surgery field part two 2

Hysterectomy
Hysterectomy is the surgical removal of the uterus. Two methods are available: abdominal hysterectomy through an incision, shown here, or vaginal hysterectomy through the vagina. In abdominal hysterectomy, the surgeon opens the abdominal cavity, cuts through the Fallopian tubes, and severs the uterus at its junction with the cervix. If the Fallopian tubes and ovaries are healthy, they are usually left in place, but if they have become diseased they are also removed.

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Intraoperative care involves several members of the surgical team. The surgeon determines the timing of the operation, the techniques, and the instruments and supplies to be used. The anesthesiologist controls the patient’s pain and, if necessary, the level of unconsciousness to make surgery more tolerable and ensure that the patient regains consciousness safely and quickly following the operation. The scrub nurse readies all instruments, ensures the sterility of the surgical field, and anticipates when instruments will be needed by the surgeon. The circulating nurse makes sure the operating room is adequately supplied and provides any additional supplies to the scrub nurse during the operation. Depending upon the hospital, surgical assistants, physician assistants, surgical residents, medical students, and nursing students may also attend an operation.

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Heart Valve Replacement Surgery

Surgeons use open-heart surgery to clear clogged arteries and to repair physical injuries to the heart caused by trauma, such as a heart attack. This form of surgery can also be used to correct congenital heart problems, including the replacement of defective heart valves.
Postoperative care begins in a recovery room or intensive care unit (ICU). Both areas are equipped to monitor blood pressure and heart rate and provide supplemental oxygen, mechanical ventilation for the lungs, and physical support under critical circumstances. Drugs are often prescribed to control postoperative pain.

History of Surgery

[/img][/size]The first surgical procedures were performed in the Neolithic Age (about 10,000 to 6000 BC). Trepanning, a procedure in which a hole is drilled in the skull to relieve pressure on the brain, may have been performed as early as 8000 BC. In Egypt, carvings dating to 2500 BC describe surgical circumcision--the removal of foreskin from the penis and the clitoris from femalgenitalia
Operations such as castration (the removal of a male’s testicles); lithotomy (the removal of stones from the bladder); and amputation (the surgical removal of a limb or other body part) are also believed to have been performed by the Egyptians. Ancient Egyptian medical texts have been found that provide instructions for many surgical procedures including repairing a broken bone and mending a serious wound. In ancient India, the Hindus surgically treated bone fractures and removed bladder stones, tumors, and infected tonsils. They are also credited with having developed plastic surgery as early as 2000 BC in response to the punishment of cutting off a person’s nose or ears for certain criminal offenses. Using skin flaps from the forehead, Hindu surgeons shaped new noses and ears for the punished criminals. In the 4th century BC, the Greek physician Hippocrates published descriptions of various surgical procedures, such as the treatment of fractures and skull injuries, with directions for the proper placement of the surgeon’s hands during these operations.
During most of the Middle Ages (5th century to 14th century AD), the practice of surgery declined. It was viewed as inferior to medicine, and its practice was left to barbers who traveled from town to town cutting hair, removing tumors, pulling teeth, stitching wounds, and bloodletting, the practice of draining blood from the body, then thought to cure illness. The red-and-white striped pole that today identifies barbershops derived its design from this practice. The red stripes symbolize blood and the white stripes signify bandages.
In 1316 the French surgeon Guy de Chauliac published Chirurgia magna (Great Surgery). This massive text describes how to remove growths, repair hernias (protrusion of an organ through surrounding structures), and treat fractures using slings and weights. The text helped surgery gain respect as a serious science. At this time a new order of surgeons arose in France. They were called surgeons of the long robe, distinguished from the barber surgeons who were known as surgeons of the short robe. The barber surgeons had little medical training, while the surgeons of the long robe were studied physicians and considered such practices as bloodletting primitive. Corporations, or guilds, of surgeons of the long robe were formed in several countries.
During the 16th, 17th, and 18th centuries, many discoveries in surgical practice took place. Much credit belongs to the French surgeon Ambroise Paré, often called the father of modern surgery. Paré successfully employed the method of ligating, or tying off, arteries to control bleeding, thus eliminating the old method of cauterizing, or searing, the bleeding part with a red-hot iron or boiling oil. Discoveries about functions of the human body also helped make surgery a more accurate science during this period. For example, the English physician and anatomist William Harvey discovered the process of blood circulation and Italian anatomist Marcello Malpighi identified the existence of tiny blood vessels called capillaries that carry blood from the major blood vessels to the cells of the body. John Hunter, a British anatomist and surgeon, stressed the close relationship between medicine and surgery and performed many experimental operations that advanced the practice of surgery.
Most surgery, however, continued to be restricted to less critical areas of the body or to operations that did not penetrate the skin too deeply. Surgeons rarely opened the abdomen, chest, or skull because of the pain it caused the patient and the risk of infection. This changed in 1846 when anesthesia was used as a way to mask pain during surgery by American dentist William Morton. Although Morton is often credited with the discovery of surgical anesthesia, American surgeon Crawford W. Long used anesthesia in 1842 during the removal of tumors but did not publish his results until 1849.
Post-surgical infections remained a serious complication of surgery until the mid-19th century when the French chemist Louis Pasteur discovered that fermentation or putrefaction, the decay and death of body tissue, is caused by bacteria in the air. In 1865 the British surgeon Joseph Lister applied Pasteur’s work to surgery, developing antiseptic (germ-killing) techniques including the use of a carbolic acid spray to kill germs in the operating room before surgery. These antiseptic procedures helped eliminate postoperative infection. Other physicians, including Austrian Ignaz Semmelweiss and American Oliver Wendell Holmes, determined that bacteria are also carried on the hands and clothing and transferred from patient to patient as a physician attends one after another. These physicians pioneered techniques such as washing hands and changing into clean clothing before surgery that prevent wounds from being contaminated during surgery.
In the late 1800s, having solved the problems of pain and infection, surgeons began performing new types of surgery including procedures on the abdomen, brain, and spinal cord. At the turn of the 20th century, improved diagnostic abilities and methods of treatment helped surgery become even more effective. When the German physicist William Conrad Roentgen invented X rays in 1895 to “photograph” the inside of the body he changed the way surgery was performed. The discovery of the blood groups A, B, and O by Austrian pathologist Karl Landsteiner enabled surgeons to give patients transfusions of their own blood type to ensure survival during surgery. The need for a readily available supply of blood for transfusions led to the creation of blood banks in 1937.
Other technological advances permitted surgeons to perform increasingly complex and difficult operations. The introduction of antibiotics in the 1940s further minimized the risk of postoperative infection. The development of the heart-lung machine in 1953 by American surgeon John H. Gibbon allowed surgeons to more easily and successfully perform surgery on these organs. It also marked the beginning of modern clinical heart surgery. The operating microscope, developed in the 1950s, provided surgeons with a way to perform delicate operations on minute body structures like the inner ear and the eye, and more recently, enabled surgeons to reattach the tiny blood vessels from severed limbs to the body (see [size=20

