OPHTHALMIC OPERATIONS 1 removal chalazion

Excision of Chalazion

Objective

The removal of a cystic enlargement of the Meibomian gland in the eyelid.

Position

Supine with head elevated.

Anesthesia

The skin or conjunctiva overlying the lesion is infiltrated with local anesthesia.

Procedure

1.  The cyst is usually removed via the conjunctiva but occasionally through the skin.

2.  A chalazion clamp is applied with the cyst projecting into the ring of the forceps.

3.  Approach to the cyst through the conjunctiva vertical incision is made to the lid margin, for this type of wound closes readily without sutures.

4.  The cyst is curetted.

5.  Or a recurred cyst is dissected out with sharp scissors or a scalpel.

6.  The cyst can be approached through the skin.

7.  The incision is made parallel with the lid margin.

8.  And closed afterwards with a few interrupted synthetic non-absorbable or silk sutures.

Instruments

•   Sponge holding forceps (Rampley), 2

•   Scalpel handle, and No. 15 blade (Bard Parker)

•   Tarsal cyst forceps (Greene) (Fig. 14.40)

•   Meibomian cyst curettes, 3 sizes (Fig. 14.41)

•   Fine needle holder (Barraquer) (Fig. 14.4)

•   Towel clips (Backhaus), 4

•   Hand cautery and points

•   6/0 synthetic non-absorbable or black silk

•   Small cutting needle for skin closure.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review.

Visitor tat follow may post contributions to the site,please write to address above.

To create consumer/provider engagement visit www.surginstruatlas.blogspot.com

www.drmmkapur.blogspot.com               www.surgseminar.blogspot.com

UROLOGIC OPERATION 18 vasovasostomy

Vasovasostomy

Objective

In case of:

•   Demand for reversal

•   Anastomosis of the severed ends of the vas deferens.

Position

Supine.

Anesthesia

Local, spinal or general.

Procedure

1.  A scrotal incision exposes the vas deferens above and below site of the previous ligation.

2.  Scar tissue is excised from both ends of the vas.

3.  Under magnification sutures are placed in the mucosal lining of the lumen.

4.  Muscularis is approximated separately.

5.  Wound is closed.

Instruments

•   Vasectomy set

•   Vasovasostomy microscopic instruments, for example,

     1 tissue forceps,

     2 curved smooth forceps,

     1 curved tying forceps,

     1 castroviejo needle holder,

     1 vas holder

•   Electrosurgical pencil with needle tip

•   Scrotal support

•           Microscope or magnifying loop.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review.

Visitors that follow may post contributions to the site,please write to address above.

To create consumer/provider engagement visit www.surginstuatlas.blogspot.com

www.drmmkapur.blogspot.com                www.surgseminar.blogspot.com

UROLOGIC OPERATION 17 Vasectomy

Vasectomy

Objective

•   To achieve permanent male contraception

•   Excision of a segment of the vas deferens

•   Ligation of the distal and proximal ends.

Position

Supine (legs apart).

Anesthesia

Local.

Procedure

1.  The vas is palpated through the scrotum.

2.  Anesthetic is administered.

3.  A scrotal incision is made.

4.  Vas is seized and is freed of surrounding tissue.

5.  Segment of vas is excised and the ends ligated.

6.  Severed ends may be cauterized or crushed with a clamp prior to ligation.

7.  The wound is closed.

8.  The procedure is repeated on the other side.

Instruments + Supply

•   Vasectomy set

•   Scrotal support

•   Small specimen container.

Any questions be sent to drmmkapur@gmail.com

Allolder posts are stored in archives for access and review.

Visitors that follow may post contributions to the site,please write to address above.

To create consuer/provider engagement visit www.surginstruatlas.blogspot.com

www.drmmkapur.blogspot.com              www.surgseminar.blogspot.com

Urologic operation 16 0rchidectomy

Orchiectomy

Objective

In case of

•   Tumor or torsion of testis

-   Torsion of testis

•   Removal of testicles.

Position

Supine.

Anesthesia

General.

Procedure

1.  Incision can be made transcrotally or inguinally.

2.  The testis is identified, the spermatic cord ligated and the testis are removed.

3.  Repeated bilaterally if required.

4.  For testicular malignancy, high ligation of the spermatic cord is done.

5.  Radical lymphadenectomy may be performed through an abdominal incision to the level of the transection of the spermatic cord, are removed. A testicular prosthesis may be placed at the time of orchiectomy.

