Deepak Mudgil Training

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STERICAT PLANT at Manesar

Deepak Mudgil

Mission and Vision of STERICAT Sutures

Mission: Leading suture Manufacturing and Marketing

company of India.

Vision: Offering high quality surgical products, developed in

close relationship with our customers and thus close to the market, for a reasonable price in order to help the hospitals save money.

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Deepak Mudgil

Company Presentati

on

More then 30 years of Suture Manufacturing experience

Contents1. Common Medical Terminology:

1. Prefixes2. Suffixes3. Roots4. Planes5. Quadrants

2. Anatomy of skin & Muscles.

2. Anatomy of Digestive System Organs & Associated Surgeries.

3. Anatomy of Reproductive System Organs & Associated Surgeries.

4. Types of Hernias & Associated Procedures.

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MEDICAL PREFIXES, SUFFIXES & ROOTS

Medical terminology is very precise. If you learn the medical prefixes and suffixes, you can follow technical conversation with assurance, whether or not you are fully familiar with the procedure. For example, any surgical removal is referred to as an “ectomy”…

Appendectomy, removal of the appendix, Gastrectomy, removal of the stomach , etc. Thoroughly memorize your basic prefixes, suffixes and roots and you will have a built-in mental dictionary for quick reference when talking with surgeons.

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Deepak Mudgil Training Manual

PREFIXES

SUFFIXES itis : inflammation ofectomy : surgical removal ofostomy : surgical creation of an opening between two

organs or from an organ to the outsideOrrphaphy : surgical repair ofplasty : restorative or reconstructionPexy : surgical repositioningoscopy : examination of visualization of the inside of an

organ through an optical instrumentBronchoscopy : lung (bronchus)Esophagoscopy: esophagusLaparoscopy : abdomenGastroscopy : stomachSigmoidoscopy: sigmoid colonProctoscopy : rectumCystoscopy : Urinary bladder

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ROOTS THORACIC thoraco : chest tracheo : trachea broncho : bronchus pneumono : lung pulmono : associated structures or vessels of the lung GENERAL laparo : abdomen chole : gall.bile cholecysto : gallbladder choledocho : commonbile duct esophago : esophagus gastro : stomach entero : intestines duodeno : first part of the small intestine

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jejuno : second part of small intestine ileo : third part of small intestine Colo : colon pancreato : pancreas spleno : spleen hepato : liver masto,mammo : breast GYNECOLOGIC hystero : uterus oophoro : ovary salpingo : fallopian tube Colpo : vagina URINARY nephro : kidney reno : associated structures or vessels of the kidney pyelo : pelvis of the kidney uretero : ureter Cysto : urinary bladder lith : calculus, stoneDeepak Mudgil 11

MISCELLANEOUS Cranio : skull (neurologic) neuro : nerve (neurologic) hema,hemo,hemato : blood (term used in all areas) vas : vessel of duct (term used in all areas)

GYNECOLOGIChystero : uterusoophoro : ovary salpingo : fallopian tubecolpo : vagina

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URINARY

nephro : kidneyreno : associated structures or vessels of

the kidneypyelo : pelvis of the kidneyuretero : uretercysto : urinary bladderlith : calculus, stone

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TERMINOLGY Terms that describe location and arrangements of Body

Structures Anterior :Ventral – towards the front of the body - also in front of Posterior :Dorsal – towards the back of the body - also in back of Medical :Towards the midline Lateral :Away from the midline Contra lateral :Situated on the opposite side Ipsilateral :Situated on the same side Internal :Towards the inside External :Towards the outside or on the outside Proximal :Close to the beginning or point of origin Distal :Away from the beginning or point of origin Peripheral :Pertaining to the outer aspects of an organ Parietal :Pertaining to the walls of a cavity Visceral :Pertaining to the organs within a cavity Superior :Above Inferior :Below Cephalad :Towards the head Caudad :Towards the feet- opposite of cephalad Axilla or Axillary :The area of the armpit Axillary Line :Imaginary line which run down the side of the body starting at the armpitDeepak Mudgil 14

Proximal – Nearest to the point of attachment, to the central part of the body, to the origin, or to a point of reference.

