Types of needles

Curved needles 1/2 of circle 3/8 of circle 5/8 of circle

Types of needles according to the threading Eyed Eyeless

Types of needles according to cut section Cutting needle Rounded needle

Control of 1ry hemorrhage

1ry hemorrhage Place pack for 4 min

Hold the injured vessels by 2 artery forceps

3 ligations 2 ligations Artery :high pressure Vein :low pressure

Adhesive tapes

Types of sutures

Simple stitches

Tension suture It takes muscles &peritoneum On tension of the suture

Continuance stitches

Lambert's suture

Mattress stitches

Chest drain

Position of the patient in the chest drain

Sit of the incision Mid axillary line Ant. Axillary line

Med. axillary line Ant. axillary line Points of drain

Spread the muscle fibers by artery forceps to expose pleura Lung Spread the muscle fibers by artery forceps to expose pleura

Pierce pleura and introduce finger to confirm entry to pleura

Guiding of the drain by your finger

Make sure that the incision is large enough to accommodate the drain + your finger

Suture the drain with loss sutures to the skin

Rib Drain Rib

Spleen

Normal spleen anatomy

Stomach Gastrosplenic lig. Ant.lienorenal lig Spleen Pancreas Kidney Post.lienorenal lig.

Anterior lienorenal ligament Gastro pherenic ligament Spleen Anterior lienorenal ligament Pancreas posterior lienorenal ligament

Gastropherenic ligament Post. Layer of lienorenal ligament Ant. layer of lienorenal ligament Post. Layer of lienorenal ligament

splenectomy

Down displacement of the stomach

Insertion of hot packs behind spleen

Hot packs around spleen

Divide the posterior layer of lienorenal ligament Stomach (medially) Spleen (medially) Hot packs Divide the posterior layer of lienorenal ligament

Divide the posterior layer of lienorenal ligament Traction of the spleen medially

Divide the gastrosplenic ligament

Divide the gastrosplenic ligament

Divide the anterior layer of the lienorenal ligament

Ant. Lienorenal lig. Pancreas Splenic artery Spleen Pos. lienorenal lig.

Squeeze the spleen Divide splenic vein

Problems

Multiple splenic adhesions

Rectum and anal canal

Overall view of the rectum and anal canal

Anatomy of rectum and anal canal Dentate line External sph. Internal sph.

Internal plexus of veins Superior rectal vein Internal plexus of veins External anal sphincter Anal canal Internal anal sphincter Anatomical anal canal structure

Anal Fistula

Internal opening of the fistula External opening of the fistula The track of the fistula

Insertion of probe Probe

Insertion of rode of glass in the fistula

Opining of the fistula by cut the skin on the glass rode along the all track

The external opining of the fistula Anus The triangular track of the incision

The healing by Granulation tissue

Anal fissure

Anal fissure (lower part of anal canal)

Anal fissure Traction of the fissure from sentinel pile Sentinel pile

Removal of the fissure+ the skin around it Internal sphincter

Fissuerectom and posterior internal sphincterectomy

Hemorrhoidectomy

Superior rectal vein Plexus of veins (site of internal piles External sphincter Internal sphincter

Superior rectal vein Internal piles

Hold the piles by 2 Allis forceps

Sit of the V- incision in the anal skin

Ligation of the root of the piles Part of anal skin

V- shape incision in the skin

V shape incision The pile

Sits of primary piles 11 3 7

Granulation tissue Healthy skin

Circumcision

Uncircumcised penis

Retract the propuce backwards Clean the coronal sulcus by alcohol

Ring anesthesia at the base of the penis

Traction of the propuce by artery forceps

Squeeze pines glandes

Bone cutting method circumcision Bone cutting forceps Bone cutting method circumcision

Artery forceps Cut the prepuce till sulcus of glans penis

Cut the propuce all around the coronal sulcus

Interrupted sutures Mucous membrane of the penis

Circumcised penis

Renal operations

Incision for renal operations Anterior superior iliac spine Ribs Incision Anterior superior iliac spine

External obliq. Per renal fat Internal obiq. Peritoneum Tranversus abd. Serretus post. Kidney Fascia trans. Ltissmus dorsi Site of incision

External oblique Latissmus dorsi Incision

External obliq. Internal obliq. Latissmus dorsi Serretus posterior

External obliq. Internal obliq. Fascia Transversalis Latissmus dorsi Serretus posterior

Transverses abdominus Lumber fascia

Move the pre renal fat by finger Peritoneum Pre renal fat kidney Move the pre renal fat by finger

Separation of the peri renal fat to separate kidney from supra renal gland

If we don't separate the ft we remove the supra renal gland with kidney

Identify the ureter Renal vein (anterior) Renal artery (middle ) Ureter (posterior)

Ligate and divide the ureter as low as possible

Brodel's bloodless line Nephrolithetomy Brodel's bloodless line incision

Renal stone

Nephrolithetomy Radial incision

Pyelolithotomy

Ligation above &below the stone in the ureter

Removal of the stone

Stone in the urinary bladder

Site of incision

Removal of the stone