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File:Surgeon operating, Fitzsimons Army Medical Center, circa 1990.JPEG

Surgery (from the Greek: χειρουργική

cheirourgikē, via chirurgiae, meaning "hand work") is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, to help improve bodily function or appearance, or sometimes for some other reason.  An act of performing surgery may be called a surgical procedure, operation, or simply surgery.  In this context, the verb operating  means performing surgery.  The adjective surgical means pertaining to surgery; e.g. surgical instruments or surgical nurse.  The patient or subject on which the surgery is performed can be a person or an animal.  A surgeon is a person who performs operations on patients.  Persons described as surgeons are commonly medical practitioners, but the term is also applied to podiatrists, dentists and veterinarians.  Surgery can last from minutes to hours, but is typically not an ongoing or periodic type of treatment.  

The term surgery can also refer to the place where surgery is performed, or simply the office of a physician, dentist, or veterinarian.

Definitions of surgery

Surgery is a medical technology consisting of a physical intervention on tissues. As a general rule, a procedure is considered surgical when it involves cutting of a patient's tissues or closure of a previously sustained wound. Other procedures that do not necessarily fall under this rubric, such as angioplasty or endoscopy, may be considered surgery if they involve "common" surgical procedure or settings, such as use of a sterile environment, anesthesia, antiseptic conditions, typical surgical instruments, and suturing or stapling. All forms of surgery are considered invasive procedures; so-called "noninvasive surgery" usually refers to an excision that does not penetrate the structure being excised (e.g. laser ablation of the cornea) or to a radiosurgical procedure (e.g. irradiation of a tumor).

Types of surgery

Surgical procedures are commonly categorized by urgency, type of procedure, body system involved, degree of invasiveness, and special instrumentation.

Elective surgery is done to correct a non-life-threatening condition, and is carried out at the patient's request, subject to the surgeon's and the surgical facility's availability. Emergency surgery is surgery which must be done quickly to save life, limb, or functional capacity. Exploratory surgery is performed to aid or confirm a diagnosis. Therapeutic surgery treats a previously diagnosed condition.

Amputation involves cutting off a body part, usually a limb or digit. Replantation involves reattaching a severed body part. Reconstructive surgery involves reconstruction of an injured, mutilated, or deformed part of the body. Cosmetic surgery is done to improve the appearance of an otherwise normal structure. Excision is the cutting out of an organ, tissue, or other body part from the patient. Transplant surgery is the replacement of an organ or body part by insertion of another from different human (or animal) into the patient. Removing an organ or body part from a live human or animal for use in transplant is also a type of surgery.

When surgery is performed on one organ system or structure, it may be classed by the organ, organ system or tissue involved. Examples include cardiac surgery (performed on the heart), gastrointestinal surgery (performed within the digestive tract and its accessory organs), and orthopedic surgery (performed on bones and/or muscles).

Minimally invasive surgery involves smaller outer incision(s) to insert miniaturized instruments within a body cavity or structure, as in laparoscopic surgery or angioplasty. By contrast, an open surgical procedure requires a large incision to access the area of interest. Laser surgery involves use of a laser for cutting tissue instead of a scalpel or similar surgical instruments. Microsurgery involves the use of an operating microscope for the surgeon to see small structures. Robotic surgery makes use of a surgical robot, such as the Da Vinci or the Zeus surgical systems, to control the instrumentation under the direction of the surgeon.

Terminology

  • Excision surgery names often start with a name for the organ to be excised (cut out) and end in -ectomy.
  • Procedures involving cutting into an organ or tissue end in -otomy. A surgical procedure cutting through the abdominal wall to gain access to the abdominal cavity is a laparotomy.
  • Minimally invasive procedures involving small incisions through which an endoscope is inserted end in -oscopy. For example, such surgery in the abdominal cavity is called laparoscopy.
  • Procedures for formation of a permanent or semi-permanent opening called a stoma in the body end in -ostomy.
  • Reconstruction, plastic or cosmetic surgery of a body part starts with a name for the body part to be reconstructed and ends in -oplasty. Rhino is used as a prefix for "nose", so rhinoplasty is basically reconstructive or cosmetic surgery for the nose.
  • Reparation of damaged or congenital abnormal structure ends in -rraphy. Herniorraphy is the reparation of a hernia, while perineorraphy is the reparation of perineum.

Description of surgical procedure

At a hospital, modern surgery is often done in an operating room using surgical instruments, an operating table for the patient, and other equipment. The environment and procedures used in surgery are governed by the principles of aseptic technique: the strict separation of "sterile" (free of microorganisms) things from "unsterile" or "contaminated" things. All surgical instruments must be sterilized, and an instrument must be replaced or re-sterilized if it becomes contaminated (i.e. handled in an unsterile manner, or allowed to touch an unsterile surface). Operating room staff must wear sterile attire (scrubs, a scrub cap, a sterile surgical gown, sterile latex or non-latex polymer gloves and a surgical mask), and they must scrub hands and arms with an approved disinfectant agent before each procedure.

Prior to surgery, the patient is given a medical examination, certain pre-operative tests, and an ASA score. If these results are satisfactory, the patient signs a consent form and is given a surgical clearance. If the procedure is expected to result in significant blood loss, an autologous blood donation may be made some weeks prior to surgery. If the surgery involves the digestive system, the patient may be instructed to perform a bowel prep by drinking a solution of polyethylene glycol the night before the procedure. Patients are also instructed to abstain from food or drink (an NPO order after midnight on the night before the procedure, to minimize the effect of stomach contents on pre-operative medications and reduce the risk of aspiration if the patient vomits during or after the procedure.

