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PRACTICAL LESSON 1

Theme of lesson:Table of contents, tasks and methods of study of the topographical anatomy and operative surgery. History of discipline. Surgical tool.

Time division:Acquaintance with composition of group - 10%Theoretical interviews about history and task of discipline - 10%Study of instruments with a teacher - 50%Independent mustering of educational material - 20% Control of final knowledge level and conclusions - 10%

Educational tasks:To know:1. Table of contents, history and method of study of topographical anatomy and operative surgery.2. Student's duties and work order in the department.3. Basic principles of classification and requirement to the surgical instruments, stitch material.4. Structure and special purpose setting of operating block apartments. 5. Setting and technique of application of general and special surgical instruments.6. Positions and rules of using a scalpel.7. Rules of stitch priming material and needle.8. Ways of the handling the instruments during the operations.9. Types of surgical knots and their application. To be able to do:1. To distinguish basic surgical instruments in accordance with their setting.2. To be able to use pincers, hooks, styptic clamps correctly.3. To tuck in the stitch material in the needle.4. To tuck in the needle in a needleholder.5. To tie up woman, surgical and marine knots.

Confirmed at the department meeting «____» __________Protocol №____

Head of department prof. Kostyuk G.Y.

PRACTICAL LESSON 2

Theme of Lesson:Initial forms of surgical technique

Division of time:Control of final knowledge level- 20%Theoretical options and interviews - 10%Practical work (section of fabrics, imposition of clamp, imposition of stitches, venesection) - 60%

Educational tasks:To know:1. Classification of operative interferences.2. Basic stages of operative interferences.3. Descriptions of operative access.4. Dentological approaches of work with a dead body.5. Basic functional duties of an operating brigade member6. Basic principles of disconnection and connection of fabrics.7. Types of stitches for connection of soft fabrics.8. Types of local anaesthetizing.9. Technique of venesection.10. General principles of surgical cleansing of the surface wounds.

To be able to do:1. The section of surface layers by different positions of scalpel2. The section of fascias by the groovy probe.3. The section of muscles by blunt way.4. The imposition of the knot and continuous stitches on a skin and cellulose, muscles.5. The imposition of a styptic clamp.6. The ligating of vessels.



PRACTICAL LESSON 3Theme of lesson:Topographical anatomy of cerebral department of head. Surgical cleansing of wounds of skull. Antropotomy. Topography of shells of cerebrum and venous sines of hard shell of cerebrum. Chart of Krenlein - Brusova. Trepanation of skull.Division of time:Control of final knowledge's level - 10% Theoretical options and interviews - 25% Practical work - 50% Control of final knowledge's level- 15%Educational tasks:To know:1. Difference of layer structure of regions of skull vault. 2. Connection of the venous systems of person and skull.3. Possibility of distribution of haematomas of skull vault 4. Possible complication at the traumas of temporal area.5. Localization of intracraneal haematomas.6. Practical value of triangle of Shypo.7. Modern methods of stop bleeding of vessels of different layers of vault of skull.8. Stop bleeding from the sines of hard brain-tunic.9. Stop bleeding from the veins of sponge.10. Topography of spider web shell of cerebrum11. Topography of soft shell of cerebrum12. Description of breaks of basis cranii13. Topography of cisterns of cerebrum14. Value of effluence of neurolymph at the traumas of ear, nose15. Topographical anatomy and some clinical descriptions inwardly cranial haematomasTo be able to do:1. To show on preparation (a dead body is fixed) layers of the frontal-parietal-back of head, temporal areas and papillary sprout.2. To select the scopes of trepanation triangle of Shipo and to explain possibility of complications during the trepanation.3. To take apart on preparation the possible ways of distribution of festerings processes from the layers of temporal area.4. To conduct the surgical wounds processing of skull vault . 5. To draw the chart of Kreilen-Brusova.6. To be able to stop bleeding from a meningeal artery and sine of hard shell of cerebrum.7. To execute decompressive trepanation of skull on a dead body.



