1.) Types of incisions One of the most common types of incisions is the midline incision.

This incision is the most common incision used to open up the abdominal cavity during surgery. It is a vertical incision that follows the line of the linea alba. There are different versions of the midline incision which include the upper midline incision, which usually goes from the xiphoid process to the umbilicus, and the lower midline incision, which is a cut from underneath the umbilicus to the pubic symphysis. These incisions tend to provide the most unfettered access to organ and soft tissue structure within the abdominal cavity and heal relatively easily. A midline incision is a vertical cut made in the abdomen to allow access for any of a number of medical procedures. This cut may be made in the upper or lower portion of the abdomen, or it may run all the way from the top to the bottom of the abdominal cavity. The midline incision allows the doctor to access the internal organs including the stomach, pancreas, bladder, and liver. It is commonly used during trauma surgery, when immediate access to a wide range of internal organs is essential. The upper midline incision usually extends from the xiphoid process to the umbilicus. A typical lower midline incision is limited by the umbilicus superiorly and by the pubic symphysis inferiorly. Sometimes a single incision extending from xiphoid process to pubic symphysis is employed, especially in trauma surgery. Transverse incisions in abdominal surgery are based on better anatomical and physiological principles. They should be recommended, as the early postoperative period is associated with fewer complications (pain, burst abdomen, and pulmonary morbidity) and there is lower incidence of late incisional hernia after transverse compared with vertical laparotomy. Subcostal abdominal incision is also known as Kochers incision. Right subcostal is mainly used for open cholecystectomy and left subcostal is for splenectomy. A combination of both is called a roof-top incision, useful in gastric and hepatopancreatobiliary surgery. Other common laparotomy incisions include: the Kocher (right subcostal) incision (after Emil Theodor Kocher); appropriate for certain operations on the liver, gallbladder and biliary tract.[1][2] This shares a name with the Kocher incision used for thyroid surgery: a transverse, slightly curved incision about 2 cm above the sternoclavicular joints; the Davis or Rockey-Davis "muscle-splitting" right lower quadrant incision for appendectomy; the Pfannenstiel incision, a transverse incision below the umbilicus and just above the pubic symphysis.[3][4] In the classic Pfannenstiel incision, the skin and subcutaneous tissue are incised transversally, but the linea alba is opened vertically. It is the incision of choice for Cesarean section and for abdominal hysterectomy for benign disease. A variation of this incision is the Maylard incision in which the rectus abdominis muscles are sectioned transversally to permit wider access to the pelvis.[5] Lumbotomy consists of a lumbar incision which permits access to the kidneys (which are

retroperitoneal) without entering the peritoneal cavity. It is typically used only for benign renal lesions. It has also been proposed for surgery of the upper urological tract.[6] Cherney Incision 2.)Minor surgery - any surgical procedure that does not involve anesthesia or respiratory assistance during the surgical procedure, - a medical procedure involving an incision with instruments; performed to repair damage or arrest disease in a living body( Ex. Hemorhoids, Tissue neurosis in absces There are many conditions that can be treated quickly and easily by: - vaporisation with electrical diathermy (Example: Warts destrucition) - simple excision (Example: Mole biopsy) This just requires a little local anaesthetic and a few minutes of your time. Major surgery - any surgical procedure that involves anesthesia or respiratory assistance. Minor surgery can involve the use of local, regional anesthesia. (We do not perform this here Scalpel: This is a surgical knife that comes with a sharp stainless steel blades. Whether it is a minor or a major surgery, a correct surgical incision is a must, which is not possible without a scalpel. Each and every surgery has its own specific needs. For instance, a minor surgery will require a small incision whereas a major surgery may demand an incision deep into the skin tissues. So taking this into consideration, scalpels are manufactured in a variety of sizes. The blades of scalpel are detachable and many times this instrument is designed for one time use only. Surgical Staples: Talking about list of surgical instruments and one simply cannot forget to mention about surgical staples. Normally, an incision made or an open wound that occurs during surgery cannot be left open as it can trigger internal bleeding. A common practice is to seal these cuts using stitches but nowadays surgeons to use surgical staples instead of stitches. The main advantage is that the possibility of blood leaking from a wound closed by a surgical staple is minimal. Apart from closing the incision, surgical staples are also useful to reattach and remove portions of certain organs. For instance, a bowel surgery may demand cutting certain parts of the intestine and reconnecting the remaining portion of the intestine. This can be effectively and precisely done using surgical staples. Needle Holders: As we all know, stitching the body tissues that are cut at the time of surgery is a very important task. Even a slight mistake while sewing the tissue is likely to make the patient uncomfortable days after completing the surgery. An improperly sewn skin tissue can be a cause of great pain and may require another surgery to correct it. To avoid all these complications and to carry out sewing of tissues accurately, surgeons often make use of needle holders. These instruments allow the surgeon to hold the needle firmly while stitching the required tissue. A needle holder that has a shape similar to a scissor, consists of straight, smooth jaws, joints and handles. It comes with a tungsten carbide inserts that are attached at the end of both the

