WikiSurgery - The Free Surgical Encyclopaedia

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Wikisurgery is collaboratively building the most comprehensive and trusted free surgical encyclopaedia. With over 32,000 articles for surgeons and patients, including news, articles, operation scripts, biographies and images.

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The IJS

The International Journal of Surgery (IJS) sponsors Wikisurgery. The IJS is a multidisciplinary, peer-reviewed journal covering clinical and experimental research and reviews. It is indexed in Medline/Pubmed, EMBASE, SCOPUS, EBSCO host's Academic Search Complete and others. It is distributed to nearly 5,000 institutions in over 70 countries. The journal is published by Elsevier and owned and managed by Surgical Associates Ltd.

Key Topics
Operation Scripts Breast Surgery (6) Breast-localisation-and-excision Breast-subareolar-excision Breast-wide-excision Fine needle aspiration Mastectomy Trucut needle biopsy Endocrine Surgery (1) Parathyroidectomy General Surgery (34) Amputation-above-knee Amputation-below-knee Amputation-toe Anal-fissure-lateral-sphincterotomy Anal-fistula Anterior resection Appendicectomy-laparoscopic Cholecystectomy-laparoscopic Colostomy-closure Cryosurgery Epididymal-cyst-excision Gastroscopy Haemorrhoidectomy Hemicolectomy-left Hemicolectomy-right Hernia-femoral-adult Hernia-inguinal-TAPP Hernia-inguinal-adult Hickman-line-removal Nailbed-excision Oesophagectomy-1-stage Oesophagectomy-2-stage Oesophagectomy-3-stage Parotidectomy Pfannenstiel-incision Pilonidal-sinus Rectum-abdomino Rectum-anterior-resection-and-total-mesorectal-excision Submandibular-gland-excision Thiersch-suture-insertion Total-mesorectal-excision Tracheostomy-open Varicose-veins Vasectomy Head and Neck Surgery (2) Parotidectomy Submandibular-gland-excision Hepatobiliary (1) Cholecystectomy-laparoscopic Paediatric Surgery (6) Circumcision-child Hernia-inguinal-child-herniotomy Hydrocele-child Pyloromyotomy-child Thyroglossal-cyst-excision Tongue-tie-division Thoracic Surgery (4) Oesophagectomy-1-stage Oesophagectomy-2-stage Oesophagectomy-3-stage Tracheostomy-open Urology (1) Vasectomy-Operationscript Vascular Surgery (2) Aortic-aneurysm-graft Femoral-embolectomy Basic Surgical Skills Training Program PrimeSkills in Surgery (17) PrimeSkills in Surgery Overview Introductory Sections Interactive surgical training How to use the program Learning profile Attitude Goals Got what it takes? Getting yourself ready Aptitude test Scrub �n� Stretch Video Equipment and Materials The Surgical Sections and Subsections Structures of Surgical Sections and Subsections Structure of the Surgical Information Index of Surgical Sec and Subsec Gloves (4) Recall Screen Preparation screen Introduction Summary screen Scissors (12) Recall Screen Preparation screen Equipment and materials Introduction Parts How scissors cut How to cut with scissors Exercises Scissors in practice Checking scissors Tests Summary screen Retractors (32) Recall screen Preparation screen Equipment and materials Introduction Parts of retractors How retractors work How to use a retractor Exercises Retractors in practice Checking retractors Tissue holding- Littlewood Tissue holding- Lane Tissue holding- Poirier Tissue holding- Babcock Hand held with blades- Skin hooks Hand held with blades- Cat's paws Hand held with blades- Langenbeck Hand held with blades- Morris Hand held with blades- Kelly & Mark's Hand held with blades- Deaver Hand held with blades- Lung Self-retaining with ratchets- West Self-retaining with ratchets- Travers Self-retaining with ratchets- Goligher Self-retaining with ratchets- Joll Abdominal self-retaining- Introduction Abdominal self-retaining- Balfour Abdominal self-retaining- McKeown Abdominal self-retaining- Finochietto Abdominal