PRACTICAL Lesson 4Theme of lesson:Topographical anatomy of facial department of head. Lateral area of person. Parotid -masticatory area. Deep area of face. The operations are on priornasal sinuses. Sections at the phlegmons of person and behindgullet abscesses. Surgical processing of face wounds. Division of time:Control of final level of knowledges - 10% Theoretical options and interviews - 15% Practical work - 55% Control of final level of knowledges - 20%Educational tasks: To know:1. Age-old features of face2. Sources of arterial blood supply of person3. Anatomic ground of dividing into areas4. Function of trifacial.5. Function of facial nerve.6. Possibility of retrograde of blood current in the area of face7. Presence of connection of face veins with the sines of hard brain-membrane8. Classification of muscles of face, their functional features9. Features of topography of mimic muscles.10. Features of bone basis of face, forming of sinuses, their copula.11. division of face into areas.12. layer topography of parotid-masticatory area13. extracranial department of facial nerve, its topography14. parotid salivary gland. Capsule. Weak points15. topography of channel of parotid salivary gland. Projection16. deep (interjaw area of face, cellular spaces, their connections.17. nearpharyngeal and beyondpharyngeal cellular spaces. Connection with the cellular spaces of face.18. Surgical processing of face wounds 19. Typical cuts on the faceTo be able to do:1. Reparate lateral area of face.2. To design the branches of facial nerve and channel of parotid salivary gland on a face.3. To execute the section on face at festerings paratitises.4. To execute trepanation of frontal sinus on a dead body.5. To execute trepanation of antrum on a dead body.



PRACTICAL LESSON 5Theme of lesson:Topographical anatomy of neck. Fascias of neck.Division of time:Control of entrance level of knowledge - 5 %Theoretical options and interviews - 20%Practical work - 65 %Control of eventual level of knowledge – 10%Educational tasks:To know:1. Classification of neck fascias.2. Age features of neck topography .3. Individual features of topography of neck.4. Divisions of neck into areas.5. List of basic operative interferences with different areas of neck.6. Possibility of bandaging of carotid branches on a neck.7. Bandaging of vessels on a neck at the operations and wounds in other areas of body.8. Co-arrangement of neck organs .9. Possibility of connections of the cellular spaces of neck with the cellulose of other areas of body.10. Possibility of accesses to the large neuroplexes and barrels with the purpose of implementation of blockades.11. Scopes of neck, division into areas.12. Triangles of neck.13. Fascias of neck.14. Cellular spaces of neck.15. Lower-jaw triangle.16. Triangle of M.I.Pyrohov17. Sleepy triangle.18. Topography of basic vascular-nervous bunch of neck.19. Difference between external and internal carotids.20. Branches of external carotid in a sleepy triangleTo be able to do:1. To know layers and neck fascias at cuts.2. To be able to distinguish an external carotid from internal.3. To bare an internal jugular vein, external and general carotid.4. To find external orientations for implementation of vagosympathetic blockade after Vyshnevsky.5. To give the anatomic substantiation of the rational cuts at phlegmons and abscesses of neck.



PRACTICAL LESSON 6Theme of lesson:Topographical anatomy of neck. Organs of neck. The operations on the organs of neck.Division of time:Control of initial level of knowledge - 5%Theoretical options and interviews - 10%Practical work - 70%Control of eventual level of knowledge - 15%Educational tasks:To know:1. Individual and age-old features of position of organs of neck.2. Possibility of congenital and acquired phlebitis of jugular veins.3. The necessity of operative interferences on the lymphatic knots of neck at the malignant tumours of front face divisions.4. Congenital torticollis5. The features of anaesthetizing at operative interferences on the organs of neck.6. Description of wounds of neck. Features of wounds. Pathological processes of thyroid gland, which require operative interferences7. Topography of trachea.8. Topography of neck part of gullet.9. Branches of cerviciplex.10. Scopes of lateral triangle of neck, division of it on scapular-trapezoid and the scapular-clavicular triangles.11. Layers of lateral triangle of neck12. Cellular space of lateral triangle of neck.13. Topography of neck part of diaphragmatic nerve.14. Technique of tracheostomy.15. Errors and complications at tracheostomy.16. Features of operative access to neck part of gullet17. The operations are on a thyroid gland.To be able to do:1. To reparate lateral triangle of neck.2. To execute overhead tracheostomy 3. To execute lower tracheostomy .4. To execute access to the lower part of gullet.5. To take apart the technique of punction of suclavian vein on preparation.6. To explain the errors and complications at intubation