jaws. They ensure that the needle does not move while sewing tissues. In simple words, these instruments are designed to provide a strong grip on the needle, thereby substantially reducing the chances of any error during this stage of surgery. Retractors: When an incision is made, it has to be kept open during surgery. This job of keeping the incision wide open is done by retractors. These instruments are used to pull back the tissues so that the surgeon can easily access the operation site and perform the surgery without any hindrance. Sometimes, even the organs have to be held back using retractors, so as to expose the surgical site to the desired level. Retractors are made available in different sizes and shapes. Also, there are different types of retractors and each one is designed to retract a specific organ. For instance, lung retractors may be used to push aside the lungs gently for getting an unobstructed view of the surgical site. Be it a gallbladder surgery or a breast reduction surgery, it cannot be done without retractors. Forceps: Forceps are like kitchen tongs that allow the surgeon to grasp and hold skin tissues firmly. Whether it is holding a part of intestine or clamping the arteries during operation, one can always rely on these forceps. Also, this surgical instrument comes in a range of sizes so that the surgeon can choose one depending upon his specific needs. Forceps that are designed to hold a baby's head are quite large and their main purpose is to safely remove the baby from the birth canal during a cesarean. Scissors: As the name suggests, this surgical instrument is mainly used to cut body tissues. Scissors used in surgery come in two main types: Mayo and Metzenbaum scissors. When it comes to cutting or dissecting soft delicate tissues, surgeons prefer the metzenbaum scissors. The Mayo scissors are used for cutting hard tissues such as joints. Thick tissues located in the breast and the muscles can also be cut using Mayo scissors. Usually, these scissors are made up of stainless steel and are manufactured in variable lengths. Types of anesthesia Local anesthesia numbs a small part of the body. You get a shot of medicine (anesthetic) directly into the surgical area to block pain. Sometimes the doctor will apply a numbing medicine to part of your body, such as your nose or mouth. Local anesthesia is used only for minor procedures. You may stay awake during the procedure, or you may get medicine to help you relax or sleep. Regional anesthesia blocks pain to a larger part of your body. Anesthetic is injected around major nerves or the spinal cord. You may get medicine to help you relax or sleep. Major types of regional anesthesia include: Peripheral nerve blocks. A nerve block is a shot of anesthetic near a specific nerve or group of nerves. It blocks pain in the part of the body supplied by the nerve. Nerve blocks are most often used for procedures on the hands, arms, feet, legs, or face. Epidural and spinal anesthesia. This is a shot of anesthetic near the spinal cord and the nerves that connect to it. It blocks pain from an entire region of the body, such as the belly,

