Surgery


Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions, to alter bodily functions, to reconstruct or alter aesthetics and appearance, or to remove unwanted tissues, neoplasms and foreign bodies.
The act of performing surgery may be called a surgical procedure or surgical operation, or simply "surgery" or "operation". In this context, the verb "operate" means to perform surgery. The adjective surgical means pertaining to surgery; e.g. surgical instruments, surgical facility or surgical nurse. Most surgical procedures are performed by a pair of operators: a surgeon who is the main operator performing the surgery, and a surgical assistant who provides in-procedure manual assistance during surgery. Modern surgical operations typically require a surgical team that typically consists of the surgeon, the surgical assistant, an anaesthetist, a scrub nurse, a circulating nurse and a surgical technologist, while procedures that mandate cardiopulmonary bypass will also have a perfusionist. All surgical procedures are considered invasive and often require a period of postoperative care for the patient to recover from the iatrogenic trauma inflicted by the procedure. The duration of surgery can span from several minutes to tens of hours depending on the specialty, the nature of the condition, the target body parts involved and the circumstance of each procedure, but most surgeries are designed to be one-off interventions that are typically not intended as an ongoing or repeated type of treatment.
In British colloquialism, the term "surgery" can also refer to the facility where surgery is performed, or simply the office/clinic of a physician, dentist or veterinarian.

Definitions

As a general rule, a procedure is considered surgical when it involves cutting of a person'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 antiseptic measures and sterile fields, sedation/anesthesia, proactive hemostasis, typical surgical instruments, suturing or stapling. All forms of surgery are considered invasive procedures; the so-called "noninvasive surgery" ought to be more appropriately called minimally invasive procedures, which usually refers to a procedure that utilizes natural orifices or does not penetrate the structure being excised, are percutaneous, or to a radiosurgical procedure.

