types of surgery

Types of Surgery

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

Surgery is a unique experience of a planned physical alteration encompassing three phases:

PREOPERATIVE, INTRAOPERATIVE AND POSTOPERATIVE.

These 3 phases are together referred to as the PERIOERATIVE PERIOD.

Surgical procedures are commonly grouped according to:

A. Purpose

Diagnostic
Confirms or establishes a diagnosis; Example - biopsy of a mass in a breast.

Palliative
Relieves or reduces pain or symptoms of a disease; it does not cure; Example - resection of nerve roots.

Ablative
Removes a diseased body part; Example - removal of a gallbladder (cholecystectomy)

Constructive
Restores function or appearance that has been lost or reduced; Example - breast implant

Transplant
Replaces malfunctioning structures; Example - hip replacement

B. Degree of Urgency

Emergency Surgery
Is performed immediately to preserve function or the life of the client. Example - surgeries to control internal hemorrhage

Elective Surgery
Is performed when surgical intervention is the preferred treatment for a condition that is not imminently life threatening (but may ultimately threaten life or well being) or to improve the client’s life. Example - cholecystectomy for chronic gallbladder disease, plastic surgery procedures such as breast reduction surgery

C. Degree of Risk

Major Surgery
It involves a high degree of risk, for a variety of reasons: It may be complicated or prolonged, large losses of blood may occur, vital organs may be involved, or postoperative complications may be likely. Example - organ transplant, open heart surgery, removal of kidney

Minor Surgery
It involves little risk, produces few complications, and is often performed in a “day surgery”. Example - breast biopsy, removal of tonsils, knee surgery.
The degree of risk involved in a surgical procedure is affected by the client’s age, general health, nutritional status, use of medications, and mental status.

Age
Very young and elder clients are greater surgical risks than children and adults.The physiologic response of an infant to surgery is substantially different from an adult’s.The blood volume in an infant is small, and its fluid reserves limited.The older adult often has fewer physiologic reserves to meet the extra demands caused by surgery.The older adult may be poorly nourished, which can impair healing.

General Health
Surgery is least risky when the client’s general health is good. Common health problems that increase surgical risk and may lead to the decision to postpone or cancel surgery are malnutrition, cardiac conditions, blood coagulation disorders, renal diseases, diabetes mellitus, liver diseases, etc.

Nutritional Status
Adequate nutrition is required for normal tissue repair.Obesity contributes to postoperative complications such as pneumonia, wound infection and wound separation.Obese and underweight client are vulnerable to pressure ulcer formation due to positioning required for surgery.A malnourished client is at risk for delayed wound healing, wound infection and fluid and electrolyte alterations.

Medications
The following medication can increase surgical risk:Anticoagulants increase blood coagulation time.Tranquilizers may interact with anesthetics, increasing the risk of respiratory depression.Corticosteroids may interfere with wound healing and increase the risk of infection.Diuretics may affect fluid and electrolyte balance.

Mental Status
Clients with dementia may have difficulty understanding proposed surgical procedures and may respond unpredictably to anesthetics.Extreme anxiety also increases surgical risk and interferes with the client’s ability to process information and respond appropriately to instructions.