hips, or legs. General anesthesia affects the brain as well as the entire body. You may get it through a vein (intravenously, or IV), or you may breathe it in. With general anesthesia, you are completely unaware and do not feel pain during the surgery. General anesthesia often causes you to forget the surgery and the time right aft Medications, uses Anesthetics are used to prevent you from experiencing pain during surgery. Anesthetics can be used on an area of a person's body---called a local anesthetic---or on the entire body for major surgery. Anesthetics also can prevent the body from going into shock. Anesthesia may be used to: Relax you. Block pain. Make you sleepy or forgetful. Make you unconscious for your surgery. 15 principles of aseptic technique Other principles that are applied to maintain asepsis in the operating room include: All items in a sterile field must be sterile. Sterile packages or fields are opened or created as close as possible to time of actual use. Moist areas are not considered sterile. Contaminated items must be removed immediately from the sterile field. Only areas that can be seen by the clinician are considered sterile (i.e., the back of the clinician is not sterile). Gowns are considered sterile only in the front, from chest to waist and from the hands to slightly above the elbow. Tables are considered sterile only at or above the level of the table. Nonsterile items should not cross above a sterile field. There should be no talking, laughing, coughing, or sneezing across a sterile field. Personnel with colds should avoid working while ill or apply a double mask. Edges of sterile areas or fields (generally the outer inch) are not considered sterile. When in doubt about sterility, discard the potentially contaminated item and begin again. A safe space or margin of safety is maintained between sterile and nonsterile objects and areas.
When pouring fluids, only the lip and inner cap of the pouring container is considered sterile; the pouring container should not touch the receiving container, and splashing should be avoided. Tears in barriers and expired sterilization dates are considered breaks in sterility. The Perioperative Nurse's Duties and Responsibilities Surgical Nursing Defined The perioperative nurse is responsible and accountable for the major nursing activities occurring in the surgical suite. These include, but are not limited to the following: Assessing of the patient's physiological and psychological status before, during, and after surgery Identifying priorities and implementing care based on sound nursing judgment and individual patient needs

 Functioning as a role model of a professional perioperative nurse for students and colleagues Functioning as a patient advocate by protecting the patient from incompetent, unethical, or illegal practices during the perioperative period Coordinating all activities associated with the implementation of nursing care by other members of the health-care team Demonstrating a thorough knowledge of aseptic principles and techniques to maintain a safe and therapeutic surgical environment Directing or assisiting with the care and handling of all supplies, equipment, and instruments, to ensure their economic and efficient function for the patient and personnel under both normal and hazardous conditions Performing as a scrub or circulating nurse as needed, based on knowledge and expertise for a specific procedure Participating in continuing education programs directed toward personal and professional growth and development Participating in professional organizational and research activities that support and enhance perioperative nursing practice Operating Room Nursing Activities Circulating Nurse Perioperative nursing practice has one continuous goal: to provide a standard of excellence in the care of the patient before, during, and after surgery. As the only nonscrubbed member of the surgical team, besides anesthesia, the circulating nurse represents the coordinating link between the scrub team and all other departments and personnel associated with the surgical patient and the procedure. Other departments that may be involved in the patient's surgical experience include, but are not limited to, x-ray, pathology, blood bank, laboratory, blood gas lab, tissue banking, mammography, and radiation oncology. The Circulating nurse, by virtue of her professional educational preparation and specialized skill, is responsible for managing patient care activities in the operating suite, so his/her duties begin long before the patient arrives in the operating room and continues until the final dispensation of the patient, operating room records, and specimens is completed. The following list depicts some of the activities performed by the circulating nurse prior to induction of anesthesia, during the procedure, and upon conclusion of the procedure: Assisting and preparing the procedure room Supervising the transporting, moving, and lifting of the patient Assisting anesthesia as requested during induction and reversal of anesthesia Positioning the patient for surgery Performing the surgical skin prep Conducting and maintaining accurate records of counts Maintaining accurate documentation of nursing activities during the procedure Dispensing supplies and medications to the surgical field Maintaining an aseptic and safe environment Estimating fluid and blood loss Handling special equipment, specimens, etc Communicating special postoperative needs to appropriate persons at the conclusion of the case Function of PACU Nurse: PACU nurses are typically responsible for providing patient care during the immediate postoperative recovery period. PACU nurses typically have training in basic life support measures, airway management, acute surgical wound care, catheter procedures and the special requirements associated with anesthesia. PACU nurses may also be trained in the use of cardiac life support equipment.