part2
Microsurgery[/size][size=20The first kidney transplants were performed in the 1950s, and the first heart transplant, in 1967, was performed by South African physician Christiaan Barnard.

[Surgery Today
[/size]New techniques continue to advance the field of surgery. High frequency sound waves, called ultrasound, are directed at kidney and gallbladder stones to break them apart so that they can be eliminated through the excretory system. Cryosurgery freezes and destroys abnormal tissue and is used to treat hemorrhoids and some cervical disorders, and to remove certain skin growths. Laser surgery, on the other hand, uses a beam of light to vaporize or destroy tissue, a
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One of the most prevalent causes of heart attack is the buildup of plaque in the arteries leading to the heart. Balloon angioplasty is a common surgical treatment for this condition. If successful, the procedure eliminates the need for more involved surgery such as coronary bypass.
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procedure commonly employed in ophthalmology, neurosurgery, and thoracic surgery.
A variety of surgical procedures are performed using an endoscope, an instrument that permits doctors to view the inside of the body without making a large incision and through which special tools such as lasers or knives can be inserted to operate on a particular area of the body. Surgery using an endoscope, also called laparoscopy, is used to perform tubal ligation,
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surgery field part two 2 SterileF-HowTo2

surgery field part two 2 SterileF-HowTo2

[/size]Tubal ligation, or surgical sterilization, is an operation to prevent pregnancy in which the Fallopian tubes in the female reproductive system are closed off so that the eggs produced by the ovaries can not be fertilized by sperm after sexual intercourse. Surgeons typically use a laparascope, a thin, hollow tube inserted via a tiny incision in the abdominal wall in this procedure. The tubes may be closed off by a variety of methods including cauterization, searing the tubes closed with burning heat; clamping using plastic clips that remain in the body; constriction using a plastic band; or cutting away a section of the tube and tying off the severed ends.
gall bladder removal, or lung removal. This technique is commonly used for biopsies, in which tissue is removed from an organ for evaluation under a microscope, or for removing patches of diseased tissue.
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Transplantation surgery, in which organs or tissues are removed from one person and surgically implanted into another person, is now performed for the eye lens and cornea, blood, bones and bone marrow, heart, lung, liver, and pancreas. In severe burn cases, healthy skin from an uninjured site is transferred to an area that has been damaged. Patients typically receive transplants when their own organs fail. Donor organs come from recently deceased individuals who have indicated on organ donor cards a desire to donate organs or whose family members have authorized donation of the deceased’s organs. Donated organs must be transplanted within 24 to 48 hours after a donor’s death.
Ambulatory, or same-day surgery, is performed in a physician’s office or clinic. It involves operations that use minimally invasive techniques, require less extensive cutting, and use anesthesia that clears rapidly from the body. Some types of plastic surgery, implantation of permanent pacemakers, breast surgery, and biopsies are typically performed in ambulatory surgical clinics.

