| You have to know everything of these entities. |
| Physician surgeon medical emergency |
| Physician surgeon elective surgery |
| Anesthesiology | The specialty of anesthesia during surgery and pain management. |
| Bariatric Surgery | The specialty of treating obesity with surgery. |
| Cardiac Surgery | The specialty of treating heart problems with surgery. |
| Cardiothoracic Surgery | The specialty of treating heart, lung and other problems in the chest with surgery. |
| Colon & Rectal Surgery | The specialty of treating problems of the small and large intestine, the rectum and anus with surgery. |
| General Surgery | The specialty of treating common abdominal problems such as hernias and appendicitis with surgery. |
| Gynecologic Surgery | The specialty of treating problems with the female reproductive system with surgery. |
| Maxillofacial Surgery | The specialty of treating problems of the mouth, jaw, neck and facial bones with surgery. |
| Neurosurgery | The specialty of treating the central nervous system, including the brain and spinal cord, with surgery. |
| Obstetrics | The specialty of treating women before, during and after childbirth which may include surgery such as a C-section. |
| Oncology | The specialty of treating cancer with surgery. |
| Ophthalmology | The specialty of treating conditions of the eye with surgery. |
| Oral Surgery | The specialty of treating dental problems with surgery, such as wisdom tooth removal and root canals. |
| Orthopedic Surgery | The specialty of treating problems of the bones, joints, ligaments and tendons with surgery. |
| Otolaryngology (Ear, Nose and Throat, ENT ) | The specialty of treating problems of the ears, nose and throat with surgery. |
| Pediatric Surgery | The specialty of treating health problems of children with surgery. |
| Plastic Surgery: Cosmetic & Reconstructive Surgery | The specialty of improving the appearance for cosmetic reasons, or to correct defects for a more appealing appearance. |
| Podiatry Surgery (Podiatry) | The specialty of treating problems of the feet with surgery. |
| Thoracic Surgery | The specialty of treating problems in the chest cavity, except the heart, with surgery. |
| Transplant Surgery | The specialty of replacing failing organs with donated organs with surgery. |
| Trauma Surgery | The specialty of treating injuries from car crashes, gunshot wounds, stabbings and other traumatic injuries with surgery. |
| Vascular Surgery | The specialty of treating problems of the blood vessels with surgery. |
| Surgery: Is it really indicated? |
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A statement mentions that the surgery department lacks equipments and infrastructure. What type of equipment do you need? If you audit existing surgeries, you will discover that most of them are not required, and there has been wrong clinical diagnosis. A diagnosis of appendicitis: on operation, no findings of appendicitis. A diagnosis of cholecystitis or cholelithiasis: on operation, no findings of cholecystitis or cholelithiasis. A medical doctor is required to make correct clinical diagnoses. A surgeon is basically a medical doctor. They ask for number of unwanted investigations but after that they still cannot reach a correct diagnosis and treatment. |
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Q: Who is a surgeon? A: A surgeon is a medical doctor with additional training in specific medical procedures. Getting the title of surgeon does not mean he or she is a competent medical doctor. Not all surgeons can perform all medical procedures. Not all medical doctors can perform all medical procedures. Making an eight-inch incision and closing in three layers does not prove you are a surgeon or a medical doctor. Doing a burr hole and closing does not prove you are a surgeon. This is a medical or surgical procedure that can be taught in a few weeks. Doing medical or surgical procedures does not prove you are a competent medical doctor. The ability to reach to a correct diagnosis and provide treatment is a requirement of all medical doctors while maintaining good character and good behavior. |
| Surgical Skills |
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A-Z Surgical Specialties What are the surgical specialties? |
| What type of suggestions should a medical doctor (MD) forward to improve training programs in health care and medical education? |
| What do you have to do in case you need to be a surgeon? |
| What questions should a medical doctor or surgeon ask an anesthetist? |
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What are the different types of surgery? What are the surgical specialties? |
Neurosurgery
Q: What is a neurosurgeon? Q: Who sees a neurosurgeon? Q: What might neurological care involve? Q: What areas of care are available? Q: Who is a neurosurgeon? Q: What does neuroscience care involve? Q: Where is the neuroscience patient cared for? Q: What medical conditions require brain surgery? Q: What risks are associated with brain surgery? Q: How is brain surgery done? Q: What are other names for brain surgery? Here are further guidelines. |
Cardiothoracic surgery
Q: What is an MCh in cardiovascular and thoracic surgery? Q: How many MCh's in cardiovascular and thoracic surgery are required in the state? Q: What skills and knowledge are needed for an MCh in cardiovascular and thoracic surgery? Q: What are the duties and responsibilities of a person with an MCh in cardiovascular and thoracic surgery? Q: What equipment does cardiovascular and thoracic surgery need? Q: What other resources does cardiovascular and thoracic surgery need? Here are further guidelines. |
