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Surgery Information

Surgery (from the Greek: χειρουργική cheirourgikē, via Latin: chirurgiae, meaning "hand work") is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.

An act of performing surgery may be called a surgical procedure, operation, or simply surgery. In this context, the verb operate means to perform surgery. The adjective surgical means pertaining to surgery; e.g. surgical instruments or surgical nurse. The patient or subject on which the surgery is performed can be a person or an animal. A surgeon is a person who performs operations on patients. Persons described as surgeons are commonly physicians, but the term is also applied to podiatrists, dentists (known as oral and maxillofacial surgeons) and veterinarians. A surgery can last from minutes to hours, but is typically not an ongoing or periodic type of treatment. The term surgery can also refer to the place where surgery is performed, or simply the office of a physician, dentist, or veterinarian.

Contents

Definitions of surgery

Surgery is a 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 (e.g. laser ablation of the cornea) or to a radiosurgical procedure (e.g. irradiation of a tumor).

Types of surgery

Surgical procedures are the commonly categorized by urgency, type of procedure, body system involved, degree of invasiveness, and special instrumentation.

Terminology

Description of surgical procedure

At a hospital, modern surgery is often done in an operating theater using surgical instruments, an operating table for the patient, and other equipment. The environment and procedures used in surgery are governed by the principles of aseptic technique: the strict separation of "sterile" (free of microorganisms) things from "unsterile" or "contaminated" things. All surgical instruments must be sterilized, and an instrument must be replaced or re-sterilized if it becomes contaminated (i.e. handled in an unsterile manner, or allowed to touch an unsterile surface). Operating room staff must wear sterile attire (scrubs, a scrub cap, a sterile surgical gown, sterile latex or non-latex polymer gloves and a surgical mask), and they must scrub hands and arms with an approved disinfectant agent before each procedure.

Prior to surgery, the patient is given a medical examination, certain pre-operative tests, and their physical status is rated according to the ASA physical status classification system. If these results are satisfactory, the patient signs a consent form and is given a surgical clearance. If the procedure is expected to result in significant blood loss, an autologous blood donation may be made some weeks prior to surgery. If the surgery involves the digestive system, the patient may be instructed to perform a bowel prep by drinking a solution of polyethylene glycol the night before the procedure. Patients are also instructed to abstain from food or drink (an NPO order after midnight on the night before the procedure, to minimize the effect of stomach contents on pre-operative medications and reduce the risk of aspiration if the patient vomits during or after the procedure.

In the pre-operative holding area, the patient changes out of his or her street clothes and is asked to confirm the details of his or her surgery. A set of vital signs are recorded, a peripheral IV line is placed, and pre-operative medications (antibiotics, sedatives, etc.) are given. When the patient enters the operating room, the skin surface to be operated on, called the operating field, is cleaned and prepared by applying an antiseptic such as chlorhexidine gluconate or povidone-iodine to reduce the possibility of infection. If hair is present at the surgical site, it is clipped off prior to prep application. The patient is assisted by an anesthesiologist or resident to make a specific surgical position, then sterile drapes are used to cover all of the patient's body except for the head and the surgical site or at least a wide area surrounding the operating field; the drapes are clipped to a pair of poles near the head of the bed to form an "ether screen", which separates the anesthetist/anesthesiologist's working area (unsterile) from the surgical site (sterile).

Anesthesia is administered to prevent pain from incision, tissue manipulation and suturing. Based on the procedure, anesthesia may be provided locally or as general anesthesia. Spinal anesthesia may be used when the surgical site is too large or deep for a local block, but general anesthesia may not be desirable. With local and spinal anesthesia, the surgical site is anesthetized, but the patient can remain conscious or minimally sedated. In contrast, general anesthesia renders the patient unconscious and paralyzed during surgery. The patient is intubated and is placed on a mechanical ventilator, and anesthesia is produced by a combination of injected and inhaled agents.

An incision is made to access the surgical site. Blood vessels may be clamped to prevent bleeding, and retractors may be used to expose the site or keep the incision open. The approach to the surgical site may involve several layers of incision and dissection, as in abdominal surgery, where the incision must traverse skin, subcutaneous tissue, three layers of muscle and then peritoneum. In certain cases, bone may be cut to further access the interior of the body; for example, cutting the skull for brain surgery or cutting the sternum for thoracic (chest) surgery to open up the rib cage.

Work to correct the problem in body then proceeds. This work may involve:

  • clearing clogged ducts, blood or other vessels
  • removal of calculi (stones)
  • draining of accumulated fluids
  • debridement- removal of dead, damaged, or diseased tissue

Blood or blood expanders may be administered to compensate for blood lost during surgery. Once the procedure is complete, sutures or staples are used to close the incision. Once the incision is closed, the anesthetic agents are stopped and/or reversed, and the patient is taken off ventilation and extubated (if general anesthesia was administered).

