Additional Information
Book Details
Abstract
The Seventh Edition of this highly regarded title for surgical trainees gives clear, concise guidance on all aspects of acquiring surgical techniques to ensure operative success. The full range of surgical skills is comprehensively reviewed in a clear ‘how-to-do-it’ style, which consolidates those learnt both in theatre and on training courses. This new edition has been thoroughly revised by a new author based on the much praised editions by its original author Mr R M Kirk. Key Points boxes throughout the text summarise the important aspects of each technique.
- Provides guidance on the full range of surgical techniques required by all trainee surgeons.
- Concentrates on the main principles behind the use of the surgical techniques
- Key Points boxes provide hints and tips to reinforce the main aspects of each technique.
- Now renamed Kirk’s Basic Surgical Techniques a new author has comprehensively revised the text taking full account of new developments in surgical techniques and equipment.
- A new final chapter on the handling the patient.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| IFC_expert consult page | IFC1 | ||
| Half title page | i | ||
| Dedication | ii | ||
| Kirk's Basic Surgical Techniques | iii | ||
| Copyright Page | iv | ||
| Table Of Contents | v | ||
| Raymond Maurice (Jerry) Kirk | vi | ||
| Preface | vii | ||
| Acknowledgements | ix | ||
| 1 Handling yourself | 1 | ||
| Chapter Contents | 1 | ||
| Attitudes – the Five Cs | 2 | ||
| Physical Attributes | 2 | ||
| Hands | 2 | ||
| Stability | 3 | ||
| What Is Skill? | 3 | ||
| Exercises Versus Practice | 4 | ||
| Haptics | 5 | ||
| Transferable Skills | 6 | ||
| Speed | 6 | ||
| Sequence (L sequi = to follow) | 6 | ||
| Skills Courses | 7 | ||
| Thought Processes | 7 | ||
| Rational Assessment of Information | 7 | ||
| Communication | 8 | ||
| Procedural Practice | 8 | ||
| References | 9 | ||
| Further Reading | 9 | ||
| 2 Handling instruments | 10 | ||
| Chapter Contents | 10 | ||
| Scalpel | 10 | ||
| Other ‘Scalpels’ | 12 | ||
| Scissors | 12 | ||
| Dissecting Forceps (Thumb Forceps) | 13 | ||
| Artery Forceps (Haemostatic Forceps, Haemostats) | 14 | ||
| Tissue Forceps | 16 | ||
| Needle-Holders | 16 | ||
| Retractors | 18 | ||
| Clamps | 18 | ||
| Haemostatic Clips | 19 | ||
| Stapling Devices | 19 | ||
| Dissection Aids | 21 | ||
| Electrosurgical dissection | 22 | ||
| Diathermy. | 22 | ||
| Ultrasonic dissection | 23 | ||
| Miscellaneous methods | 23 | ||
| Intraoperative Diagnostic Ultrasound | 24 | ||
| 3 Handling threads | 25 | ||
| Chapter Contents | 25 | ||
| Thread Characteristics | 25 | ||
| Sizes | 26 | ||
| Knots | 26 | ||
| Two-handed knot | 28 | ||
| One-handed knot tied with the left hand | 31 | ||
| Three-finger hitch | 34 | ||
| Knot tied using instruments | 36 | ||
| Laying and tightening knots | 36 | ||
| Tightening under tension | 39 | ||
| Tying knots in cavities | 41 | ||
| Ligatures | 41 | ||
| Stitches | 43 | ||
| Needles | 44 | ||
| Stitching with a curved needle | 46 | ||
| Types of stitch (Fig. 3.67) | 48 | ||
| Interrupted stitches | 49 | ||
| Continuous stitches | 49 | ||
| Choice of Suture Material | 51 | ||
| 4 Handling ducts and cavities | 53 | ||
| Chapter Contents | 53 | ||
| Intubation | 54 | ||
| Percutaneous access | 54 | ||
| Cricothyroid puncture | 56 | ||
| Cricothyrotomy | 56 | ||
| Lumbar puncture | 56 | ||
| Pericardiocentesis | 57 | ||
| Suprapubic cystostomy | 57 | ||
| Peritoneal diagnostic lavage | 58 | ||
| Chest needle thoracentesis | 58 | ||
| Chest drain | 58 | ||
