846Hypertrophied Turbinates 604 Turbinectomy 846Deviated Nasal Septum 604 Septoplasty, Septal Reconstruction, and

Submucous Resection847

Septal Perforation 604 Repair of a Perforated Septum 847Epistaxis 604 Epistaxis 845DIAGNOSTIC PROCEDURES 605Direct Vision 605Mirror Examination 605Radiography 605PREOPERATIVE CONSIDERATIONS 605 General Considerations 845SPECIAL INSTRUMENTS, SUPPLIES, AND DRUGS

606

NASAL PROCEDURES 609 Surgical Procedures of the Nose 845Submucous Resection (SMR) 609 Septoplasty, Septal Reconstruction, and

Submucous Resection847

Polypectomy 612 Polypectomy 846Intranasal Antrostomy 612Removal of Foreign Body 612 Nasal Obstruction 846Internal Maxillary Artery Ligation 613 Artery Ligation 846Sinus Procedures 613 Paranasal Sinus Procedures 847Caldwell-Luc 613 Procedure 847Ethmoidectomy 615 Ethmoidectomy 847Sphenoidectomy 616 Sphenoid Sinus Procedure 848Drainage of the Frontal Sinus 616Sinus Endoscopy 616 Endoscopic Sinus Surgery 848ANATOMY OF THE UPPER AERODIGESTIVE TRACT

618 Anatomy and Physiology of the Oral Cavity and Throat

848

Pharynx 618 Anatomy and Physiology of the Oral Cavity and Throat

848

Larynx 620 Anatomy and Physiology of the Neck 853Trachea 621 Anatomy and Physiology of the Neck 853Bronchi and Lungs 621 Thoracic Cavity (Ch.41) 867Esophagus 621 Gastric Procedures (Ch. 33) 654PATHOLOGY AFFECTING THE UPPER 621


AERODIGESTIVE TRACTPharyngitis 621Epiglottis 622Tonsillitis 622Sleep Apnea 623Laryngitis 623Polypoid Corditis or Vocal Cord Polyps 623Vocal Cord Nodules 623Vocal Cord Granulomas 623Laryngeal Neoplasms 624Tracheitis and Bronchitis 624Laryngotracheobronchitis (Croup) 624Foreign Bodies 624PATHOLOGY AFFECTING THE ESOPHAGUS

624

Esophagitis 624Ulceration of the Esophagus 624Neoplasms Affecting the Esophagus 624Foreign Bodies 625Zenker’s Diverticulum 625DIAGNOSTIC PROCEDURES/TESTS 625Direct Visualization 625Indirect Visualization 625Laboratory Tests 625Radiological Examinations 625Videostroboscopy 626Polysomnography 626Multiple Sleep Latency Test (MSLT) 626PREOPERATIVE CONSIDERATIONS 626SPECIAL INSTRUMENTS, SUPPLIES, DRUGS

626

AERODIGESTIVE TRACT PROCEDURES

628

Adenoidectomy 628 Adenoidectomy 850Tonsillectomy 628 Tonsillectomy 850Incision and Drainage of a Peritonsellar Abscess

631 Incision and Drainage of a Peritonsellar Abscess

850

Uvulopalatopharyngoplasty 631 Uvulopalatopharyngoplasty 849Laryngoscopy 633 Laryngoscopy 852Bronchoscopy 636 Bronchoscopy (Ch. 41) 871Esophagoscopy 636 Esophagoscopy 855Panendoscopy 636Radical Neck Dissection with Mandibulectomy

636 Neck Dissections 859

CHAPTER 18ORAL AND MAXILLOFACIAL SURGERY

CH. 40OTORHINOLARYNGOLOGIC AND HEAD AND NECK SURGERY

ANATOMY OF THE ORAL CAVITY 645 Anatomy and Physiology of the Oral Cavity and Throat

848

Lips 645Teeth 645Palate 646 Anatomy and Physiology of the Oral

Cavity and Throat848

Cheeks 646


Tongue 646 Anatomy and Physiology of the Oral Cavity and Throat

848

ANATOMY OF THE FACE AND CRANIUM

646 Anatomy and Physiology of the Face 861

Orbit 647 Anatomy and Physiology of the Face 861Facial Muscles and Innervation 647EMBRYOLOGICAL EVELOPMENT OF THE FACE

648

PATHOLOGY OF THE ORAL CAVITY 649Mouth 649Jaw Bones 649 Orthognathic Surgery 865Mandibular Fractures 649 Mandibular Fractures 864Frontal Fractures 650Orbital Fractures 650 Reduction of Orbital Fractures 863Zygomatic Fractures 650 Reduction of Zygomatic Fractures 864Midfacial Fractures 651 Midfacial Fractures 863Craniofacial Deformities 651 Resection of Craniofacial Tumors and

