Thoracic Surgery Lobectomy Lung

Pulmonary Lobectomy

Objective

In cases of benign or malignant lesion limited to a lobe:

•   Excision of one or more lobes of the lung bearing the tumor.

Position

Lateral.

Anesthesia

General.

Procedure

   1.  Lung is exposed through a posterolateral incision.

   2.  Diseased lobe is identified.

   3.  The visceral pleura is dissected free from the hilus.

   4.  The pulmonary artery and vein of the diseased lobe are ligated and divided.

   5.  The bronchus is isolated, doubly clamped and transsected.

   6.  Bronchial stump is sutured; more frequently a stapling device may be employed.

   7.  The suture line is tested for air leaks.

   8.  Hemostatis is achieved.

   9.  Chest tubes are inserted.

10.  Chest is closed in layers.

11.  Chest tubes are connected to a sealed drainage unit.

Instruments

•   Major procedures tray 

•   Thoracotomy tray 

•   Vascular procedures tray 

•   Hemoclip appliers, assorted sizes, long handled 

•   Long Pean clamps 

•   Stapling devices 

•   Cushing vein retractors 

•   Basin set 

•   Suction tubing 

•   Blades (3) No. 10, (1) No. 15 

•   Dissectors

•   Asepto syringes (2) 

•   Staples

•   Hemoclips

•   Vessel loops, umbilical tapes 

•   Chest drainage tube(s) 

•   Connector for example, straight or large Y 

•   Sealed drainage unit.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archive for accessand reiew

Thosewho follow may post contributions to the site,please writo tp address above.

To create consumer/provider enagement visit www.surginstruatlas.blogspot.co

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

Also available now on android & smartphones same internet addre

Thoracic Surgery segmental resection lung

Segmental Resection of the Lung

Objective

In cases of benign or malignant disease of lungs:

•   Excision of anatomic subdivisions of the pulmonary lobes bearing the tumor.

Position

Lateral (diseased side up).

Anesthesia

General.

Procedure

   1.  Posteriolateral incision.

   2.  Diseased segment is identified.

   3.  The visceral pleura is dissected free from blood vessels and bronchi of the appropriate bronchiopulmonary segment.

   4.  Segmental pulmonary vein and segmental branches of the pulmonary artery are ligated.

   5.  The segmental bronchus is isolated, doubly clamped, and transsected.

   6.  Bronchial stump is sutured or stapled.

   7.  Pleural space is irrigated.

   8.  Hemostasis is achieved.

   9.  Chest tube is inserted.

10.  Wound is closed in layers.

11.  Chest tube is connected to a sealed drainage unit.

Instruments

•   Major procedures tray 

•   Thoracotomy tray 

•   Vascular procedures tray 

•   Hemoclip appliers, assorted sizes, long handled 

•   Long Pean clamps 

•   Stapling devices 

•   Cushing vein retractors 

•   Basin set 

•   Suction tubing 

•   Blades (3) No. 10, (1) No. 15 

•   Dissectors

•   Asepto syringes (2) 

•   Staples

•   Hemoclips

•   Vessel loops, umbilical tapes 

•   Chest drainage tube(s) 

•   Connector for example, straight or large Y 

•   Sealed drainage unit.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archive for accessand reiew

Thosewho follow may post contributions to the site,please writo tp address above.

To create consumer/provider enagement visit www.surginstruatlas.blogspot.co

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

Also available now on android & smartphones same internet addres

Thoracic surgery Mediastinoscopy

Mediastinoscopy

Objective

In cases of suspected malignancy:

•   Endoscopic visualization of the mediastinum (tracheobron­cheal junction, bronchi, aortic arch and regional lymph nodes) 

•   Biopsy if required.

Position

Supine.

Anesthesia

General.