Distal – farthest from the origin, from the center, from a medical line, or from the trunk. Opposed to proximal. For example, the arm is proximal to the forearm and the hand is distal to the forearm. It also relates to the relations to the origin of as structure within a system; the duodenum is distal to the stomach; the esophagus is proximal of the stomach.

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The various patient positions for Surgery: SUPINE : When a body is placed in the anatomical position, it is erect,

the eyes are open and level; The Head is in mid position. The arms are down at the sides, and the palms face forward. The feet are parallel to each other and the heels are close together. The supine position is a position of the body; lying down with the face up, as opposed to the prone position, which is face down.

PRONE is a position of the body lying face down LATERAL RECUMBENT When a body is placed lying on its side the patient

lies on one side with the under arm behind the back and the upper thigh flexed.

TRENDELENBURG the body is laid flat on the back with the head lower than the pelvis. This is a standard position used in abdominal and gynecological surgery. It allows better access to pelvic organs and intestines move towards the head by gravity. It was named for the German surgeon Friedrich Trendelenburg.

LITHOTOMY The position is perhaps most recognizable as the “standards” position for child birth; the patient is lain on the back with knees bent, positioned above the hips, and spread apart through the use of stirrups.

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ANATOMICAL POSITONS AND TERMINOLOGY

Frontal/Coronal Plane:Longitudinal plane dividing front from back

Sagittal Plane:Longitudinal plane dividing right from left

Transverse Plane:Trasverse plane dividing upper body from lower

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ANATOMICAL LOCATION & POSITONS

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a. Midline The most commonly used incision, made longitudinally in the center of the abdomen along the linea alba nad between the muscles. Can provide access to all quadrants,. i.e: Gastrectomy.

b Right or Left Paramedian

Vertical incision, lateral and parallel to the midline. Used for specific surgical procedures, e.g. Splenectomy.

c McBurnny The incision generally used for an Appendectomy.

d Oblique Inguinal Incision made in area of groin for Herniorrhaphy

e Sub-costal (Kocher’s)

Incision made below the ribs generally for Gallbladder procedures.

ABDOMINAL INCISIONS

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A.Midline

E.Sub-costal (Kocher’s)

C.McBurnny

A.Midline

D.Oblique inguinal

A.Midline

B.Right & Left Paramedian

C.McBurnny

D.Oblique inguinal

E.Sub-costal (Kocher’s)

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Skin Protective covering

Sub-cutaneous tissue Fatty layer under the skin. (Thickness will vary considerably according to individual’s weight.

Fascia (Anterior and Posterior) – a layer of firm connective tissue that covers muscles.

Muscle Fibrous tissue formed into sheaths

Peritoneum Thin membranous lining of abdominal cavity beneath the posterior fascia

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Abdominal Wall Muscles

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Abdominal Wall Muscles

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Abdominal Wall Closure

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Skin is the soft outer coveringThe adjective cutaneous means "of the skin" (from Latin cutis, skin).

The skin is an organ made up of multiple layers of Ectodermal tissue, and guards the underlying muscles, bones, ligaments and internal organs.

All mammals have hair on their skin, even which appear to be hairless. The skin interfaces with the environment and is the first line of defence from external factors. For example, the skin plays a key role in protecting the body against pathogens and excessive water loss. Its other functions are insulation, temperature regulation, sensation, and the production of vitamin D folates. Severely damaged skin may heal by forming Scar tissue. This is sometimes discoloured and de-pigmented. The thickness of skin also varies from location to location on an organism. The skin located under the eyes and around the eyelids is the thinnest skin in the body at 0.5 mm thick, and is one of the first areas to show signs of aging such as wrinkles. The skin on the palms and the soles of the feet is 4 mm thick and the thickest skin in the body. The speed and quality of wound healing in skin is promoted by the reception of estrogen.

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Epidermis It is composed of the outermost layers of the skin. It forms a protective

barrier over the body's surface, responsible for keeping water in the body and preventing pathogens from entering, and is a stratified squamous epithelium, composed of poliferating basal differentiated suprabasal Keratinocytes. Epidermis also helps the skin regulate body temperature.