| Direct access | 59 | ||
| Tracheal intubation | 59 | ||
| Oropharyngeal Airway | 60 | ||
| Nasopharyngeal Airway | 60 | ||
| Feeding jejunostomy | 60 | ||
| Urethral catheterisation | 61 | ||
| Fixing catheters and tubes | 62 | ||
| Self-retaining catheters | 62 | ||
| Non–self-retaining catheters | 63 | ||
| Dilating Ducts | 63 | ||
| Bougies | 63 | ||
| Balloons | 66 | ||
| Other methods | 66 | ||
| Endoscopic Access | 67 | ||
| Rigid instruments | 69 | ||
| Sigmoidoscopy | 69 | ||
| Proctoscopy | 70 | ||
| Haemorrhoids | 70 | ||
| Other rigid instruments | 71 | ||
| Flexible endoscopes | 71 | ||
| Display | 72 | ||
| Occlusion | 73 | ||
| Divided duct | 73 | ||
| In continuity | 74 | ||
| Control of leakage | 74 | ||
| Disobliteration | 74 | ||
| Repair | 79 | ||
| Gastrointestinal tract | 79 | ||
| Other ducts and cavities | 79 | ||
| Resection | 80 | ||
| Bowel | 80 | ||
| Other ducts | 80 | ||
| Anastomosis | 81 | ||
| Principles | 81 | ||
| Bowel | 81 | ||
| Alternative methods | 83 | ||
| Mobile bowel, edge to edge, single layer, interrupted stitches | 83 | ||
| Edge to edge, single layer, continuous stitches | 83 | ||
| Fixed bowel, single layer, interrupted stitches | 84 | ||
| Two-layer anastomosis | 84 | ||
| Stapled anastomosis | 84 | ||
| Variations | 86 | ||
| Other ducts | 86 | ||
| Bowel Transfer | 88 | ||
| Sphincters | 88 | ||
| Myotomy | 89 | ||
| Sphincterotomy | 89 | ||
| Sphincteroplasty | 90 | ||
| Sphincter repair | 90 | ||
| Sphincter reversal | 90 | ||
| Acquired Channels and Cavities | 90 | ||
| Sinus | 90 | ||
| Fistula | 91 | ||
| Stoma | 92 | ||
| Cysts | 93 | ||
| Abscesses | 94 | ||
| References | 94 | ||
| 5 Handling blood vessels | 95 | ||
| Chapter Contents | 95 | ||
| Percutaneous Puncture | 96 | ||
| Veins | 96 | ||
| Arteries | 98 | ||
| Percutaneous Cannulation | 99 | ||
| Veins | 99 | ||
| Arteries | 100 | ||
| Percutaneous Catheterisation | 100 | ||
| Seldinger technique | 100 | ||
| Endovascular Procedures | 102 | ||
| Sutures | 103 | ||
| Exposure and Control | 105 | ||
| Incision | 105 | ||
| Veins – Direct Procedures | 106 | ||
| Varicose veins | 108 | ||
| Endovenous ablation | 108 | ||
| Intravascular sclerosants | 108 | ||
| Local avulsions | 109 | ||
| Saphenofemoral ligation | 109 | ||
| Greater saphenous vein stripping | 109 | ||
| Arterial replacement with vein | 110 | ||
| Arteries – Direct Procedures | 110 | ||
| Incision and closure | 111 | ||
| Direct catheterisation | 111 | ||
| Embolectomy | 111 | ||
| Vein patch | 111 | ||
| Arterial Anastomosis | 112 | ||
| End-to-end anastomosis | 112 | ||
| End-to-side anastomosis | 113 | ||
| Microvascular Surgery | 114 | ||
| Basic technique | 115 | ||
| References | 117 | ||
| 6 Handling skin | 118 | ||
| Chapter Contents | 118 | ||
| Structure | 118 | ||
| Healing | 119 | ||
| Open wounds | 119 | ||
| Wound Management | 120 | ||
| Wound closure | 121 | ||
| Analgesia | 122 | ||
| Incision | 122 | ||
| Excision | 124 | ||
| Skin lesions | 124 | ||
| Intradermal or subcutaneous cyst | 125 | ||
| Closure | 125 | ||
| Simple linear | 125 | ||
| Subcuticular stitch | 127 | ||
| Closing defects | 129 | ||
| Grafts | 129 | ||
| Split-skin graft | 130 | ||
| Full-thickness graft | 133 | ||
| Flaps | 133 | ||
| Random pattern flaps | 133 | ||
| Axial pattern flaps | 133 | ||
| Free flaps | 133 | ||
| Z-plasty | 134 | ||
| Transposition flaps | 134 | ||
| Myocutaneous and compound flaps | 134 | ||
| Free Tissue Transfer | 135 | ||
| Tissue Expansion | 135 | ||
| Aesthetic Procedures | 135 | ||
| Liposuction | 135 | ||
| Lipoplasty | 135 | ||
| Clostridium botulinum | 135 | ||