Types of surgery

Surgical procedures are commonly categorized by urgency, type of procedure, body system involved, the degree of invasiveness, and special instrumentation.
  • Based on timing:
  • * Elective surgery is done to correct a non-life-threatening condition, and is carried out at the person's convenience, or to the surgeon's and the surgical facility's availability.
  • * Semi-elective surgery is one that is better done early to avoid complications or potential deterioration of the patient's condition, but such risk are sufficiently low that the procedure can be postponed for a short period time.
  • * Emergency surgery is surgery which must be done without any delay to prevent death or serious disabilities or loss of limbs and functions.
  • Based on purpose:
  • * Exploratory surgery is performed to establish or aid a diagnosis.
  • * Therapeutic surgery is performed to treat a previously diagnosed condition.
  • ** Curative surgery is a therapeutic procedure done to permanently remove a pathology.
  • * Plastic surgery is done to improve a body part's function or appearance.
  • ** Reconstructive plastic surgery is done to improve the function or subjective appearance of a damaged or malformed body part.
  • ** Cosmetic surgery is done to subjectively improve the appearance of an otherwise normal body part.
  • * Bariatric surgery is done to assist weight loss when dietary and pharmaceutical methods alone have failed.
  • * Non-survival surgery, or terminal surgery, is where euthanasia is performed while the subject is under anesthesia so that the subject will not regain conscious pain perception. This type of surgery is usually done in animal testing experiments.
  • By type of procedure:
  • * Amputation involves removing an entire body part, usually a limb or digit; castration is the amputation of testes; circumcision is the removal of prepuce from the penis or clitoral hood from the clitoris. Replantation involves reattaching a severed body part.
  • * Resection is the removal of all or part of an internal organ and/or connective tissue. A segmental resection specifically removes an independent vascular region of an organ such as a hepatic segment, a bronchopulmonary segment or a renal lobe. Excision is the resection of only part of an organ, tissue or other body part without discriminating specific vascular territories. Exenteration is the complete removal of all organs and soft tissue content within a body cavity.
  • * Extirpation is the complete excision or surgical destruction of a body part.
  • * Ablation is destruction of tissue through the use of energy-transmitting devices such as electrocautery/fulguration, laser, focused ultrasound or freezing.
  • * Repair involves the direct closure or restoration of an injured, mutilated or deformed organ or body part, usually by suturing or internal fixation. Reconstruction is an extensive repair of a complex body part, often with some degrees of structural/functional replacement and commonly involves grafting and/or use of implants.
  • * Grafting is the relocation and establishment of a tissue from one part of the body to another. A flap is the relocation of a tissue without complete separation of its original attachment, and a free flap is a completely detached flap that carries an intact neurovascular structure ready for grafting onto a new location.
  • * Bypass involves the relocation/grafting of a tubular structure onto another in order to reroute the content flow of that target structure from a specific segment directly to a more distal segment.
  • * Implantation is insertion of artificial medical devices to replace or augment existing tissue.
  • * Transplantation is the replacement of an organ or body part by insertion of another from a different human into the person undergoing surgery. Harvesting is the resection of an organ or body part from a live human or animal for transplantation into another patient.
  • By organ system: Surgical specialties are traditionally and academically categorized by the organ, organ system or body region involved. Examples include:
  • * Cardiac surgery — the heart and mediastinal great vessels;
  • * Thoracic surgery — the thoracic cavity including the lungs;
  • * Gastrointestinal surgery — the digestive tract and its accessory organs;
  • * Vascular surgery — the extra-mediastinal great vessels and peripheral circulatory system;
  • * Urological surgery — the genitourinary system;
  • * ENT surgery — ear, nose and throat, also known as head and neck surgery when including the neck region;
  • * Oral and maxillofacial surgery — the oral cavity, jaws, and face;
  • * Neurosurgery — the central nervous system, and;
  • * Orthopedic surgery — the musculoskeletal system.
  • By degree of invasiveness of surgical procedures:
  • * Conventional open surgery requires a large incision to access the area of interest, and directly exposes the internal body cavity to the outside.
  • * Minimally-invasive surgery involves much smaller surface incisions or even natural orifices to insert miniaturized instruments within a body cavity or structure, as in laparoscopic surgery or angioplasty.
  • * Hybrid surgery uses a combination of open and minimally-invasive techniques, and may include hand ports or larger incisions to assist with performance of elements of the procedure.
  • By equipment used:
  • * Laser surgery involves use of laser ablation to divide tissue instead of a scalpel, scissors or similar sharp-edged instruments.
  • * Cryosurgery uses low-temperature cryoablation to freeze and destroy a target tissue.
  • * Electrosurgery involves use of electrocautery to cut and coagulate tissue.
  • * Microsurgery involves the use of an operating microscope for the surgeon to see and manipulate small structures.
  • * Endoscopic surgery uses optical instruments to relay the image from inside an enclosed body cavity to the outside, and the surgeon performs the procedure using specialized handheld instruments inserted through trocars placed through the body wall. Most modern endoscopic procedures are video-assisted, meaning the images are viewed on a display screen rather than through the eyepiece on the endoscope.
  • * Robotic surgery makes use of robotics such as the Da Vinci or the ZEUS robotic surgical systems, to remotely control endoscopic or minimally-invasive instruments.
  • By age:
  • * Fetal surgery treats unborn children.
  • * Pediatric surgery exclusively treats infants, toddlers, children, and adolescents.
  • * Geriatric surgery involves surgical treatment tailored to the specific needs of older adults.

    Terminology

  • Resection and excisional procedures start with a prefix for the target organ to be excised and end in the suffix -ectomy. For example, removal of part of the stomach would be called a subtotal gastrectomy.
  • 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, such as creation of a colostomy, a connection of colon and the abdominal wall. This prefix is also used for connection between two viscera, such as how an esophagojejunostomy refers to a connection created between the esophagus and the jejunum.
  • Plastic and reconstruction procedures start with the name for the body part to be reconstructed and end in -plasty. For example, rhino- is a prefix meaning "nose", therefore a rhinoplasty is a reconstructive or cosmetic surgery for the nose. A pyloroplasty refers to a type of reconstruction of the gastric pylorus.
  • Procedures that involve cutting the muscular layers of an organ end in -myotomy. A pyloromyotomy refers to cutting the muscular layers of the gastric pylorus.
  • Repair of a damaged or abnormal structure ends in -orraphy. This includes herniorrhaphy, another name for a hernia repair.
  • Reoperation, revision, or "redo" procedures refer to a planned or unplanned return to the operating theater after a surgery is performed to re-address an aspect of patient care. Unplanned reasons for reoperation include postoperative complications such as bleeding or hematoma formation, development of a seroma or abscess, anastomotic leak, tissue necrosis requiring debridement or excision, or in the case of malignancy, close or involved resection margins that may require re-excision to avoid local recurrence. Reoperation can be performed in the acute phase, or it can be also performed months to years later if the surgery failed to solve the indicated problem. Reoperation can also be planned as a staged operation where components of the procedure are performed or reversed under separate anesthesia.