Epidermis can be further subdivided into the following strata or layers (beginning with the outermost layer):

Stratum Corneum = Outter most Layer Stratum Lucidum (only in palms & sole) Stratum Granulosum Stratum Spinosum Stratum Germinativum (also called the Stratum Basale ) = Inner most Layer. Epidermis contains no blood vessels and in the deepest layers cells are nourished by

diffusion from blood capillaries extending to the upper layers of the Dermis. Basement membrane: It is a thin sheet of fibers which separates the Epidermis

from Dermis, and is made through the action of both tissues. The Basement Membrane controls the traffic of the cells & molecules between the Dermis & Epidermis.

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Dermis It consists of connective tissue and cushions the body from stress and strain. It provides tensile strength & elasticity to the skin through an extra-cellular matrix

composed of collagen fibrils, microfibrils & elastic fibers, embedded in proteoglycans.

It harbors nerve endings, provide the sense of touch & heat. It contains the hair follicles, sweat glands, sebaceous glands. The blood vessels in the dermis provide nourishment and waste removal from its own cells as well as for the epidermis.

The Dermis is tightly connected to the Epidermis through a basement membrane and is structurally divided into two areas: a superficial area adjacent to the Epidermis, called the papillary region, and a deep thicker area known as the reticular region.

Papillary region. The papillary region is composed of loose areolar connective tissue. It interdigitates with the epidermis, strengthening the connection between the two layers of skin.

Reticular region: Lies deep in the papillary region and is usually much thicker. It is composed of dense irregular connective tissue, and receives its name from the dense concentration of collagenous, elastic reticular fibers that weave throughout it. Theseprotein fibers give the dermis its properties of strength,extensiility and elasticity. Also located within the reticular region are the roots of the hair, sebaceous glands, sweat glands, receptors, nails & blood vessels.

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Hypodermis: Subcutaneous Tissue

The Hypdermid is not part of the skin, and lies below the Dermis. Its purpose is to attach the skin to underlying bone and muscle as well as supplying it with blood vessels & nerves.

It consists of loose connective tissue and elastin. The main cell types are fibroblasts, macrophages and adibocytes (the hypodermis contains 50% of body fat).

Fat serves as padding and insulation for the body. Another name for the hypodermis is the subcutaneous tissue.

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Digestive System

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Naso, Oro & Laryngo Pharynx

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Naso, Oro & Laryngo Pharynx

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ThyoidectomySurgical removal of complete Thyroid gland or Half (Hemi-Thyoidectomy).

Vessel ligation using silk (STERISIL)

Platysma muscles using Absorbable Suture (I-COL; 4/0 or 3/0).

Subcutaneous tissue using Absorbable Suture ,4/0 (I-COL).

Skin Suturing 5/0 or 4/0 Absorbable ( MONOCOL), Non Absorbable (STERILON)

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Clinical Significance Enterotomy : Any G.I. Procedure

Palatoplasty is a surgical procedure used to correct or reconstruct the palate in a person with a cleft palate. The basic goals of the procedure are to close the abnormal opening between the nose and mouth, to help the patient develop normal speech, and to aid in swallowing, breathing and normal development of associated structures in the mouth. The procedure is usually performed on infants. The ideal age for the patient is between six and twelve months of age.

Genioglossus Advancement (GA) also known as Genial Tubercle Advancement (GTA), is a surgical procedure or sleep surgery in which the base of the tongue is pulled forward, usually to increase airway size due to deformity or a sleep breathing disorder. Frequently performed with Maxillomandibular advancement surgeries.

Glossectomy is the surgical removal of all or part of the tongue. It is performed in order to curtail malignant growth such as oral cancer. Often only a portion of the tongue needs to be removed, in which case the procedure is called a Hemiglossectomy. 37Deepak Mudgil

ESOPHAGUS STRUCTURE:

Muscular Tube, 30 cm Long, behind wind pipe & heart from Pharynx to Stomach. Commonly known as the foodpipe or gullet, which consists of a fibromuscular tube through which food passes, aided by peristaltic contractions, from the pharynx to the stomach. In humans, it is usually 18–25 centimeters (cm) long. It travels behind the trachea and heart, passes through the diaphragm and empties into the cardia of the stomach. Esophagus in Greek means "to carry to eat.The lower sphincter helps to prevent reflux of acidic stomach content. The esophagus has a rich blood supply and vascular drainage. Its smooth muscle and in addition voluntary nerves.

FUNCTIONS: Swallowing, Reducing gastric reflux & Movement of food with help of Peristalsis.

Clinical significance: Inflammation, Cancer, Strictures.

