1. Deep Epigastric Vessels
2. Inguinal Ligament
3. Rectus abdominis muscle

1. Hiatal
2. Epigastric
3. Umbilical
4. Inguinal
5. Femoral

• Occur within Hesselbach's Triangle

• Protrude into the inguinal canal but not into the spermatic cord (and rarely into the scrotum)

• Occur lateral to the deep epigastric vessels

• Protrude through the internal inguinal ring and pass with the spermatic cord structures down the inguinal canal; may descend into the scrotum

Special Features of Hernia Surgery

Patient is usually positioned in the (supine, Trendelenburg) position.

Special Features of Hernia Surgery

Since the peritoneal cavity may be entered when the hernia sac is opened, accurate sponge, sharp, and instrument counts (may, must) be done

Special Features of Hernia Surgery

A (Jackson-Pratt, Penrose) drain is used to retract the spermatic cord structures.

Special Features of Hernia Surgery

to decrease the trauma to the tissue, the drain should be (moistened, dry) when passed to the surgeon

Special Features of Hernia Surgery

(Cutting and Keith, Mayo and Ferguson) needles may be utilized with interrupted sutures of the repair

1. Curved Mosquitos
2. Curved Crile
3. Allis forceps
4. Metz
5. Curved Mayo
6. Adson with teeth
7. Tissue forceps with and without teeth
8. Senns Retractor

Complete for Inguinal Hernia

Patient is placed in the supine position and the area from above the umbilicus to mid-thights is prepped and draped as for an abdominal procedure with (groin, popliteal) area on the affected side exposed

Complete for Inguinal Hernia

Surgeon makes the incision over the hernia and uses the (electrocautery, shaw knife) for hemostatsis

Complete for Inguinal Hernia

Suregon incises the (fascia, muscle) lying over the spermatic cord and retracts with several hemostats

Complete for Inguinal Hernia

Surgical tech mounts the moistened (Penrose drain 4X4 sponge) on a medium clamp and passes it to the surgeon who passes it around the spermatic  cord for retraction

Complete for Inguinal Hernia

If hernia is direct, surgeon sutures (tranversalis fascia, external oblique fascia) as technologist takes first closure count.

Complete for Inguinal Hernia

Surgeon ligates or oversews indirect hernia sac as technologist takes (1st, 2nd) closing count

Complete for Inguinal Hernia

Surgeon sutures transversalis fascial defect using heavy (interrupted, continuous) sutures.

Complete for Inguinal Hernia

Surgeon passes specimen to (pathologist, technologist)

Complete for Laparoscopic Hernia

Laparoscopic hernioplasty has a number of (advantages, disadvantages) over traditional, "open" hernioplasty

Complete for thyroid gland

The primary function of the thyroid gland is (calcium, iodine) metabolism

1. Hyperthyroidism (Grave's disease)
2. Hypothyroidism (Myxedema and cretinism)
3. Cancer
4. Enlarged thyroid (Goiter)

True or False for Thyroid Surgery

Patient is placed in Trendelenburg position with the neck hyperextended

False

Patient is supine with neck hyperextended

1. Mosquito (curved and straight)
2. Crile artery forceps (curved)
3. Allis forceps
4. Kochers
5. small right angle clamps
6. Schnidt forceps
7. Metz
8. Mayo (curved and straight)
9. Adson with & without teeth
10. Tissue forceps with & without teeth
11. Senns retractor
12. skin hooks
13. Richardson retractor small
14. Gelpi or Weitlaner
15. Suction tips (Frazier & tonsil)
16. No 3 & No 7 knife handles
17. Clip applier and clips

Complete for subtotal thyroidectomy

Patient is positioned, prepped, and draped according to ______

_______ retractors may be used for deep retraction.

Complete for Parathyroid Gland

the parathyroid glands are (2, 4) small, yellowish-brown masses of tissue lying behind the thyroid gland

Basic Procedures of Parathyroid Surgery

Total Parathyroidectomy with autotransplantation

1. Positioning, prepping, and draping procedures are the same as for thyroid surgery
2. The incision and exposure is the same as for thyroidectomy
3. Several specimens may be obtained. As with every specimen, parathyroid specimens must be clearly labeled when sent to pathology for frozen section.

Complete for Breast

Breasts are mammary glands that lie on the (pectoralis major, rectus abdominis) of the anterior chest wall

To Diagnose

To Treat

True or False for Breast Surgery

Patients may be apprehensive about the possibility to having breast

True or False for Breast Surgery

Patient is positioned on the OR table in the prone position

False

Patient is in supine position

True or False for Breast Surgery

Skin prep depends on the location of the lesion and the intended surgery.

True or False for Breast Surgery

Draping should allow adequate exposure of the affected breast

True or False for Breast Surgery

Spinal anesthesia is usually preferred for a mastectomy

False

General anesthesia is preferred

True or False for Breast Surgery

Breast biopsies may be performed under general or local anesthesia

Radial (on breast)

Supraareolar (follows over curve of areola)

Infraareolar (follows under curve of areola)

Inframammary (follows under breast)

1. Curved Mosquito
2. Curved Kelly
3. Allis Forceps
4. Metz
5. Mayo curved & straight
6. Adson with teeth
7. Tissue with teeth
8. Senns retractors
9. skin hook
10. knife handles No 3 with 10 & 15 blades

1. Curved Mosquito
2. Curved Kelly
3. Allis Forceps
4. Lahey Clamps
5. Kocher Clamps
6. Metz
7. Mayo (curved  straight)
8. Adson with teeth
9. Tissue with teeth
10. Richardson
11. Skin hooks
12. Knife handle #3 with 10 blade

Complete for Excisional breast biopsy

Patient is placed in the _____ position, prepped and raped with the affected breast exposed.

True or False for Modified Radical Mastectomy

Patient is placed in the prone position.  The arm on the affected side is placed on an arm board but is not included in the scrub prep

False

Patient is supine.  Arm on armboard of affected side is prepped in the event that lymph nodes must be removed

True or False for Modified Radical Mastectomy

Beren's retractors are commonly used to elevate the skin flaps

True or False for Modified Radical Mastectomy

Blades dull easily and will need to be changed frequently.

True or False for Modified Radical Mastectomy

Wound is irrigated with plasmalyte

False

Wound is irrigated with warm normal saline

True or False for Modified Radical Mastectomy

Surgeon closes with absorbable sutures or staples

True or False for Modified Radical Mastectomy

Moderate pressure dressing is applied and may be held in place with Ace bandage or a surgical bra

1. Tumor cells can spread by direct and indirect contact, so the involved area requires minimal and gentle handling to avoid dislodging tumor cells.
2. To prevent cross contamination, each procedure should have a separate set-up including instruments, drapes, gowns, and gloves
3. When a biopsy or frozen section and possible mastectomy are scheduled, but separate preps, drapes an instrument set up are recommended (1 or each procedure)
4. If a procedure includes biopsies of tumors in both breasts, followed by frozen section and possible mastectomy, separate set ups must be available for each biopsy as well as for the mastectomy.
5. For multiple procedures on the same patient, each procedure should have its own setup which should include skin prep, instruments, sponges, drapes, gown, and gloves to prevent cross contamination.