| Oral and maxillofacial surgery |
| Otolayrngology |
| Eye Surgery |
| OB/GYN Surgery |
| Paediatric surgery |
| Plastic Surgery |
| Orthopaedic surgery |
| Urology |
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General surgery
Do all cases of appendicitis need surgery? Do all cases of cholecystitis or gallstones need surgery? Dr. Qureshi's technique Q: What are the advantages of laparoscopy? A: It is less invasive, cost effective, results in fewer infections, and shorter hospital stay. Also, early return to work, minimal postoperative complications, and cosmetic advantages, too. Can appendicitis be managed with endoscopic/Laparoscopy removal without general anesthesia? Q: What does the surgeon use to close the wound? Q: What is the difference between sutures, staples and Steri-Strips? Q: Do all sutures dissolve? Q: Is it painful to have sutures and staples removed? Q: How is the wound bandaged? Q: How should I care for my wound? Q: Is it normal for the wound to itch? Q: How do I take care of my wound at home? Q: When can I take a shower? Q: Does it take a long time for the wound to heal? Do you have a question? Can you make me wiser? How? Can you make us wiser? How? Would you like to add anything? Who among you has done laparoscopic surgery? How many surgeries have you done so far? What was the diagnosis? What were the indications? What were the results? Were there any post- procedure complications? What were these complications? What is been done to prevent these complications? Who is the manufacturer of the equipment? What is the material of the existing equipment? What is been done to enhance the efficiency of a laparoscopy? What is been done to train others? Who has the responsibility to fund this research and development? |
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Surgical Skills
Do you know various surgical skills? What are various surgical skills? What is a surgical technique? A systematic surgical procedure by which a medical condition is treated. What questions should you answer in case you introduce new surgical technique? Is this a new surgical technique or already listed in surgical skills practiced by others on human beings? New Surgical Technique Is there any specific name for this new surgical technique? What is the name of this new surgical technique? Have you discussed with other doctors the benefits, complications, and harms due to this new surgical technique? For what type of patients is diagnosis and treatment with this new surgical technique useful? How is this surgical technique going to improve the condition of the patient? How is this surgical technique performed, from beginning to end? For what medical condition is this surgical technique the only option of treatment? What issues is this medical condition causing the patient? What complications can occur due to this surgical technique? Why was there a need to elaborate on these facts? On September 12, 2013, Department of Surgical Gastroenterology SKIMS started sophisticated pancreatic surgery, pancreaticoduodenectomy with portal venous resection and later reconstruction. A team of surgeons headed by Prof. Omar Javed Shah was the first of its kind in Kashmir. The above questions were not answered in the academic deliberations. Here are further guidelines. |
| In case of any surgical recommendations, get second and third consultation immediately from supervisors before any surgical recommendations. |
| Anesthesia |
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How many surgical instruments are there for human surgery? There are hundreds of surgical instruments for human surgery. Can you name various surgical instruments? Instruments used in general surgery. What are six classes of surgical instruments by functions? Six classes of surgical instruments by function. 1. Cutting surgical instruments 2. Grasping or holding surgical instruments 3. Haemostatic forceps surgical instruments (instruments used to stop blood flow) 4. Retractors surgical instruments 5. Clamps and distractors surgical instruments 6. Accessories and implants surgical instruments What minimum resources are required by physician surgeon medical emergency and physician surgeon elective surgery in general surgery emergency or elective surgery? 1. Surgical needle holder 2. Surgical needle with thread 3. Scalpel 4. Haemostatic forceps 5. Suction tips and tubes 6. Dressing (medical) 7. Surgical table 8. Physician for assistance 9. General anesthesia (anesthetist) 10. Guide, for example Doctor Asif Qureshi at www.qureshiuniversity.com/surgeryworld.html from a distance. If any juniors or students are around, this must be recorded. In various surgeries other than general surgery emergency or elective, these surgery resources are required plus some extra surgical instruments. Nowadays, computer and Internet with guidelines at www.qureshiuniversity.com/surgeryworld.html are essential. What are several classes of surgical instruments? There are several classes of surgical instruments: Graspers, such as forceps Clamps and occluders for blood vessels and other organs Retractors, used to spread open skin, ribs, and other tissue Distractors, positioners and stereotactic devices