Esophagectomy : Oesophagectomy (British English) is the surgical removal of all or part of the esophagus.

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STOMACH Healing time 14-21 Days STRUCTURE:

In adult humans, the stomach is oblong rounded Muscular, has a relaxed, near empty volume of about 45 to 75 milliliters. Because it is a distensible organ, it normally expands to hold about one litre of food. A newborn human baby will only be able to retain about 30ml. The stomach lies between the esophagus and the duodenum (the first part of the small intestine). It is on the left upper part of the abdominal cavity. The top of it lies against the diaphragm. Lying behind the stomach is the pancreas. Two sphincters keep the contents of the stomach contained. They are the esophageal sphincter dividing the tract above, and the pyloric sphincter dividing the stomach from the small intestine. Rugae a longitudinal folds in gastric mucosa to facilitate Expansion & Contraction.

FUNCTIONS: Food Digestion.

Clinical significance: Gastrectomy : A gastrectomy is a partial or full surgical removal of the stomach.

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Stomach

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Stomach Details

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Tissue Layers of Gastrointestinal Track

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Stomach Parts CARDIA:

STRUCTURE: The esophagus connects to the stomach at a small region called the cardia. It is a narrow, tube-like region that opens up into the wider regions of the stomach. Within the cardia is the lower esophageal sphincter, a band of muscle tissue that contracts to hold food and acid inside of the stomach. The cardia is defined as the region following the "z-line" of the gastroesophageal junction, the point at which the epithelium changes from stratified squamous to columnar. Near the cardia is the lower esophageal sphincter.

FUNDUS: The fundus is formed by the upper curvature of the organ.

CORPUS: The body (Latin: corpus) is the main, central region.

PYLORUS: It is the lower section of the organ that facilitates emptying the contents into the small

intestine. Inferior to the body is a funnel shaped region known as the pylorus. The pylorus connects the stomach to the duodenum and contains the pyloric sphincter. The pyloric sphincter controls the flow of partially digested food (known as chyme) out of the stomach and into the duodenum. It Control opening to small Intestine.Deepak Mudgil 43

Stomach Details

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Ligation of blood vessels 0-4/0End to side Anastomosis with Absorbable. 2/0 – 3/0, HRAbdominal wall Suturing.

Esophagus is joined to partial stomach.

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Esophagogastrectomy

Gastrectomy

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Clinical Significance Duodenal switch :

The Duodenal switch (DS) procedure, also known as Biliopancreatic diversion with duodenal switch (BPD-DS) or Gastric reduction duodenal switch (GRDS), is a weight loss surgery procedure that is composed of a restrictive and a malabsorptive aspect.The restrictive portion of the surgery involves removing approximately 70% of the stomach along the greater curvature.

Pyloromyotomy : Pyloromyotomy is a surgical procedure in which an incision is made in the longitudinal

and circular muscles of the pylorus. It is used to treat hypertrophic pyloric stenosis. Hypertrophied muscle is cut along the whole length, till mucosa bulges out. If mucosa is injured, it is sutured horizontally using interrupted silk sutures

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SMALL INTESTINE: DUODENUM, JEJUNUM SMALL INTESTINE, 14 Days full strength.(Absorbable Sutures)

FUNCTIONS: Digestion & Absorption. DUODENUM:

STRUCTURE: The first & shortest section of the small intestine. The duodenum precedes the jejunum and ileum. It is C-Shaped hollow tube from Pylorus to jejunum, 30 cm long, curves around head of pancreas & entry of common bile duct. Connecting Stomach to the jejunum. It begins with the duodenal bulb and ends at the ligament of Treitz.

FUNCTIONS: In mammals the duodenum may be the principal site for iron absorption & where most chemical digestion takes place.

JEJUNUM: STRUCTURE: 250 cm Long, The jejunum lies between the duodenum and the ileum. The

change from the duodenum to the jejunum is usually defined as the Duodenojejunal flexure and is attached to stomach by the ligament of Treitz.

FUNCTIONS: The pH is usually between 7 and 9 (neutral or slightly alkaline). The lining is specialized for the absorption, by enterocytes, of small nutrient particles which have been previously digested by enzymes in the duodenum. Once absorbed, nutrients (with the exception of fat, which goes to the lymph). Mesentery which gives the bowel great mobility within the abdomen. It also contains circular and longitudinal smooth muscle which helps to move food along by a process known as peristalsis.

