Institute of Surgical Research

Basic Surgical Skills - Workshops

Year 2016-2017 / 2nd semester

 Institute of Surgical Research
Basic Surgical Skills Workshop VI.

1. Information about the exams in general

2. Preparation to the practical exam: tastks, evaluation

3. Further courses of our institute

4. Other optional activities: research, instructorship at the practices

 Exams / Marks

Theoretical test exam: during the exam period, multiple choice questions and false/true.
Time: see at the Neptun (weekly dates will be offered).

What to study?
Topics of the lectures: see Coospace annotations:
1.Asepsis and antisepsis. Historical background. Surgical infections, sources of infections. Types, classification, risks and
prevention of wound contaminations. Sterilization, disinfection. Preparation of the patient before operation: scrub preparation
and isolation of the surgical site. Scrubbing, disinfection, gowning and gloving of the operating team. Personnel attire and
movement. Basic rules of asepsis in the operating room. Postoperative wound management. Surgical antisepsis. Design and
equipments of the operating room, basic technical background. Operating room personnel and their duties. Positioning of the
patient on the operating table. Positioning.
2.Surgical instruments. Basic surgical instruments, special surgical tools and technologies, suture materials. Wound closure
(sutures, clips, adhesive strips). Imperfections of suturing techniques. Removal of sutures. Drainage.
3.The operation. Basic surgical interventions. Indications for an operation, informed consent, operative risk, the surgeons
responsibility. Preoperative investigations. Perioperative fluid balance, fluid requirements and fluid therapy. Preoperative
preparation of the patient. Local anesthesia (drugs, types of local anesthesia, complications).
4.Wounds. Types and classification of accidental wounds. Wound healing, scar formation. Surgical wounds. Wound closure
and its complications. Management of accidental wounds. Dressings, types of bandages. Innovations in wound treatment.
5.Bleeding. Types and classification of hemorrhage. Signs and consequences of blood loss. Bleeding in surgery (pre-, intra-
and postoperative bleeding). Factors influencing operative blood loss. Surgical hemostasis (mechanical, thermal, chemical-
biological methods). Blood replacement in surgery, autotransfusion.
6.Complications. Definition and classification of complications. Complications related to surgery and anaesthesia.
Complications of wound healing. Haemorrhagic complications. Pathophysiology, signs and treatment of hemorrhagic shock
7.Basics of minimally invasive surgical interventions. Historical background. Components of the laparoscopic tower,
laparoscopic instruments.
 Exams / Marks

Practical exam: during the study period on week 14 (we make it possible also for those who
missed a maximum of practices).

Everyone has to attend the practical exam on the day which is designated to her/his group.
Accordingly, 3 groups will be simultaneously present, the exam will be taken individually, in
rotation between the 3 different task stations (as follows).

Those who still would like to practice on week 14, it will be possible (place: Skills Center).

Practical exam tasks: 1. Knotting by hands under tension (1 prefered type should be showed)
2. Suturing (sec Donati) + instrument tie knotting
3. Cleansing, gowning and gloving
The practical mark is calculated as the average of the 3 task marks.
Videos of knotting and criteria of giving the marks have been uploaded to Coospace.

Only exam task with mark 1 (failing) has to be /can be repeated on week 15. Marks gotten
on week 14 cannot be improved (except for 1).

If someone does not show up on week 15 to improve mark 1, the average of the 3 marks will
be calculated (even though one of them is 1)
 Exams / Marks

Final (5 grade) mark: the average of the test and practical exams (each but should be at
least 2)
Information on the Coospace
Preparation for the
practical exam
 Tasks

-scrubbing, gowning
-tying a knot under tension
-wound closure with Donati-stitches

Evaluation sheets, practicing opportunities..

 Scrubbing and disinfection

Mechanical cleansing (2 min)

1. (Cut nails and clean subungual areas)
2. Wash hands with soap (hygienic wash) rinse
3. Wash hands and forearms with soap (scrubbing) rinse
4. Dry hands and forearms with sterile paper towels

Chemical disinfection (5 x 1 min)

 Evaluation of scrubbing

Task Mistake (1 mark is deducted)

