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OT Resource for K9 Overview of Surgical Procedures

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OT Resource for K9 Overview of surgical procedures Prepared by: Hannah Woolley Stage Level 1 2 Gynecology/Oncology Surgeries Lymphadenectomy (lymph node dissection) Surgical removal of lymph nodes Radical: most/all of the lymph nodes in tumour area are removed Regional: some of the lymph nodes in the tumour area are removed Omentectomy Surgical procedure to remove the omentum (thin abdominal tissue that encases the stomach, large intestine and other abdominal organs) Indications for omenectomy: Ovarian cancer Sometimes performed in combination with TAH/BSO Posterior Pelvic Exenteration Surgical removal of rectum, anus, portion of the large intestine, ovaries, fallopian tubes and uterus (partial or total removal of the vagina may also be indicated) Indications for pelvic exenteration Gastrointestinal cancer (bowel, colon, rectal) Gynecological cancer (cervical, vaginal, ovarian, vulvar) Radical Cystectomy Surgical removal of the whole bladder and proximal lymph nodes In men, prostate gland is also removed In women, ovaries and uterus may also be removed Following surgery: Urostomy (directs urine through a stoma on the abdomen) Recto sigmoid pouch/Mainz II pouch (segment of the rectum and sigmoid colon used to provide anal urinary diversion) 3 Radical Vulvectomy Surgical removal of entire vulva (labia, clitoris, vestibule, introitus, urethral meatus, glands/ducts) and surrounding lymph nodes Indication for radical vulvectomy Treatment of vulvar cancer (most common) Sentinel Lymph Node Dissection (SLND) Exploratory procedure where the sentinel lymph node is removed and examined to determine if there is lymph node involvement in patients diagnosed with cancer (commonly breast cancer) Total abdominal hysterectomy/bilateral saplingo-oophorectomy (TAH/BSO) Surgical removal of the uterus (including cervix), both fallopian tubes and ovaries Indications for TAH/BSO: Uterine fibroids: benign growths in the muscle of the uterus Endometriosis: condition where uterine tissue grows on structures outside the uterus (i.e. fallopian tubes, ovaries, other pelvic structures) Abnormal uterine bleeding Chronic pelvic pain Endometrial cancer Gynecologic cancer (vulvar, vaginal, ovarian, cervical) 4 Hepato-Biliary Surgery Distal Pancreatectomy Surgical removal of the lower half of the pancreas, often accompanied by removal of the spleen (splenectomy) Can be performed openly (one large incision) or laparoscopically (multiple small incisions). Recovery is more rapid with laparoscopic procedure. Major Hepatectomy Resection of four or more liver segments to remove invasive masses or metastases Pancreaticduodenectomy (Whipple procedure) Surgical removal of the head of the pancreas, gallbladder, portion of the duodenum, small portion of the pylorus (part of the stomach), lymph nodes near the pancreas. Indication for pancreaticduodectomy Removal of tumours in the pancreas (most common) Common complication: Delayed gastric emptying, sometimes resulting in the need for feeding tube post-op 5 General Surgeries Appendectomy Surgical removal of the appendix Can be performed openly (one large incision) or laparoscopically (multiple small incisions). Recovery is more rapid with laparoscopic procedure. Cholecystectomy Surgical removal of the gallbladder (often due to gallstones causing pain/infection) Can be performed openly or laparoscopically. Recovery is more rapid with laparoscopic procedure. Incisional (Ventral) Hernia Repair Surgical repair of a ventral hernia, which appears following incisions made during surgery, most commonly in the middle of the abdomen. The hernia is repaired using synthetic mesh to prevent further damage/recurrence. Can be performed openly or laparoscopically. Recovery is more rapid with laparoscopic procedure. Inguinal Hernia Repair Surgical repair of inguinal/groin hernia where the weakness in the abdominal wall is repaired and patched with synthetic mesh Can be performed openly or laparoscopically. Recovery is more rapid with laparoscopic procedure. Lysis of Adhesions (Adhesiolysis) Surgical separation of structures in the abdomen (i.e. scar tissue) following surgery in order to prevent complications Most common complication as a result of adhesions is small bowel obstruction, which can necessitate further surgical interventions Nephrostomy An opening created between the kidney and the skin in order to drain urine in the event of an infection or blockage in the ureter. A nephrostomy tube connects to a pouch that collects the urine on the outside of the body. 6 Colorectal surgeries Colectomy Partial or total removal of the colon (large intestine), rectum and/or anus Can be performed openly (one large incision) or laparoscopically (multiple