After completion of surgery, the patient is transferred to the post anesthesia care unit and closely monitored. When the patient is judged to have recovered from the anesthesia, he/she is either transferred to a surgical ward elsewhere in the hospital or discharged home. During the post-operative period, the patient's general function is assessed, the outcome of the procedure is assessed, and the surgical site is checked for signs of infection. There are several risk factors associated with post operative complications, such as immune deficienty and obesity. Obesity has long been considered a risk factor for adverse post-surgical outcomes. It has been linked to many disorders such as obesity hypoventilation syndrome, atelectasis and pulmonary embolism, adverse cardiovascular affects, and wound healing complications.[2] If removable skin closures are used, they are removed after 7 to 10 days post-operatively, or after healing of the incision is well under way.

Post-operative therapy may include adjuvant treatment such as chemotherapy, radiation therapy, or administration of medication such as anti-rejection medication for transplants. Other follow-up studies or rehabilitation may be prescribed during and after the recovery period.

In special populations

Elderly people

Older adults have widely varying physical health. Frail elderly people are at significant risk of post-surgical complications and the need for extended care. Assessment of older patients before elective surgeries can accurately predict the patients' recovery trajectories.[3] One frailty scale uses five items: unintentional weight loss, muscle weakness, exhaustion, low physical activity, and slowed walking speed. A healthy person scores 0; a very frail person scores 5. Compared to non-frail elderly people, people with intermediate frailty scores (2 or 3) are twice as likely to have post-surgical complications, spend 50% more time in the hospital, and are three times as likely to be discharged to a skilled nursing facility instead of to their own homes.[3] Frail elderly patients (score of 4 or 5) have even worse outcomes, with the risk of being discharged to a fraternity rising to twenty times the rate for non-frail elderly people.

History

Main articles: History of surgery, Prehistoric medicine, and History of general anesthesia

The earliest known compendium on Surgery were penned down by ancient Indians. Sushruta was an in ancient Indian sage who had extensively described about various surgeries in Sushruta Samhita ranging from rhinoplasties, labioplasties and ceasarians. At least two prehistoric cultures had developed forms of surgery. The oldest for which there is evidence is trepanation,[4] in which a hole is drilled or scraped into the skull, thus exposing the dura mater in order to treat health problems related to intra cranial pressure and other diseases. Evidence has been found in prehistoric human remains from Neolithic times, in cave paintings, and the procedure continued in use well into recorded history. Surprisingly, many prehistoric and premodern patients had signs of their skull structure healing; suggesting that many survived the operation. Remains from the early Harappan periods of the Indus Valley Civilization (c. 3300 BCE) show evidence of teeth having been drilled dating back 9,000 years.[5] A final candidate for prehistoric surgical techniques is Ancient Egypt, where a mandible dated to approximately 2650 BCE shows two perforations just below the root of the first molar, indicating the draining of an abscessed tooth.

Hippocrates stated in the oath (c. 400 BC) that general physicians must never practice surgery and that surgical procedures are to be conducted by specialists.

The oldest known surgical texts date back to ancient Egypt about 3500 years ago. Surgical operations were performed by priests, specialized in medical treatments similar to today. The procedures were documented on papyrus and were the first to describe patient case files; the Edwin Smith Papyrus (held in the New York Academy of Medicine) documents surgical procedures based on anatomy and physiology, while the Ebers Papyrus describes healing based on magic. Their medical expertise was later documented by Herodotus: "The practice of medicine is very specialized among them. Each physician treats just one disease. The country is full of physicians, some treat the eye, some the teeth, some of what belongs to the abdomen, and others internal diseases."[6]

In ancient Greece, temples dedicated to the healer-god Asclepius, known as Asclepieia (Greek: Ασκληπιεία, sing. Asclepieion Ασκληπιείον), functioned as centers of medical advice, prognosis, and healing.[7] At these shrines, patients would enter a dream-like state of induced sleep known as "enkoimesis" (Greek: ἐγκοίμησις) not unlike anesthesia, in which they either received guidance from the deity in a dream or were cured by surgery.[8] In the Asclepieion of Epidaurus, three large marble boards dated to 350 BCE preserve the names, case histories, complaints, and cures of about 70 patients who came to the temple with a problem and shed it there. Some of the surgical cures listed, such as the opening of an abdominal abscess or the removal of traumatic foreign material, are realistic enough to have taken place, but with the patient in a state of enkoimesis induced with the help of soporific substances such as opium.[8]

12th century eye surgery.

The Greek Galen was one of the greatest surgeons of the ancient world and performed many audacious operations — including brain and eye surgery — that were not tried again for almost two millennia.

In China, Hua Tuo was a famous Chinese physician during the Eastern Han and Three Kingdoms era who performed surgery with the aid of anesthesia.

