BASIC SURGERY SERIES – LECTURE 1

Position of a surgeon–

It depends the case and need of the surgery.
Surgeon should be comfort when he operates a case.
Surgeon should be sitting and standing as per need.
For right-handed surgeon, it is better to stand to the right side of the patient but as per need he/she can change his/ her potion according to need. Example- left inguinal hernia…
Instrument holding
A surgeon uses thump and ring finger for holding instruments like scissor, needle holder, artery forceps.
One should use thump index finger, middle finger to hold the instruments like dissecting forceps, b.p. handle.
Movements of the hand of a surgeon should be definitive precise and non-repetitive.
Surgeon should be like a worker but surgeon must be like a creative/innovative worker.
It is Important to have optimum efficiency in the heart and hand of the surgeon, when he holds an instrument.
Instruments should be properly sterilized and efficient not only in shape but also in size and curvature.
Incision making–
For beginners it is better to mark incision site first, then make an

Control is almost important during incision; depth control is more important than belly control (length of incision).
Stab position of knife should be use for drainage purpose like in abscess.
Fiddle bow position should be used to make a simple incision like any abdominal surgery.
Pen holding position be used for dipper structure.
Incision should be done parallel to crease line.
Incision should be made with single stroke and with required depth.
Incision should be planed earlier for cosmetic values.
Dipper contents like muscle, nerves, vessels, bowel and organ should be preserved.
Abdominal incision-

Right subcostal/ Kochar’s incision-Gall bladder, liver surgery.
Left subcostal `incision-Spleen surgery Stomach surgery.
Upper mid line incision- Perforation, Stomach surgery.
Lower midline incision-Uterus, Ovarian, urinary bladder surgery, small intestine, Rectum, Appendix.
Right upper paramedian incision-gall blader, stomach, liver surgery.
Left upper paramedian incision-spleen, pancreas, perforation.
Right lower paramedian incision- as per midline incision
Left lower paramedian incision- as per midline incision
Pfannenstiel incision -uterine, ovarian surgery, LSCS.
Mc Burney incision-appendix, caecum surgery.
Mid line incision- cancer surgeries, perforation, stomach, intestinal surgeries, tumors of abdomen.
Sub mammary and sub areolar incision-breast surgery.