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SMALL INTESTINE: DUODENUM, JEJUNUM

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Duodenum, Pancreas, Liver, Gallbladder

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Appendix

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Appendix & Ileocacel Valve

Appendix Opening APPENDIX

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Appendectomy

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Clinical significance Cholecystectomy : It is the surgical removal of the gallbladder. It is a common

treatment of symptomatic gallstones and other gallbladder conditions. Surgical options include the standard procedure, called laparoscopic cholecystectomy, and more invasive procedure, called open cholecystectomy.

Frey's procedure : It is a surgical technique used in the treatment of chronic pancreatitis in which the diseased portions of the pancreas head are cored out.

Hepatoportoenterostomy : or Kasai portoenterostomy is a surgical treatment performed on infants with biliary atresia to allow for bile drainage. In these infants, the bile is not able to drain normally from the small bile ducts within the liver into the larger bile ducts that connect to the gall bladder and small intestine.

Hepatectomy : The surgical resection of the liver. Term is employed for the removal of the liver from a liver transplant recipient or partial resections of hepatic tissue.

Lithotomy : Lithotomy from Greek for "lithos" (stone) and "tomos" (cut), is a surgical method for removal of calculi, stones formed inside certain hollow organs, such as the kidneys (kidney stones), bladder (bladder stones), and gallbladder (gallstones) by means of a surgical incision (Invasive), lithotripsy.(non-invasive).

Pancreatectomy : It is the surgical removal of all or part of the pancreas.

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Gallbladder

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Liver, Gallbladder, Spleen

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ILEUM, Appendix, LARGE INTESTINE

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Appendix & Ileocacel Valve

Appendix Opening APPENDIX

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ILEUM, LARGE INTESTINE• ILEUM :

• STRUCTURE: 200cm to 400cm long, ends at ileocecal valve. The ileum follows the duodenum and jejunum and is separated from the cecum by the ileocecal valve (ICV). In humans,The pH is usually between 7 and 8 (neutral or slightly alkaline). Ileum is derived from the Greek word eilein, meaning "to twist up tightly.”FUNCTIONS: The function of the ileum is mainly to absorb vitamin B12, bile salts and whatever products of digestion were not absorbed by the jejunum. They absorb fatty acid and glycerol.

CECUM: STRUCTURE: Pouch Like, The cecum or caecum from the Latin caecus meaning blind) is

a pouch, usually peritoneal, that is considered to be the beginning of the large intestine. It receives chyme from the ileum, and connects to the ascending colon of the large intestine. It is separated from the ileum by the ileocecal valve. The appendix is connected to the cecum. While the cecum is intraperitoneal, the ascending colon is retroperitoneal.

Ascending Colon: STRUCTURE: from Cecum to hepatic flexure, 12.5cm long. The ascending colon is the

part of the colon located between the cecum and the transverse colon.The ascending colon is smaller in caliber than the cecum from where it starts. It passes upward, opposite the colic valve, to the under surface of the right lobe of the liver, on the right of the gall-bladder, where it is lodged in a shallow depression, the colic impression; here it bends abruptly forward and to the left, forming the right colic flexure (hepatic) where it becomes the transverse colon.

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Clinical significance Jejunostomy : It is the surgical creation of an opening (fistula) through the

skin at the front of the abdomen and the wall of the jejunum (part of the small intestine).

Hartmann's operation: It's a procedure with a proximal end colostomy or ileostomy is the most common operation carried out by general surgeons for management of malignant obstruction of the distal colon. During this procedure, the lesion is removed, the distal bowel closed intraperitoneally, and the proximal bowel diverted with a stoma.

Partial ileal bypass surgery: Partial ileal bypass surgery is a surgical procedure which involves shortening the ileum.

Appendectomy: It is the surgical removal of the vermiform appendix. This procedure is normally performed as an emergency procedure, when the patient is suffering from acute appendicitis.

Colectomy : It consists of the surgical resection of any extent of the large intestine (colon). It is also an occasional term used to describe removing the entire large intestine along with the rectum, but the appropriate term is proctocolectomy, where the whole large intestine and rectum are removed.