In the Middle Ages, surgery was developed to a high degree in the Islamic world. Abulcasis (Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi), an Andalusian-Arab physician and scientist who practised in the Zahra suburb of Córdoba, wrote medical texts that shaped European surgical procedures up until the Renaissance.[9]

In Europe, the demand grew for surgeons to formally study for many years before practicing; universities such as Montpellier, Padua and Bologna were particularly renowned. According to Peter Elmer and Ole Peter Grell, "Guy de Chauliac (1298-1368) was one of the most eminent surgeons of the Middle Ages. His Chirurgia Magna or Great Surgery (1363) was a standard text for surgeons until well into the seventeenth century."[10] By the fifteenth century at the latest, surgery had split away from physic as its own subject, of a lesser status than pure medicine, and initially took the form of a craft tradition until Rogerius Salernitanus composed his Chirurgia, laying the foundation for modern Western surgical manuals up to the modern time. Late in the nineteenth century, Bachelor of Surgery degrees (usually ChB) began to be awarded with the (MB), and the mastership became a higher degree, usually abbreviated ChM or MS in London, where the first degree was MB, BS.

Barber-surgeons generally had a bad reputation that was not to improve until the development of academic surgery as a specialty of medicine, rather than an accessory field.[11] Basic surgical principles for asepsis etc., are known as Halsteads principles

Modern surgery

Ambroise Paré (ca. 1510-1590), father of modern military surgery.

Modern surgery developed rapidly with the scientific era. Ambroise Paré (sometimes spelled "Ambrose"[12]) pioneered the treatment of gunshot wounds, and the first modern surgeons were battlefield doctors in the Napoleonic Wars. Naval surgeons were often barber surgeons, who combined surgery with their main jobs as barbers. Three main developments permitted the transition to modern surgical approaches - control of bleeding, control of infection and control of pain (anaesthesia).

Bleeding
Before modern surgical developments, there was a very real threat that a patient would bleed to death before treatment, or during the operation. Cauterization (fusing a wound closed with extreme heat) was successful but limited - it was destructive, painful and in the long term had very poor outcomes. Ligatures, or material used to tie off severed blood vessels, originated as early as ancient Rome,[13] and were improved by Ambroise Paré in the 16th century. Though this method was a significant improvement over the method of cauterization, it was still dangerous until infection risk was brought under control - at the time of its discovery, the concept of infection was not fully understood. Finally, early 20th century research into blood groups allowed the first effective blood transfusions.
Pain
Modern pain control through anesthesia was discovered by Crawford Long. Before the advent of anesthesia, surgery was a traumatically painful procedure and surgeons were encouraged to be as swift as possible to minimize patient suffering. This also meant that operations were largely restricted to amputations and external growth removals. Beginning in the 1840s, surgery began to change dramatically in character with the discovery of effective and practical anaesthetic chemicals such as ether and chloroform, discovered by James Young Simpson and later pioneered in Britain by John Snow. In addition to relieving patient suffering, anaesthesia allowed more intricate operations in the internal regions of the human body. In addition, the discovery of muscle relaxants such as curare allowed for safer applications.
Infection
Unfortunately, the introduction of anesthetics encouraged more surgery, which inadvertently caused more dangerous patient post-operative infections. The concept of infection was unknown until relatively modern times. The first progress in combating infection was made in 1847 by the Hungarian doctor Ignaz Semmelweis who noticed that medical students fresh from the dissecting room were causing excess maternal death compared to midwives. Semmelweis, despite ridicule and opposition, introduced compulsory handwashing for everyone entering the maternal wards and was rewarded with a plunge in maternal and fetal deaths, however the Royal Society in the UK still dismissed his advice. Significant progress came following the work of Louis Pasteur and his advances in microbiology, when the British surgeon Joseph Lister began experimenting with using phenol during surgery to prevent infections. Lister was able to quickly reduce infection rates, a reduction that was further helped by his subsequent introduction of the techniques of Robert Koch (such as the Steam Steriliser, which proved more successful than the carbolic acid spray that Lister had been using previously) to sterilize equipment, have rigorous hand washing and a later implementation of rubber gloves. Lister published his work as a series of articles in The Lancet (March 1867) under the title Antiseptic Principle of the Practice of Surgery. The work was groundbreaking and laid the foundations for a rapid advance in infection control that saw modern aseptic operating theatres widely used within 50 years (Lister himself went on to make further strides in antisepsis and asepsis throughout his lifetime).
Cognitive and memory decline
Surgery may cause post-operative decline in memory and cognitive function due that inflammatory proteins may cause damage to the blood-brain barrier and allow for immune competent blood cells to interfere with memory functions, but may be prevented with a pre-operative dosage of a nicotine alike medicine. This affects 20 - 25% of the patients for a few months, but very few are affected for more than 1 year.[14]

Surgical specialties and sub-specialties

Some other specialties involve some forms of surgical intervention, especially gynaecology. Also, some people consider invasive methods of treatment/diagnosis, such as cardiac catheterization, endoscopy, and placing of chest tubes or central lines "surgery". In most parts of the medical field, this view is not shared.

