Orientation to Surgical Technology & History of Surgery

ST210Concorde Career College

History

Objectives:

•Provide a timeline of events leading up to modern medical/surgical practice

•Understand the development of the role of the surgical technologist

•List and describe reasons for surgical intervention

History

Refer to Table 1-1 Pages 4-5 (ST4ST)

•Ancient Times•Dark Ages•Renaissance•Classical Period•Modern Age

Ancient Times4,000 BC

Cuneiform Script

Ancient Times• Imhotep

▫ Circa 2,500 BC▫ Considered the first

physician of recorded history

▫ Wrote one of the first surgical texts

▫ Considered divine due to his work

Ancient Times• Code of Hammurabi• Contains contractual laws

and medical practices of the day

• Many medical references are religious in nature

Code printed on clay tablet

Ancient Times• Moses

▫ Circa 2000 BC▫ Established laws for

cleanliness• Caduceus

▫ Numbers 21:4-9

Ancient Times• Circa 1500

▫ Ebers Papyrus▫ Egyptian Medical

hieroglyphs▫ Hindu Vedas

Ancient Times• Circa 1,000 BC

▫ Homer Early Greek historian

and mythologist Described military

medicine▫ Susruta

Father of Indian medicine

Classical Period (500 BC – 500 AD)• Hippocrates

▫ 460 – 370 BC▫ Greek physician▫ The Father of Medicine▫ Introduced the concept

that illness has a physical and rational explaination

Classical Period

• Aristotle▫ 384 – 322 BC▫ Established early

scientific mindset▫ Founder of comparative

anatomy

Classical Period• Herophilos

▫ 335 – 380 BC▫ Father of Anatomy▫ First to describe the

pulse as a diagnostic tool/vital sign

Classical Period• Aulus Cornelius Celsus

▫ 25 BC – 50AD ▫ Greek Encyclopaedist ▫ First to describe the

cardinal signs of inflammation

Classical Period• Aelius Galen

▫ 129 – 200AD▫ World’s first great

anatomist▫ Observations remained

unchallenged for over 1,500 years

▫ Believed that science was ruled by theology and adapted writings to reflect this viewpoint

Dark Ages (500 AD – 1100 AD)

Dark Ages• Avicenna

▫ 980 – 1037 AD▫ Persian philosopher▫ Wrote The Canon of

Medicine▫ Revived Aristotle’s

theories

Renaissance (1450 – 1600)• Paracelsus

▫ 1493 – 1541 AD▫ Swiss physician▫ Disagreed with Galen and

Avicenna, but could not prove his theories scientifically

▫ Called the Luther of Medicine

Renaissance• Ambroise Pare

▫ 1510 – 1590 AD▫ French barber surgeon▫ Greatest surgeon of the

16th century▫ Began ligating arteries

after amputation▫ Stopped cauterizing

wounds with hot irons and oils

Renaissance • Andreas Vesalius

▫ 1514 – 1564▫ Flemish anatomist▫ Father of Modern

Anatomy▫ Openly challenged Galen▫ Performed dissections on

human cadavers himself▫ Hired famous illustrators

to depict his anatomic findings

▫ Changed the world’s approach to anatomic discovery

Vesalius

Renaissance• William Harvey

▫ 1578 – 1657▫ First to accurately

describe circulatory anatomy and physiology

Modern Age• Morgagni

▫ Developed modern-day clinical pathology

• Edward Jenner▫ 1749 – 1843 AD▫ Credited with discovering

the small pox vaccine▫ Father of Immunology▫ His work has saved more

lives than any other man

Modern Age• Louis Pasteur

▫ 1822 – 1895 AD▫ French chemist and

microbiologist ▫ Father of Microbiology

Modern Age• Joseph Lister

▫ 1827 – 1912 AD▫ Father of Asepsis▫ Used carbolic acid to

cleanse wounds and sterilize surgical instruments

Modern Age• William S. Halsted

▫ 1852 – 1922▫ Developed techniques for

meticulous wound closure

▫ Halsted’s Principles of Tissue Handling

▫ Developed sterile surgical gloves

Modern Age• Michael E. DeBakey

▫ 1908 – 2008 AD▫ Developed the first

ventricular assistive pump device

▫ Invented critical components of the heart-lung machine

▫ Inventions and discoveries made cardiac surgery possible

▫ Developed and patented numerous surgical instruments

Modern Age• Denton Cooley

▫ Born 1920▫ Perfected the heart-lung

machine▫ Performed first US heart

transplant▫ Implanted first total

artificial heart

What differences do you see?

History

Once these three principles were identified and solutions found – modern medicine

could emerge!

