basic surgical skills course

BASIC SURGICAL SKILLS COURSE

Purnama Hotel Kuningan

13 th October 2015

dr. Asep Hermana, SpB, FINACS, FICS

AIMS

INSTRUMEN HANDLING

SUTURE MATERIAL

KNOTTING & SUTURING

INCISION

AIMS

To learn one safe way to do a surgical procedure.

The course should instructive educational AND enjoyable

Acquire good habits earlier – it is difficult to unlearn bad habits

SAFE ENJOYHABITS

Pass sharps in a kidney dish to your assistant / nurseSafety of all is responsibility of operating surgeon

NEVER DIRECTLY HANDLE SHARPS WITH YOUR FINGERS (i.e. blades or needles).

SAFETY FIRST !

SAFETY FIRST !

Always dispose of sharps in a sharps bin −not on patient or

operating table!In case of injury

assess the injuryassess patient status

.

BASIC SURGICAL SKILLS COURSE

INSTRUMEN HANDLING

PRICIPLES

1 Safety2 Economy of movement3 Relaxed handling4 Avoidance of awkward movement

BASICPRINCEPLE

INSTRUMEN HANDLING

Cutting Instruments:Scalpel

- attachment- detachment- holding - like a table knife

- like a pen- cutting- passing the scalpel in a kidney dish

INSTRUMEN HANDLING

INSTRUMEN HANDLING

INSTRUMEN HANDLING

Cutting Instruments:Scissors (2 types) - holding

- cutting

INSTRUMEN HANDLING

INSTRUMEN HANDLING

Holding Instruments:

• Forceps (toothed and non-toothed) - holding

• Artery Forceps

• Needle Holders

INSTRUMEN HANDLING

INSTRUMEN HANDLING

INSTRUMEN HANDLING

BASIC SURGICAL SKILLS COURSE

KNOTTING

Knotting• Knot-tying is a fundamental technique in

surgery, and is often performed badly

• Take time to perfect your knotting technique

• Uses of knots:− Tying sutures− Ligation (tying vessels)

KNOTTING

KNOTTING PRINCIPLE

MUST

• NOT SAW• NO DAMAGE• NO TEAR TISSUE• NO EXCESSIVE TENSION

NO

• FIRM• SMALL• RIGHT MATERIAL

KNOTTING

Types of Knots• Reef / Square Knot - one hand

- two hands- instrument tie

• Surgeon’s Knot - one hand- two hands- instrument tie

• Slip Knot - must always be followed by a reef knot

KNOTTING

Square ( Reef ) Knot

KNOTTING

KNOTTING

Surgeon’s knot

KNOTTING

DEEP TIE

KNOTTING

KNOTTING

BASIC SURGICAL SKILLS COURSE

SUTURING

SKIN SUTURE PRINCIPLE

MUST

• NOT TENSION• NO EVERSI• NO INVERSI• NO DEAD SPACE

NO

• EPITEL TO EPITEL• ALL SURFACE• RIGHT MATERIAL

SUTURING

SUTURING

SUTURING

SUTURING

SUTURING

SUTURING

SUTURING

BASIC SURGICAL SKILLS COURSE

SUTURE MATERIAL

Types of Suture MaterialSutures:

Multifilament (twisted, braided)

Monofilament

EyeBodyTip

Needles:CurvedJ-shapedStraight

SyntheticBiologicalNon-absorbableAbsorbable

Types of Suture Material (cont.)

Needles:Curved EyeJ-shaped BodyStraight TipRound BodyTaper - blunt - cutting (forward /reverse)

BASIC SURGICAL SKILLS COURSE

INCISION

X

≥ 3 X

Ellipse

•X• ≥ 3 X

Ellipse