Dysplasia863

DIAGNOSTIC TESTS 651ORAL PROCEDURES: GENERAL CONSIDERATIONS

652

Tooth Extraction/Odontectomy 653Tooth Restoration 657Implantation 657 Dental Implant 851MAXILLOFACIAL PROCEDURES: GENERAL CONSIDERATIONS

658

Graft Materials 658 Inlay Bone GraftsMandibular Reconstruction

851864

Repair of Mandibular/Maxillary Fractures 659Application of Arch Bars 659Wire Fixation 662Plate and Screw Fixation of Mandibular Fracture

663

Frontal Fracture Repair 666Orbital Floor Fracture Repair 667Reduction of Zygomatic Fractures 670 Reduction of Zygomatic Fractures 864Le Fort I Fracture Repair 671 Midfacial Fractures 863Le Fort II and III Fracture Repair 675 Midfacial Fractures 863Craniofacial Reconstruction 675Correction of Retrognathism or Prognathism

679 Orthognathic Surgery 865

Temporomandibular Joint Procedures 682 Temporomandibular Joint Procedures 864CHAPTER 19PLASTIC AND RECONSTRUCTIVE SURGERY

CH. 39PLASTIC AND RECONSTRUCTIVE SURGERY

ANATOMY 685Skin and Underlying Structures 685Palate 687Nose 687Hand 687Breast 694SURGICAL PATHOLOGY 694Pathology Affecting the Skin 694 Scars

Dermabrasion829830


Skin CancerBurns

830831

Cleft Lip and Palate 696 Plastic and Reconstructive Surgery (Ch. 8)

144

Pathology Affecting the Hand 697 Plastic and Reconstructive Surgery (Ch. 8)

145

Pathology Affecting the Breast 701 Breast 826DIAGNOSTIC PROCEDURES AND TESTS

701

SPECIAL INSTRUMENTATION, SUPPLIES, DRUGS, AND EQUIPMENT

701 General Considerations in Plastic Surgery 813

Nasal Set 701Dermatome 702 Skin Graft Knives and Dermatomes 815Mesh Graft Device 704 Types of Skin and Tissue Grafts 817SURGICAL INTERVENTION 704Rhytidectomy 704 Rhytidectomy 824Blepharoplasty 706 Blepharoplasty 823Suction Lipectomy 707 Liposuction 825Abdominoplasty 708 Abdominoplasty 825Skin Grafts 709 Skin and Tissue Grafting 815Dermabrasion 713 Dermabrasion 830Scar Revision 713 Scar Revision 829Cheiloplasty and Palatoplasty 713Rhinoplasty 714 Rhinoplasty 824Hand Surgery 716 Plastic and Reconstructive Surgery

(Ch. 8)145

Mammoplasty 723 Breast 826

CHAPTER 20GENITOURINARY SURGERY

CH. 35 UROLOGIC SURGERY

ANATOMY 732 Anatomy And Physiology of the Urinary System

706

Suprarenal Glands 732 Endocrine Glands 737Kidneys 732 Kidneys 706Ureters 735 Ureters 708Urinary Bladder 736 Urinary Bladder 708Male Reproductive System 737 Urethra

Male Reproductive Organs709728

PATHOLOGY AFFECTING THE ADRENAL GLANDS

739

Cushing’s Syndrome 739Adrenal Insufficiency (Addison’s Disease) 739Pheochromocytoma 739PATHOLOGY AFFECTING THE URINARY SYSTEM

739

Bladder Tumors 739 Urinary Bladder 723Urinary Calculi 740 Urolithiasis (Urinary Calculus) 718Kidney Disorders 740 Kidney 715PATHOLOGY AFFECTING THE MALE REPRODUCTIVE SYSTEM

743 Male Reproductive Organs 728

Phimosis 743Hypospadias/Epispadias 743Benign Prostatic Hypertrophy 743 Prostate Gland 730Cancer of the Prostate 744 Prostate Gland 730


Cryptorchidism 744Testicular Torsion 744 Testicular Torsion 729Testicular Cancer 744 Testes 728Trauma to the Genitourinary System 745DIAGNOSTIC PROCEDURES/TESTS 745History and Physical 745Laboratory Findings 745Radiological Findings 751Biopsy 751Endoscopy 751 Urologic Endoscopy 709SPECIAL EQUIPMENT, INSTRUMENTS, SUPPLIES, DRUGS