Mechanical cutters (scalpels, lancets, drill bits, rasps, trocars, Ligasure, Harmonic scalpel, surgical scissors, rongeurs etc.) Dilators and specula, for access to narrow passages or incisions Suction tips and tubes, for removal of bodily fluids Sealing devices, such as surgical staplers Irrigation and injection needles, tips and tubes, for introducing fluid Powered devices, such as drills, dermatomes Scopes and probes, including fiber optic endoscopes and tactile probes Carriers and appliers for optical, electronic, and mechanical devices Ultrasound tissue disruptors, cryotomes, and cutting laser guides Measurement devices, such as rulers and calipe Cardiothoracic surgery, neurosurgery, orthopedic surgery, plastic surgery, other categories have some extra instruments compared to general surgery emergency or elective surgery. |
| Inside operating room |
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Is there a difference between operating room equipment and surgical instruments? Yes, there is. What are examples of operating room equipments? What are examples of surgical instruments? |
| Operating Room Equipment |
| Operating room management |
| Operating Room Skills |
| Operating Room Skills Checklist |
| Surgical instruments |
| Surgical Documentation |
| Patients |
| Surgery |
| Surgical Procedures |
| Elective surgery |
| Surgical Skills |
| Surgery |
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What is emergency surgery? How should emergency surgeries be classified? What cases need emergency surgery? What cases need an emergency operating room (OR)? What cases need elective surgery? What cases need an elective operating room (OR)? What are examples of emergency surgeries? Is there a difference between operating room equipment and surgical instruments? What are examples of operating room equipments? What are examples of surgical instruments? |
| What should physician surgeon elective surgery know? | ||
| Annotation or definition of elective surgeries. | ||
| Basic abilities of a physician primary care, physician medical emergency room. | ||
| Surgical skills. | ||
| Seniority | ||
| Questions that need answers before, during, and after surgical procedure. | ||
| Types of elective surgeries. | ||
| Operating room equipment | ||
| Operating room management | ||
| Operating room skills | ||
| Operating room skills checklist | ||
| Patients | ||
| Surgical instruments | ||
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Annotation or definition of elective surgeries.
Elective surgery
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Alert for all physicians.
In what situations in surgical emergencies or elective procedures is incision not required? If there is any stab wound that caused prolapse of intestines, do not do any incision. Do not do any laparotomy. Do not cut any site or location in this situation. Relocate the intestines to their original location and suture the stab wound. Critical monitoring of the individual is required. In what situation is surgical incision required? See surgical incisions details. What are the types of surgical incisions? Head and neck Chest Abdomen and pelvis Eye Head and neck Wilde's incision Descriptions of Common Neurosurgical Operations Burr Holes and Craniotomy Anterior Cervical Discectomy and Fusion Lumbar Microdiscectomy Lumbar Decompressive Laminectomy Carpal Tunnel Release Ulnar Nerve Decompression or Transposition Chest I do not recommend Median sternotomy procedures unless the likely advantage to patient is discussed and verified. Median sternotomy - This is the primary incision used for cardiac procedures. It extends from the sternal notch to the xiphoid process. The sternum is divided, and a finochietto retractor used to keep the incision open. Thoracotomy - A division of the ribs from the side of the chest. Abdomen and pelvis Midline incision or midline laparotomy - The most common incision for laparotomy is the midline incision, a vertical incision which follows the linea alba. The upper midline incision usually extends from the xiphoid process to the umbilicus. A typical lower midline incision is limited by the umbilicus superiorly and by the pubic symphysis inferiorly. Sometimes a single incision extending from xiphoid process to pubic symphysis is employed, especially in trauma surgery. Typically, a smooth curve is made around the umbilicus. Pfannenstiel incision - The Pfannenstiel incision, a transverse incision below the umbilicus and just above the pubic symphysis. In the classic Pfannenstiel incision, the skin and subcutaneous tissue are incised transversally, but the linea alba is opened vertically. It is the incision of choice for Caesarean section and for abdominal hysterectomy for benign disease. Chevron incision - This incision a cut is made on the abdomen below the rib cage. The cut starts under the mid-axillary line below the ribs on the right side of the abdomen and continues all the way across the abdomen to the opposite mid-axillary line thereby the whole width of the abdomen is cut to provide access to the liver. The average length of the incision is approximately 24 to 30 inches. Cherney incision - Cherney described a transverse incision that allows excellent surgical exposure to the space of Retzius and the pelvic sidewall. The curvilinear skin and rectus fascial incision is made 2 finger breadths above the symphysis pubis and carried in Langer's lines from 2 fingerbreadths