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Transverse Colon Transverse Colon:

STRUCTURE: Horizontal section from Liver to Spleen. It is the longest and most movable part of the colon, crosses the abdomen from the ascending colon at the hepatic or right colic flexure. Toward its splenic end there is often an abrupt U-shaped curve which may descend lower than the main curve. It is almost completely invested by peritoneum.

FUNCTIONS: The transverse colon absorbs water and salts.

Descending Colon: STRUCTURE: It begins at the splenic flexure at the upper left part of the abdomen. It

passes downward through lumbar regions, along the lateral border of the left kidney and end at the lower left part of the abdomen where it is continues as the sigmoid (S-Shaped section of colon from end of colon descending to onset of Rectum)colon. The function of the descending colon in the digestive system is to store the remains of digested food that will be emptied into the rectum. Vertically down wards along side abdomen towards pelvis.

FUNCTIONS: While the first part of the large intestine is responsible for the absorption of water and other substances from the chyme, the main function of the descending colon is to store waste until it can be removed from the body in solid form, when a person has a bowel movement. The stools gradually solidify as they move along into the descending colon.

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STOMA

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RECTUM, ANAL CANAL RECTUM:

STRUCTURE: Lower section of colon 12cm long.(No Serosa). The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the large intestine and begins at the rectosigmoid junction (the end of the sigmoid colon), It is followed by the anal canal.

FUNCTIONS: The rectum acts as a temporary storage site for feces. If defecation is delayed for a prolonged period, constipation and hardened feces results.When the rectum becomes full, the increase in intrarectal pressure forces the walls of the anal canal apart, allowing the fecal matter to enter the canal.

Anal Canal:

STRUCTURE: 3.5cm long,encercled by sphincter.The anal canal is the terminal part of the large intestine. It is situated between the rectum and anus. It extends from the anorectal junction to the anus. It is directed downwards and backwards. It is surrounded by inner involuntary and outer voluntary sphincters which keep the lumen closed in the form of an anteroposterior slit.

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RECTUM, ANAL CANAL

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Clinical significance Proctocolectomy : is the surgical removal of the rectum and all or part of the

colon. It is a most widely accepted surgical method for ulcerative colitis and Familial Adenomatous Polyposis (FAP). It can also be performed for Crohn's disease that has damaged the entire large intestine and caused complications, but it does not cure or eliminate the disease.

Abdomino Perineal Resection (APR) : The principal indication for AP resection is a rectal carcinoma situated in the distal (lower) one-third of the rectum. following initial, usually definitive combination chemoradiotherapy. It involves removal of the anus, the rectum and part of the sigmoid colon along with the associated (regional) lymph nodes, through incisions made in the abdomen and perineum. The end of the remaining sigmoid colon is brought out permanently as an opening, called a colostomy, on the surface of the abdomen.

Colostomy : A colostomy is a surgical procedure in which a stoma is formed by drawing the healthy end of the large intestine or colon through an incision in the anterior abdominal wall and suturing it into place, provides an alternative channel for feces to leave the body.

Total mesorectal excision : Total mesorectal excision (TME) is a standard technique for treatment of colorectal cancer.

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Clinical significance Anal fistula: Fistula-in-ano, is an abnormal connection between the epithelialised

surface of the anal canal and (usually) the perianal skin. If the outlet of glands becomes blocked, an abscess can form which can eventually point to the skin surface. The tract formed by this process is the fistula.

Transanal Hemorrhoidal Dearterialization: (THD) is a surgical procedure for the treatment of internal hemorrhoids. Hemorrhoids are fed by arteries and drained by veins. The arterial blood supply is based on the superior rectal (hemorrhoidal) artery. Just as veins in the leg weaken and become prominent, hemorrhoidal veins also may become varicose, resulting in internal hemorrhoids or “piles”. Internal hemorrhoids are divided into four grades. Grade I to IV.

Coloanal anastomosis: It is a surgical procedure in which the colon is attached to the anus after the rectum has been removed. Also called coloanal pull-through.

Colorectal surgery: Colorectal surgery is a field in medicine, dealing with disorders of the rectum, anus, and colon. The field is also known as proctology, is most often employed to identify practices relating to the anus and rectum in particular. The word proctology is derived from the Greek words ("Proktos"), meaning anus or hindparts, and ("Logos") meaning science or study.