751

PREOPERATIVE AND INTRAOPERATIVE PREPARATION

752

Incisional Options 754SURGICAL PROCEDURES 757Adrenalectomy 757 Adrenal Glands 737Nephrectomy 757 Nephrectomy 715Renal Transplant 762 Kidney Transplantation (Ch. 44) 933Stone Removal 763Cystostomy 764 Suprapubic Cystostomy 723Cystectomy/Ileal Conduit 766 Cystectomy 724Procedures for Stress Incontinence Affecting Women

771 Urinary Incontinence 726

Transurethral Endoscopy of the Genitourinary Tract

774

Circumcision 776 Adult Male Circumcision 735Orchiectomy 778 Orchiectomy 728Orchiopexy 778 Orchiopexy (Ch. 8) 138Hydrocelectomy 781 Hydrocelectomy 729Varicocelectomy 781 Varicocele Ligation 729Hypospadias Repair 782 Urethral Repair (Ch. 8) 138Insertion of Inflatable Penile Prosthesis 782 Penile Prosthesis 735Vasectomy 783 Vasectomy 729Vasovasostomy 784 Vasovasostomy 730Prostatectomy 784 Prostatectomy (Suprapubic and

Retropubic)732

CHAPTER 21ORTHOPEDIC SURGERY

CH. 21 ORTHOPEDIC SURGERY

BONE AND BONE TISSUE 792 Anatomy and Physiology of the Musculoskeletal System

741

Bone Tissue 792 Bones 741Types of Bones 794 Bones 741Types of Joints 794 Joints 741Bone Growth and Bone Cells 797Intramembranous Bones 798Endochondral Bone 798Mineral Storage 798Factors That Affect Bone Growth 798Clinical and Bone Landmark Terms 798PATHOLOGY 798Types of Fractures 805 Fractures 751Normal Bone Healing 805 Bone Healing 742


Pathological Bone Healing 806Diagnostic Terms and Procedures 808THE SKELETON 808The Skull 808Vertebral Column 811Bones of the Thoracic Region 812Clavicles 812Scapula 812Pectoral Girdle 812Humerus 812Radius and Ulna 813Hand and Wrist 814Pelvis 814Hip and Femur 814Tibia and Fibula 814Ankle and Foot 816EQUIPMENT 818 Special Features of Orthopedic Surgery 744Positioning Devices 818 Orthopedic Table

Special Considerations in Orthopedic Surgery

749750

Pneumatic Tourniquets 819 General ConsiderationsPneumatic Tourniquet

750532

Traction 819 Orthopedic TableSkeletal Traction

749752

Lasers 819 Lasers 749Radiography 819 X-Ray Control 749Air Flow 820 Ultraclean Air System 749Continuous Passive Range-of-Motion Machines

820

Transcutaneous Electrical Nerve Stimulation

820 Nerve Simulator 749

Electrical Stimulation of Bone 820 Special Considerations in Orthopedic Surgery

750

Saws, Drills, and Reamers 820 Cutting Instruments 745Arthroscopic Equipment 820 Arthroscopy 759SUPPLIES 821 Items Used Frequentl 747Implants 821 Prosthetic Implants 747Suture 821 Sutures 749Methyl Methacrylate 821 Methyl Methacrylate (Ch. 28) 558Pharmacology 821PROCEDURES 822Bone Grafting 822 Bone Grafts

Biologic Materials (Ch. 28)747555

Knee Arthroscopy 824 Arthroscopy 759Arthroscopic Repair of Meniscal Tear 827 Knee Injuries 760Arthroscopic Anterior Cruciate Ligament Repair

Knee Injuries 759

Above-the-Knee Amputation Above-Knee Amputation (Ch.33) 669Endoscopic Carpal Tunnel Release 832 Neurolysis 761Colle’s Fracture 835Metacarpal Phalangeal Joint Arthroplasty 840 Total Joint Replacement 758Triple Arthrodesis 840 Arthrodesis 755Achilles Tendon Repair 841Bunionectomy 842 Bunionectomy 760


Open Reduction-Internal Fixation (ORIF) of the Humerus

842

Shoulder Joint Arthroscopy 845 ArthroscopyShoulder Injuries

759762

Acromioplasty 846Repair of the Rotator Cuff 846 Shoulder Injuries 762Internal Fixation of Femoral Shaft Fracture 851Repair of Hip Fracture 852Total Hip Arthroplasty 852 Total Joint Replacement 756Total Knee Arthroplasty 859 Total Joint Replacement 756

