Types of Surgery
Surgery is a medical technology consisting of a physical intervention on tissues. As a general rule, a procedure is considered surgical when it involves cutting of a patient’s tissues or closure of a previously sustained wound. Other procedures that do not necessarily fall under this rubric, such as angioplasty or endoscopy, may be considered surgery if they involve “common” surgical procedure or settings, such as use of a sterile environment, anesthesia, antiseptic conditions, typical surgical instruments, and suturing or stapling. All forms of surgery are considered invasive procedures; so-called “noninvasive surgery” usually refers to an excision that does not penetrate the structure being excised (i.e. laser ablation of the cornea) or to a radiosurgical procedure (i.e. irradiation of a tumor).
Surgery is a unique experience of a planned physical alteration encompassing three phases: PREOPERATIVE, INTRAOPERATIVE AND POSTOPERATIVE. These 3 phases are together referred to as the PERIOERATIVE PERIOD.
Surgical procedures are commonly grouped according to:
|Diagnostic||Confirms or establishes a diagnosis; Example – biopsy of a mass in a breast.|
|Palliative||Relieves or reduces pain or symptoms of a disease; it does not cure; Example – resection of nerve roots.|
|Ablative||Removes a diseased body part; Example – removal of a gallbladder (cholecystectomy)|
|Constructive||Restores function or appearance that has been lost or reduced; Example – breast implant|
|Transplant||Replaces malfunctioning structures; Example – hip replacement|
B. Degree of Urgency
|Emergency Surgery||Is performed immediately to preserve function or the life of the client. Example – surgeries to control internal hemorrhage|
|Elective Surgery||Is performed when surgical intervention is the preferred treatment for a condition that is not imminently life threatening (but may ultimately threaten life or well being) or to improve the client’s life. Example – cholecystectomy for chronic gallbladder disease, plastic surgery procedures such as breast reduction surgery|
C. Degree of Risk
|Major Surgery||It involves a high degree of risk, for a variety of reasons: It may be complicated or prolonged, large losses of blood may occur, vital organs may be involved, or postoperative complications may be likely. Example – organ transplant, open heart surgery, removal of kidney|
|Minor Surgery||It involves little risk, produces few complications, and is often performed in a “day surgery”. Example – breast biopsy, removal of tonsils, knee surgery.|
The degree of risk involved in a surgical procedure is affected by the client’s age, general health, nutritional status, use of medications, and mental status.
|Age||Very young and elder clients are greater surgical risks than children and adults.
The physiologic response of an infant to surgery is substantially different from an adult’s.
The blood volume in an infant is small, and its fluid reserves limited.
The older adult often has fewer physiologic reserves to meet the extra demands caused by surgery.
The older adult may be poorly nourished, which can impair healing.
|General Health||Surgery is least risky when the client’s general health is good. Common health problems that increase surgical risk and may lead to the decision to postpone or cancel surgery are malnutrition, cardiac conditions, blood coagulation disorders, renal diseases, diabetes mellitus, liver diseases, etc.|
|Nutritional Status||Adequate nutrition is required for normal tissue repair.
Obesity contributes to postoperative complications such as pneumonia, wound infection and wound separation.
Obese and underweight client are vulnerable to pressure ulcer formation due to positioning required for surgery.
A malnourished client is at risk for delayed wound healing, wound infection and fluid and electrolyte alterations.
|Medications||The following medication can increase surgical risk:
Anticoagulants increase blood coagulation time.
Tranquilizers may interact with anesthetics, increasing the risk of respiratory depression.
Corticosteroids may interfere with wound healing and increase the risk of infection.
Diuretics may affect fluid and electrolyte balance.
|Mental Status||Clients with dementia may have difficulty understanding proposed surgical procedures and may respond unpredictably to anesthetics.
Extreme anxiety also increases surgical risk and interferes with the client’s ability to process information and respond appropriately to instructions.
- Excision surgery names often start with a name for the organ to be excised (cut out) and end in -ectomy.
- Procedures involving cutting into an organ or tissue end in -otomy. A surgical procedure cutting through the abdominal wall to gain access to the abdominal cavity is a laparotomy.
- Minimally invasive procedures involving small incisions through which an endoscope is inserted end in -oscopy. For example, such surgery in the abdominal cavity is called laparoscopy.
- Procedures for formation of a permanent or semi-permanent opening called a stoma in the body end in -ostomy.
- Reconstruction, plastic or cosmetic surgery of a body part starts with a name for the body part to be reconstructed and ends in -oplasty. Rhino is used as a prefix for “nose”, so rhinoplasty is basically reconstructive or cosmetic surgery for the nose.
- Reparation of damaged or congenital abnormal structure ends in -rraphy. Herniorraphy is the reparation of a hernia, while perineorraphy is the reparation of perineum.
Fundamentals of Nursing – Barbara Kozier et al