for surgery students

1. Surgical terminology
and types of surgical
interventions
Institute of cardiovascular diseases Vojvodina
Clinic for cardiovascular surgery
Sremska Kamenica
Assist. Prof. Mirko Todić
Prof. Lazar Velicki
Novi Sad, November 2022

2. Basic surgical terminology
• Incision
• Excision
• Ablation
• Extiraption
• Resection
• -tomy (lat. tomia)
• -stomy (lat. stomia)
• enucleation
• excochleation
• amputation

3. Incision (cutting)
• Every operative
procedure starts with
incision of the skin,
subcutaneous tissue,
fascia, muscles,
peritoneum or pleura

4. Excision (removal)
• Removal (cutting out) of the
pathological tissue

5. Extirpation
Removal of pathological processes
together with part of or with the whole
diseased organ, usually from cavity

6. -tomy
• Greek word in origin, means opening
of body cavity (thoracotomy,
laparotomy…)

7. -ectomy
•Greek word in origin, removal of an
organ in part or in total
(pulmectomy)

8. -stomy
• Means forming a communication or
opening of a permanent or temporary
type between the external
environment and the body cavity

9. Resection
• The removal of the organ (or part of
it) with respect to the corresponding
vasculature (pulmonary lobe
resestion, liver resection…)

10. Enucleation
•Removal of the pathological process
in its entirety, together with capsule

11. Excochleation
•Removal of pathological
processes within its capsule,
which remains.

12. Amputation
• Removal of organs, body
parts such as limbs, in
whole or parts of the
limbs.
(breast, rectum…)

13. Ablation
•One of the synonyms for the removal of any
organ (or part of it) or any pathological
process

14. Types of surgical interventions –
timing (urgency)
• Emergency
• Urgent
• Elective

15. Types of surgical interventions -
Purpose
• Palliative
• Radical (curative)
•Two stage procedure

16. Radical surgical procedures
• Involve removal of pathological process in its
entirety
• Form of surgery which is the definitive surgical
cure.

17. Palliative surgical procedures
• In cases where the general condition of the patient
or the nature of the disease does not allow the use
of extensive (radical) approach – palliative
interventions.

18. Two stage procedure
• These are surgical procedures that must be
performed in two stages, either for reasons of local
operability, either for reasons of general
operability.

19. Types of surgical interventions -
Purpose
•Reconstructive surgery
•Amputational surgery
•Cosmetic

20. Reconstructive surgery
Involves maintaining the vitality and function of the
affected organ or part of the body, not its removal
• Reparative surgery
• Implantation surgery
• Transplantation surgery

21. Reparative surgery
• These types of surgeries
are most common in the
field of plastic and
orthopedic surgery.
• Include the correction of
certain congenital or
acquired deformities,
fractures, lesions, etc.

22. Implantation surgery
•Implantation of certain artificial
substituents for certain organs or
body parts

23. Transplantation surgery
Transplant surgery - one of the highest
steps in surgery, and in medicine in
general. This is not so much because of
the technical aspects but because of the
complexity of transplantation medicine in
general.

24. Types of grafts:
a. Organ transplants - the organ
as a whole or part of it
b. Free grafts
c. Cell transplants – tissue or cell
cultures

25. Transplants according to location
a. Orthotropic transplant - if
transplanted to a natural
place in the body (heart,
liver, lungs)
b. Heterotopic transplant - if
transplanted to another
place in the body (kidney,
pancreas, etc.).

26. Transplants according to function
a. Allovital transplants - continue
their normal physiological
function (all organ transplants
for example.)
b. Allostatic (hemostatic)
transplants – only a static role of
"matrix" through which will form the
normal tissue (bone grafts).