PRACTICAL LESSON 7Theme of lesson:Class in the operating room. The operations on the trachea. Tracheostomy.Aim of lesson:On the basis of exact knowledge of topographic-anatomic correlations of formations and organs of neck. To be able to execute on a dead body accesses and operations on a trachea, thyroid gland. Division of time:Control of initial level of knowledge - 5%Theoretical options and interviews - 10%Practical work - 70%Control of eventual level of knowledge - 15%Educational tasks:To know:1. Individual and age-old features of position of organs of neck.2. Possibility of congenital and acquired phlebitis of jugular veins.3. The features of anaesthetizing at operative interferences on the organs of neck.4. Description of wounds of neck. Features of wounds. Pathological processes of thyroid gland, which require operative interferences1. Topography of trachea.2. Layers of medial triangle of neck3. Cellular space of medial triangle of neck.4. Technique of tracheostomy.5. Errors and complications at tracheostomy.To be able to do:1. To reparate medial triangle of neck.2. To execute overhead tracheostomy 3. To execute lower tracheostomy .



PRACTICAL LESSON 8Theme of lesson:Topographical anatomy of chest wall. Layers. Mammary [lactiferous] gland. The operations on mammary [lactiferous] gland. Pleurocentesis (thoracocentesis). Closing of pneumothorax. The anatomico-physiological features of breast in infancy (childhood).Division of time:Control of initial level/ standard of knowledge - 10% Theoretical guidelines and interview - 10% Practical work - 65 % Control of ultimate level/ standard of knowledge - 15%Educational tasks:To know:1. Forms of thorax;2. Birth defects of thorax;3. Individual features of location of thorax vessels;4. Age features of thorax;5. The surgical correction of birth defects of thorax.6. Thorax borders, fragmentation.7. Relative borders for determination of projection of thoracic cavity organs.8 Anterosuperior area of thorax.9. Topography of mammary [lactiferous] gland and ways of lymph outflow, its blood supply and innervation.10. Topography of intercostal spaces.11. Pleura borders.12. Pleural sinuses and their topography.13. Sections at mastitis. Radical mastectomy.14. Function of pleura. 15. Resection of rib (costotomy).16. Methods of closing of open pneumothorax.To be able to do:1. To conduct section at intramammary mastitis. 2. To conduct section at retromammary [submammary] mastitis.3. To conduct section at subareolar mastitis.4. To conduct the sector resection of mammary [lactiferous] gland on a dead body.5. To conduct pleurocentesis (thoracocentesis) on a dead body.6. To conduct the resection of rib (costotomy).7. To conduct closing of pneumothorax.



PRACTICAL LESSON 9Theme of lesson:Topographical anatomy of thoracic cavity: Pleura, innervation, blood supply, lymph outflow. Lungs. Anterior and posterior mediastinum. Approaches to lungs, modern surgical procedures on lungs (pneumonectomy, resection of lungs, segmental resection/ectomy).Division of time:Control of initial level/ standard of knowledge - 10% Theoretical guidelines and interview - 10% Practical work - 65 % Control of ultimate level/ standard of knowledge - 15%Educational tasks:To know (to have an overview):1. Surgical anatomy of birth defects of esophagus.2. Modern possibilities of esophagoplasty.3. Modern possibilities of surgical treatment at birth defects of esophagus.4. Modern possibilities of drainage of thoracic lymphatic duct.5. Modern possibilities of surgical treatment at birth defects of lungs.6. Surgical methods of treatment at staphylococcal destruction of lungs.7. Surgical anatomy of lungs.8. Anatomic features of division of lungs into parts and segments.9. The notions of the hilus and root of lungs. The surgical anatomy of root of lungs.10. To define the notion of "mediastinum", division of mediastinum into superior, lower, anterior, posterior, and middle. Organs placed in all parts of mediastinum.11. Surgical anatomy of thymus (gland), superior vena cava, phrenic nerves.12. Surgical anatomy of thoracal part of esophagus. The grounds of approaches to esophagus at different levels. Opening of esophagus.13. Surgical anatomy of thoracic duct, azygos and hemiazygos veins, sympathetic trunk, forming of splanchnic nerves.14. Anatomic and physiological grounds of surgical approaches to lungs, esophagus.15. Ground states of pulmonectomy.To be able to do:1. To conduct on a dead body anterolateral approach to lungs.2. To conduct on a dead body posterolateral approach to lungs.3. To close the wound of lungs.4. To close the wound of esophagus.5. To conduct a segmental resection of lungs.6. To be able to dissect elements of root of lungs. 7. To be able to execute the costectomy.