self-retaining- Omnitract Tests Summary Following (10) Recall screen Preparation screen Equipment and materials Parts How following works How to follow Exercises in following Following in practice Tests Summary Haemostats (12) Recall Screen Preparation screen Equipment and materials Introduction Parts How haemostats work How to use a haemostat Exercises Haemostats in practice Checking haemostats Tests Summary screen Swabbing (12) Recall Screen Preparation screen Equipment and materials Introduction Parts of swabbing How swabbing works How to swab Exercises Swabbing in practice Checking swabs Tests Summary screen Suction (12) Recall Screen Preparation screen Equipment and materials Introduction Parts of Suction How suction works How to use a Suction Exercises Suction in practice Checking Suckers Tests Summary screen Dissecting forceps (12) Recall Screen Preparation screen Equipment and materials Introduction Parts How dissecting forceps works How to use dissecting forceps Exercises Dissecting forceps in practice Checking dissecting forceps Tests Summary screen Needleholders (12) Recall Screen Preparation screen Equipment and materials Introduction Parts How needle holders works How to use needle holders Exercises Needle holders in practice Checking needle holders Tests Summary screen Needles (13) Recall Screen Preparation screen Equipment and materials Introduction Parts How needles works How to use needles Needles skid pan Exercises Needles in practice Checking needles Tests Summary screen Sutures (13) Recall Screen Preparation screen Equipment and materials Introduction Parts How sutures works How to use sutures Sutures skid pan Exercises Sutures in practice Checking sutures Tests Summary screen Tying knots (16) Recall Screen Preparation screen Equipment and materials Introduction Parts of a knot How to tie knots Sutures skid pan Exercises Knots in practice Instrument knot Two handed knot Single handed knot (right handed) Single handed knot (left handed) Tie off vessel Tests Summary screen Suturing simulated skin (16) Recall Screen Preparation screen Equipment and materials Introduction Plain suture Needle insertion - general Needle insertion - forehand Needle insertion - backhand Knot -general Mattress suture Continuous suture Subcuticular suture Suturing simulated wounds Exercises Tests Summary Screen Scalpels (12) Recall Screen Preparation screen Equipment and materials Introduction Parts How Scalpels works How to use Scalpels Exercises Scalpels in practice Checking Scalpels Tests Summary screen Basic Laparoscopic Training Program Cholecystectomy (120) Index Introduction to laparoscopic surgery Advantages 02.2 Disadvantages 02.3 Principles Anatomy 03.1 Anatomy introduction 03.2 Anatomy/ Abdominal wall & cavity 03.2.1 Anatomy/ Umbilicus 03.2.2 Anatomy/ Epigastrium 03.2.4 Anatomy/ Right side abdomen 03.3 Anatomy/ Gallbladder 03.4 Anatomy/ Cystic artery 03.5 Anatomy / Bile ducts Pathology 04.1 Pathology introduction 04.2 Biliary colic 04.3 Acute cholecystitis 04.3.1 Acute cholecystitis complications 04.3.1.1 Empyema of gallbladder 04.3.1.2 Mucocele of gallbladder 04.3.1.3 Simple inflammation surrounding gallbladder 04.3.1.4 Free perforation of gallbladder 04.3.1.5 Localised perforation of gallbladder 04.3.1.6 Internal biliary fistula 04.3.1.7 Biliary peritonitis 04.3.1.8 Subphrenic abscess 04.3.1.9 Bile duct stricture 04.3.2.1 Abdominal adhesions 04.3.2.2 Gallbladder and bile duct stones 04.3.2.3 Chronic cholecystitis and carcinoma of the gallbladder Inventories Inventory 1 Non surgical equipment Inventory 2 Standard sterile instruments Inventory 3 Special sterile surgical instruments Inventory 4 Surgical disposables Inventory 5 Surgical disposable spares Inventory 6 Operating room furniture Inventory 7 Surgical materials Inventory 8 Pharmaceuticals Inventory 9 Assorted