1. Infection

2. Pain

3. Hemorrhage

History

Development of the Role of the Surgical Technologist

•How/why did the profession originate?•How has surgical technology education

evolved?•Why are you here?

History

Reasons for Surgical Intervention

•Trauma•Disease•Condition•Congenital Anomaly•Desire

History

Classifications of Surgical Intervention

• Emergent – Immediate threat to life or limb (requires immediate treatment)

• Urgent – Urgent threat to life or limb (requires treatment within a short period of time)

• Elective – Does not have to be performed within a short period of time (may be scheduled in the future)

• Optional – Not pathological in the traditional sense (not necessary)

History

Surgical Specialties• General Surgery (General)• Obstetric and Gynecologic Surgery (OB/GYN)• Ophthalmic Surgery (Eye)• Otorhinolaryngologic Surgery (ORL/ENT)• Oral and Maxillofacial Surgery (OMF)• Plastic and Reconstructive Surgery (Plastic)• Genitourinary Surgery (GU)• Orthopedic Surgery (Ortho)• Cardiothoracic Surgery (Hearts/Chest)• Peripheral Vascular Surgery (PV)• Neurosurgery (Neuro)

Workplace Management• CAAHEP: Commission on the Accreditation of

Allied Health Education Programs

• ARC/STSA: Accreditation Review Council on Education in Surgical Technology and Surgical Assisting

• NBSTSA: National Board of Surgical Technology and Surgical Assisting

• JC: Joint Commission, formerly known as the Joint Commission Accreditation of Health Care Organizations (JCAHO)

Phases of Surgical Care Management•Preoperative: prior to initiation of the

surgical procedure

•Intraoperative: while procedure is being performed

•Postoperative: when surgical procedure is terminated

PPEOR PreparationSterile field (creating, organizing, maintaining)OrganizingAssisting with gowning and glovingDraping

PREOPERATIVE CASE PREOPERATIVE CASE MANAGEMENTMANAGEMENT

Maintain the sterile fieldHandling of instruments, supplies, etc.Preparing medicationsCountingProper specimen identification and labelingDressing application

INTRAOPERATIVE CASE INTRAOPERATIVE CASE MANAGEMENTMANAGEMENT

Maintain the sterile field until the patient is out of the roomDisassemble the sterile fieldPatient transportationRoom turnover

POSTOPERATIVE CASE POSTOPERATIVE CASE MANAGEMENTMANAGEMENT

Surgical Team Members

NON-STERILE SURGICAL NON-STERILE SURGICAL TEAM MEMBERSTEAM MEMBERS

Circulator (RN, LPN, or Surgical Technologist)Anesthesia ProviderRadiology TechnologistPathologySurgical ObserversAnyone outside of the sterile field

Preparing the ORConducting pre-op patient interviewTransporting to and from the OR (Pre-op, PACU)Transporting the pt. to and from the OR tablePositioningPrepping the skinAssist with drapingAssist anesthesiaCounting, gathering suppliesVarious cord hook-upsMaintaining the OR recordSpecimensDressings

CIRCULATING DUTIESCIRCULATING DUTIES

Non-sterile Team Members

ANESTHESIA PROVIDER ANESTHESIA PROVIDER RESPONSIBILITIESRESPONSIBILITIES

MD, DO, CRNAPt. assessmentDetermining type of anesthesiaDiscussing the risks of anesthesiaMonitoring vital signsProviding supportive measures (airway, fluids)

STERILE TEAM MEMBERSSTERILE TEAM MEMBERS

WHO ARE THEY?WHO ARE THEY?

Surgical TechnologistSurgeon

MD, DO, DPM, DDS, DMD

Surgical AssistantCSFA, CSA, SA-C, CRNFA or RNFA, PA-C, OT-C or OPA-C, surgical resident, or other surgeonCST (limited scope)

The SurgeonThe Surgeon

•Assumes full responsibility for all medical acts of judgment and management of the surgical patient

Surgical First Assistant

Manual dexterity Manual dexterity and physical and physical stamina are stamina are requiredrequired

Acts as co-Acts as co-surgeonsurgeon

Responsible for Responsible for exposure and exposure and visualization of visualization of the woundthe wound

Why Surgical Technologists?

Personal Characteristics

•Ability to multi-task•Neat, accurate•Ability to stay focused in any situation•Stable temperament, patience•Manual dexterity, physical stamina•Ability to anticipate “what comes next”

Working Conditions

• Brightly lit, quiet, temperature controlled OR• Standing for long periods of time• Lifting heavy objects• Concentration• Unpleasant sites, odors, hazardous

materials, communicable diseases• 40 hour work-week plus “call rotation”

nights, holidays, and weekends