PRACTICAL LESSON 10Theme of lesson:Topographical anatomy of heart and pericardium. Surgical approaches to heart. Karyolysis. Operations on the heart because of its wound. Mitral commissurotomy. The congenital heart diseases and acquired valvular diseases and their surgical treatment. Surgical treatment of cardiac ischemia.Division of time:Control of initial level/ standard of knowledge - 10% Theoretical guidelines and interview - 10% Practical work - 65 % Control of ultimate level/ standard of knowledge - 15%Educational tasks:To know (to have an overview):1. Surgical anatomy of congenital heart diseases.2. Surgical anatomy of the acquired valvular diseases.3. Modern possibilities at the congenital heart diseases and great vessels.4. Modern possibilities at the acquired valvular diseases.5. The modern views on heart transplantation.6. Modern possibilities of shunting of great vessels. To know:1. Surgical anatomy of heart (skeletopy, syntopy, blood supply, innervation, ways of venous and lymphatic outflow).2. The congenital heart diseases.3. The acquired valvular diseases.4. Surgical anatomy of aorta and its branches.5. Surgical anatomy of pulmonary trunk and pulmonary arteries.6. Anatomical and physiological grounds of surgical approaches to the heart.7. Pericardiocentesis. Closure of wound of heart.8. Mitral commissurotomy.9. Coronary artery bypass grafting.10. Stenting of coronal arteries.11. Principles of heart transplantation.To be able:1. To conduct on the dead body longitudinal median [midline] sternotomy.2. To conduct on the dead body longitudinal transverse sternotomy.3. To close [to repair] a wound of heart.4. To conduct a mitral commissurotomy.



PRACTICAL LESSON 11Theme of lesson:Topographical anatomy of abdominal wall. Division into parts. Projection of organs of abdominal cavity on a front wall. Layered sectional structure of the front abdominal wall. Blood supply, innervation, lymph outflow. Surgical approaches to the organs of abdominal cavityDivision of time:Control of initial level/ standard of knowledge — 10%Theoretical guidelines and interview — 30%Practical work — 40%Control of ultimate level/ standard of knowledge — 20%Educational tasks:To know (to have an overview):1. The age and sexual structure peculiarities of studied area.2. The birth development defects related to anatomic formations of front-lateral abdominal wall (pathology of urachus, omphalocele and methods of their treatment).3. The classification of sections of front-lateral abdominal wall.To know:1. Division of front-lateral abdominal wall into parts.2. Projections of internal on the front-lateral abdominal wall.3. Structure of front layer of front-lateral abdominal wall.4. Structure of middle layer of front-lateral abdominal wall, forming sheath of rectus muscle.5. Topographical anatomy of deep layer, fossa and fold of posterior surface of front-lateral abdominal wall.6. Weak points of front-lateral abdominal wall (white [Hunter's] line, umbilical ring).7. Blood supply, innervation, lymph outflow of front-lateral abdominal wall.8. Classification of sections of front-lateral abdominal wall.9. Grounds of the use of rational approaches.10. Layered/sectioned description of vertical [lengthwise, longitudinal] incision and Volkovich-Diakonov’s oblique incision.To be able:1. To execute middle midline laparotomy.2. Paramedian incision3. Transrectal incision4. Lenander’s incision 5. Volkovich-Diakonov’s incision



PRACTICAL LESSON 12Theme of lesson:Topographical anatomy of inguinal canal. Inguinal region. Notion of hernia. Operations at inguinal [groin] hernia. Girard's-Spasokukotsky’s, Bassini’s, Martinov’s methods of the plasty. Femoral canal. Operations at femoral, umbilical, midline [epigastric] hernias.Distribution of time:Control of initial level/ standard of knowledge — 10%Theoretical guidelines and interview — 25%Practical work — 50%Control of ultimate level/ standard of knowledge — 15%Educational tasks:To know (to have an overview):

1. age and sexual features of studied area;2. notions of hernia and its classification;3. methods of treatment of congenital inguinal hernia;4. age and sexual features of anatomic structure of studied area;5. classification of hernia;6. internal hernia and places of their formation;7. sliding [slip(ped), extrasaccular] hernia and peculiarities of its surgical treatment;8. diaphragmatic hernia;9. parietal [Richter's] hernia and retrograde strangulation;10.conservative methods of treatment of umbilical hernia at children of early age;