6.  Wound is closed.

Instruments

General Set

•   Cord hook (Fig. 11.17)

•   Cord clamp.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review.

Visitors that follow may post contributions to the site.

To create consumer/provider engagement visit www.surginstruatlas.blogspot.com

www.drmmkapur.blogspot.com                www.surgseminar.blogspot.com

UROLOGIC OPERATION 15 renal transplantation

Renal Transplantation

Objective

In case of renal failure:

•   Kidney from live donar

•   Or kidney from cadaver is transplanted to restore renal function.

Position

Supine.

Anesthesia

General.

Procedure

   1.  In live donor a nephrectomy is carried out as described care is mobilizing renal artery and vein so as not to injure them.

   2.  Ureter is similarly mobilized with perureteric tissue. Kidney perfused with cold irrigating fluid.

   3.  The iliac fossa of patient (RP) is used.

   4.  Oblique muscle cutting used for access.

   5.  Peritoneum pushed medially.

   6.  Internal iliac artery mobilized branches ligated.

   7.  External iliac vein mobilized.

   8.  Donor kidney renal vein anastomosed to external iliac vein.

   9.  End of internal iliac artery anastomosed to donor kidney renal artery.

10.  Ureter is implanted to bladder.

11.  Wound closed after placing kidney iliac fossa.

Instruments

•   General set

•   Laparotomy set

•   Deep set

•   Vascular clamps (Potts, De Bakey or Satinsky), 2

•   Large bulldog clamps (Potts), 4     (Fig. 8.126)

•   Small bulldong clamps (Potts), 4

•   Heparinized saline, and syringes with cannulae

•   Suction tubing, nozzles and tube anchoring forceps

•   Diathermy leads, electrodes and lead anchoring forceps

•   Tantalum marker clips and insertion forceps

•   Laparotomy ligatures and sutures

•   1 and 0.75 (5/0 and 6/0) Synthetic nonabsorbable or silk on small fine curved arterial needles for anastomosis.

Any questions be sent to drmmkapur@gmail.com

All older posts are tored in archives for access and review.

Visitors tha follow may post contributions to the site,please write to address above.

To create consuer/provider engagement visit www.www.surginstratlas.blogspot.com

www.drmmkapur.blogspot.com          www.surgseminar.blogspot.com

UROLAGIC OPERATION 14 nephtrctomy

Nephrectomy

Objective

In case of tumor or other disease:

•   removal of a kidney.

Position

Lateral.

Anesthesia

General.

Procedure

   1.  For benign disease a flank incision is made (with or without rib resection).

   2.  The kidney and ureter are mobilized.

   3.  The ureter is divided and the distal end ligated.

   4.  Vascular pedicle (artery and vein) is ligated.

   5.  For malignant disease a radical nephrectomy is performed.

   6.  A transperitoneal or anterior retroperitoneal incision is used.

   7.  For large upper-pole lesions, a transthoracic approach may be employed.

   8.  On the right side, the duodenum is protected with mois­tened laparotomy pads.

   9.  The vascular pedicle is transected and lymph node bearing tissue excised.

10.  The ureter is divided, and the kidney and surrounding fat, adrenal gland, and fascia are removed en bloc.

11.  If tumor is present in the renal vein, the vena cava is mobilized and the tumor embolus removed.

12.  The distal ureter is dissected free of surrounding tissues and a small cuff of bladder is excised with the intramural portion of the ureter.

13.  The bladder incision is repaired.

14.  A suprapubic cystostomy catheter may be placed and the distal ureter and bladder cuff are delivered into the flank.

15.  The flank incision may be closed with or without drainage.

16.  For trauma and some presentations of calculus disease involving only a portion of the kidney, a partial nephrec­tomy may be performed.

Instruments

•   General set

•   Deep instrument set

•   Kidney set

•   Thoracotomy tray, vascular procedures tray, and laparotomy procedures set (available)

•   Hemoclip appliers (assorted sizes and lengths) 

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review.

Visitors that follow may post contributions to the site,please rite to address above.

To create consumer/provider engagement visit www.surginstruatlas.blogspot.com

www.drmmkapur.blogspot.com www.surgseminar.blogspotom