There are many superb books on how to do operations but there are few or none on how to assist at them, and none written either by or for medical students or doctors. Therefore, the skills that make an expert surgical assistant are difficult to acquire. Normally, they can only learn in a haphazard way, by spending years in the operating theater. This book describes those skills in a concise and systematic way, in surgery in general, and in ten different speciality areas. Although intended mainly for clinical-level medical students and junior doctors, other people who assist at surgical operations, including general practitioners, nurse assistants and surgical technologists, will also find it useful. Whether planning a career in surgery, or simply aiming for high marks in a surgical rotation, there are few better ways to impress a surgeon than by skilfully assisting at surgical operations.
Author(s): Comus Whalan
Series: Cambridge Clinical Guides
Edition: 1
Publisher: Cambridge University Press
Year: 2006
Language: English
Pages: 225
Half-title......Page 3
Title......Page 5
Copyright......Page 6
Contents......Page 7
Contributors......Page 9
Foreword......Page 11
Preface......Page 13
A note on terminology......Page 15
Relationship with theatre staff......Page 17
Stress......Page 19
Talking in the operating theatre......Page 20
Food and drink......Page 21
Know dimensions......Page 22
If you suffer a needle-stick injury......Page 23
If you suffer an eye splash......Page 24
Scrubs......Page 25
Hat......Page 26
Eye protection......Page 27
Jewellery......Page 28
Re-entering the operating suite......Page 29
Instrument nurses or ‘scrub nurses’......Page 30
Radiographers......Page 31
Part 2 The operation itself......Page 33
5 Preparing for the operation......Page 35
Concentrate on your task......Page 38
Anticipation......Page 39
Adjusting the light source......Page 41
Steady hands......Page 42
Improving the surgeon’s view......Page 43
Patient positioning......Page 44
Applying anti-thromboembolic devices......Page 45
Mobilisation......Page 46
Drain insertion......Page 47
Other: key points......Page 48
8 Sterility and the ‘sterile zone’......Page 49
Scrub taps......Page 50
Scrub technique......Page 51
Gowning......Page 52
Glove type......Page 53
Donning gloves: unassisted method (see Figure 8.1)......Page 54
Where to put your hands (see Figure 8.3)......Page 56
Antiseptic painting......Page 59
Clipping the drapes......Page 61
Incise drapes......Page 63
9 Tissue planes: traction and counter-traction......Page 65
Introduction......Page 68
Cutting instruments......Page 69
Gripping instruments......Page 77
Types of diathermy (see Figure 10.19)......Page 90
‘Touching’ with the diathermy (see Figure 10.20)......Page 92
Overview......Page 93
Simply ignore it......Page 94
Diathermy (see also ‘Touching with the diathermy’)......Page 95
Clip and tie......Page 96
Transfixion-ligation......Page 101
‘Following’ a suture line (see also p. 61 and p.178)......Page 102
Drains......Page 103
Prosthetic materials......Page 104
Part 3 Assisting at special types of surgery......Page 107
The median sternotomy......Page 109
Harvesting the internal mammary artery......Page 110
Coronary bypass grafting......Page 111
Coming off cardiopulmonary bypass......Page 112
Assisting in aortic valve, mitral valve or tricuspid valve surgery......Page 113
Video-assisted thoracoscopic procedures......Page 114
Specific situations in thoracic surgery......Page 115
General layout of instruments......Page 117
Camera and associated instruments......Page 118
The light cord......Page 119
White balance......Page 120
Ports......Page 121
Diathermy......Page 122
Use the correct grip (see Figure12.2)......Page 123
Frame the picture (see Figure 12.3)......Page 124
‘Zoom in’ or ‘Zoom out’ when it is helpful......Page 127
Keep yourself oriented......Page 128
‘Batman view’......Page 129
‘Doris Day view’......Page 130
Equipment......Page 132
Surgical access......Page 133
Retraction......Page 134
SUGGESTED FURTHER READING......Page 135
Obstetric operations......Page 136
SUGGESTED FURTHER READING......Page 137
SUGGESTED FURTHER READING......Page 138
Pre-operative preparation......Page 139
Marking the operation site (see also p. 21)......Page 143
Setting up......Page 144
Fluid irrigation......Page 145
Holding the scope......Page 146
Arthroscopy of smaller joints......Page 147
Preparation......Page 148
Intra-operatively......Page 149
Total knee replacement......Page 150
Positioning the patient......Page 151
Intra-operatively......Page 152
Distal radial fracture (Colles’ fracture)......Page 153
Preparation of the patient......Page 154
Ear surgery......Page 155
Head and neck surgery......Page 156
Conclusions......Page 157
FURTHER READING......Page 158
Keep infants warm......Page 159
Local anaesthetic considerations......Page 160
Thoracotomy......Page 161
SUGGESTED FURTHER READING......Page 162
Flap......Page 163
Cutting sutures (see also p. 57)......Page 164
Split thickness grafts......Page 165
Pedicled flaps......Page 166
Microsurgery......Page 167
How to hold microsurgery instruments (Figures 19.5 and 19.6)......Page 168
Handling tissues......Page 171
Conclusion......Page 172
Tips for the GP......Page 173
Tips for the medical student......Page 174
Standards......Page 175
Language......Page 176
Work productivity......Page 177
The surgical team......Page 178
Fatigue......Page 179
Specific operating theatre safety......Page 180
Instruments......Page 181
The operation......Page 183
The local surgical staff......Page 184
Summary......Page 185
Open operations......Page 186
Control of vessels......Page 187
Temporary occlusion of vessels......Page 188
The ‘therapeutic’ part of the operation......Page 189
Aortic surgery......Page 193
Introduction......Page 194
Endovascular procedures......Page 195
Handling catheters and wires......Page 196
Specialised equipment: balloons, stents, etc.......Page 197
Embolisation......Page 198
Part 4 Immediately after the operation......Page 201
24 Immediately after the operation......Page 203
Barium enema......Page 206
Distal (cf. proximal, below)......Page 207
Gauge (in reference to suture material)......Page 208
Ischaemia (noun)/ischaemic (adjective)......Page 209
Necrose (verb)......Page 210
Prophylactic......Page 211
Sigmoidoscopy......Page 212
Viscoelastic or ophthalmic viscoelastic device......Page 213
Warfarin......Page 214
Miscellaneous......Page 215
References......Page 217
Index......Page 219