extras Off table equipment checks TV monitor checks Light source checks Camera checks CO2 Insufflator checks Smoke evacuator checks Video camera checks Diathermy checks Suction checks Operation steps introduction 07.01.00 Patient checks 07.01.01 Check you have the correct patient 07.01.02 Check the diagnosis 07.01.03 Check there is no other procedure to do 07.01.04 Check consent for an open operation if needed 07.01.05 Check bladder 07.01.06 Check operating table 07.01.07 Check there is a diathermy pad 07.01.08 Check nasogastric tube 07.01.09 Check antibiotics 07.01.10 Check anticoagulation 07.02.00 Anaesthesia 07.03.00 Position 07.04.00 Stance 07.05.00 Off-patient equipment positioning 07.06.00 Skin preparation 07.07.00 Applying skin drapes 07.08.00 On-patient equipment preparation and checks 07.08.01 Irrigation set up 07.08.02 Suction set up 07.08.03 Diathermy set up Insufflator set up 07.08.05 Light cable setup 07.08.06 Camera setup Telescope setup 07.08.08 Check the camera setup 07.08.09 Monitor setup and picture checks 07.08.10 Cameraman checks 07.09.00 Pneumoperitoneum creation � open method 07.10.00 Pneumoperitoneum creation � Veress needle method 07.11.00 Umbilical port insertion 07.12.00 Umbilical camera insertion 07.13.00 Check for needle or trocar damage 07.14.00 Examine the lower abdomen and pelvis for other pathology 07.15.00 Examine the upper abdomen 07.16.00 Epigastric port insertion 07.17.00 Adhesion division 07.18.00 Subcostal port insertion 07.19.00 Iliac port insertion 07.20.00 Inspect abdomen for injuries 07.21.00 Inspect abdomen for other pathology 07.22.00 Check illumination, lens and focus 07.23.00 Check for gas leaks 07.24.00 Gallbladder fundus retraction 07.25.00 Clearing the gallbladder 07.26.00 Hartmann's pouch retraction 07.27.00 Start dissecting the cystic duct and cystic artery area 07.28.00 Cystic duct variants 07.29.00 Cystic artery variants 07.30.00 Cystic duct dissection 07.31.00 Cystic artery dissection 07.32.00 Cystic artery clipping 07.33.00 Cystic duct clipping 07.34.00 Cystic artery cutting 07.35.00 Cystic duct cutting 07.36.00 Gallbladder mobilisation 07.37.00 Gallbladder removal Quizzes Anatomy Quiz Pathology Quiz Equipment and materials Quiz Equipment assembly and checking Quiz Pneumoperitoneum Quiz Camera handling Quiz Adhesion division Quiz Gallbladder dissection Quiz Cystic duct and artery Quiz Gallbladder removal Quiz Operative Images 3 (1) 3 tubes on left A (20) Add second diathermy lead Adhesion division Adhesions on gallbladder Adjust focus Anaesthesia Apply 2nd clip on cystic artery Apply 3rd clip on cystic artery Apply drape 1 Apply drape 2 Apply drape 3 Apply drape 4 Apply drape 5 Apply drape clips Apply drapes routine Apply dressings Approach cystic artery with the 2nd clip Approach cystic duct with the 2nd clip Approach the cystic artery with the 1st clip Attach CO2 line to umbilical port Attach light lead B (11) Beware hot diathermy hook Bile duct injury type 1 Bile duct injury type II Bile duct injury type III a Bile duct injury type III b Bile duct injury type IV Bile duct stones Biliary colic Biliary duct variants Blood dripping from port Blood on the telescope lens C (78) CO2 at 4 litres per minute automatic CO2 at 4 litres per minute fixed Camera handling Camera into bottom of sheath Camera into sheath Carcinoma of gallbladder Causes of blocked CO2 flow Check 5mm. trocar Check CO2 is flowing Check Cefuroxime Check behind the cystic duct Check camera brightness Check camera focus again Check camera is working Check camera rotation Check clip applier Check clip on cystic duct Check consent Check diathermy pad Check focus Check for gas leaks Check for no gas flow Check gallbladder retraction Check heparin Check illumination Check irrigator Check lens Check light source Check monitor is in line Check naso-gastric