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Gynecology & Obs.

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Main Female Organs

Vagina:It is a fibro-muscular tubular tract leading from the Uterus & joins at cervix (the lower part of uterus) to the outside of the body. Also known as the birth canal.

Cervix:It is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall. The cervix is also named the neck of the uterus.

Uterus: or womb is the major female reproductive organ. The uterus provides mechanical protection, nutritional support & waste removal for the embryo (weeks 1 to 8) and fetus (until the delivery). The uterus is a pear shaped muscular organ.

Fallopian tube: The Fallopian tubes or Oviducts are two tubes leading from the ovaries of female mammals into the uterus. On maturity of an ovum, allowing it to escape and enter the Fallopian tube. If the ovum is fertilized while in the Fallopian tube, then it normally implants in the endometrium, when it reaches the uterus, which signals the beginning of pregnancy.

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Associated Surgeries

Mastectomy (Greek "breast" & ektomia "cutting out")Medical term for the surgical removal of one or both breasts, partially or completely. It is usually carried out to treat breast cancer & prophylactic in women / men believed to be at high risk.

Tubal ligation or tubal occlusion ("tying the tubes"). Surgery to cut, cauterize, or band the fallopian tubes to prevent the egg from being transported to the uterus. Tubal ligation is designed to be a permanent method of birth control.

Trachelectomy: Surgical removal of the cervix (but not the rest of the uterus). A radical trachelectomy is the removal of the cervix and surrounding tissue, along with some pelvic lymph nodes.

Myomectomy: It is the surgical removal of uterine fibroids without the removal of the uterus. There are several techniques that may be used, and the choice of the technique depends on the location and size of the fibroids as well as the characteristics of the woman. It is sometimes impossible to remove all the fibroids, and new fibroids may grow after a myomectomy. Deepak Mudgil 69

Mastectomy

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Mastectomy

Myomectomy Surgical removal of Uterine fibroids

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A Caesarean section (C-section): It is a Surgical procedure in which one or moreincisions are made through a mother's abdomen ( Laparotomy) & Uterus (Hysterotomy) to deliver one or more babies or rarely to remove a dead fetus. A late-term abortion using Caesarean section procedures is termed Hysterotomy Abortion and is very rarely performed. The first modern Caesarean section was performed by German gynecologist Ferdinand Adolf Kehrer in 1881.It is often performed when a Vaginal delivery would put the baby's or mother's life or health at risk. Many are also performed upon request.Professional societies have established guidelines for non-medically indicated cesarean before 39 weeks.

• Oophorectomy: (removal of ovaries) is frequently done together with hysterectomy to decrease the risk of ovarian cancer.

Hysterectomy is the surgical removal of the Uterus. It may also involve removal of the cervix, ovaries, fallopian tubes and other surrounding structures. Hysterectomy may be total (removing the body, fundus & Cervix of the uterus; often called "complete") or partial (removal of the uterine body while leaving the cervix intact; also called "supracervical"). It is the most commonly performed gynecological surgical procedure.

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Caesarean section (C-section)

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Caesarean section (C-section)

Hysterectomy Hysterectomy: in the literal sense of the word, means merely removal of the

uterus. However other organs such as ovaries, fallopian tubes and the cervix are very frequently removed as part of the surgery.

Radical hysterectomy: complete removal of the uterus, cervix, upper vagina, and parametrium. Indicated for cancer. Lymph nodes, ovaries and fallopian tubes are also usually removed in this situation.

Total hysterectomy : Complete removal of the uterus and cervix, with or without Oophorectomy.

Subtotal (supracervical) hysterectomy : removal of the uterus, leaving the cervix in situ. Itwas originally proposed with the expectation that it may improve sexual functioning after hysterectomy, it has been postulated that removing the cervix causes excessive neurologic and anatomic disruption. It does not eliminate the possibility of having cervical cancer since the cervix itself is left intact and may be contraindicated in women with increased risk of this cancer, regular PAP Smear to check for cervical dysplasia / Cancer are still needed.

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Schematic drawing of types of Hysterectomy

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Ectopic Pregnancy

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EpisiotomyPerformed when perineum is thinned & 3-4cm of baby head is visible during contraction.

