Operational Medicine Medical Education and Training

Special Surgical Procedures II





While each patient brings new challenges to the surgical team, there are certain problems and techniques associated with particular kinds of special surgery that can be anticipated. By preparing for these peculiarities of the various specialties, the team can circumvent a great many problems that would otherwise arise.

In this subcourse, a large number of operations in various specialties are described, along with special dangers that may attend these particular procedures. The more familiar you become with these, the more effectively you will be able to do your part as a member of the operating room team.


Length: 166 Pages

Estimated Hours to Complete: 8

Format: PDF file

Size: 1.7 MB


Anyone may take this course. However, to receive credit hours, you must be officially enrolled and complete an examination furnished by the Nonresident Instruction Branch at Fort Sam Houston, Texas. Enrollment is normally limited to Department of Defense personnel. Others may apply for enrollment, but acceptance is not guaranteed


Special Surgical Procedures II

Distance Learning Course
166 Pages
Est. 8 Hours
1.7 MB pdf file

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Section I. Eye Surgery

Section II. Ear Surgery

Section III. Nose Surgery

Section IV. Throat, Tongue, and Neck Surgery


Section I. Anatomy of the Female Reproductive System

Section II. Vaginal Surgery

Section III. Abdominal Gynecological and Obstetrical Surgery


Section I. Anatomy and Physiology of the Genitourinary Organs

Section II. General Considerations in Genitourinary Surgery

Section III. Operations on the Kidney, Ureter, and Adrenal Glands

Section IV. Operations on the Bladder and Prostate

Section V. Operations on the Scrotum, Penis, and Urethra







a. General. The anatomy, physiology, and the location of the eye make surgery upon the eye a highly specialized field of surgery. Therefore, procedures done by the specialist when assisting with eye surgery differ from procedures used for other surgical specialties. However, the principles of asepsis and safe, skillful care apply as in all other surgery. The ensuing text presents a discussion of the necessary considerations that are applicable in the majority of cases in this specialty.

b. Special Care of Instruments. The specialist is to use exacting care when working with instruments for eye, ear, nose, and throat surgery because most of these instruments are delicate. Sharp surfaces of these instruments must be preserved to ensure the success of the operative procedure. The specialist is to follow local policy in the care and handling of these instruments.

c. Anatomy and Physiology of the Eye. The eye is also referred to as the eyeball or globe. In the adult, it is slightly less than one inch in its longest diameter. See figure 1-1 for parts of the eye.

(1) The lids and anterior surface of the eye, except for the center, are covered by the conjunctiva.

(2) The cornea forms the anterior center of the eye and transmits and refracts light. Behind it, the anterior chamber contains the iris (which gives eye color and forms the pupil) and the aqueous humor.

(3) The lens focuses light on the retina allowing for near and far vision.

(4) The posterior chamber contains the jelly-like vitreous humor, which helps give rigidity to the eye.

(5) The retina receives light and converts it to impulses to the brain via the optic nerve.

(6) The main body of the eye is made of three layers called tunics. The external tunic includes the sclera (the white part of the eye) and clear cornea. The middle tunic includes the choroid, the ciliary body, and the iris. The iris is the colored part that changes the aperture size over the eye lens. The internal tunic is sometimes called the nervous covering, but is usually referred to as the retina. The retina is a thin network of nerve cells and fibers that receives the images of objects the eye is seeing.


Figure 1-1. Parts of the eye.


a. Instruments. All instruments used for eye surgery are made for this purpose, and are unlike those for surgical procedures in other areas of the body. Preferences for instruments vary so widely among eye surgeons that it may be necessary to list all instruments used for each operation by each different surgeon. Therefore, the surgeon's card must be carefully checked when selecting instruments for an eye operation.

b. Sponges. Gauze sponges are considered much too rough for use on an eyeball. Instead, dampened cotton applicators are used. Special cellulose sponges, specifically designed and prepackaged sterile by manufacturers for eye surgery, are also available.

c. Magnifying Glasses. The surgeon may wish to use special magnifying glasses during the procedure; therefore, these must be cleansed and ready for use.

d. Lighting. Illumination for eye surgery may be furnished by a number of methods.

(1) One method is the use of the standard overhead light. The circulator may be responsible for adjusting the light during surgery. If this need occurs, he should pay particular attention to not contaminating the sterile field and scrubbed personnel.

(2) A second source is the use of an electric head lamp. This lamp is strapped to the surgeon's head and is used in the same manner as a coal miner's helmet. The surgeon may redirect the light during surgery.

(3) The third method is the use of the operating microscope. This is a device used to magnify the site of surgery and enable the surgeon to do very delicate work with excellent illumination. This device is draped with sterile material before the procedure is started, and the surgeon may make any adjustments. The microscope is being used more and more for eye and other delicate surgery.

e. Medications. As many as 5 or 6 solutions may be kept within the sterile field for use during eye procedures; examples of these are saline (for dampening the eyeball), local anesthetic agents, and epinephrine. If these are not prepackaged and sterilized in individually labeled doses, the specialist should label medicine glasses to show the name and the strength of each solution. During preparation for an operation, the circulator should pour the solutions needed into the medicine glasses, making sure that the solution he is pouring matches the label on the glass. Great care should be taken to assure that ophthalmic solutions of the desired drugs are used.

f. Sterile Setup. If both of the patient's eyes are to be operated on for correction of defects requiring muscle surgery or other extraocular procedures, only one Mayo table needs to be up. However, if intraocular surgery is to be performed on both eyes, the specialist sets up two tables--one for each eye. When the procedure on the first eye is completed, the surgeon and specialist change only their gloves in preparation for the second eye.

NOTE: A large percentage of intraocular surgery does not require double setups. Advancement in techniques and equipment makes the practice ineffective and costly.

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