tube Check no other procedure planned Check red/blue mix on camera Check red/blue mix on the monitor Check retraction of gallbladder before dissecting it Check suction Check suction pressure Check surgiport Check swab, needle and instrument counts Check telescope Check the Veress needle Check the bladder is empty Check the clip on the artery Check the cystic artery is free Check the cystic artery is free for the clip applier Check the diagnosis Check the picture is clear Check the scissors Check trocar Check tubes and leads Check umbilical trocar and port Check you have the correct patient Cholecystitis acute Cholecystitis chronic Cholecystitis free perforation Cholecystitis internal fistula Cholecystitis local inflammation Cholecystitis localised perforation Choose epigastric port site Choose iliac port site Choose subcostal port site Close CO2 bottle Collage of preparations for laparoscopy Complete paperwork Connect the Veress needle Connect the suction systen Continue cystic duct dissection Correct epigastric port site Crush large gall stones Cut adhesions off Hartmann's pouch Cut open the gallbladder Cut strands of tissue between body of gallbladder and liver Cut the cystic artery Cut the cystic artery first Cut the cystic duct Cystic artery dissection Cystic artery variants Cystic duct and artery cut Cystic duct variants D (19) Damage to common bile duct by the hook electrode Damage to tented common bile duct Damage to tissues by needles and trocars Danger of damaging the right hepatic artery Dangers of wrong angle of Veress needle Deal with bleeding from the cystic artery area Dealing with bleeding Decision calculator Diathermy pedal at foot Diathermy plugs Diathermy troubleshooting 1 Diathermy troubleshooting 2 Dictate a letter to the general practitioner and referring physician Dissect the fundus of the gallbladder from the liver bed Dissect the left side of the gallbladder from the liver bed Dissect the right side of the gallbladder from the liver bed Dissecting forceps: Checking Dissecting forceps: Size Dissecting forceps: Symmetry E (4) Elevate the gallbladder fundus Empyema and mucocele of the gallbladder End of operation Enlarge the epigastric opening F (14) Failed Veress needle insertion Fasten 3 tubes to the drapes Fasten the 1st clip on the cystic duct Fasten the 1st cystic artery clip Fill in histology and bacteriology forms Fill in laparoscopy audit form Fill in surgical audit form Finding the cystic artery Finger guards the trocar Finger on shaft of trocar First tube on left First view of the gallbladder fundus Fit lead to diathermy hook Fix 3 tubes to drapes G (7) Gallbladder ready for disssecting the cystic antery and duct Grasp Hartmann's pouch with cholecystectomy forceps Grasp the body of the gallbladder Grasp the gallbladder fundus Grasp the lower abdomen Grasp the neck of the gallbladder Grasp the subumbilical fat H (12) Haemostat: Casual grip Haemostat: Holding a suture Haemostat: Joint Haemostat: Parts Haemostat: Protect the patient Haemostat: Ratchet Haemostat: Routine 1 Haemostat: Routine 2 Haemostat: Routine 2a Haemostat: Routine 3 Haemostat: Types Hartmann's pouch retracted to the patient's left I (20) Identify the cystic duct Identify the epigastric port site Incise epigastric port skin Incise epigastric skin Incise iliac port site Incise subcostal port skin Incise the subumbilical skin Infiltrate the wounds Insert a suction drain Insert down sizer Insert hook electrode Insert subcostal port Insert the 1st clip on the cystic artery Insert the rotweiler forceps Insert the scissors Insert the sucker into the gallbladder Insert trocar through the skin Inserting the Veress needle Inspect upper abdomen Irrigation tubing L (6) Listen for the hiss of CO2 Load 2nd clip Load the clip applier Locate the rotweiler forcep in the abdominal cavity Look