The document discusses key principles for surgery including: 1) Mastering surgical instruments and procedures such as cutting, hemostasis, and suturing. 2) Understanding principles of sterile technique and minimally invasive surgery. 3) Ensuring asepsis throughout the operative phases to prevent infection and tumor dissemination.

1. Fundament of Surgery
PYSSANOVA ZHANAT

2. Teaching Requirements
1, to master the correct method for the
surgical instruments.
2, familiar cut, separation, hemostasis,
ligation, suture.
3, to master the principles of sterile
surgical procedures.
4, to understanding of the painless
principles for operation.
5, to understand the principles of minimally
surgery.

3. 1.The surgical instruments
commonly used in surgery

4. Scalpel

5. scissors
 Anatomy, separation, cutting line

6. hemostat, clamp
Blocking clamp
 Curved clamp
 Straight clamp
 Toothed clamp
 Noninvasive clamp
 Mosquito clamp

7. forceps
 noninvasive forceps
 No toothed forceps
 Toothed forceps

8. needle holder

9. Other common devices Pliers
 towel clips
 Allis
 sponge forceps
 intestine clamp
 stomach clamp
Allis
intestine
clamp
pockets forceps

10. needle
 Straight needle
 Curved needle
 noninvasive needle
 Triangular needle
 Circular needle

11. Surgical suture

12. Absorbable suture and non absorbable suture
 absorbable suture：intestine suture, Synthetic,
fiber suture（Dexon、Vicryl、Maxon、PDS、
PVA)
 non-absorbable suture：Silk, cotton, wire,
no absorption synthetic suture

13. retractor
 Thyroid retractor
 Flat abdominal retractor
 Skin retractor
 S-retractor

14. Automatic retractor

15. suction

16. Dressing
 Gauze
 Large gauze pad

17. 2.Basic Procedure For Surgery

18. Tissue incision
 Incision of skin and soft tissue
 Lumen incision
切肝

19. Knotting method
 half knot
 square knot
 Triple knot
 surgeon knot
 false knot
 slip knot

20. Knotting method
 One-hand Knotting method
 Hands Knotting method
 Needle holder Knotting method

21.  fishing

22. Tissue dissection
 sharp dissection
 blunt dissection

23. Local hemostasis
 Ligation hemostasis
 Electric hemostasis
 Compression hemostasis
 Tourniquet hemostasis
 Bone wax hemostasis

24. Common suture

25. Common suture

26. Common suture

27. Common suture

28. anastomosis

29. surgical drainage

30. The purpose of surgical drainage
 Surgical drains are used in a wide variety of different types
of surgery. Generally speaking the intention is to
decompress or drain either fluid or air from the area of
surgery. Examples include:.
 To prevent the accumulation of fluid (blood, pus and
infected fluids)
 To prevent accumulation of air (dead space)
 To characterise fluid (for example early identification of
anastomotic leakage)

31. Common drainage
 Gauze
Rubber sheet
Pipe drainage
Double-tube drainage

32. Basic microsurgical technique

33. Microsurgical equipment

34. 3.Basic principles for operation

35.  Asepsis
 Tumor-free
 Minimal-invasion
Prevent post-operative infection
prevent the spread of tumors
Prevent unnecessary damage to body Tissue
In order to facilitate postoperative rehabilitation,
to improve the effect of surgical treatment

36. Asepsis
Asepsis is the state of being free from disease-
causing contaminants, such as bacteria, viruses,
fungi, and parasites etc. and prevention of the
contact with microorganisms.

37.  ASEPSIS
Steam sterilization
Boiling sterilization
Fire sterilization
Ultraviolet ray
12% aethylenum oxide and 88% difluorodichloromethane

38.  Preparation of surgeon and operative regions
 Methods of scrubbing
 To change shoes and dressing, to put on mouth shad and hat, to trim the nail.
 Arm sterilization
 To scrub surgeon himself from finger tip to above elbow
 Sapo for scrubbing:
 To wash hands in common practice To scrub arm with aseptic hairbrush
from finger tip to above elbow 10 cm for three times about 10min To
wipe dry arm with aseptic towel from finger tip to above elbow
 Key points: to pay attention to scrub nail edge, nail sulcus, ventro-nail etc.
 To keep post of bowing arm, not to let arm descensus and not to touch
article which is garbage, otherwise to scrub arm again.

39.  Preparation to operative region of patient(skin
preparation)
 To clean the operative region of patient the day before
preoperative.
 To shave hair of operative region; shaving is not
necessary, if there is rare fine hair in that region.
 To inunction the skin with iodophor two times to
cover aseptic operative sheet and

40. THE BASIC ASEPTIC PRINCIPLES
THROUGHOUT OPERATIVE PHASES
Once surgeon had scrubbed arms, his arm couldn’t touch the
things which isn’t sterilized; After put on aseptic operating coat
and gloves, we couldn’t touch the place where is below back and
waist, where is over shoulder; Hands and forearm couldn’t droop
below waist and operation table.

41.  Not to hand over and take over instruments; not to
pick up things that were dropped bellow the margin of
the operation table.
 Changing aseptic glove(s), if it was(were) damaged or
polluted; changing aseptic coat or muff, if forearm was
polluted; covering aseptic sheet additionally, if initial
sheet was wet through.
 During the operation process if the surgeons need to
change each position, one draw back a step and turn
around (back to back each other) .

42.  To count all of operative instruments and to record carefully
before operation; to check again at the end of operation before
closing the wound.
 To deal with the margin of the wound
 To sterilized again with ethanol cotton before cutting open and
suturing operative incision.
 To protect lumen organs before cutting it open.
 One, who had acute infection or upper respiratory tract
infection, does not permit to go into operating teatre, and need
put on the clean dress of operating teatre. Visitors had better to
be not more than 2 persons, not to be too close and high, not to
move back and forth frequently.
 Not to discuss aloud.

43. ADMINISTRATION OF OPERATING TEATRE
 Protection of the surgical patient from infection is a primary
principle throughout the preoperative, operative, and
postoperative phases of care. The incidence and severity of
infection, particularly wound sepsis, are related also to the
bacteriologic status of the hospital environment and to the care
with which basic principles of asepsis, antisepsis, and surgical
technique are implemented.
 The entire hospital environment must be protected from undue
bacterial that will invade surgical wounds in the operating room
in spite of aseptic precautions taken during operation.
Prevention of wound infection therefore involves both
application of general concepts and techniques of antisepsis and
asepsis in the hospital at large and the use of specific procedures
in preparation for operation.

44. Tumor free principles
To make all the effort to prevent tumor
dissemination in surgery procedure.
To avoid from mistake making through
doctor who cause the tumor metastasis,
and dissemination.

45. Preoperative discussion
To make sure the diagnosis and surgical indications
To set up possible surgical options
To judge the tolerance for patients
To assess if it is enough for preoperative preparation
To predict the in- or post-operative possiablity
The choice of anesthesia
The organization of surgical members
Special equipments, medicines and other items
To determination of operation time

46. Surgical team work
1.Major surgeon
2. First assistant
3. Operating Nurse
4. Anesthetist
5. Second assistant
6. Assistant nurse