10. Discuss the importance of keyhole surgery. What complications and risks does it reduce?

Surgery is a repairing body with knives and stitches. For thousands of years it was limited to amputations which were performed very fast, without anesthetic and knowledge of hygiene. Success rates were low and many patients died from shock or post-operative infections.

Even with modern anesthetics and antiseptics pa tients still suffer from the consequences of the operations. Open surgery still remains a bloody busi ness. However, the invention of the laparoscope - a tube for looking inside the body - has led to the development of the "keyhole" surgery. It is highly appreciated because it means less pain and less scarring. For example, in conventional by-pass surgery the surgeon has to open the patient's chest with a 30 cm long incision whereas keyhole surgery involves just three one-centimeter cuts. Now complex operations are done through small inci sions. While performing such a procedure surgeons see images on screens made by a tiny video camera at the end of laparoscope. Keyhole surgery demands a lot of practice in hand-eye coordination in order to accurately navigate around the internal organs.

The next stage of development of the keyhole surgery is involving robots in operative proc ess. Robot's hands have a greater range of movement and don't shake.

As you see, keyhole surgery opens a great variety of opportunities for surgical manipulations. But nowadays it is exactly determined that it helps to avoid such complications as hematomas, hernias, fewer wound complications like infection. That's why keyhole surgery is a new stage of surgery development providing a pretty huge field for further scientific investigations.Discuss the importance of pre-operative procedures. List them. What are the benefits of pre-op patient education, both for patient and for the healthcare system?

Surgery has always been risky and even with modern anesthetics, bloods transfusion and antiseptics patients still suffer from the consequences of the operations. Patient usually worry about such things as pain after and during the op­eration, searing, MRSA and dying during surgery. That is why it is twice important for the surgeon to inform his patient what procedure is going to be, and the surgeon must do all his best to be prepared well for the operation and to prepare his patient.

But the operation is not performed only by a surgeon. It is performed by the group of experts in operative proce­dure, pain management and specific patient care, which is called "surgical team". The basic surgical team includes sur­geon, anesthetist, anesthetist nurse and operating nurse. In teaching hospitals attached to medical schools the team may be enlarged by interns, residents and nursing students. A surgical team during surgery is led by one surgeon performing most clinical work himself while directing his team to assist with or to overtake less clinical parts. Anesthetists is a physician who is directly or indirectly involved in all three stages of surgery (pre-operative, operative and post-operative) due to his focus on pain management and patient safety. The anaesthetist nurse supports the anaesthetist and takes full control of anaesthesia during the operation. Operating nurse is the general assistant to surgeon during the actual operation phase. The nursing staff performs comprehensive care, assistance and pain management during each surgical phase.

Pre-operative management contains a lot of different manipulations which are performed by members of surgical team and include preparation of patient, surgeon and operating room.

The patient should be admitted to the hospital some day before operation. It is necessary to make some preparations for operation such as evacuation of the bowel. If evacuation of the bowel has been regular a water enema on the morning of the operation is adequate. As a rule the skin receives its first preparation on the evening before the surgical manipula­tions. The operative area is first washed with soap and also must be painted with antiseptic.

As for surgeon's hands he should wash his hands thoroughly with soap and hot water for 3-5 minutes. Special care should be taken with the grooves round the nails. The hands and arms should be immersed in alcohol rubbed with a piece of gauze for a few minutes and then dried. Finally the cleaned and sterilized rubber gloves are drawn on. All these prepa­rations should be done immediate by before the operation, just before the patient is anaesthetized.

The operating room should be well lighted, well heated, well ventilated. It must also contain all the necessary sup­plies such as: instrument basing, sutures, needles, syringes, drains, tubes, gauze and others. There are the instruments used during the operation: scalpels, scissors, dissecting forceps, tissue forceps, sponges, curette, tourniquet and bandages. All the instruments should be sterilized by boiling for 15 to 20 minutes in water containing 1 or 2 per-cent of carbonate of soda. The operating nurse must also prepare the apparatuses for blood transfusion and artificial respiration. The surgical instruments and supplies are counted before the operation in order to avoid forgetting them in the patient's body.

Before the operation the anesthetist nurse may give a pre-med to a patient. It is a liquid sedative which makes pa­tient feel relaxed and sleepy. The anesthetist connects patient to the monitoring equipment and then gives some drugs that will send patient to sleep. Then anesthetist asks the patient to count backwards from 100.... And the next thing the patient sees is the recovery room.

All these pre-operative procedures help to avoid complications after the operation and reduce the risk of wide spreading of infectious diseases. That is why they are indispensable and very useful both for patients and for the health­care system on the whole.