for pathology in the lower abdomen and pelvis Look for pathology in the upper abdomen M (1) Movement of forceps while dissecting N (14) Needle holders: Handles Needle holders:Curving Needle holders:Jaws Needle holders:Parts Needles: Action Needles: Curved Needles: Cutting Needles: Description Needles: Domestic Needles: Examples Needles: Eyelet Needles: Materials Needles: Point Needles: Swage O (8) Off-patient equipment positioning On the right fasten 2 tubes and 2 wires On-patient equipment Open Hasson method Open camera lock Open gas tap on port Operating theatre scene Other pathology in the abdomen P (22) Pass beaks forceps through subcostal port Pass diathermy hook through the epigastric port Pass racquets forcep through iliac port Place diathermy hook in holder Place suction irrigator Place the gallbladder in formaldhyde Position 1st clip on cystic artery Position 2nd clip on the cystic duct Position 3rd clip on the cystic duct Position first clip on cystic duct Position on operation table Position the scissors to cut the cystic artery Position the scissors to cut the cystic duct Prepare to grasp the neck of the gallbladder Pull Hartmann's pouch to the patient's right Pull Hartmann's pouch to the patient's right again Pull out the gallbladder Pull out the trocar Pull the epigastric port, rotweiler forcep and gallbladder neck through the abdominal wall Pull the gallbladder neck to the epigastric port Pull the gallbladder through the abdominal wall Push Veress needle in R (22) Reasons for no clear view Reduce the gallbladder size Release the CO2 from the abdomen Release the fundus of the gallbladder Remove audio cassette Remove clip applier from cystic artery Remove clip applier from cystic duct Remove clip applier from patient Remove the clip applier Remove the down sizer Remove the hook electrode Remove the iliac forceps Remove the iliac port Remove the naso-gastric tube Remove the subcostal forcep Remove the subcostal port Remove the telescope Remove the trocar Remove the umbilical port Removing the gallbladder photograph Replace the down sizer Run irrigator S (112) Scalpel: Scalpel: Blade cuts on the curvature Scalpel: Blade, broad S cont. Scalpel: Blade, straight no 11 and a Beaver blade Scalpel: Brace your fingers as you cut Scalpel: Check Beaver knife collar Scalpel: Cutting practice doily Scalpel: Dagger grip Scalpel: Delicate tissue grip Scalpel: Dissecting with the handle Scalpel: Don't hand the scalpel blade first Scalpel: End of incision dictate the wound's direction Scalpel: Handing a scalpel Scalpel: Inaccurate cutting Scalpel: Kitchen knife Scalpel: Load a blade safely Scalpel: Making fish tails Scalpel: Medium and larger scalpels Scalpel: Missing the apex of the wound Scalpel: Pen grip Scalpel: Press harder at the ends as you cut Scalpel: Put scalpel in a dish Scalpel: Small scalpel Scalpel: Stabbing blade Scalpel: Table knife grip Scalpel: Tougher tissue grip Scalpel: Two instruments in one hand Scalpel: Wound shallower at ends Scalpel: bayonet fitting on handle for the blade Scalpel: disposable Scalpel: flat sides and top to the handle Scalpel: handle Scalpel: long handled Scalpel: no 15 blade Scalpel: oblique end to bayonet fitting Scalpel: parts of Scalpel: round handle on a Beaver scalpel Scissors: Bracing 1 Scissors: Bracing 2 Scissors: Bracing 3 Scissors: Bracing 4 Scissors: Bracing 5 Scissors: Bracing 6 Scissors: Checking Scissors: Chisel action Scissors: Curved blades Scissors: Cutting 1 Scissors: Cutting 2 Scissors: Cutting 3 Scissors: Cutting 4 Scissors: Cutting 5 Scissors: Cutting 6 Scissors: Enhanced shearing Scissors: Guillotine effect Scissors: Handles pressed apart increases jaw pressure Scissors: Handles pressed together decreases jaw pressure Scissors: Holding scissors - dagger method Scissors: Holding scissors 1 Scissors: Holding