| Breast procedures | 135 | ||
| References | 136 | ||
| Further Reading | 136 | ||
| 7 Handling connective and soft tissues | 137 | ||
| Chapter Contents | 137 | ||
| Percutaneous Diagnostic Procedures | 138 | ||
| Aspiration of fluid for cytological examination | 138 | ||
| Needle biopsy | 139 | ||
| Open biopsy | 139 | ||
| Connective Tissue | 140 | ||
| Areolar tissue | 140 | ||
| Aponeuroses | 141 | ||
| Tendons | 141 | ||
| Ligaments | 142 | ||
| Nerves | 143 | ||
| Skeletal Muscle | 143 | ||
| Cartilage | 144 | ||
| Mucoperiosteum | 144 | ||
| Breast | 145 | ||
| Lymph Nodes | 145 | ||
| Sentinel node biopsy | 146 | ||
| Fat transfer | 146 | ||
| Abdominal Wall | 147 | ||
| Midline abdominal incision | 147 | ||
| Gridiron incision | 148 | ||
| Hernia | 149 | ||
| Abdominal Contents | 150 | ||
| Bowel | 150 | ||
| Liver | 150 | ||
| Spleen | 151 | ||
| Pancreas | 151 | ||
| Urological System | 151 | ||
| Kidney | 151 | ||
| Ureter | 151 | ||
| Bladder | 151 | ||
| Testis | 151 | ||
| Penis | 152 | ||
| Gynaecological System | 152 | ||
| Uterus | 152 | ||
| Ovaries | 152 | ||
| Cardiorespiratory System | 152 | ||
| Lung | 152 | ||
| Heart | 152 | ||
| Endocrine System | 152 | ||
| Brain and Spinal Cord | 152 | ||
| Reference | 153 | ||
| 8 Handling bone and joints | 154 | ||
| Chapter Contents | 154 | ||
| Bone | 154 | ||
| Physical characteristics | 154 | ||
| Exposure | 155 | ||
| Steadying | 155 | ||
| Biopsy | 155 | ||
| Cutting | 156 | ||
| Hand saw | 156 | ||
| Gigli saw | 156 | ||
| Powered saws (Fig. 8.4) | 157 | ||
| Osteotome | 157 | ||
| Chisel | 158 | ||
| Bone-cutting forceps | 158 | ||
| Rongeurs | 158 | ||
| File or rasp | 159 | ||
| Drilling | 159 | ||
| Fixing | 161 | ||
| Screws | 161 | ||
| Stitching | 163 | ||
| Wiring | 163 | ||
| Plates | 164 | ||
| External fixators | 166 | ||
| Intramedullary fixation | 166 | ||
| Bone grafts | 167 | ||
| Amputation | 168 | ||
| Joints | 168 | ||
| Cartilage | 170 | ||
| Ligaments | 170 | ||
| Tendon Insertion | 170 | ||
| 9 Handling dissection | 171 | ||
| Chapter Contents | 171 | ||
| Organize | 171 | ||
| Expose | 172 | ||
| Dissection Methods | 173 | ||
| Sharp | 173 | ||
| Blunt | 174 | ||
| Instrumental (see also Ch. 2) | 176 | ||
| Layered or Solid Tissues? | 177 | ||
| Tissue Planes | 177 | ||
| Solid Tissues | 179 | ||
| Imaging | 179 | ||
| Dissecting | 179 | ||
| Diseased Tissues | 181 | ||
| Neoplasms | 182 | ||
| Aids to Dissection | 183 | ||
| Anatomy | 183 | ||
| Palpation | 183 | ||
| Haemostasis | 183 | ||
| Find a safe starting point | 183 | ||
| Tension | 183 | ||
| Dissecting around structures | 184 | ||
| Needles | 185 | ||
| Fluid infiltration | 186 | ||
| Transillumination | 186 | ||
| Probes and catheters | 186 | ||
| Dyes | 186 | ||
| Marker stitch | 186 | ||
| Intraoperative ultrasound scanning | 186 | ||
| Flexibility | 186 | ||
| Priorities | 186 | ||
| Reference | 187 | ||
| 10 Handling bleeding | 188 | ||
| Chapter Contents | 188 | ||
| Haemorrhage | 188 | ||
| Prevention | 188 | ||
| Aids | 190 | ||
| Elevation | 190 | ||
| Fluid infiltration | 190 | ||
| Transillumination | 190 | ||
| Tourniquet | 190 | ||
| Technical aids (see also Ch. 2) | 190 | ||
| Control | 191 | ||
| Intracavity bleeding | 193 | ||
| Intracranial Bleeding | 194 | ||
| 11 Handling drains | 195 | ||
| Chapter Contents | 195 | ||
| Caution | 195 | ||
| Types | 196 | ||
| Packs and wicks | 196 | ||
| Sheet drains | 196 | ||
| Tube drains | 197 | ||
| Sites | 199 | ||
| Subcutaneous | 199 | ||
| Subfascial and intramuscular | 199 | ||
| Extraperitoneal | 199 | ||