To know:1. Walls and openings/foramens of inguinal canal;2. Content of inguinal canal;3. Surgical anatomy of oblique and direct inguinal hernias;4. Femoral canal and crural ring;5. Definition of concept of hernia and elements of its surgical anatomy (hernial gate,

hernial sack, hernial content);6. Origin of congenital inguinal hernia;7. Surgical methods of the plasty of inguinal canal (Girard's-Spasokukotsky’s,

Bassini’s, Martinov’s).8. Surgical treatment of femoral hernia (Bassini’s, Ruggi-Parlaveccio’s).9. Surgical treatment of umbilical hernia (Meyo’s, Sapezhko’s, Lexer’s);

To be able:1. To define the boundaries of inguinal region, external and internal landmarks and

projections;2. To execute the layered section of front wall of abdomen parallel to inguinal

[Poupart's] ligament;3. To prepare inguinal canal with determination of its walls and openings;4. To execute the Girard's-Spasokukotsky’s, Martinov’s plasty of walls of inguinal

canal;Confirmed at the department meeting «____» __________Protocol №____


PRACTICAL LESSON 13Theme of lesson:Topographical anatomy of abdominal cavity. Peritoneum, its connection with the organs of abdomen. Bursas, canals, nooks of peritoneum. Topography of stomach, liver, gall-bladder.Distribution of time:Control of initial level/ standard of knowledge — 10%Theoretical guidelines and interview — 25%Practical work — 50%Control of ultimate level/ standard of knowledge — 15%Educational tasks:To know (to have an overview):- difference between notions "abdominal cavity" that "peritoneal cavity";- peritoneal track its connection with the organs of peritoneum;- formation of peritoneum in the upper floor of peritoneal cavity;- formation of peritoneum in the lower floor of peritoneal cavity;- ways of spreading of pyoinflammatory processes within peritoneal cavity;- spreading of metastatic processes at malignant neoplasms of stomach;- forms of stomach and age features/peculiarities;- fixating mechanism of liver;- sphincteric mechanism of extrahepatic/anhepatic bile [biliary, gall] ducts;- mechanism of filling and emptying of bile of gall-bladder.To know:- boundaries of peritoneal cavity;- topography of omental bursa and epiploic [Winslow's] foramen;- topographical anatomy of ligamentous apparatus of stomach;- features/peculiarities of arterial blood supply and venous outflow from a stomach;- innervation of stomach (nerve plexus of stomach);- blood supply of liver and its venous mechanism;- forming of intrahepatic and extrahepatic/anhepatic bile [biliary, gall] ducts;- blood supply of gall-bladder;- topography of triangle of Kallo.To be able:1. To show on preparation (fixed dead body) formations of peritoneum in the upper and lower floors.2. On a dead body (or preparation), to find and show the parts of stomach, arteries and veins of stomach.3. To show the nervous mechanism of stomach.4. On preparation of liver to find and show hepatic ligaments, topography of hepatic hilus.5. On preparation to show the separation of elements of hepatoduodenal ligament.


Head of department prof. Kostyuk G.Y.PRACTICAL LESSON 14Theme of lesson:Intestinal sutures. Resection of intestines. Enteroanastomotic techniques “end-to-end”, “side-to-side”, and “end-to-side”.Distribution of time:Control of initial level/ standard of knowledge — 10%Theoretical guidelines and interview — 15%Practical work — 60%Control of ultimate level/ standard of knowledge — 15 %Educational tasks:To know (to have an overview):- layered structure of intestinal wall and wall of stomach;- difference between the structure of wall of stomach, of small and large intestines;- seroserosal and seromuscular sutures;- uninterrupted suture, blanket suture and interrupted suture;- indication for resection of intestines;- substantiation of using one or another method of enteroanastomosis;- advantages of certain method of enteroanastomosis, disadvantages of other;- closure of wounds of small intestine;- application of intestinal fistula.To know:1. Albert's suture and (interrupted) Lembert suture. Their techniques.2. Through intestinal suture and blanket uninterrupted suture. Their techniques.3. Technique of resection of intestines.4. Anastomotic technique “end-to-end”, “side-to-side”.5. Complications at enterostomies.6. Advantages and disadvantages of some intestinal sutures in comparison.7. Technique of closure of intestinal wounds.8. Judin’s enterostomy.To be able:1. To show on preparation the layers of small intestine, stomach.2. To show on preparation passages of parietal and mesenteric vessels of intestines.3. To execute on preparation anastomotic technique “side-to-side”.4. To execute on the segments of intestine enteroanastomotic technique “end-to-end”.5. Through palpation to define a size and patency/ permeability of anastomosis.