Procedure

1.  Transverse incision over the suprasternal notch and extended down to the pretracheal fascia. 

2.  Blunt dissection the superior mediastinum is entered.

3.  Scope is passed.

4.  Avoid injury to nearby blood vessels.

5.  Lymph node tissue biopsied.

6.  Hemostasis is achieved.

7.  Scope is removed.

8.  Wound is closed.

Instrument

•   Mediastinoscope (Fig. 19.11)

•   Electrosurgical unit 

•   Suction

•   Fiberoptic light source 

•   Basin set 

•   Blade (1) No. 15 

•   Telfa dressing pads and 22 gauge needle

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archive for accessand reiew

Thosewho follow may post contributions to the site,please writo tp address above.

To create consumer/provider enagement visit www.surginstruatlas.blogspot.co

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

Also available now on android & smartphones same internet addres. 

Thoracic surgery bronchoscopy

THORACIC OPERATION

Bronchoscopy

Objective

In cases of suspected bronchial lesions:

•   Endoscopy

•   For visualization of the trachea, main bronchi and their openings and the segmental bronchi 

•   Obtaining material for histopathologic and bacteriologic examination if required 

•   Foreign body removal.

Position

Supine.

Anesthesia

General.

Procedure

1.  The head is lowered.

2.  Well-lubricated scope is inserted into the mouth.

3.  The epiglottis is elevated with the tip of the bronchoscope and the scope is passed into the trachea.

4.  The scope is advanced into the bronchi.

5.  Bronchial washings, biopsy, may be obtained.

6.  The bronchial passages are well suctioned, and the scope is removed slowly.

Instruments

Rigid bronchoscopy

•   Rigid fiberoptic bronchoscope (Fig 19.8)

•   Endotracheal adaptor 

•   Fiberoptic telescope 

•   Fiberoptic light cords (2) 

•   Suction cannula (Fig. 19.9) 

•   Suction tubing 

•   Specimen collectors 

•   Biopsy forceps 

•   Sponge carriers (2) (Fig. 19.10)

•   Grasping forceps 

•   Lubricant

•   Bronchoscopy sponges 

•   Small basin with sterile saline and syringe 

•   Telfa dressing pads and 25 gauge needle 

•   Laser may be employed.

Flexible bronchoscopy

•   Flexible fiberoptic bronchoscope 

•   Endotracheal adaptor 

•   Fiberoptic light cord 

•   Biopsy forceps 

•   Brush

•   Culture jar for biopsy specimen 

•   Small basin with sterile saline and syringe 

•   Suction tubing 

•   Specimen collector 

•   Lubricant

•   Telfa dressing pads and 25 gauge needle.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archive for accessand reiew

Thosewho follow may post contributions to the site,please writo tp address above.

To create consumer/provider enagement visit www.surginstruatlas.blogspot.co

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

Also available now on android & smartphones same internet addres

Plastic Surgery Reimplantation hand fingers

Replantation-Hand or Fingers

Objective

Replantation of amputated parts—hand or fingers—by micro­surgery.

Position

Supine with arm resting on a hand table.

Anesthesia

General + brachial.

Procedure

1.  Prepare amputated part and the stump and dissect its vessels, nerves, tendons and bone.

2.  Fixation of the amputated part with K wires.

3.  Repair tendons.

4.  Anastomosis of arteries, veins and nerves.

5.  Hemostasis.

6.  Closure dressing and splinting.

Instruments

•   Plastic surgery set

•   Microsurgery set

•   Hand surgery set consisting of:

     a.  Tourniquet (pneumatic)

     b.  Hand table

     c.  Rubber bands

     d.  K wires of different sizes

     e.  Wire driver with Jacob chuck and key

     f.   Fine periosteum elevation

     g.  Bone cutter

     h.  Wire cutting pliers

     i.   Esmarch’s bandage.