| Intraperitoneal | 199 | ||
| Pleural cavity | 200 | ||
| Abscesses and Cysts | 201 | ||
| External Fistulas | 202 | ||
| Negative Pressure Wound Healing | 202 | ||
| Reference | 202 | ||
| 12 Handling infection | 203 | ||
| Chapter Contents | 203 | ||
| Principles | 203 | ||
| Infections | 204 | ||
| Cellulitis | 204 | ||
| Necrotizing fasciitis | 204 | ||
| Pyomyositis | 204 | ||
| Pseudomembranous colitis | 204 | ||
| Abscess | 204 | ||
| Sepsis | 205 | ||
| Viral Transmission | 205 | ||
| Universal Precautions | 205 | ||
| Trauma | 206 | ||
| Preoperative | 206 | ||
| Operating Routines | 207 | ||
| Operation | 207 | ||
| Bleeding | 208 | ||
| Surgical Site Infection | 208 | ||
| Treating Infections | 209 | ||
| Cellulitis | 209 | ||
| Necrotizing fasciitis | 209 | ||
| Abscess | 209 | ||
| References | 210 | ||
| Further Reading | 210 | ||
| 13 Handling minimal access surgery | 211 | ||
| Chapter Contents | 211 | ||
| Examples | 211 | ||
| Laparoscopy | 212 | ||
| Access | 212 | ||
| Closed pneumoperitoneum | 212 | ||
| Open pneumoperitoneum | 213 | ||
| Placing a Second Cannula (Port) | 214 | ||
| Technical Aspects | 214 | ||
| Closure | 216 | ||
| Acquiring Skills | 217 | ||
| Other Procedures | 219 | ||
| Robotic surgery | 221 | ||
| References | 221 | ||
| Further Reading | 221 | ||
| 14 Handling the patient | 222 | ||
| Chapter Contents | 222 | ||
| Preoperative Factors | 222 | ||
| Physical preparedness | 222 | ||
| Allergy | 223 | ||
| Anticoagulation | 223 | ||
| Antiplatelet agents | 223 | ||
| Age | 223 | ||
| Nutritional status | 223 | ||
| Immunosuppression | 223 | ||
| Previous surgery | 223 | ||
| Anaesthetic preassessment | 223 | ||
| Optimization | 224 | ||
| Psychological preparedness | 224 | ||
| Types of consent form | 224 | ||
| Planning the Order of an Operating List | 225 | ||
| Periprocedural Factors | 225 | ||
| Preprocedural marking | 225 | ||
| Nil By Mouth (NBM) | 225 | ||
| Special equipment | 225 | ||
| Radiographer | 225 | ||
| Frozen section | 226 | ||
| Intensive therapy unit | 226 | ||
| Prion disease | 226 | ||
| Nonspecimen retention of tissue | 226 | ||
| In the Operating Theatre | 226 | ||
| Deep vein thrombosis prophylaxis | 226 | ||
| Positioning on the table | 226 | ||
| Protection of pressure areas | 227 | ||
| Diathermy pad | 227 | ||
| Implanted devices | 227 | ||
| Local anaesthetic infiltration | 227 | ||
| Warming devices | 227 | ||
| Wearing appropriate personal protective wear | 227 | ||
| Skin preparation | 227 | ||
| Swab, needle and instrument count | 227 | ||
| Postoperative team briefing | 227 | ||
| Writing the operation note | 228 | ||
| Postoperative Care | 228 | ||
| Emergency Procedures | 228 | ||
| Reference | 228 | ||
| 15 Handling craft skills | 229 | ||
| Chapter Contents | 229 | ||
| Physician/Surgeon | 229 | ||
| Skills Courses | 230 | ||
| Operating Precepts | 231 | ||
| Gentleness | 231 | ||
| ‘Setting up’ | 231 | ||
| Speed | 232 | ||
| Sequence | 232 | ||
| Strategy/tactics | 232 | ||
| Tissue oxygenation | 233 | ||
| Emergencies | 233 | ||
| Error Avoidance | 233 | ||
| Assisting at Operations | 234 | ||
| Mentoring | 235 | ||
| Ten reminders | 235 | ||
| Common Sense | 236 | ||
| References | 236 | ||
| Index | 237 | ||
| A | 237 | ||
| B | 237 | ||
| C | 238 | ||
| D | 238 | ||
| E | 239 | ||
| F | 239 | ||
| G | 239 | ||
| H | 239 | ||
| I | 239 | ||
| J | 240 | ||
| K | 240 | ||
| L | 240 | ||
| M | 240 | ||
| N | 240 | ||
| O | 240 | ||
| P | 241 | ||
| Q | 241 | ||
| R | 241 | ||
| S | 241 | ||
| T | 242 | ||
| U | 242 | ||
| V | 242 | ||
| W | 243 | ||
| Y | 243 | ||
| Z | 243 |