PRACTICAL LESSON 15Theme of lesson:Topographical anatomy of stomach, liver, gall-bladder.Distribution of time:Control of initial level/ standard of knowledge — 10%Theoretical guidelines and interview — 25%Practical work — 50%Control of ultimate level/ standard of knowledge — 15%Educational tasks:To know (to have an overview):- spreading of metastatic processes at malignant neoplasms of stomach;- forms of stomach and age features/peculiarities;- fixating mechanism of liver;- sphincteric mechanism of extrahepatic/anhepatic bile [biliary, gall] ducts;- mechanism of filling and emptying of bile of gall-bladder.To know:- topographical anatomy of ligamentous apparatus of stomach;- features/peculiarities of arterial blood supply and venous outflow from a stomach;- innervation of stomach (nerve plexus of stomach);- outflow of lymph from a stomach (superficial and deep lymphatic collectors);- blood supply of liver and its venous mechanism;- forming of intrahepatic and extrahepatic/anhepatic bile [biliary, gall] ducts;- blood supply of gall-bladder;- topography of triangle of Kallo.To be able:1. To show on preparation (fixed dead body) formations of peritoneum in the upper and lower floors.2. On a dead body (or preparation), to find and show the parts of stomach, arteries and veins of stomach.3. To show the nervous mechanism of stomach.4. On preparation of liver to find and show hepatic ligaments, topography of hepatic hilus.5. On preparation to show the separation of elements of hepatoduodenal ligament.



PRACTICAL LESSON 16Theme of lesson:The operations on stomach. Dissection, suture, abscess of stomach. Gastroenterostomy. Organ-preserving operations. Principles of stomach [gastric] resection.Distribution of time:Control of initial level/ standard of knowledge —10%Theoretical guidelines and interview — 25%Practical work — 50%Control of ultimate level/ standard of knowledge — 15 %Educational tasks:To know (to have an overview):- commons rules of execution of gastrotomy - indication for and technique of gastrotomy- complications at gastrotomy- types of gastroenteroanastomosis, basic principles of operations- technique of gastroenteroanastomosis- stomach [gastric] resection: classification and operative intervention regimen- organ-preserving operations on stomach, classification and technique of vagotomy - drainage operations on stomach at stomach ulcer. To know:1. Technique of gastrotomy. Complications during this operation.2. Technique of Witzel's gastrostomy, gastrotomy by the methods of Stamm-Senn-Kader, Toprover.4. Technique of Brown’s interintestinal enteroanastomosis5. Reasons of formation of incorrect circle.6. Stomach [gastric] resection by the I method of Bilrot. Technique of operation.7. Stomach [gastric] resection by the II method of Bilrot. Technique of operation and basic postoperative complications.8. Basic modifications of operations of stomach [gastric] resection by the I and II method of Bilrot.9. Organ-preserving operations. Basic stages of vagotomy. Postoperative complications.10. Drainage operations. Technique of operations by Heineke-Mikulicz, Finney, Zabulet.To be able:1. Sections of stomach in middle third of body2. Forming of Witzel's gastrostomy, gastrotomy by Stamm-Senn-Kader, Toprover and by Beck-Giane.4. Technique of basic stages of stomach [gastric] resection after Bilrot I, II


