Definitions[ edit ] Surgery is a 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. Types of surgery[ edit ] 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.
A semi-elective surgery is one that must be done to avoid permanent disability or death, but can be postponed for a short time.
Emergency surgery is surgery which must be done promptly to save life, limb, or functional capacity. Exploratory surgery is performed to aid or confirm a diagnosis.
Therapeutic surgery treats a previously diagnosed condition. Cosmetic surgery is done to subjectively improve the appearance of an otherwise normal structure. By type of procedure: Amputation involves cutting off a body part, usually a limb or digit; castration is also an example.
Resection is the removal of all of an internal organ or body part, or a key part lung lobe; liver quadrant of such an organ or body part that has its own name or code designation. Replantation involves reattaching a severed body part. Reconstructive surgery involves reconstruction of an injured, mutilated, or deformed part of the body. Excision is the cutting out or removal of only part 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 or muscles. By degree of invasiveness of surgical procedures: 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 such as a laparotomy 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.
List of surgical procedures 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", therefore a rhinoplasty is reconstructive or cosmetic surgery for the nose. Repair of damaged or congenital abnormal structure ends in -rraphy. Reoperation return to the operating room refers to a return to the operating theater after an initial surgery is performed to re-address an aspect of patient care best treated surgically.
Reasons for reoperation include persistent bleeding after surgery, development of or persistence of infection. Description of surgical procedure[ edit ] Location[ edit ] Inpatient surgery is performed in a hospital, and the patient stays at least one night in the hospital after the surgery. Outpatient surgery occurs in a hospital outpatient department or freestanding ambulatory surgery center, and the patient is discharged the same working day.
Among United States hospitalizations for nonmaternal and nonneonatal conditions in , more than one-fourth of stays and half of hospital costs involved stays that included operating room OR procedures.
All surgical instruments must be sterilized , and an instrument must be replaced or re-sterilized if it becomes contaminated i.
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. Preoperative care Prior to surgery, the patient is given a medical examination , receives certain pre-operative tests, and their physical status is rated according to the ASA physical status classification system.
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.
Some medical systems have a practice of routinely performing chest x-rays before surgery. The premise behind this practice is that the physician might discover some unknown medical condition which would complicate the surgery, and that upon discovering this with the chest x-ray, the physician would adapt the surgery practice accordingly.
Please help improve this section by adding citations to reliable sources. Unsourced material may be challenged and removed. June Learn how and when to remove this template message 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. When the patient enters the operating room, the skin surface to be operated on, called the operating field, 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.
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.
Choice of surgical method and anesthetic technique aims to reduce the risk of complications, shorten the time needed for recovery and minimise the surgical stress response. Surgery[ edit ] An incision is made to access the surgical site. Blood vessels may be clamped or cauterized 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 the 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. Whilst in surgery aseptic technique is used to prevent infection or further spreading of the disease. The surgeons' and assistants' hands, wrists and forearms are washed thoroughly for at least 4 minutes to prevent germs getting into the operative field, then sterile gloves are placed onto their hands.
An antiseptic solution is applied to the area of the patient's body that will be operated on. Sterile drapes are placed around the operative site. Surgical masks are worn by the surgical team to avoid germs on droplets of liquid from their mouths and noses from contaminating the operative site. Work to correct the problem in body then proceeds.
This work may involve: 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. Reduction — the movement or realignment of a body part to its normal position.
Reduction of a broken nose involves the physical manipulation of the bone or cartilage from their displaced state back to their original position to restore normal airflow and aesthetics. 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. Pins or screws to set and hold bones may be used. Sections of bone may be replaced with prosthetic rods or other parts. Sometimes 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. Spinal fusion is an example of adjacent vertebrae connected allowing them to grow together into one piece. Once the procedure is complete, sutures or staples are used to close the incision. Once the incision is closed, the anesthetic agents are stopped or reversed, and the patient is taken off ventilation and extubated if general anesthesia was administered.
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. There are several risk factors associated with postoperative complications, such as immune deficienty and obesity. Obesity has long been considered a risk factor for adverse post-surgical outcomes.
It has been linked to many disorders such as obesity hypoventilation syndrome, atelectasis and pulmonary embolism, adverse cardiovascular effects, and wound healing complications. It is not uncommon for surgical drains see Drain surgery to be required to remove blood or fluid from the surgical wound during recovery. Mostly these drains stay in until the volume tapers off, then they are removed.
These drains can become clogged, leading to abscess. Postoperative therapy may include adjuvant treatment such as chemotherapy , radiation therapy , or administration of medication such as anti-rejection medication for transplants.