Putting on caps, mask, and Missing to put on any of them Incorrectly applied (uncovered hair, nose).
shoe cover
Preparation for mechanical Wearing ring, wrist watch, bracelet, nail polish, or if the long sleeve of the cloth
scrub covers the elbow and the forearm.
Hygienic hand wash Missing or false (not rinsing)
Hand and forearm wash Missing or false: the extent, intensity or length of time of the scrub is not
with soap appropriate, wrong order
Rinsing Inappropriate, the hand is held lower than the elbow, irregular rinsing; residual
lather;
Water tap closing The tap is closed by hand or forearm instead of the elbow (touch with washed hand
surface).
Mechanical scrub Breaching the rules of asepsis, e.g. touching non-sterile things
Drying hands Missing or disinfectant is applied on a wet hand
Desinfection Touching the feeder with hand or forearm instead of the elbow
Desinfection Missing, fewer than 5 dosages; the time is decreased or not controlled.
Desinfection Breaching the rules of desinfection (area, order)
Desinfection Rinsing the disinfectant
Desinfection Unintentional or unrecognized breaching the rules of asepsis; Hands kept irregularly,
the feeder is operated not by the elbow
Donning sterile gown Contamination of the gown while removing from the container
Putting on sterile gown Breaching the rules of putting on a gown (hanging arms, contamination)

Assisted sterile gloving Contamination of gloves (naked finger contact with sterile surface)
Removing gloves Contamination with naked fingers
 Evaluation of knotting

Task Mistake (1 mark is deducted)

Knotting (the type is The threads or hands are not crossed
optional
(reef=sailors, Knotting with the same hand (not with changed hands)
surgeons or Viennese Incorrect knotting technique
knot)
The knot is loose, can be easily removed
Donati stitch

Task
Mounting a needle holder,
closing an approx. 5 cm-
long incision with vertical
mattress (Donati) sutures
(min. 4, max. 6 stitches),
knotting with an
instrument
(maximum: 10 minutes)
Evaluation of Donati-style stitching
Mistake (1 mark is deducted)
Incorrect mounting of the needle holder with needle and thread
Breaking the needle/ straightening the needle
Holding and using the needle holder and/or the forceps incorrectly
The distances between stitches are not identical
The depth of the stitches and/or their distances from the incision site are
not appropriate or not identical
The position of stitches is not perpendicular to the incision
The knots are not on the same side of the wound.
Mistakes in the knotting technique
The sutures are too tight or loose
Holding the forceps

Mounting a needle holder

Vertical matress (Donati) suture

1 cm

2 mm
Too loose stitches Too tight stiches
Knots are at different sides Not perpendicular to the wound edge
Thread was cut to too short
Distance from the wound edge is not equal
The depth of the stitch is not appropriate The distance among the stitches is not equal
 Further courses offered by us (1)
ADVANCES SURGICAL SKILLS

Year 2017/2018- (always in the first semester)

Compulsory elective subject for 3rd-5th-year students of the Faculty of Medicine

Credits: 2

The aim of the subject:teaching basic surgical techniques, invasive interventions and advanced
surgical knowledge to medical students interested in different surgical specialties

Method: lectures (12 hours) + practices (12 hours)

Topics of the practices:
1.Minor Skin Procedures. Local anesthesia. Ellipse excision of skin. Removal of encapsulated
structures (cysts, tunors). Incision of abscesses
2.Advanced suturing techniques Enterotomy. Intestinal and vessel anastomoses.
3.Minimally invasive surgery
4.5-6. Advanced forms of surgical hemostasis and suturing techniques on a large animal model.
Tracheostomy. Laparotomy (in anesthetized PIGS)
 Further courses offered by us (2)
MICROSURGERY (8 students / group)
(more places always in the second semester)

Compulsory elective subject for 3rd-fifth-year students of the Faculty of Medicine

Credits: 2

The aim of the subject: teaching basic surgical techniques, invasive interventions
and advanced surgical knowledge to medical students interested in different
surgical specialties

Method: lectures (8 hours) + practices (20 hours)

Topics of the practices (20 hours):

1. Appropriate posture at the operating microscope and the adjustment of the
microscope. Eye-hand coordination exercises
2. Tying basic microsurgical knots under macroscopic and microscopic conditions
3-4. Stitching and tying knots with microsurgical instruments on rubber gloves
5-6. Suture of tubes (model of end-to-end and end-to-side anastomoses)
7-8. End-to-end anastomosis of rat carotid artery ex vivo
We offer other activities for the students
BECOME AN INSTRUCTOR AT OUR PRACTICES

Contact: Dr. Dniel rces

(erces.daniel@med.u-szeged.hu

PERFORM RESEARCH WITH US

Contact: Dr. Jzsef Kaszaki
(kaszaki.jozsef@med.u-szeged.hu