Patronage

The patron saints for surgeons are Saint Luke the Evangelist the physician and disciple of Christ, Saints Cosmas and Damian (3rd century physicians from Syria), Saint Quentin (3rd century saint from France), Saint Foillan (7th century saint from Ireland), and Saint Roch (14th century saint from France).

See also

Governing bodies

Qualifications in the UK and Ireland

References

  1. ^ Wagman LD. "Principles of Surgical Oncology" in Pazdur R, Wagman LD, Camphausen KA, Hoskins WJ (Eds) Cancer Management: A Multidisciplinary Approach. 11 ed. 2008.
  2. ^ Doyle, S. L., Lysaght, J. and Reynolds, J. V. (2010), Obesity and post-operative complications in patients undergoing non-bariatric surgery. Obesity Reviews, 11: 875–886.
  3. ^ a b Makary MA, Segev DL, Pronovost PJ, et al. (June 2010). "Frailty as a predictor of surgical in older patients". J. Am. Coll. Surg. 210 (6): 901–8. doi:10.1016/j.jamcollsurg.2010.01.028. PMID 20510798. Lay summary (28 December 2010).
  4. ^ Capasso, Luigi (2002) (in Italian). Principi di storia della patologia umana: corso di storia della medicina per gli studenti della Facoltà di medicina e chirurgia e della Facoltà di scienze infermieristiche. Rome: SEU. ISBN 88-87753-65-2. OCLC 50485765.
  5. ^ "Stone age man used dentist drill". BBC News. 6 April 2006. http://news.bbc.co.uk/1/hi/sci/tech/4882968.stm. Retrieved 24 May 2010.
  6. ^ Herodotus, Histories 2,84
  7. ^ Risse, G.B. Mending bodies, saving souls: a history of hospitals. Oxford University Press, 1990. p. 56 [1]
  8. ^ a b Askitopoulou, H., Konsolaki, E., Ramoutsaki, I., Anastassaki, E. Surgical cures by sleep induction as the Asclepieion of Epidaurus. The history of anesthesia: proceedings of the Fifth International Symposium, by José Carlos Diz, Avelino Franco, Douglas R. Bacon, J. Rupreht, Julián Alvarez. Elsevier Science B.V., International Congress Series 1242(2002), p.11-17. [2]
  9. ^ biography from Famousmuslims.com accessed 16 April 2007.
  10. ^ Peter Elmer, Ole Peter Grell (2004). "Health, disease, and society in Europe, 1500-1800: a source book". Manchester University Press. p.8. ISBN 0-7190-6737-5
  11. ^ Sven Med Tidskr. (2007). "From barber to surgeon- the process of professionalization". Svensk medicinhistorisk tidskrift 11 (1): 69–87. PMID 18548946.
  12. ^ Levine JM (March 1992). "Historical notes on pressure ulcers: the cure of Ambrose Paré". Decubitus 5 (2): 23–4, 26. PMID 1558689.
  13. ^ Medical innovations and war,Science Museum,London
  14. ^ wiley.com - Resolving postoperative neuroinflammation and cognitive decline, DOI: 10.1002/ana.22664 received 2011-07-26 published 2011-12-21

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Medicine
Specialties and subspecialties
  • Surgery
Diagnostic
Other specialties
Others
Surgery, Nervous system: neurosurgical and other procedures (ICD-9-CM V3 01–05+89.1, ICD-10-PCS 00-01)
Skull Craniotomy · Craniectomy (Decompressive craniectomy) · Cranioplasty
CNS
Brain

thalamus and globus pallidus: Thalamotomy · Thalamic stimulator · Pallidotomy

ventricular system: Ventriculostomy · Suboccipital puncture · Intracranial pressure monitoring

cerebrum: Psychosurgery (Lobotomy, Bilateral cingulotomy) · Hemispherectomy · Anterior temporal lobectomy

pituitary: Hypophysectomy

hippocampus: Amygdalohippocampectomy

Brain biopsy
Cerebral meninges Meningeal biopsy
Spinal cord and spinal canal

Spinal cord and roots (Cordotomy, Rhizotomy)

Vertebrae and intervertebral discs: see
Medical imaging CT head · Cerebral angiography · Pneumoencephalography · Echoencephalography/Transcranial doppler · MRI of brain and brain stem · Brain PET · SPECT of brain · Myelography
Diagnostic Electroencephalography · Lumbar puncture · Polysomnography
CPRs Glasgow Coma Scale · Mini-mental state examination · NIH stroke scale · CHADS score
PNS
Cranial and peripheral nerves Nerve block · Vagotomy
Sympathetic nerves or ganglia Ganglionectomy · Sympathectomy (Endoscopic thoracic sympathectomy)
Nerves (general) Axotomy · Neurectomy · Nerve biopsy
Diagnostic Nerve conduction study · Electromyography
Medical imaging Magnetic resonance neurography