27. Transplantation surgery
D – donor
R – recipient
D & R – same individual
a. Autotransplant
b. Autograft
c. Autologous graft
D & R – same species–
hystogenetically identical
(twins)
a. Isotransplants
b. Isograft
c. Syngeneic graft

28. D & R – same species
a. Allotransplants
b. Allograft
c. Homologous graft
D & R – different
species
a. Heterotransplant
b. Xenotransplant
c. Heterogenous graft
d. Xenologous graft
Transplantation surgery
D – donor
R – recipient

29. Transplantation tissues in
clinical use
 Skin - (auto graft, allograft)
 Blood vessels - (auto graft, allograft)
 Nerves - (auto graft, allograft)
 Cornea - (allograft)
 Bones - (auto graft, allograft)
 Cartilage - (auto graft, allograft)
 Bone marrow- (isotransplant,
autotransplant)
 Endocrine glands - (autotransplant,
isotransplant, allotransplant)

30. Organ transplants in clinical use
• kidney transplantation
• liver transplantation
• heart transplantation
• lung transplantation
• pancreas transplantation
• Transplantation of the stomach and
intestines

31. Amputating procedures on
the extremities
1. Open (guillotine) amputations - rarely
have an indication at the present time,
except in cases of development of
anaerobic infections
2. Closed amputations

32. • amputation of fingers
• amputation of wrist and carpal segment
• amputation of forearm
• elbow disarticulation
• upper arm amputation
• shoulder disarticulation
Amputating procedures on
arms

33. Upper arm amputation

34. • amputation of fingers
• TMT amputation
• disarticulation of the foot
• below knee amputation
• knee disarticulation (Gritty-Stokes)
• thigh amputation
• hip disarticulation
• hemipelvectomy
Amputating procedures on
lower extremities

35. TMT amputation

36. Surgical approaches to head
Each brain surgery involves opening the skull, i.e.
trepanation or craniotomy. There are basically two ways
to craniotomy:
1. osteoclastic trepanation
2. osteoplastic trepanation

37. Osteoclastic trepanation
Involves the opening
of the cranial cavity
after which there is a
permanent deformity
in the cranium that can
be only replaced with
certain form of bone or
artificial plastic
material or titanium

38. Osteoplastic trepanation
Involves the formation of bone "flap“-
cover, which is, after the intervention,
returned back to the appropriate place
maintaining the continuity of the skull
vault.

39. Surgical approaches to the neck
•Anterior cervicotomy
•Collar cervicotomy

40. Anterior cervicotomy
The incision along the
front edge of the
sternocleidomastoid
muscle to gain access
to the blood vessels of
the neck, and cervical
spine, as well as some
other structures.

41. Collar cervicotomy
Arched incision on the front door to access
the thyroid gland, trachea, etc.

42. Surgical approaches to the
abdomen (laparotomy)
• Midline laparotomy
• Pararectal laparotomy (Lenander)
• Subcostal laparotomy Kocher
• Alternating laparotomy (McBurney)

43. 1. The median laparotomy
2. Right paramedian
laparotomy
3. Right pararectak
laparotomy
4. Subcostal incision
5. The upper transverse
laparotomy
6. Left thoracoabdominal
incision

44. Linea alba

45. Midline laparotomy
(linea alba incision, provides access to any
abdominal organ)
• Upper midline laparotomy - access to the
stomach, the terminal part of the esophagus, the left
lobe of the liver, spleen, etc.
• Central midline laparotomy - transverse colon,
small intestine, pancreas, etc..
• Lower midline laparotomy - usually urological
and gynecological surgery in the pelvis, but also access
to the rectum.
• Xyphopubic laparotomy - a combination of all of
the previous three, is used for major surgery in the
abdomen, in large vascular operations, etc.

46. Midline laparotomy

47. Pararectal laparotomy (Lennander)
Incision along the side edges of rectus abdominis
muscle. Nowadays it is rarely used because of the
resulting atony of front abdominal muscles due to
cutting of the terminal branches of the nerve.
Previously used for access to the bile ducts,
appendix, spleen, etc.

48. Subcostal laparotomy - Kocher
(right, left, biarcuate)
Incision at 2 cm below the rib arches.
Access to the liver and bile ducts – on
the right. Access the spleen – on the
left. Biarcuate - for major surgery -
resection of the liver.

49. Alternating laparotomy (McBurney)
Named for alternating dissection of
obliquus ext. and int. abdominis
muscles, and transversus abdominis.