small incisions). Recovery is more rapid with laparoscopic procedure. Indications for colectomy: Rectal cancer Polyps (growths) in the lining of the colon Diverticulitis Inflammatory Bowel Disease Crohn’s disease Ulcerative colitis Uncontrolled bleeding Hartmann’s Procedure (Proctosigmoidectomy) Surgical removal of a portion of the sigmoid colon and/or rectum Sometimes performed in combination with colostomy if the bowel cannot be re- joined Indications for Hartmann’s Procedure Abscess Diverticular disease Bowel cancer Ileo/Colostomy (Colon Resection) Ileostomy: surgical procedure where the small intestine is routed outside the body on the abdomen to form a stoma, where a pouch is attached to collect stool. This is often performed in conjunction with colectomy (removal of the colon, rectum and/or anus) Colostomy: surgical procedure where the large intestine is routed outside the body on the abdomen to form a stoma, where a pouch is attached to collect stool. Both procedures can be permanent (long-term) or temporary (short-term) 7 Useful Terminology Jackson Pratt (JP) drain: small bulb that uses negative pressure to drain fluid from incision or wound; closed drain that reduces the risk of infection Commonly seen in: Radical vulvectomy Abdominal surgery Mastectomy Thoracic surgery https://www.mskcc.org/cancer-care/patient-education/caring-your-jackson-pratt-drainage-system Pigtail drain: routes unwanted fluids away from an organ, duct or abscess. Inserted by a radiologist. Commonly seen in: Nephrostomy Bile draining Pleural effusion https://www.cookmedical.com/products/uro_pigtail025_webds/ 8 Chest tube: drainage system to remove fluid, air or blood from pleural (chest) space Indicated for: Haemothorax: collection of blood in pleural space Pneumothorax: collection of air in pleural space Chylothorax: collection of fluid in pleural space Pleural effusion: exudate/transudate in pleural space Chest tubes can be very sensitive/painful; therefore patients will likely have regular pain medication for management Drain should never be lifted above chest level, as it relies solely on gravity http://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Chest_Drain_Management/ Nasogastric (NG) tube: tube that passes through the nostril to the stomach, Commonly used for: Feeding (i.e. TPN) http://www.oxfordmedicaleducation.com/clinical-skills/procedures/nasogastric-ng-tube/ 9 Foley Urinary Catheter: thin flexible tube inserted into the bladder through the urethra, which drains urine into a bag outside the body http://sterigear.com/the-fig-leaf/ PleurX Catheter: system to drain fluid found in pleural effusion and ascites (excessive build up of fluid in the abdomen) http://www.sind.si/html/__pleurx_drainage_kit.htm Double J Stent (Ureteric stent): thin, hollow tube placed in the ureter, creating an unobstructed pathway between the kidney to the bladder Commonly used: Kidney stones Post-operatively to ensure urinary drainage Photo:http://www.kidneystoneclinic.com.au/urinary-tract-double-j.html 10 Colostomy/Ileostomy pouch: Collects stool from abdominal stoma (large intestine routed outside the body through opening on the abdomen) Commonly seen in: Colectomy Colostomy/Ileostomy https://www.mskcc.org/cancer-care/patient-education/posterior-pelvic-exenteration Peripherally Inserted Central Catheter (PICC) Line: Intravenous (IV) tube that remains inserted and protrudes on the outside of the patient’s body so that it is easily accessible for taking blood and providing medication (without having to perform multiple injections) http://www.macmillan.org.uk/information-and-support/treating/chemotherapy/being-treated-with-chemotherapy/picc-lines.html 11 Normal Values for Vital Signs Heart Rate (HR): 72 beats/minute Blood Pressure (BP): 110-140/70-90 mmHg Respiratory Rate (RR): 12-15/minute Temperature: 37 degrees Celsius (orally) Oxygen saturation (SaO2): 92-97% 12 Works Cited American Cancer Society. (2014). What is a urostomy?. Retrieved from https://www.cancer.org/treatment/treatments-and-side- effects/physical-side-effects/ostomies/urostomy/what-is-urostomy.html American Cancer Society. (2017). What is an ileostomy?. Retrieved from https://www.cancer.org/treatment/treatments-and-side- effects/physical-side-effects/ostomies/ileostomy/what-is-ileostomy.html American College of Obstetricians and Gynecologists. (2015). Hysterectomy. Retrieved from http://www.acog.org/Patients/FAQs/Hysterectomy American College of Surgeons. (2015). Cholesystectomy: Surgical removal of the gallbladder. Retrieved from https://www.facs.org/~/media/files/education/patient%20ed/cholesys.ashx Bard Medical Inc. (n.d.). Foley catheter care and maintenance. Retrieved from http://www.bardmedical.com/media/629466/ud_foleycatheterpteducationguide.pdf BD. (2017). PleurX drainage system.
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