CHAPTER 22CARDIOTHORACIC SURGERY

CH. 41 THORACIC SURGRYCH. 42 CARDIAC SURGERYCH. 8 PERIOPERATIVE PEDIATRICS

ANATOMY OF THE CHEST 864 Anatomy and Physiology of the Thorax(Ch. 41)

867

The Thorax 864 Thoracic Cavity (Ch. 41) 867The Trachea 866 Lungs (Ch. 41) 867The Bronchial Tree 866 Lungs (Ch. 41) 867The Lungs 867 Lungs (Ch. 41) 867ANATOMY AND PHYSIOLOGY OF THE HEART

868 Anatomy of the Heart and Great Vessels(Ch. 42)

880

Location of the Heart 868 Heart (Ch. 42) 880Coverings of the Heart 869 Heart (Ch. 42) 880The Heart Wall 869 Heart (Ch. 42) 880The Heart Chambers 869 Heart (Ch. 42) 880The Heart Valves 869 Valves (Ch. 42) 880Blood Flow Through the Heart 870 Coronary Circulation (Ch. 42) 881Blood Supply for the Heart 871 Heart (Ch. 42) 881The Cardiac Cycle 871 Cardiac Cycle (Ch. 42) 882Cardiac Output 872Cardiac Conduction 872 Electrical Conduction of the Heart

(Ch. 42)881

Anatomical Development of the Heart 872OPERATIVE PATHOLOGY 873The Chest Wall 873The Mediastinum 873The Lungs 874Thoracic Trauma 875 Chest Trauma (Ch. 41) 877Thoracic Outlet Syndrome 877 Thoracic Outlet Syndrome (Ch. 41) 876Thoracic Aortic Aneurysm 877Coronary Artery Disease 879 Coronary Artery Disease (Ch. 42) 891Valvular Disease 881 Valvular Heart Disease (Ch. 42) 890Cardiomyopathy 882Cardiac Dysrythmias 882 Cardiac Dysrythmias 894Congenital Heart Defects 884 Cardiovascular Surgery (Ch. 8) 149DIAGNOSTIC PROCEDURES: THORAX 887 Endoscopy (Ch. 41) 870Bronchoscopy 887 Bronchoscopy (Ch. 41) 870Mediastinoscopy 887 Mediastinoscopy (Ch. 41) 871Thoracoscopy 887 Thoracoscopy (Ch. 41) 872Thoracentesis 889 Thoracentesis (Ch. 41) 877DIAGNOSTIC PROCEDURES: CARDIAC

889

Radiological Studies 889 Noninvasive Procedures (Ch. 42) 890


SURGICAL INTERVENTION: THORACIC

889

Special Preoperative Considerations 889 Special Features of Thoracic Surgery (Ch. 41)

868

Special Instrumentation, Supplies, Drugs, and Equipment

889 Special Features of Thoracic Surgery (Ch. 41)

870

Patient Preparation 890Thoracoscopy 892 Thoracoscopy (Ch. 41) 872Scalene/Supraclavicular Node Biopsy 895 Mediastinotomy (Ch. 41) 874Thoracotomy for Upper Lobectomy 895 Thoracotomy (Ch. 41) 875Thoracotomy for Right Pneumonectomy 899 Thoracotomy (Ch. 41) 876Thoracotomy for Wedge Resection or Segmentectomy

899 Thoracotomy (Ch. 41) 875

Decortication of Lung 899 Pulmonary Decortication (Ch. 41) 876SURGICAL INTERVENTION: CARDIAC (ADULT)

900

Preoperative Considerations 900 Special Features of Cardiac Surgery (Ch. 42)

883

Patient Preparation 901 Median Sternotomy (Ch. 42) 885Techniques of Cardiopulmonary Bypass 901 Cardiopulmonary Bypass (Ch. 42) 887Mechanical Circulatory Assistance 904 Intraaortic Balloon Pump (Ch. 42) 898Coronary Artery Bypass Grafting 905 Coronary Artery Bypass Graft (Ch. 42) 891Aortic Valve Replacement 911 Aortic Valve Replacement (Ch. 42) 891Mitral Valve Replacement 916 Mitral Valve Replacement (Ch. 42) 891Thoracic Aortic Aneurysmectomy 917Pericardiectomy/Pericardial Window 918Heart Transplantation 919 Cardiac Transplantation (Ch. 42)

Heart Transplant (Ch. 44)895935

Permanent Pacemaker Insertion 920 Mechanical Assist Devices (Ch. 42) 895Percutaneous Transluminal Coronary Angioplasty

