What are surgical procedures? |

Indications and Procedures

Surgery
has progressed as rapidly as other areas of medicine. Early surgeries consisted of gross excision (the cutting out of abnormal or diseased tissue). Today, surgery has been transformed by scientific advances so that surgeons commonly use microscopes, lasers, and endoscopes that allow the surgeon to make small incisions in order to gain access to the surgical site. Modern operations are much more precise and emphasize repair or replacement rather than excision.

When a patient requires surgery, several preoperative procedures are performed to increase the chances of a successful outcome. First, the patient is asked to abstain from eating for at least eight hours prior to surgery. This action reduces the chances of the individual vomiting during surgery and aspirating the gastric contents into the trachea (windpipe). After arriving at the hospital or clinic, the patient removes his or her clothes and puts on a gown, allowing the medical staff easy access to the patient for catheter insertion, intravenous line insertion, monitor placement, and preparation of the surgical site. Next, an intravenous (IV) line is placed in a vein of the hand or arm and connected to a bottle or bag of solution, which is suspended above the level of the patient’s arm. The intravenous line gives the physician rapid vascular access for sampling blood and injecting drugs. Just before the actual surgery, the patient is usually given a sedative by an anesthesiologist, and electrocardiogram (ECG or EKG) leads and a
blood pressure cuff are applied to the patient to monitor heart rate, heart rhythm, and blood pressure. The anesthesiologist will then anesthetize the patient further while the surgical team begins to prepare the site for the operation. Preoperative antibiotics may be given if there is a significant risk of infection.

The surgery may require either general anesthesia

, in which the patient is unconscious, or local anesthesia, in which a specific region of the body is anesthetized. For general anesthesia, the patient will be injected with an intravenous anesthetic and quickly intubated, a procedure in which a tube is inserted into the trachea and attached to a ventilator. This arrangement gives the anesthesiologist the ability to administer gaseous drugs such as nitrous oxide and halothane as well as to control the patient’s breathing. Surgical assistants prepare the operative site by cleansing the skin with a disinfectant. A sterile drape is used to cover all areas of the body except the surgical site. Surgeons and assistants must mask themselves and prepare for surgery by thoroughly washing their hands and arms. They then carefully put on a sterile gown and gloves. At this point, they must not come into contact with anything nonsterile.

The surgeon uses a scalpel to make an incision through the skin and any underlying structures in order to gain access to the area of the body needing attention. When blood vessels are cut, bleeding must be controlled by cauterizing, clamping, tying off with sutures, or applying direct pressure to the vessel; this process is known as hemostasis.

After the surgery, the incision sites are closed with sutures, and the anesthetic is reversed. The patient is then taken to a recovery room to be monitored closely. Routine care of the patient recovering from anesthesia includes repeated evaluation of body temperature, pulse, blood pressure, and respiration. Postoperative pain medication (such as meperidine, morphine, or fentanyl) is given as needed.

Uses and Complications

Complications from surgery can result from surgical errors, infections, and abnormal patient reactions to the procedure or medications (idiosyncratic reactions). Occasionally, surgery involves damage to healthy tissues, including nerves and blood vessels. Significant intraoperative blood loss may also occur, requiring transfusion. An incision into any part of the body provides an opportunity for bacteria to enter and infect the surgical wound; prophylactic antibiotics help reduce the chance of surgical infection. Rarely, a patient may have an unexpected response to the procedure or drugs, which could result in permanent disability or death. These very infrequent reactions may include a blood clot causing a stroke or heart attack, an abnormal heart rhythm, or severe allergic reactions to medication.

Perspective and Prospects

Modern surgery includes the use of surgical implants, microsurgery, laser surgery, endoscopic surgery, and transplant surgery. Surgical implants are used to replace a part of the body with an artificial implant. These implants include joints, heart valves, eye lenses, and sections of blood vessels or of the skull. During microsurgery, the surgeon uses specially designed instruments and a microscope to perform an operation on minute structures such as blood vessels, nerves, and parts of the eyes or ears. Microsurgery is also being used to reattach severed fingers and toes. Laser surgery utilizes a high-energy, narrow beam that can cut through tissues like a scalpel but that also cauterizes blood vessels during the incision. Lasers can be used on the retina, skin blemishes, and even tumors. Recovery from endoscopic surgery, in which a fiber-optic tube is inserted into the body to view the surgical site, is generally faster than from conventional operations because a smaller incision is made and less tissue damage results. Endoscopes are used to remove stones from the urinary tract and gallbladder and to remove or repair damaged cartilage in joints. With the availability of drugs that suppress tissue rejection, damaged organs can now be surgically replaced by donated organs. The most common examples are the heart, lungs, liver, kidneys, and bone marrow.

Bibliography

Brunicardi, F. Charles, et al., eds. Schwartz’s Principles of Surgery. 9th ed. New York: McGraw-Hill, 2010.

Leikin, Jerrold B., and Martin S. Lipsky, eds. American Medical Association Complete Medical Encyclopedia. New York: Random House Reference, 2003.

MedlinePlus. "Surgery." MedlinePlus, June 17, 2013.

Mulholland, Michael W., et al., eds. Greenfield’s Surgery: Scientific Principles and Practice. 5th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins, 2011.

Zollinger, Robert M., Jr., and Robert M. Zollinger, Sr. Zollinger’s Atlas of Surgical Operations. 9th ed. New York: McGraw-Hill Co., 2011.