Contributed By:
Norman S. Kato
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MEDICAL TRIUMPH
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First Human Heart Transplanted
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Los Angeles Times
December 4, 1967

This Los Angeles Times article reports on a medical breakthrough: the first successful human heart transplant. Dr. Christiaan Barnard led the South African medical team that performed the operation. His name is spelled differently here than in other reports.
CAPE TOWN, South Africa—A South African hospital Sunday made medical history with the world's first human heart transplant. Surgeons removed the heart of a young woman who died after an automobile crash and placed it in the chest of a 55-year-old man, dying of heart damage, a hospital announcement said.

[size=20When the transplanted heart was in place, it was started beating by an electric shock, said Dr. Jan H. Louw, hospital chief surgeon. He added: “It was like turning the ignition switch of a car.”
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Groote Schuur Hospital said the man was in satisfactory condition late Sunday, but that the next few days would be a critical period.

Heart Removed From Body
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The heart was removed from the body of Denise Ann Darvall, 25, an accounting machine operator at a bank, and transferred to Louis Washkansky, a wholesale grocer, the hospital said.

Washkansky was reported fully conscious and in very satisfactory condition after the five-hour operation that ended at 6 a.m. The announcement said his blood pressure was normal by Sunday afternoon.

In the first stage of the heart transplant operation, both Washkansky and the body of Miss Darvall were put on heart-lung machines, each manned by a team of technicians.

In the second stage, the donor's heart was removed and the circulation of her heart, once it was removed, was kept going by a pump.

The third stage was the removal of Washkansky's heart.

Most Intricate Stage
The fourth and most intricate stage of the operation was the placing of the donor's heart in Washkansky's body. When the transplant was completed, electrodes were placed against the heart walls, and a high current was switched on for a fraction of a second.

The heart started beating immediately, Louw said.

Hospital sources at Groote Schuur Hospital said the transplant for Washkansky nearly took place last Wednesday with another donor but was canceled at the last moment because the donor died too soon.

Miss Darvall's kidneys also were removed and taken to Cape Town's Karl Bremer Hospital for a successful kidney transplant to Jonathan Van Wyk, 10.

The announcement of the transplant to Washkansky came from Dr. Jacobus G. Burger, medical supervisor of the hospital.

“The operation was his only chance,” Dr. Burger said. “Washkansky was dying and wouldn't have lived longer than a few days otherwise.”

The doctor said the next two or three days would be the critical postoperative period.

“The longer Washkansky goes on, the better,” he said, “although that does not mean the heart will not be rejected later. The body could decide in 5 or 10 years that it doesn't want this heart.”

Washkansky had a tracheotomy—a tube inserted in his throat through which he is breathing—and is unable to speak, said Dr. Burger. He is being kept absolutely quiet in a special room.

“Even the nurses don't speak to him,” he added.

Dr. Burger said apart from the body's natural tendency to reject the heart, the main danger could come from blood clotting and resultant heart failure.

Washkansky is being fed anticlotting drugs to counter this possibility.

“We are also using steroids to prevent the heart being thrown out (rejected),” Dr. Burger said.

He said Washkansky had been kept alive by using pumps to assist his heart, but this could not have gone on indefinitely.

“The heart muscle was fibrosed, which means that all the muscle was gone and there was only fibrous tissue there,” the doctor said. “It wouldn't pump the blood any more, and his condition was deteriorating.”

Life Depended on Pumps
“We thought he was dying a week ago, and he would have died immediately if we had taken the pumps away.

“Washkansky knew what he was going into, but it was his only chance.”

Heading the team of five cardiac surgeons was Prof. Christian Barnard.

In addition to the cardiac surgeons, there were two neurosurgeons and two anesthetists. Altogether there were about 20 in the operating theater, including five or six nurses, said Burger. All the surgeons were South Africans.

The woman donor was injured fatally in an auto accident Saturday afternoon. Neurosurgeons, with an electroencephalogram to measure her brain waves, alerted the cardiac surgeons the instant she died—shortly before 1 a.m.—and the operation began immediately.

Consent earlier had been obtained from her father to use her heart.

“The operation had to begin within half an hour of her death,” Burger said.

The woman's mother was killed instantly in the same auto accident.

Mrs. Washkansky said that before the transplant her husband's life was “hanging by a thread.” She said he was approached three weeks ago by doctors who told him “in great detail what it would entail. He snapped up the chance, not even making use of the two days they gave him to think it over. He kept saying: ‘I'll pull through.’”

Mrs. Washkansky said, “I was petrified but my husband had such confidence in medical men he inspired me as well.” She said he had had heart trouble for seven years and in the last two years his condition became progressively worse.

The hospital said the operation “was his only chance.” The donor's father, Edward Darvall, said: “I gave the doctors permission to remove my daughter's heart and kidneys and donate them to other persons if it could save their lives—it was shortly before midnight after I was informed she was dying.”

Dr. Burger said heart transplant experiments on cats and dogs had been carried out over the last 10 years at Groote Schuur, which in Afrikaans means big barn.

“Prof. Barnard has two registrars—young doctors studying for postgraduate degrees—continually experimenting in his animal laboratory,” Dr. Burger said. “I know he has successfully transplanted hearts of dogs, but I don't know how long the animals lived afterwards.”

Source: Los Angeles Times, December 4, 1967

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