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Endocrine system intervention / Endocrine surgery (ICD-9-CM V3 06-07, ICD-10-PCS 0G)
Pancreas

Islet cell transplantation (also see )

Noninvasive glucose monitor

Glucose tolerance test (Postprandial glucose test)

diabetes mellitus: Insulin tolerance test
Hypothalamic/ pituitary axes +parathyroid
Pituitary

Hypophysectomy/Transsphenoidal surgery

E/S: Combined rapid anterior pituitary evaluation panel
Thyroid axis

Thyroidectomy · Parathyroidectomy

Medical imaging: Radioactive iodine uptake test · Sestamibi parathyroid scan

E/S: hypothyroidism (TRH stimulation test)
Adrenal axis

Adrenalectomy

E/S: Cushing's syndrome (Dexamethasone suppression test) · adrenal insufficiency (ACTH stimulation test) · Captopril suppression test

Fluid deprivation test
Gonadal axis see ,
Pineal gland Pinealectomy
General hormone therapy Replacement therapy / in oncology · sex reassignment (female-to-male, male-to-female)

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Surgery · eye surgery and other procedures (ICD-9-CM V3 08-16+95.0-95.2, ICD-10-PCS 08)
Adnexa
Eyelids Blepharoplasty (East Asian blepharoplasty) · Epicanthoplasty · Tarsorrhaphy
Lacrimal system Dacryocystorhinostomy · Punctoplasty
Globe
Cornea Radial keratotomy · LASIK · Keratomileusis · Epikeratophakia · Corneal transplantation · Photorefractive keratectomy · Intracorneal rings
Iris, ciliary body, sclera, and anterior chamber Glaucoma surgery: Trabeculectomy · Iridectomy
Lens Phacoemulsification · Cataract surgery · Capsulorhexis
Retina, choroid, vitreous, and posterior chamber Vitrectomy
Orbit and eyeball Enucleation of the eye
Extraocular muscles Harada-Ito procedure
Medical imaging

Fluorescein angiography · Fundus photography · Corneal topography · Optical coherence tomography

Electrodiagnosis: Electrooculography · Electroretinography · Electronystagmography
Eye examination Gonioscopy · Dilated fundus examination · Ocular tonometry · Ophthalmoscopy · Retinoscopy · Color perception test · Perimetry
Radiotherapy Plaque radiotherapy

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Operations/surgeries and other procedures on the ear (ICD-9-CM V3 18-20+95.4, ICD-10-PCS 09)
Outer ear Otoplasty
Middle ear Myringotomy · Stapedectomy · Tympanoplasty · Tympanocentesis
Inner ear Mastoidectomy
Diagnosis

Hearing test/Audiometry (Pure tone audiometry, Tympanometry)

Physical exam: Rinne test · Weber test · Otoscope (Pneumatic otoscopy) · Dix–Hallpike test · Caloric reflex test

ABR · OAE · Electronystagmography

: EAR

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Operations/surgeries and other procedures on the mouth, and pharynx (ICD-9-CM V3 25-29, ICD-10-PCS 09)
Mouth

lip: Labial frenectomy · Lip lift · Lip augmentation · Cheiloplasty

tongue: Lingual frenectomy · Genioglossus advancement · Glossectomy

teeth: see

gingiva: see

Stomatoplasty
Oropharynx

palate: Palatoplasty · Pharyngeal flap surgery

tonsil: Tonsillectomy · Adenoidectomy

uvula: Uvulotomy · Uvulopalatoplasty

Uvulopalatopharyngoplasty

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Respiratory system surgeries and other procedures (ICD-9-CM V3 21-22, 30-34, ICD-10-PCS 0B)
Upper RT

nose: Rhinoplasty · Septoplasty · Rhinectomy · Rhinomanometry

sinus: Sinusotomy

larynx: Laryngoscopy · Laryngectomy · Laryngotomy (Thyrotomy)
Lower RT

trachea: Cricothyrotomy · Tracheoesophageal puncture · Tracheotomy

bronchus: Bronchoscopy

lung: Pneumonectomy · Wedge resection · Lung transplantation · Decortication of lung · Heart-lung transplant
Chest wall, pleura, mediastinum, and diaphragm

pleura/pleural cavity: Thoracentesis · Pleurodesis · Thoracoscopy · Thoracotomy · Chest tube

mediastinum: Mediastinoscopy

Nuss procedure
Medical imaging Bronchography · CT pulmonary angiogram · High resolution CT · Spiral CT · Ventilation/perfusion scan
CPRs Pneumonia severity index · CURB-65
Lung function test Body plethysmography · Spirometry · Bronchial challenge test · Capnography · Diffusion capacity
Cytology Sputum culture · Bronchoalveolar lavage
Respiratory therapy/ intubation Mechanical ventilation · Positive pressure ventilation · Artificial respiration · Nebulizer · Hyperbaric medicine · Oxygen therapy · Decompression chamber · Heliox · Negative pressure ventilator · Postural drainage · CPR