medial to one anterior superior iliac spine to the corresponding position medial to the opposite anterior superior iliac spine. The anterior rectus fascia is mobilized distally off the underlying rectus muscle bodies. The pyramidalis muscles are dissected free and sharply excised to expose the underlying rectus tendons. With an index finger, a plane is developed between the fibrous tendons of the rectus muscle and the underlying transversalis fascia. Using a sharp no.10 scalpel blade, the rectus tendons are transected transversely 1–2 cm distal to the superior edge of the pubic bone. Rectus muscle should never be cut. The rectus muscles are retracted and the peritoneum opened.The inferior epigastric vessels may need division. Closure is accomplished with 5 to 6 horizontal mattress sutures of permanent braided suture approximating the anterior rectus tendons to the intact distal anterior rectus fascia. Continuous monofilament suture closure of lateral edges of the rectus muscle to the anterior rectus fascia prevents hernia. Patients should wear a binder for at least 2 weeks. No incision provides wider pelvic exposure, and is relatively painless compared to midline incisions. Result is the most pleasing cosmetic result of any abdominal incision. Gridiron's incision (Mc Burney's incision) - Described in 1894 by McBurney, used for appendectomy. An oblique incision made in the right lower quadrant of the abdomen, classically used for appendectomy. Incision is placed perpendicular to the spinoumblical line at Mc Burney's point, i.e. at the junction of lateral one-third and medial two-third of spino-umblical line. Kocher’s incision - An oblique incision made in the right upper quadrant of the abdomen, classially used for open cholecystectomy. Named after Emil Theodor Kocher. It is appropriate for certain operations on the liver, gallbladder and biliary tract. This shares a name with the Kocher incision used for thyroid surgery: a transverse, slightly curved incision about 2 cm above the sternoclavicular joints; Kustner’s incision - A transverse incision is made 5 cms above the symphysis pubis but below the anterior iliac spine. The subcutaneous tissue is then separated in the midline and the linea alba is exposed. A vertical midline incision is made through the linea alba. Care is taken to control and ligate any branches of the superficial epigastric vessels. This step of the incision is usually time consuming and is one of the limitations associated. This type of incision offers little extensibility and less exposure than a Pfannestiel incision. Lanz incision - A variation of the traditional Mc Burney's incision, which was made at McBurney's point on the abdomen: The Lanz incision is made at the same point along the transverse plane and deemed cosmetically better. It is typically used to perform an open appendectomy. Variations exist on the method used to locate the incision. Some surgeons advocate that the incision is made approximately 2 cm below the umbilicus centered on mid clavicular-midinguinal line. Others imply use of McBurney's point to center the incision (1/3rd of the distance from the anterior superior iliac spine to the umbilicus). Maylard incision - A variation of Pfannenstiel incision is the Maylard incision in which the rectus abdominis muscles are sectioned transversally to permit wider access to the pelvis.[4] The Maylard incision is also called the Mackenrodt incision. The incision in the rectus muscles is performed with the help of cautery, scalpel or surgical stapler. It is important to identify the inferior epigastric vessels on the lateral surface of these muscles and ensure their isolation and ligation if the incision will span more than half the rectus muscle width. It is advisable not to separate the rectus muscles from the anterior rectus sheath to prevent their retraction, which in turn facilitates closure at the end of the procedure. Among the complications associated with this type of incision is delayed bleeding from the cut edges of the rectus muscles as well as the deep epigastric vessels. Furthermore depending on the patient's body habitus, this incision may not offer adequate exposure to the upper abdomen. McBurney incision - This is the incision used for open appendectomy, it begins 2 to 5 centimeters above the anterior superior iliac spine and continues to a point one-third of the way to the umbilicus (McBurney's point). Thus, the incision is parallel to the external oblique muscle of the abdomen which allows the muscle to be split in the direction of its fibers, decreasing healing times and scar tissue formation. This incision heals rapidly and generally has good cosmetic results, especially if a subcuticular suture is used to close the skin. McEvedy's incision - McEvedy's original incision was a lateral paramedian incision which used to incise the rectus sheath along its lateral margin and gain access by pulling the rectus medially. This incision became obsolete because of very high incisional hernia rate. A modification was introduced by Nyhus which used a transverse (oblique) skin incision 3 cm above the inguinal ligament and a transverse incision (oblique) to divide the anterior rectus sheath. The rectus muscle was then pulled medially. This modification prevented the high incisional hernia rate. Turner-Warwick's incision - This type of incision is placed 2 cm above the symphysis pubis and within the lateral borders