scissors 2 Scissors: Holding scissors 3 Scissors: Holding scissors 4 Scissors: Holding scissors with open hand Scissors: Left handed scissors Scissors: Lever effect Scissors: No cross action Scissors: Push on suture Scissors: Stitch scissors Scissors: Variety Scissors: shearing Second tube on left See iliac port site See the gallbladder in the epigastric wound Set coagulation Skin preparation Stance around operation table Starting the cystic duct dissection Steps to increase flow Store the gallbladder above the liver Stretch sheath Suck out the gallbladder bile Sucker holder Suction areas Suction tubing Suture the skin Sutures: Braided Sutures: Domestic thread Sutures: Materials Sutures: Monofilament Sutures: Strength Swab the gallbladder bile Swabbing Swabbing: Capillary attraction Swabbing: Larger swab Swabbing: Pressure needed Swabbing: Smaller swab Swabbing: Springing of fibres Swabbing: Standard swab Swabbing: Standard swab capacity Swabbing: Swabs catch in instruments Swabbing: smallest swabs - spears Swabbing: swabs as retractors Sweep adhesions off Hartrmann's pouch Sweep adhesions off gallbladder Swing l Hartmann's pouch to the patient's left Switch CO2 to high flow Switch off CO2 supply Switch off TV monitor Switch off diathermy Switch on CO2 Switch on CO2 at 1 litre per minute Switch on the CO2 at 1 litre per minute Switch on video recorder T (5) Tape sheath to camera Temporary elevation of the gallbladder fundus Test irrigator Third tube on left Tilt the table U (2) Use beaks forceps to assist hook electrode clear adhesions Use beaks forceps to assist hook electrode find gallbladder V (5) Veress needle at wrong angle Veress needle insertion Veress needle insertion sites Veress needles closed Veress needles open W (4) Warning about iliac port site Where to dissect the gallbladder Write operation details Wrong epigastric sites Patient Information Breast Surgery (7) Breast-localisation-and-excision Breast-subareolar-excision-daycase Breast-subareolar-excision-not-daycase Breast-wide-excision Mastectomy Mastectomy-subcutaneous-male-daycase Mastectomy-subcutaneous-male-not-daycase Endocrine Surgery (3) Parathyroidectomy Thyroglossal-cyst-removal-adult Thyroidectomy General Surgery (40) Amputation-above-knee Amputation-below-knee Amputation-toe Anal-fissure-lateral-sphincterotomy Anal-fistula Anterior resection Appendicectomy-laparoscopic-adult Appendicectomy-open-adult Cholecystectomy-laparoscopic Colostomy-open Circumcision-adult-daycase Circumcision-adult-not-daycase Colostomy-closure Epididymal-cyst-excision-daycase Epididymal-cyst-excision-not-daycase Gastrectomy-partial Gastroscopy Haemorrhoidectomy Hemicolectomy-left Hemicolectomy-right Hernia-femoral-adult-daycase Hernia-femoral-adult-not-daycase Hernia-inguinal-daycase Hernia-inguinal-adult-not-daycase Hernia-umbilical-adult-daycase Hernia-umbilical-adult-not-daycase Lumps-and-bumps Oesophageal-dilatation Oesophagectomy PEG-gastrostomy Pancreatitis Parathyroidectomy Parotidectomy Pilonidal-sinus Rectum-abdomino-perineal-resection Rectum-anterior-resection Splenectomy Varicose-veins-daycase Varicose-veins-not-daycase Vasectomy Head and Neck Surgery (2) Parotidectomy Submandibular-gland-removal Hepatobiliary (3) Cholecystectomy-laparoscopic Cholecystectomy-open Pancreatitis Paediatric Surgery (8) Appendicectomy-laparoscopic-child Appendicectomy-open-child Circumcision-child Hernia-inguinal-child-herniotomy Hernia-umbilical-child Orchidopexy-child Pyloromyotomy-child Testicular-fixation-child Thoracic Surgery (2) Oesophagectomy-dilation Oesophagectomy Urology (3) Circumcision-adult-daycase Circumcision-adult-not-daycase Vasectomy Vascular Surgery (5) Aortic-aneurysm-graft Bypass-axillo-femoral Bypass-femoro-femoral Bypass-femoro-popliteal Femoral-embolectomy

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