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Healthcare science – Medicine · Surgery · Cardiac procedures (ICD-9-CM V3 35-37+89.4+99.6, ICD-10-PCS 02)
Surgery and IC
Heart valves and septa

Valve repair · Valvulotomy · Mitral valve repair · Valvuloplasty (aortic, mitral) Valve replacement - Aortic valve replacement (Ross procedure, Percutaneous aortic valve replacement) · Mitral valve replacement

production of septal defect in heart: enlargement of existing septal defect (Atrial septostomy, Balloon septostomy) · creation of septal defect in heart (Blalock-Hanlon procedure)

shunt from heart chamber to blood vessel: atrium to pulmonary artery (Fontan procedure) · left ventricle to aorta (Rastelli procedure) · right ventricle to pulmonary artery (Sano shunt)

compound procedures: for transposition of great vessels (Jatene procedure, Mustard procedure) · for univentricular defect (Norwood procedure, Kawashima procedure)

shunt from blood vessel to blood vessel: systemic circulation to pulmonary artery shunt (Blalock-Taussig shunt) · SVC to the right PA (Glenn procedure)
Cardiac vessels

CHD: Angioplasty · Bypass/Coronary artery bypass (MIDCAB · Off-pump CAB · TECAB)

Coronary stent: Bare-metal stent · Drug-eluting stent

Bentall procedure · Valve-sparing aortic root replacement
Other

Pericardium: Pericardiocentesis · Pericardial window · Pericardiectomy

Myocardium: Cardiomyoplasty · Dor procedure · Septal myectomy · Ventricular reduction · Alcohol septal ablation

Conduction system: Maze procedure (Cox maze and minimaze) · Catheter ablation (Cryoablation, Radiofrequency ablation) · Pacemaker insertion

Left atrial appendage occlusion · Cardiotomy · Heart transplantation
Diagnostic tests and procedures

Electrophysiology: Electrocardiography (Vectorcardiography) · Holter monitor · Cardiac stress test (Bruce protocol) · Electrophysiology study

Cardiac imaging: Angiocardiography · Echocardiography (TTE, TEE) · Myocardial perfusion imaging · Cardiovascular MRI · Ventriculography (Radionuclide ventriculography) · Cardiac catheterization/Coronary catheterization · Cardiac CT · Cardiac PET

sound: Phonocardiogram
Function tests Impedance cardiography · Ballistocardiography · Cardiotocography
Pacing Cardioversion · Transcutaneous pacing

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Health science – Medicine · Surgery · Vascular surgery and other vascular procedures (ICD-9-CM V3 38-39, ICD-10-PCS 03-6)
Incision, excision, and occlusion of vessels

Peripheral arterial occlusive disease: Balloon embolectomy · Thrombectomy

Carotid stenosis: Endarterectomy (Carotid endarterectomy)

Varicose veins: Ambulatory phlebectomy · Laser ablation · Sclerotherapy · Vein stripping

Venous cutdown

Temporal artery biopsy

Arteriotomy · Phlebotomy
Other operations on vessels
Shunt/bypass

Peripheral arterial occlusive disease: Peripheral arterial bypass surgery

Portal hypertension: Transjugular intrahepatic portosystemic shunt (TIPS) · Distal splenorenal shunt procedure

Vascular grafting (Human umbilical vein graft)

Blalock–Taussig shunt
Repair

Aortic aneurysm / dissection: Open AAA repair · Endoluminal AAA repair (EVAR)

Peripheral arterial occlusive disease: Angioplasty with/out Stenting

Atherectomy
Auxiliary to heart surgery Cardiopulmonary bypass · Cardioplegia · Extracorporeal membrane oxygenation
Other

Carotid stenosis: Carotid stenting

Hemodialysis/Hemofiltration · Revascularization

Glomectomy
Medical imaging

Angiography (Digital subtraction angiography, Cerebral angiography, Aortography, Fluorescein angiography, Radionuclide angiography, Magnetic resonance angiography)

Venography (Portography) · Impedance phlebography

Intravascular ultrasound · Carotid ultrasonography
Other diagnostic Angioscopy · Ankle brachial pressure index · Tilt table test

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Operations/surgeries and other procedures of the hemic and lymphatic system (ICD-9-CM V3 40-41, ICD-10-PCS 07)
Bone marrow Stem cell transplantation/Hematopoietic stem cell transplantation
Thymus Thymectomy · Thymus transplantation
Spleen Splenectomy · Spleen transplantation
Lymph nodes Lymphadenectomy · Neck dissection · Retroperitoneal lymph node dissection · Lymph node biopsy
Tonsils see
Imaging Lymphogram

