13 Principles of Sterility

1. Only sterile items are used within the sterile field. 2. Sterile persons are gowned and gloved. 3. Tables are sterile only at table level. 4. Sterile persons touch only sterile items or areas. Unsterile persons touch onlyunsterile items or areas. 5. Unsterile persons avoid reaching over sterile field. Sterile persons avoid leaning overunsterile areas. 6. Edges of anything that encloses sterile content are considered unsterile. 7. Unsterile persons avoid sterile areas. 8. Sterile field is created as close as possible to the time of use. 9. Sterile areas are continuously kept in view. 10. Sterile persons keep well within sterile area. 11. Sterile persons keep contact with sterile areas to a minimum. 12. Microorganisms must be kept to irreducible minimum. 13. Destruction of integrity of microbial barriers results in contamination.

Types of Abdominal Incision

1. Midline incision - This is one of the most common and versatile incisions for abdominal surgery, allowing access to virtually all of the abdominal organs and the retroperitoneum, if necessary. After the skin and subcutaneous tissues are incised, the linea alba is opened. The advantage of this incision is that the linea alba is relatively avascular and avoids damage to any muscles or nerves. It is easy to extendable superiorly towards the exiphisternum, and, inferiorly, towards the pubic bone. The linea alba and rectus sheath are strong enough to allow secure closure. 2. Paramedian incision - An alternative for the standard midline incision is the paramedian incision. This technique stays clear of the relatively avascular linea alba, possibly avoiding impaired wound healing. Two variants are known: the conventional medial paramedian incision, in which the rectus sheath and rectus muscles are transected close to the linea alba, and the so-called lateral paramedian technique. In the latter, a longitudinal incision near the lateral border of the rectus sheath is made. 3. Transverse incision - A supraumbilical transverse incision offers excellent exposure of the upper abdomen. However, in case the operation area needs to be enlarged, extending the original incision is more difficult than when the midline incision was used and extensions do not always offer the desired view. When a full-length transverse incision is made, the oblique and transverse muscles, as well as the rectus abdominis muscle and linea alba are cut in a horizontal plane. 4. Subcostal incision - Also known as Kocher's incision. This can be right subcostal, used mainly for open cholecystectomy, or left subcostal, used mainly for splenectomy. A combination of both is called a roof-top incision, useful in gastric and hepatopancreatobiliary surgery. When extended up the midline (as may be required to implant a liver, for example) this incision may be called a Mercedes-Benz incision for its resemblance to the company's logo. 5. Right iliac fossa incision - This incision is used mainly to perform an appendicectomy, although it can be used to gain access to perform caecal decompression, appendicostomy and caecostomy. 6. McBurney's incision - 1/3 of the way along the line from the anterior superior iliac spine to the umbilicus. 7. Pfannenstiels incision - For Caesarian sections and urological surgery.

Surgical Instruments and Their Uses

1. Hemostat - A clamplike instrument used to compress a blood vessel in order to Round Kelly A type of hemostat with a curved edge that features a locking reduce or arrest the flow of blood during surgery. 2.

mechanism to allow them to act as clamps. 3. Straight Kelly - A type of hemostat with a straight edge that features a locking

mechanism to allow them to act as clamps. 4. Allis - The allis clamp is a surgical instrument with sharp teeth, used to hold or

grasp heavy tissue, but can cause damage to the tissue. Because of this, is manly used in tissue about to be removed. 5. Babcock A forcep used to hold delicate tubal structures such as the intestine

and fallopian tube during operation. 6. Scalpel - A scalpel is a small, but sharp knife most often used to make incisions

during surgeries.