In the pre-operative holding area, the patient changes out of his or her street clothes and is asked to confirm the details of his or her surgery. A set of vital signs are recorded, a peripheral IV line is placed, and pre-operative medications (antibiotics, sedatives, etc) are given. When the patient enters the operating room, the skin surface to be operated on is cleaned and prepared by applying an antiseptic such as chlorhexidine gluconate or povidone-iodine to reduce the possibility of infection. If hair is present at the surgical site, it is clipped off prior to prep application. Sterile drapes are used to cover all of the patient's body except for the surgical site and the patient's head; the drapes are clipped to a pair of poles near the head of the bed to form an "ether screen", which separates the anesthetist/anesthesiologist's working area (unsterile) from the surgical site (sterile).

Anesthesia is administered to prevent pain from incision, tissue manipulation and suturing. Based on the procedure, anesthesia may be provided locally or as general anesthesia. Spinal anesthesia may be used when the surgical site is too large or deep for a local block, but general anesthesia may not be desirable. With local and spinal anesthesia, the surgical site is anesthetized, but the patient can remain conscious or minimally sedated. In contrast, general anesthesia renders the patient unconscious and paralyzed during surgery. The patient is intubated and is placed on a mechanical ventilator, and anesthesia is produced by a combination of injected and inhaled agents.

An incision is made to access the surgical site. Blood vessels may be clamped to prevent bleeding, and retractors may be used to expose the site or keep the incision open. The approach to the surgical site may involve several layers of incision and dissection, as in abdominal surgery, where the incision must traverse skin, subcutaneous tissue, three layers of muscle and then peritoneum. In certain cases, bone may be cut to further access the interior of the body; for example, cutting the skull for brain surgery or cutting the sternum for thoracic (chest) surgery to open up the rib cage.

Work to correct the problem in body then proceeds. This work may involve:

  • excision - cutting out an organ, tumor, or other tissue.
  • resection - partial removal of an organ or other bodily structure.
  • reconnection of organs, tissues, etc., particularly if severed. Resection of organs such as intestines involves reconnection. Internal suturing or stapling may be used. Surgical connection between blood vessels or other tubular or hollow structures such as loops of intestine is called anastomosis.
  • ligation - tying off blood vessels, ducts, or "tubes".
  • grafts - may be severed pieces of tissue cut from the same (or different) body or flaps of tissue still partly connected to the body but resewn for rearranging or restructuring of the area of the body in question. Although grafting is often used in cosmetic surgery, it is also used in other surgery. Grafts may be taken from one area of the patient's body and inserted to another area of the body. An example is bypass surgery, where clogged blood vessels are bypassed with a graft from another part of the body. Alternatively, grafts may be from other persons, cadavers, or animals.
  • insertion of prosthetic parts when needed. Pins or screws to set and hold bones may be used. Sections of bone may be replaced with prosthetic rods or other parts. Sometime a plate is inserted to replace a damaged area of skull. Artificial hip replacement has become more common. Heart pacemakers or valves may be inserted. Many other types of prostheses are used.
  • creation of a stoma, a permanent or semi-permanent opening in the body
  • in transplant surgery, the donor organ (taken out of the donor's body) is inserted into the recipient's body and reconnected to the recipient in all necessary ways (blood vessels, ducts, etc.).
  • arthrodesis - surgical connection of adjacent bones so the bones can grow together into one. Spinal fusion is an example of adjacent vertebrae connected allowing them to grow together into one piece.
  • modifying the digestive tract in bariatric surgery for weight loss.
  • repair of a fistula, hernia, or prolapse
  • other procedures, including:
  • clearing clogged ducts, blood or other vessels
  • removal of calculi (stones)
  • draining of accumulated fluids
  • debridement- removal of dead, damaged, or diseased tissue

Blood or blood expanders may be administered to compensate for blood lost during surgery. Once the procedure is complete, sutures or staples are used to close the incision. Once the incision is closed, the anesthetic agents are stopped and/or reversed, and the patient is taken off ventilation and extubated (if general anesthesia was administered).

After completion of surgery, the patient is transferred to the post anesthesia care unit and closely monitored. When the patient is judged to have recovered from the anesthesia, he/she is either transferred to a surgical ward elsewhere in the hospital or discharged home. During the post-operative period, the patient's general function is assessed, the outcome of the procedure is assessed, and the surgical site is checked for signs of infection. If removable skin closures are used, they are removed after 7 to 10 days post-operatively, or after healing of the incision is well under way.

Post-operative therapy may include adjuvant treatment such as chemotherapy, radiation therapy, or administration of medication such as anti-rejection medication for transplants. Other follow-up studies or rehabilitation may be prescribed during and after the recovery period.

Surgical specialties and sub-specialties

Some other specialties involve some forms of surgical intervention, especially gynaecology. Also, some people consider invasive methods of treatment/diagnosis, such as, cardiac catheterization, endoscopy, and placing of chest tubes or central lines "surgery". In most parts of the medical field, this view is not shared.

Surgical procedures of interest to psychologists

See also


References

External links


|} Template:Endocrine system operations and other procedures Template:Eye surgery Template:Operations and other procedures on the ear Template:Operations and other procedures on the nose, mouth, and pharynx Template:Respiratory system surgeries and other procedures Template:Cardiac surgery Template:Vascular surgery procedures Template:Operations and other procedures of the hemic and lymphatic system Template:Digestive system surgical procedures Template:Urogenital surgical procedures Template:Obstetrical procedures Template:Operations and other procedures on the musculoskeletal system Template:Operations and other procedures of the integumentary system


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