Part I. Surgical instruments

A surgical operation (operatio — work, action) is an action performed by a doctor on tissues and organs, accompanied by their separation to expose a diseased organ for the purpose of treatment or diagnosis, and the subsequent connection of tissues.

Any surgical operation consists of three main stages:

1. Access.
2. The main part of the surgical treatment.
3. Completion of the surgical operation — the final stage is layer-by-layer suturing of the wound.

1. Access is a part of the operation that provides the surgeon with exposure of the organ on which the main part of the surgical treatment is supposed to be performed.

Some accesses have special names — laparotomy, lumbotomy, thoracotomy, craniotomy, etc.

Surgical access ends with a primary revision of the wound — the surgeon’s actions in the wound in order to identify topographic landmarks and find pathological foci, sources of bleeding, anomalies of the anatomical structure.

2. The main part of surgical treatment is the main stage of the operation, during which the surgical effect on the pathological focus or the affected organ is carried out: opening the abscess, removing the affected organ or part of it (gall bladder, appendix, stomach, etc.).

In some cases, access is at the same time the main stage of surgical treatment, as, for example, when making incisions for drainage of cellular spaces or trepanation of the mastoid process with mastoiditis.

The name of the surgical operation often comes from the name of the organ or other anatomical formation and the name of the surgical procedure.

Frequently used terms:

• “-tomy” — dissection of the organ, opening its lumen — (gastrotomy, enterotomy, choledochotomy);
• “-ectomy” — removal of an organ (appendectomy, gastrectomy);
• “-stomy” — the creation of an artificial communication of the organ cavity with the external environment, i.e., the imposition of a long-term fistula (tracheostomy, cystostomy) or the creation of an artificial communication of two hollow organs (choledochoejunostomy) — in this case it is synonymous with the term “anastomosis”;
• “puncture” — tissue puncture for diagnostic or therapeutic purposes and the possibility of removing pathological fluid;
• “biopsy” — excision of a piece of tissue for histological examination;
• “resection” — removal or excision of a part of an organ along its length (gastric resection);
• “amputation” — removal of the peripheral part of an organ or limb (supravaginal amputation of the uterus, amputation of the lower leg, etc.);
• “extirpation” — complete removal of the organ along with surrounding tissues (extirpation of the uterus with appendages, extirpation of the rectum, etc.);
• “anastomosis” — the creation of an artificial anastomosis of hollow organs (gastroenteroanastomosis, vascular anastomosis, etc.);
• “suturing” — suturing tissue to close a natural or artificial opening;
• “plastic” — restoration of the form and function of organs and tissues using biological or artificial materials (plasty of the inguinal canal, plasty of the esophagus with the small intestine, etc.). The liver defect can be sutured using a hemostatic sponge or omental strand, but this will not be plasty;
• “transplantation” — the transfer of organs or tissues of one organism to another (transplantation of the kidney, bone marrow, etc.);
• “prosthetics” — replacement of a pathologically altered organ or part of it with artificially created analogues (prosthetics of the hip joint with a metal prosthesis, etc.);
• “replantation” — the attachment to the body of its part, cut off as a result of injury;
• “trepanation” — the formation of a hole in the bone tissue to access the underlying cavity.

Some names of operations in Russia have developed historically — “Caesarean section”, “high section of the bladder”, “hernia repair”, “primary debridement”, etc.

3. Completion of the surgical operation is the last stage of the surgical intervention, which restores the anatomical relationships of organs and tissues that were disturbed during the access (peritonization, pleurization, layer-by-layer suturing of the surgical wound, etc.). Before the completion of the operation, a repeated revision of the wound is carried out. Such a revision is performed in order to search for sources of bleeding, leftover materials and objects in the wound. The thoroughness of the final manipulations, as well as a good approximation of the layers of soft tissues are of great importance to ensure a favorable outcome of the operation, as well as to prevent complications. If necessary, this stage of surgical treatment can end with the establishment of a drainage.