: LMO

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Digestive system surgical and other procedures / Digestive system surgery (ICD-9-CM V3 42-54, ICD-10-PCS 0D)
Digestive tract
Upper GI tract
SGs/Esophagus Esophagectomy · Heller myotomy · Sialography · Impedance-pH monitoring · Esophageal pH monitoring · Esophageal motility study
Stomach Gastrostomy (Percutaneous endoscopic gastrostomy) · Gastrectomy (Billroth I, Billroth II, Roux-en-Y) · Bariatric surgery (Gastric bypass surgery, Adjustable gastric band, Sleeve gastrectomy, Vertical banded gastroplasty surgery) · Gastroenterostomy · Hill repair · Nissen fundoplication · Gastropexy · Pyloromyotomy
Medical imaging

Endoscopy: Esophagogastroduodenoscopy

Upper gastrointestinal series · Barium swallow
Lower GI tract
Small bowel Bariatric surgery (Duodenal switch, Jejunoileal bypass) · Jejunostomy · Ileostomy · Partial ileal bypass surgery
Large bowel Colectomy · Colostomy · Appendicectomy · Hartmann's operation · Colonic polypectomy
Rectum Lower anterior resection · Abdominoperineal resection
Anal canal Rubber band ligation · Anal sphincterotomy · Lateral internal sphincterotomy · Transanal hemorrhoidal dearterialization · Anorectal manometry
Medical imaging

Endoscopy: Colonoscopy · Proctoscopy · Sigmoidoscopy · Enteroscopy · Anoscopy · Capsule endoscopy

Transrectal ultrasonography · Abdominal ultrasonography · Enteroclysis · Small bowel follow-through · Lower gastrointestinal series · Virtual colonoscopy · Defecating proctogram · Double-contrast barium enema
Stool tests Fecal pH test · Stool guaiac test · Fecal fat test
Accessory
Liver Hepatectomy · Liver transplantation · Artificial extracorporeal liver support (Liver dialysis, Bioartificial liver devices) · Liver biopsy
Gallbladder, bile duct

Cholecystostomy · ERCP · Cholecystectomy · Hepatoportoenterostomy

Medical imaging: Cholangiography (PTC, IV, MRCP) · Cholecystography · Cholescintigraphy
Pancreas Pancreatectomy · Pancreaticoduodenectomy · Pancreas transplantation · Puestow procedure · Frey's procedure
Abdominopelvic
Peritoneum Laparoscopy · Diagnostic peritoneal lavage · Paracentesis · Intraperitoneal injection · Peritoneal dialysis · Omentopexy
Hernia Hernia repair: Inguinal hernia repair · Femoral hernia repair
Other Laparotomy (Exploratory laparotomy) · Rapid urease test/Urea breath test
CPRs Ranson criteria · MELD

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Urologic surgical and other procedures (ICD-9-CM V3 55-59+89.2, ICD-10-PCS 0T)
Kidney Nephrostomy (Percutaneous nephrostomy) · Nephrotomy · Endoscopy (Nephroscopy) · Renal biopsy · Nephrectomy · Kidney transplantation · Nephropexy
Ureter Ureterostomy · Urinary diversion · Ureterosigmoidostomy · Ureterolysis · Endoscopy (Ureteroscopy)
Urinary bladder Cystectomy (Suprapubic cystostomy) · Endoscopy (Cystoscopy)
Urethra Urethropexy · Urethrotomy · Urethral sounding · Urethroplasty
General

Medical imaging: Pyelogram (Intravenous pyelogram, Retrograde pyelogram) · Kidneys, ureters, and bladder x-ray · Radioisotope renography · Cystography · Retrograde urethrogram · Voiding cystourethrogram

Urodynamic testing (Cystometry)

Urinary catheterization · Dialysis

Lithotripsy: Laser lithotripsy · Extracorporeal shock wave lithotripsy

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Female genital surgical and other procedures (gynecological surgery) (ICD-9-CM V3 65-71, ICD-10-PCS 0U)
Adnexa
Ovary Oophorectomy · Salpingoophorectomy
Fallopian tubes Falloposcopy · Salpingectomy · Tubal ligation · Essure · Tubal reversal
Uterus

general: Hysterectomy · Hysterotomy · Pelvic exenteration · Uterine artery embolization

uterine cavity: Hysteroscopy · Vacuum aspiration

endometrium: Endometrial biopsy · Endometrial ablation

myometrium: Uterine myomectomy

cervix: Colposcopy · Cervical conization (LEEP) · Cervical cerclage · Cervical screening (Pap test) · Cervicectomy
Vagina Vaginectomy · Culdoscopy · Culdocentesis · Hymenotomy · Colpocleisis · Hymenorrhaphy · Vaginal wet mount
Vulva Vulvectomy · Female genital mutilation · Labiaplasty
Medical imaging Gynecologic ultrasonography · Hysterosalpingography

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Obstetrical surgery and other procedures (ICD-9-CM V3 72-75, ICD-10-PCS 1)
Diagnostic