921 Percutaneous Transluminal Coronary Angioplasty (Ch. 42)

893

SURGICAL INTERVENTION: CARDIAC (PEDIATRIC)

921

Special Preoperative Preparation 922Atrial Septal Defect 922 Atrial Septal Defect (Ch. 8) 150Ventricular Septal Defect 922 Ventricular Septal Defect (Ch. 8) 150Patent Ductus Arteriosus 923 Patent Ductus Arteriosus (Ch. 8) 150Correction of Aortic Coarctation 924 Coarctation of the Aorta (Ch. 8) 150Procedure for Correction of Tetralogy of Fallot

924 Tetralogy of Fallot (Ch. 8) 151

Procedure for Correction of Transposition of the Great Arteries

925 Transposition of the Great Vessels (Ch. 8) 152

CHAPTER 23PERIPHERAL VASCULAR SURGERY

CH. 43 VASCUAR SURGERY

PERIPHERAL VASCULAR SURGERY 928SURGICAL ANATOMY 928 Anatomy and Physiology of the Vascular

System902

Blood Vessels 928 Anatomy and Physiology of the Vascular System

902

Blood Pressure 930The Arterial System 931The Venous System 933OPERATIVE PATHOLOGY AND DIAGNOSIS

934 Vascular Disease 905


Arterial Embolism 935 Embolectomy 915Arteriosclerosis Obliterans 935 Vascular Disease 905Aneurysms of the Abdominal Aorta 936 Aneurysmectomy 913SURGICAL INTERVENTIONS 937Peripheral Vessel Angioplasty 937 Percutaneous Transluminal Angioplasty 910Bypass Grafting and Endarterectomy 939 Vascular Surgical Procedures 912Features of Peripheral Vascular Procedure 940 Special Features of Vascular Surgery 907Aortofemoral Bypass 943Abdominal Aortic Aneurysmectomy 947 Aneurysmectomy 913Femoropopliteal Bypass 950 Femoropopliteal Bypass 912Femorofemoral Bypass 954Axillofemoral Bypass 956Carotid Endarterectomy 959 Carotid Endarterectomy 912CHAPTER 24NEUROSURGERY

CH.37 NEUOSURGERY

SURGICAL ANATOMY 966 Anatomy and Physiology of the Brain and Spinal Cord

768

Divisions of the Nervous System 966Cranium 966 Cranium 768Vertebral Column 973 Vertebral Column and Spinal Cord 771Blood Supply 974 Peripheral Nerve Surgery 791Cranial Nerves 974 Peripheral Nerve Surgery 791Spinal Nerves 974 Peripheral Nerve Surgery 791NEUROSURGICAL PATHOLOGY 976Cervical Spine 976Thoracic Spine 977Lumbar Spine 978Neoplasms 979 Intracranial Neoplasms 781Head Injury 980 Treatment of Head Injuries 783Spinal Cord Injury 982 Treatment of Spinal Injuries 785Cerebrovascular Disease 982Congenital Abnormalities 983 Neurosurgery (Ch. 8) 145INFECTION 984Abscess 984Spinal Tumors 985 Excision of a Spinal Cord Tumor 785Peripheral Nerve Disorders 985NEUROSURGICAL PROCEDURES 986 Patient Care Considerations 774Special Instrumentation, Supplies, Drugs, and Equipment

986 Special Considerations in Neurosurgery 772

Patient Preparation 990 Patient Care Considerations 774Craniotomy 991 Craniotomy 777Craniectomy 1001 Craniectomy 777Ventriculoperitoneal and Ventriculoatrial Shunt

1005

Transsphenoidal Hypophysectomy 1008 Transsphenoidal Procedures 783Stereotactic Procedure 1011 Stereotaxis 780Cranioplasty 1012 Cranioplasty 779Spinal Procedures 1012 Surgical Procedures of the Spine 784Peripheral Nerve Procedure 1020 Peripheral Nerve Surgery 791ADVANCES IN NEUROSURGERY 1022 Intraoperative MRI 1022Three-Dimensional Reconstruction 1022 Stereotaxis 780Radiosurgery 1022


Minimal Invasive Techniques 1022Stereotaxis 1022 Stereotaxis 780Intraoperative Ultrasound 1023Brain Mapping 1023Endoscopic Neurosurgery 1023Deep Brain Stimulation 1023

APPENDIX A: ANATOMY PLATES 1025APPENDIX B: COMMON PREFIXES AND SUFFIXES

1036

APPENDIX C: MEASUREMENTS 1039

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