Head of department prof. Kostyuk G.Y.PRACTICAL LESSON 17Theme of lesson:Liver operations, gall-bladder operations, biliary tract operations. Pancreas operations. Spleen excision.Time regulation:Control of entrance level of knowledge — 10%Theoretical options and interviews — 25% Practical work — 50% Control of eventual level of knowledge — 15%Educational tasks:Students should have an idea about:- Topographic-anatomic basis of operative interventions on a liver and extrahepatic ducts;- Hepatography. Basic methods of putting in of hepatic stitches in cases of traumatic defeats of liver and its resection;- Surgical approach to liver and extrahepatic bilious ducts;- Surgical approaches to spleen;- Surgical approaches to pancreas;- Basic methods of gall-bladder excision;- Basic methods of section and draining of extrahepatic bilious ducts;- Approaches to spleen’s gate with the subsequent ligation of splenic vessels;- Operative pancreas interventionsStudents should know:1. Overhead-middle laparotomy — as a basic approach to liver, gall-bladder and extrahepatic bilious ducts.2. Hepatography. Kuznetsov-Penskiy’s liver stitch.3. Technique of cholecystectomy execution from a neck and from a bottom.4. Basic method of draining of general bilious duct.5. Approach to spleen during splenectomy.6. Basic methods of spleen excision.7. Approaches to pancreas through an omental bursa.8. Approaches to pancreas through a lumbar area in case of purulent destructive processes in pancreas.10. Technique of omental bursa revision through the mesentery of transverse colon bowel.Students should be able:1. To execute surgical approach to liver, to extrahepatic bilious ducts, pancreas, spleen.2. To make a liver wound closure.3. To ligate a gall-bladder artery and neck of gall bladder, to separate a gall bladder from its bed.4. To execute the dissection of general bilious duct.5. To ligate the vessels of spleen’s gate and to separate the spleen out.


Head of department prof. Kostyuk G.Y.PRACTICAL LESSON 18Theme of lesson:Large intestine operations. AppendectomyTime regulation:Control of entrance level of knowledge — 10% Theoretical options and interviews — 25% Practical work — 50% Control of eventual level of knowledge — 15%Educational tasks:Students should have an idea about:1. Contribution of home surgeons to the development of colon surgery.2. Peculiarities of resections on colon.3. Peculiarities of colopexostomy.4. Indication and technique of bilateral resection of sigmoid colon using Grekov’s 2nd method.5. Svenson-Grekov operation’s technique.6. Complications after the colon operations.7. The essence of ileocoplastics.Students should know:1. Indications to appendectomy operations.2. Complications caused by appendectomy.3. Right hemicolectomy operation technique.4. Left hemicolectomy operation technique.5. Anal orifice imposition operation technique.6. Tubular cecostomy operation technique.7. Labial colostomy operation technique.8. Single-stage resection of sigmoid transverse colon operation technique.9. Colon wounds closure making technique.Students should be able:1. To give a scientific ground of peculiarities determination of vermix projection on the front abdominal wall.2. To execute the appendectomy operation.3. To execute the retrograde appendectomy.4. To execute the appendectomy operation in case of extraperitoneal location of vermix.5. To execute the debribement of “кукса” of vermix.



PRACTICAL LESSON 19Theme of lesson:Class in the operating room. Intestinal sutures. Surgical approaches to the organs of abdominal cavity. Enteroanastomotic techniques “end-to-end”, “side-to-side”, and “end-to-side”.Distribution of time:Control of initial level/ standard of knowledge — 10%Theoretical guidelines and interview — 15%Practical work — 60%Control of ultimate level/ standard of knowledge — 15 %Educational tasks:To know (to have an overview):- layered structure of intestinal wall and wall of stomach;- difference between the structure of wall of stomach, of small and large intestines;- seroserosal and seromuscular sutures;- uninterrupted suture, blanket suture and interrupted suture;- indication for resection of intestines;- substantiation of using one or another method of enteroanastomosis;- advantages of certain method of enteroanastomosis, disadvantages of other;- closure of wounds of small intestine;- application of intestinal fistula.To know:1. Albert's suture and (interrupted) Lembert suture. Their techniques.2. Through intestinal suture and blanket uninterrupted suture. Their techniques.3. Technique of resection of intestines.4. Anastomotic technique “end-to-end”, “side-to-side”.5. Complications at enterostomies.6. Advantages and disadvantages of some intestinal sutures in comparison.7. Technique of closure of intestinal wounds.8. Judin’s enterostomy.To be able:1. To show on preparation the layers of small intestine, stomach.2. To show on preparation passages of parietal and mesenteric vessels of intestines.3. To execute on preparation anastomotic technique “side-to-side”.4. To execute on the segments of intestine enteroanastomotic technique “end-to-end”.5. Through palpation to define a size and patency/ permeability of anastomosis.



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