of the rectus muscles. The sheath overlying the rectus muscles at the symphysis pubis is released, 4 cm transversely, and the incision angled up to the lateral borders of the rectus muscles. The lateral edges of the incisions remain medial to the internal oblique muscles. The sheath may be released off the aponeurosis with the help of traction applied using Kocker clamps. The pyramidalis muscles are typically left attached to the aponeurosis. The rectus muscles are separated and the incision is made in the midline. This type of incision is good for exposure of the retropubic space but offers limited access to the upper pelvis and abdomen. Eye I do not recommend Mini Asymmetric Radial Keratotomy and Radial keratotomy procedures unless the likely advantage to patient is discussed and verified. Mini Asymmetric Radial Keratotomy -Used in eye surgery to cure keratoconus and correct astigmatism. It consists of a series of microincisions of variable depth, with a length between 1.75 and 2.25 millimeters, always made with a diamond knife, designed to cause a controlled scarring of the cornea, which changes its thickness and shape. Radial keratotomy - Used in eye surgery: corneal microincisions made to flatten the cornea and correct myopia. |
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What are the types of surgical tables?
There are at least nine types of surgical tables. C-arm tables Examination table Examination table powered Lithotripsy tables Operating room tables Procedure Chairs Ultrasound tables Urology tables Surgical table with table accessories What type of surgical table is required for this surgery procedure? |
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What are the types of surgical positions?
Supine Lithotomy (stirrups) Prone Jackknife (3500 or 6001) Right lat decubitus (bean bag) Left lat decubitus (bean bag) There are at least 14 positions on a surgical table. Here are further facts.
What should be the position of the patient on the surgical table? |
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What is the date and time of surgery?
Date: ____________ Time of Surgery: ___________ What is the name, date of birth, identification mark of the patient? -------------------------------------------------------------------- Before anesthesia and surgery, ask patient name, date of birth, and identification mark. What is name of physician surgeon medical emergency or physician surgeon elective surgery? -------------------------------------------------------------------- What best describes the surgery? Emergency Urgent Elective -------------------------------------------------------------------- Who all are included during surgery in surgical procedure? Physician surgeon medical emergency or physician surgeon elective surgery Physician anesthetist medical emergency or elective. Operating room nurse Administrator Guide to all of them for example, Doctor Asif Qureshi www.qureshiuniversity.com/surgeryworld.html. Others. Surgical tables What type of surgical table is required for this surgery procedure? There are at least nine types of surgical tables. -------------------------------------------------------------------- Position on Surgical Table: What should be position of patient on the surgical table? Supine Lithotomy (stirrups) Prone Jackknife (3500 or 6001) Right lat decubitus (bean bag) Left lat decubitus (bean bag) There are at least 14 positions on surgical table. -------------------------------------------------------------------- Surgical incisions. Alert for all physicians. Is there any directive not to give surgical incision? In what situations can surgical incision be or not be given? See situations surgical incision cannot be given or should not be given. What should be the postoperative bed location? Surgical intensive care unit. Postoperative ward. Other location; specify. -------------------------------------------------------------------- How long will the surgical procedure last? Case length (add 15 min for intubated patient): ____________ -------------------------------------------------------------------- What resources are required for this surgical procedure, including surgical instruments? -------------------------------------------------------------------- What best describes pain block for this patient? Pain block: No block Consult Epidural Nerve block Nerve catheter Femoral block Intrascalene block Popliteral block Sciatic block -------------------------------------------------------------------- What is the diagnosis of the patient? --------------------------------------------------- What are the medical or surgical procedure details? --------------------------------------------------- |
| Questions to be answered before the surgery. |
| Preoperative instructions |
| Questions to be answered in postoperative notes. |
| Questions to be answered in follow-up consultations. |
| If the expected procedure or surgery is likely to harm the patient, do not go ahead with surgery. If all the questions are not answered, do not go ahead with surgery. |
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| Preoperative instructions |
| Inside operating room |
| Operative notes |
| Postoperative complications |
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How did the patient improve or was helped by the specific procedure or surgery?
In general, how is your physical and mental health? Postoperative follow-up |