Sutures

•   Prolene 6 ‘0’ on curved round body needle (for tagging of vessels)

•   Prolene 4 ‘0’ on curved round body needle (for tendon repair)

•   Nylon 10 ‘0’ on 4 mm curved round body needle

•   Nylon 11 ‘0’ on 3.75 mm curved round body needle (for distal finger amputations)

•   Nylon 9 ‘0’ on 6 mm curved round body needle (for proximal and hand amputations)

•   Nylon 5 ‘0’ on curved cutting needle for skin

•   Dressing paraffin gauze

•   Gamjee pads

•   Velroc or Gypsona for splinting.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archive for accessand reiew

Thosewho follow may post contributions to the site,please writo tp address above.

To create consumer/provider enagement visit www.surginstruatlas.blogspot.co

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

Also available now on android & smartphones same internet addres

Plastic Surgery microsurgical free graft

Microsurgical Free Flap Transfers

Objectives

•   Reconstruction of defects 

•   By transfer of a flap from a distant area wherein the artery and vein supplying the flap is anastomosed to an artery and vein in the recipient area 

•   Under magnification with an operating microscope

•   Operation may be done by two teams simultaneously.

Position

Depending upon the site of recipient and donor areas.

Anesthesia

General.

Procedure

1.  Clean and drape recipient and donor areas.

2.  Prepare recipient area.

3.  Dissect and prepare recipient artery and vein.

4.  Plan and flap.

5.  Raise and prepare the flap and dissect its artery and veins.

6.  Divide flap vessels, transfer flap to the recipient area.

7.  Anastomose the vessels/Close recipient area by direct closure or skin grafting.

Instruments

•   Plastic surgery set 

•   Skin grafting set 

•   Microsurgery set consisting of: 

     a.  Jewellers forceps No. 2                   2   

     b.  Jewellers forceps No. 5                   2

     c.  Vessel dilator                                  1 

     d.  Curved blunt tipped dissecting    1
microscissors 

     e.  Straight sharp microscissors          1

     f.   Microneedle holder straight          1
or curved 

     g.  Microvessel clamps                         4 

     h.  Microvessel approximator clamps   2 

     i.   Visibility background                     1

     j.   Fine suction tip                              1

     k.  Irrigation syringe with                    1
22 G venflon 

     l.   Operating microscope                    1

     m. Sterile knobs for microscope (set) 1

     n.  Microsurgical cellulose swabs

     o.  Heparin saline solution (N saline 50 mls + heparin 5000 units + xylocaine 2% 5 mls). 

Sutures

•   As for general plastic surgery 

•   10 ‘0’ Nylon on 6 mm curved round body needle or 9 ‘0’ nylon on 6 mm curved round body needle.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archive for accessand reiew

Thosewho follow may post contributions to the site,please writo tp address above.

To create consumer/provider enagement visit www.surginstruatlas.blogspot.co

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

Also available now on android & smartphones same internet addres

Plastic Surgery Full thickness skin graft

Full Thickness Skin Graft (Wolfe Graft)

Objective

Coverage of small skin defects on face, hand and fingers following surgical excision of benign lesions or traumatic skin loss. 

Position

Depends upon site.

Anesthesia

Local or general.

Procedure

   1.  Clean and drape donor and recipient areas.

   2.  Mark and excise the lesion.

   3.  Secure hemostasis.

   4.  Make a template of the defect.

   5.  Transfer template to donor area. 

   6.  Mark and harvest graft.

   7.  Close donor area.

   8.  Thin out graft to remove fat from undersurface.

   9.  Suture graft in recipient bed.

10.  Apply tie-over dressing. 

Instruments

•   Plastic surgery set 

•   Sterile polyvinyl sheet for patter outline template

•   Vaseline/paraffin impregnated nonadherent gauze (Jelonet, Fairly) 

•   Irrigation syringe 

•   Cotton soaked in betadine or acriflavin solution.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archive for accessand reiew

Thosewho follow may post contributions to the site,please writo tp address above.

To create consumer/provider enagement visit www.surginstruatlas.blogspot.co

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

Also available now on android & smartphones same internet addres