50. Extraperitoneal approaches
to the abdomen
Approaches to retroperitoneal organs
without opening the peritoneum
 "J" incision – Robb’s
 DOS SANTOS's
approach
 Lumbotomy

51. Abdominal Surgery
• Cholecystectomy and reconstructive procedures on
the extrahepatic bile ducts
• Surgical procedures on liver
• Surgical procedures on the stomach (radical,
palliative)
• Surgical procedures on the small intestine
• Surgical interventions on the large intestine
(radical, palliative)
• Surgical procedures on pancreas
• Surgical procedures on spleen
• Surgical procedures on the kidney and adrenal
gland
• Surgical procedures in the pelvis (urological and
gynecological)

52. Cardiothoracic surgery
• Sternotomy
• Posterolateral thoracotomy
• Anterolateral thoracotomy
• Axillary thoracotomy
• Bithoracotomy (Kirby Jones)
• Thoracophrenolaparatomy

53. Sternotomy

54. Posterolateral thoracotomy

55. Surgery of the lungs and pleura
• The right and left pulmectomy - removal of
the right or left lung
• Lobectomy of the right lung
• Lobectomy of the left lung
• Segmentectomies - removal of the anatomical
part of the lung
• Reconstructive procedures on the
tracheobronchial system (trachea resection,
sleeve resection)
• Adhesiolysis, decortication and pleurectomy

57. Lobectomy of the right lung
• Right upper lobectomy
• Middle lobe lobectomy
• Right lower lobectomy
• Bilobectomy

58. Lobectomy of the left lung
•Left upper lobectomy
•Left lower lobectomy

59. Minimally
invasive
surgery

60. Minimally Invasive Surgery
Past, Present and Future
• What is MIS?
• A minimally invasive medical procedure is defined as one
that is carried out by entering the body through the skin
or through a body cavity or anatomical opening, but with
the smallest damage possible to these structures.

61. Minimally Invasive Surgery
Past, Present and Future
• Includes laparoscopic, endoscopic, and other approaches.
• Why MIS?
– Decreased patient pain
– Decreased patient recovery period
– Possible decrease in inflammatory response in the patient
which may prove to have a better outcome in oncologic
operations

62. Hans Jacobeus
Pioneer of Thoracoscopy
(Stockholm 1910)
Modified Cystoscope
Jacobeus HC. The Cauterization of Adhesions in Pneumothorax Treatment of Tuberculosis.
Surg Gynecol Obster 1921:32:493-500 (40 patients)

63. Minimally Invasive Surgery
Past, Present and Future
• 1985 - The first documented
laparoscopic cholecystectomy was
performed by Erich Mühe in
Germany in 1985.
• Fascinated by Semm's technique
• Idea of laparoscopic removal of
gallstones
• 1984: designed an operative
"Galloscope”
• September 12, 1985, first lap chole
• 1986: Published his technique at
the Congress of the German
Surgical Society
• 1987: Total of 97 endoscopic
cholecystectomies.
• His concept, however, was ignored

64. Current Practices in MIS
• Procedures currently performed using MIS techniques:
– Cholecystectomy
– Appendectomy
– Hernia Repair
• Inguinal
• Ventral
• Incisional
– Colectomy
– Splenectomy
– Adrenalectomy
– Heller Myotomy
– Nissen Fundoplication
– Esophagectomy
– Gastrectomy
– Pancreatectomy
– Bile Duct Exploration
– Bariatrics
• Roux en Y Gastric Bypass
• Lap Band
– Lymph Node Biopsy
– Almost Anything

65. The Future (is now)
• Endoluminal treatment for reflux
• Endoluminal sleeve gastrectomy for bariatrics
• Deployable absorption barriers for malabsorptive weight
loss
• Gastric Ballons

66. The Future (is now)

67. NOTES
• NOTES
– Natural
– Orifice
– Transluminal
– Endoscopic
– Surgery

68. NOTES
• What is it?
• Using natural orifices as portals into the abdominal cavity
to perform procedures using a flexible endoscope
• Transgastric
• Transrectal
• Transvaginal

69. NOTES
• What has been done with NOTES so far?
– Transgastric appendectomy
– Transgastric cholecystectomy
– Transvaginal cholecystectomy
– Transrectal colectomy

70. SILS
• Single Incision Laparoscopic Surgery
• Instead of making several small incision for the insertion
of multiple trocars and instruments, make one incision
and use this to deploy a multiport system

71. Traditional incisions for Lap Chole

72. SILS Incisons for Lap Chole
2.5 cm

73. SILS
• What has been done with SILS so far?
– Cholecystectomy
– Appendectomy
– Lap Band
– Colectomy
– Nissen
– Splenectomy
– Adrenalectomy
– Nephrectomy

74. From MIDCAB to TECAB