FUNDAMENTAL SURGICAL TIMES AND THEIR CHARACTERISTICS - MEDICINE - 2025

The surgical times are each one of the steps and procedures, ordered and methodical, that must be carried out for the successful performance of a surgical intervention. The surgical technique, in addition to being methodical and exact, must be known not only by the surgeon but also by all personnel involved in the surgery.

Knowledge of the procedure and the possible complications of the technique is essential when establishing a work team. Likewise, detailed anatomical knowledge and physiology is essential for the prevention of unwanted complications on the operating table.

The coordination of surgical times depends on full anatomical and physiological knowledge, and its chronological application. There are preoperative, intraoperative and postoperative procedures; Surgical times refer specifically to intraoperative procedures.

Therefore, the initial and final asepsis and antisepsis processes are not included within the surgical times. For each of the surgical times, there is a surgical instrument specifically designed in its shape, weight and size to facilitate the surgeon's maneuver.

Each instrument must be used for its designated purpose, to obtain optimal results in surgery.

Surgical times for each procedure

Incision, cut or umlaut

The incision or diaeresis is the first step in any surgical procedure, after preoperative care and aseptic and antiseptic measures.

It is the cut that is made to the tissues that separate the exterior of the structure or organ to be addressed. This cut or section must follow a specific methodology that guarantees access control and the integrity of the sectioned tissues.

The objective of the incision or diaeresis is to obtain an ideal access route according to the site and procedure to be performed. For this, there are various types of specific surgical instruments for each incision; for example:

Instruments for making soft tissue incisions

These include the scalpel and the electrosurgical knife.

Instruments for making incisions in hard tissue

In this group can be listed mainly instruments for bone incision, such as shears or sternotomes.

Haemostasis

Haemostasis is the arrest of bleeding, which can be considered normal or pathological and which can occur through physiological mechanisms or manual procedures.

In the surgical field, the initial umlaut of organic tissues justifies the physiological production of bleeding, which can be considered normal.

In these cases, the surgeon limits said bleeding by using hemostasis surgical procedures, to prevent the presence of extravasated blood from limiting vision and preventing the continuation of the surgery. Surgical hemostasis can be classified for study into two types:

Temporary hemostasis

This procedure uses maneuvers to stop bleeding quickly and effectively while performing definitive hemostasis procedures.

To achieve temporary hemostasis, pressure maneuvers are usually used, in some cases digit pressure, direct or indirect compression, or clamping of the vessel in question is applied.

The most commonly used surgical temporal hemostasis technique is the clamping technique. It is an instrumental technique that requires one or two forceps specially designed for vessel occlusion. The technique consists of clamping before the vessel section at each end of the incision site.

There are other procedures to achieve temporary hemostasis, such as tamponade with compresses that favors the physiological hemostasis of the segment; however, the description of each of these will depend on the situation or surgical procedure to be performed.

Definitive hemostasis

There are various mechanisms of definitive surgical hemostasis, and they are used in surgeries in which complete and direct obliteration of a blood vessel is necessary.

The most commonly used technique, even in cases of broken vessels, is suture ligation. The suture material will depend on the caliber and flow of the vessel to be ligated.

Exposure (separation, aspiration, traction)

The organ or tissue is exposed after a correct hemostasis technique, for which procedures are carried out that consist of the separation of the tissues or their retraction (backward movement).

For the separation of the tissues, some surgical instruments such as forceps and retractors are used.

This separation can be classified as active or passive. It is active if the first assistant holds the instrument and can continuously adapt it to the surgeon's needs during surgery. Instead, it is passive when the instrument is fixed for a longer time without the need to constantly move it.

In some cases, the aspiration of extravasated blood remains through the tissue incision, or serous fluid is necessary to achieve a clear visual field.

Dissection

Surgical dissection consists of dividing and separating the anatomical structures, freeing them from the surrounding connective tissue in order to achieve the minimum exposure necessary for optimal access to the segment to be operated on.

According to the type of dissection that the surgeon requires, there are instruments that classify the dissection as follows:

Blunt dissection

It is mainly done when you want to dissect loose connective tissue; blunt-tip surgical instruments are used for this. This can usually be a forceps, the back of a scalpel, and even a finger that is gloved with gauze.

Sharp dissection

This type of dissection is performed when the connective tissue to be dissected is resistant, such as a tendon, and sharp and sharp surgical instruments are used to section the tissue.

An example of this type of instrument is a scalpel or scissors, which can vary in size and curvature of its end according to the surgeon's need.

Suture or synthesis

Synthesis is known as the process of various steps that the surgeon performs to reconstruct the different planes previously cut, retracted or dissected.

Each plane and tissue is sutured by bringing their edges closer together with a specific material to promote rapid healing of each tissue. In this way, the damage done to access the structure to be operated is "repaired."

Depending on the type of surgery, it may be necessary in some cases to perform a partial synthesis, leaving an unsutured space to drain blood, pus, or extravasated fluid from the operation site.

In the opposite case, the synthesis can be considered total, when all the edges of all the tissues in each plane are faced and the entrance door of the surgery is completely closed.

References

1. Jorge Shock. Surgical Times. Journal of Clinical Update Investiga. Recovered from: magazinesbolivianas.org.bo
2. Angelica González. Chapter 4: Fundamental times of the surgical technique. Recovered from: accessmedicina.mhmedical.com
3. Salvador Martínez Dubois, Surgery. Foundations of surgical knowledge and trauma support. 4th Edition. Editorial Mc Graw Hill. Chapter 10. Transoperative. P. 144-158
4. Overview of hemostasis. Boundless Anatomy and Physiology. Recovered from: courses.lumenlearning.com
5. Anatole Bender. Surgery I and II. Synthesis. Recovered from: ocw.unc.edu.ar