Pregnancy test

sampling: fetal tissue (Chorionic villus sampling · Amniocentesis) · blood (Triple test · Percutaneous umbilical cord blood sampling · Apt test · Kleihauer-Betke test) · Lecithin-sphingomyelin ratio · Fetal fibronectin test

obstetric ultrasonography: Nuchal scan · Biophysical profile (Amniotic fluid index)

other medical imaging: Fetoscopy

Cardiotocography · (Nonstress test) · Vibroacoustic stimulation

challenge: Contraction stress test

Leopold's maneuvers
Intervention Fetal surgery · Fetendo · Podalic version (External cephalic version) · Amnioinfusion
Delivery
Vaginal delivery
Induction Artificial rupture of membranes · Episiotomy · Symphysiotomy · Forceps in childbirth · Ventouse in childbirth
Dystocia management McRoberts maneuver · Woods' screw maneuver · Zavanelli maneuver
Manual placenta removal
Caesarean section Elective · On maternal request · EXIT procedure
Postpartum hemorrhage Hysterectomy · B-Lynch suture · Sengstaken-Blakemore tube

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Orthopedic surgery, operations/surgeries and other procedures on bones and joints (ICD-9-CM V3 76-81, ICD-10-PCS 0P-S)
Bones
Facial Jaw reduction · Dentofacial osteotomy · Genioplasty/Mentoplasty (Chin augmentation) · Orthognathic surgery
Spine Coccygectomy · Laminotomy · Laminectomy · Laminoplasty · Corpectomy · Facetectomy · Foraminotomy · Vertebral fixation · Percutaneous vertebroplasty
Upper extremity Acromioplasty
Lower extremity Femoral head ostectomy · Astragalectomy · Distraction osteogenesis · Ilizarov apparatus
General Ostectomy · Bone grafting · Osteotomy · Epiphysiodesis · Reduction · Internal fixation · External fixation
Medical imaging Dual energy X-ray absorptiometry/Digital X-ray radiogrammetry · pQCT · Skeletal survey · Bone scintigraphy
Cartilage Articular cartilage repair (Microfracture surgery) · Knee cartilage replacement therapy · Autologous chondrocyte implantation
Joints
Spine

Arthrodesis (Spinal fusion)

Intervertebral discs (Discectomy · Intervertebral disc annuloplasty · Intervertebral disc arthroplasty)

Back examination (Straight leg raise, Waddell's signs, Schober's test)
Upper extremity

Shoulder surgery (Shoulder replacement, Bankart repair, Weaver-Dunn procedure) · Ulnar collateral ligament reconstruction · Hand surgery (Brunelli procedure)

exam: Shoulder examination (Jobe's test, Adson's sign) · Elbow examination (Elbow extension test) · Wrist examination (Tinel sign/Phalen maneuver, Finkelstein's test)
Lower extremity

Hip resurfacing · Hip replacement · Rotationplasty · Anterior cruciate ligament reconstruction · Knee replacement/Unicompartmental knee arthroplasty · Ankle replacement · Broström procedure · Triple arthrodesis

exam: Hip examination · Knee examination (Drawer test, Ballottement) · Ankle examination (Simmonds' test)

CPRs: Pittsburgh knee rules · Ottawa knee rules · Ottawa ankle rules
General

Arthrotomy · Arthroplasty · Synovectomy · Arthroscopy · Replacement joint

imaging: Arthrogram

Arthrocentesis

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Orthopedic surgery, operations/surgeries and other procedures on muscle/soft tissue (ICD-9-CM V3 82-84, ICD-10-PCS 0K-L)
Muscle, tendon, fascia, and bursa

muscle: Myotomy (Heller myotomy) · Muscle biopsy

tendon: Tenotomy · Tendon transfer

fascia: Fasciotomy

bursa: Bursectomy
Other Amputation (Hemipelvectomy, Hemicorporectomy) · Replantation

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Operations/surgeries and other procedures of the breast (ICD-9-CM V3 85, ICD-10-PCS 0H)
Breast surgery

Breast-conserving surgery (Lumpectomy) · Mastectomy (Radical mastectomy)

Mammoplasty (Breast implant, Breast reduction) · Mastopexy · Breast reconstruction

Breast biopsy (Fine-needle aspiration )
Medical imaging X-ray (Mammography/Xeromammography) · MRI (Breast MRI) · Ultrasound (Breast ultrasound) · Scintimammography · Thermography (Breast thermography) · Positron emission mammography
Other Breast self-examination

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Operations/surgeries and other procedures of the skin and subcutaneous tissue (ICD-9-CM V3 86, ICD-10-PCS 0H)
Skin

Escharotomy · Suture · Skin grafting · Mohs surgery · Free flap · Rotation flap · TRAM flap · Electrodesiccation and curettage · Cryosurgery · Skin biopsy

Rhytidectomy · Liposuction · Z-plasty

medical imaging: Wood's lamp
Hair Hair transplantation

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