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DRAINS IN SURGERY In 1887 Lawson Tait suggested ‘when in doubt drain!’. This edict has been criticised and the value of routine drain place - ment has been scrutinised. Drains are inserted to allow fluid that might collect in a body cavity to drain freely to th...

Draping Draping is the process of forming a sterile perimeter around the operating site using disposable or reusable sterile sheets. The drape sheets ideally serve to form a fluid-resistant barrier; they are antistatic, flame resistant, lint free and, although w...

ELECTROSURGERY Electrosurgery employs high-frequency electrical current to assist in making surgical incisions, dissection of tissue and achieving haemostasis. Its widespread use in open, laparoscopic and intraluminal endoscopic surgery such as transurethral ...

Emergency gastrointestinal surgery and drains While there seems to be some anecdotal evidence advising against drainage following appendicular perforation, duode nal perforation and bowel pathology leading to localised or generalised peritonitis, a less dogmat...

FURTHER READING Kirk RM. Basic surgical techniques , 6th edn. Edinburgh: Churchill Liv - ingstone 2010. Pignata G, Bracale U, Fabrizio Lazzara F (eds). Laparoscopic surgery: key points, operating room setup and equipment . Berlin: Springer, 2016. Royal College...

Hair removal from the surgical site Hair is removed from the surgical site when it is deemed to interfere with the operation; it also makes postoperative plaster - or dressing changes relatively pain free. However, removal of hair causes microabrasions and c...

Hazards of diathermy Burns These are the most common type of diathermy accidents and occur when the current flows in some way other than that which the surgeon intended; they are far more common in (b) monopolar than bipolar diathermy . Diathermy can also caus...

INTRODUCTION Successful outcomes in surgery depend on knowledge, skills and judgement. While this chapter focuses on technical skills, the importance of surgical preparedness in the form of appro priate safety checks, correct positioning and non-technical sk...

Knotting techniques Knot tying is one of the most fundamental techniques in surgery and a poorly constructed knot may jeopardise an otherwise successful surgical procedure. The general principles behind knot tying are as follows: Figure 7.15 Figure 7.16 /uni2...

Laparoscopic access and port placement There are two fundamental ways to access the abdomen laparoscopically: - 1 the open technique (Hasson’s or modified Hasson’s) 2 the closed technique (V eress needle and/or visual entry trocar). The advantages and complicat...

Lateral position Left or right lateral positioning ( Figure 7.5 ) are useful alterna tives to prone positioning in many circumstances, such as the drainage of perianal or pilonidal abscesses. The lateral position also allows for good access to the thorax when...

Learning objectives To understand: The importance of safe patient positioning • The steps involved in surgical site preparation • The principles of surgical exposure and laparoscopic • access Learning objectives To understand: The importance of safe patient po...

Lithotomy and Lloyd-Davies position This is commonly employed for gynaecological, perineal and urological procedures. The patient is positioned supine with the legs flexed at the hip and knee and placed in stirrups. In degree of hip and knee flexion can be cont...

Monopolar and bipolar diathermy In monopolar surgery ( Figure 7.18a ), the electrical current created in the ESU passes through a single electrode (diathermy pencil) to the tissue, causing the desired tissue e ff ect (cut or coagulation). To complete the cycle,...

Needles Most needles in present practice are eyeless, or ‘atraumatic’, with the suture material embedded within the shank of the needle. The needle has three main parts: 1 shank; 2 body; 3 point. imately one-third of the way back from the rear of the needle...

POSITIONING ON THE OPERATING TABLE Summary box 7.1 Objectives of correct surgical positioning /uni25CF /uni25CF /uni25CF /uni25CF Friedrich Trendelenburg , 1844–1924, Professor of Surgery successively at Rostock (1875–1882), Bonn (1882–1895), Leipzig (1895–19...

PREPARATION OF THE SURGICAL SITE Correct skin preparation can reduce surgical site infection - (SSI). The steps involved in preparing the skin prior to making an incision are described below . PREPARATION OF THE SURGICAL SITE Correct skin preparation can reduc...

Patient safety and transfer to the operating table Patient safety is of paramount importance. The safe transfer and positioning of the patient is a responsibility that is shared by the anaesthetist, surgeon, nurse and operating department practitioners. The ...