REPAIR: Closure of vaginal mucosa using2-0 absorbable sutures, ( Continuous )Perineum muscles closure using 2-0 absorbable sutures, ( Interrupted )

Skin closure with using 2-0 absorbable sutures, ( Interrupted or subcuticular )

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Congenital diaphragmatic hernia is a birth defect in which abdominal organs protrude up into the chest cavity.

Femoral hernia is the protrusion of abdominal fat or part of the intestines through the abdominal muscles into the upper thigh area.

Hiatal hernia is the protrusion of a portion of the stomach through an opening in the diaphragm called the hiatus. Hiatal hernia is also called a hiatus hernia.

Incisional hernia is a hernia that develops through a previous surgical incision. This can occur anywhere on the abdomen or back.

Inguinal hernia is the protrusion of abdominal fat or part of the intestines through the abdominal muscles into the groin area (also called the inguinal canal). Inguinal hernia is the most common type of hernia.

Umbilical hernia is the protrusion of part of the intestines or abdominal lining through the abdominal wall around the belly button. It most often occurs in infants ages six months and younger.

TYPES OF HERNIA

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TYPES OF HERNIA

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HERNIAHERNIA: Protrusion of Organ into an other anatomical

compartment within a hernial sac, the later consisting of the organ and / or the wall of the respective compartment

Inguinal Hernias-

Indirect Inguinal HerniasThis occurs due to a weakness in the abdominal wall present at birth.

In men, this weakness is caused by a space that is created as the testes and spermatic cord descend by way of the inguinal canal (a / ½ inch canal)

Direct Inguinal HerniaThey are most common in men and usually later in life, most often

after 40, Direct inguinal hernias are due to an acquired wear and tear in the abdominal wall.

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Inguinal Hernias

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Inguinal HerniaThe protrusion of abdominal fat or part of the intestines through the abdominal muscles into the groin area (also called the inguinal canal). Inguinal hernia is the

most common type of hernia.

DIRECT INDIRECT

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Inguinal HerniaThe protrusion of abdominal fat or part of the intestines through the abdominal muscles into the groin area (also called the inguinal canal). Inguinal hernia is the

most common type of hernia.

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INGUINAL HERNIA

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Femoral HerniaOccur just below the inguninal ligament, when abdominal contents pass through a

naturally occurring weakness called femoral canal.

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Umbilical HerniaUsually in newborns & pregnant woman, seen at the site of umbilicus

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Incisional HerniaHernia occurs in incompletely healed surgical wound.

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ENDOSCOPIC HERNIA REPAIR (Minimally invasive surgery )

There are two forms of endoscopic hernia repairs:-

Trans-abdominal pre-peritoneal (TAPP), this repair involves entry into the abdominal cavity with peritoneal incision and dissection, hernia reduction, mesh placement, and closing peritoneum.

In Totally Extra-peritoneal (TEP) hernia repair the abdominal cavity is not entered. The working space is created by pre-peritoneal dissection. Mesh is placed without peritoneal incision.

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ENDOSCOPIC HERNIA REPAIR

TAPP TEP

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SURGICAL HERNIA REPAIR

Fixation of Synthetic MESH at Inguinal Ligament by

2-0 or 3-0 MONOCOL to strengthened inguinal

region

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STERISLING

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STERISLING Trans-Obturator Needle System

The Transobturator Needle System consists of Two Curved Medical Grade Stainless Steel reusable passers.

They are used to place Sling for Female patients of Stress Urinary Incontinence (SUI) with minimal blind passage.

Making it very safe, It never enters the Reptropubic space & Abdominal wall.

Decreased risk of: Bowel, Bladder Injury & Major Bleeding.

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Major Orthopedic procedures:1)Carpal tunnel Release2) Removal Support implant3) Repair Femoral fracture4) Repair of trochanteric Fracture.5)Debridement of Bone/ Fracture/ Muscle / Skin.6) Hip Replacement7) Repair Rotator cuff tendon8) Repair Fracture of Radius / Ulna.9) Lumbar Spinal Fusion.10)Repair fracture of the distal part of Radius.11) Low back Intervertebral Disc surgery.12) Repair of ankle Fracture (Fibula).13) Repair of Femoral Fracture.14)Repair of Trochanteric Fracture.

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STERICAT FAMILY

97Corporate PresentationDeepak Mudgil

OPEN SESSION&ROLL PLAY

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