Surgery and Suturing LAB

Surgery

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Surgery is used when physical intervention is required to treat a patient.  In general, surgery involves excising or correcting tissues of the body.  A non-invasive surgery refers to a surgery that does not penetrate the structure being excised or corrected, while invasive surgery does. There are many different types of surgery performed with the goal on becoming less invasive as medical technology improves.

Surgical procedures can be categorized by the type of procedure, body system(s) that are being treated, the degree of urgency, level of invasiveness, and/or the instruments being used in the surgery.  The following list is only a small example of the types of surgical procedures used commonly in medicine today.

• Emergency surgery – life threatening and must be done
• Elective surgery – non-life threatening and occurs at the patient’s request
• Exploratory surgery – used when a diagnosis has not been confirmed
• Reconstructive surgery – used to reconstruct injured or abnormal tissue
• Cosmetic surgery – used to reconstruct normal tissue
• Transplant surgery – used to replace tissue
• Orthopedic surgery – performed on muscles, bones, tendons, or ligaments
• Cardiac surgery – performed on the heart
• Gastrointestinal surgery – performed on the digestive system
• Laparoscopic surgery – a minimally invasive surgery that uses a small incision
• Laser surgery – uses a laser to perform surgical procedure
• Endoscopic surgery – uses an endoscope to perform surgical procedure
• Robotic surgery – uses surgical robots to perform surgical procedure

Suturing

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Suturing is used to close wounds and has been practiced for thousands of years.  It is commonly known by the general public as stitches.  While the materials used in suturing and techniques have changed during that time, the general goal has remained: minimize bleeding, reduce the risk of infection, close skin edges allowing for function and healing, and support and strengthen a wound until the body’s own healing process takes over.  There are many different types of suturing techniques based on the type of wound, location of the wound, skin thickness, and the desired result.  Using the correct suture technique will reduce scarring and allow for proper function of the tissue. 

Basic Suturing Principles

The Needle

Suturing needles are most commonly curved and made of 3 sections.  The point, or tip, is sharp and used to penetrate tissue.  The body is the middle of the needle, and the swage is where the suturing material attaches.

The Needle Holder

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The use of forceps or specialized needle holders to grasp the needle while suturing allows for greater dexterity while suturing.  Using needle holders also prevents the chance of the suturing needle piercing the gloves or skin of the healthcare provider during suturing, and therefore reducing the risk of contamination.  The forceps may also be used to grasp and hold the tissue during suturing.

The Suture Material

There are many different types of suture material.  The material may be synthetic and require later removal, or come from an organic source that will eventually be broken down or pushed out by the body.  The most common organic sutures are called catgut, but are usually collagen from bovine intestine.  Polyglycolide and polydioxanone are the most common synthetic sources of suture material.   

Knot Tying

The square knot is the most commonly used knot for cutaneous suturing procedures.  The square knot allows for the suture material to hold tightly and can easily be made with suture material. 

Suturing Technique

Suturing technique refers to the type of stitching used to create the suture.  The following diagram shows some most common suture techniques used.

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Materials

Procedure

In this activity (due to Covid) you will be the only person on scene to operate on this patient.  Your supplies are limited and you are performing all the parts of a surgical team by yourself.  This activity is meant to allow practice using surgical and dissecting tools as well as to learn some basic suturing techniques.

Surgical Team Roles 

You will have to use the supplies given to you as well as combine all four surgical team roles in order to complete this task.  There are four parts to the surgical team.  

• The chief surgeon will perform the incision, locate the issue, and respond accordingly
• The assisting surgeon will suture the incision
• The scrub nurse will prepare and handle equipment for the surgeon
• The circulating nurse will oversee the procedure and ensure the directions are followed

Prepare the Surgical Room

• Collect the patient and place her comfortably at your lab table
• Collect your scalpel (will have to substitute with scissors if I am not present to supervise), forceps, sutures, and face mask
• Lay a paper towel out next to the operating table and lay each tool on the paper towel where it can easily be picked up during the surgery

REMEMBER:  If you operate on the right hip, it is the patients right hip, not yours.  Directions are done on the patients point of view.