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ST 240 - Operative Procedures

Credits: 4

     A.          Communicate in acceptable English and use medical terminology accurately and appropriately.

     B.          Analyze data and discipline-based knowledge to formulate logical conclusions.

                  1.    Integrate and correlate concepts from different courses.

                  2.    Exhibit development of both inductive and deductive reasoning skills.

                  3.    Recognize patterns and trends in data and be able to justify any conclusions drawn.

                  4.    Make predictions based on evidence.

                  5.    Differentiate coincidental and causal relationships.

                  6.    Utilize graphs, tables, and charts to summarize, analyze, and interpret information.

                  7.    Apply the scientific method of inquiry and research.

     C          Work constructively within a group.

     D.         Demonstrate the ability to access, analyze, and use information from personal, print, media and electronic resources to expand his/her
                  understanding of subject matter.

                  1.    Identify and access appropriate print, media, and electronic resources to expand his/her understanding of subject matter.

                  2.    Evaluate the quality of information gathered from print and electronic sources with

                        reference to reliability of the source, currency, and applicability.

                  3.    Paraphrase, synthesize, and summarize information gathered from multiple sources.

2.  Demonstrate knowledge of the use of various types of surgical lasers and the safety measures required.

     A.          Locate visible light on the electromagnetic spectrum and compare its activity with longer and shorter wavelengths.

     B.          Translate the acronym "laser".

     C.          Discuss the generation and characteristics of laser energy, and explain what occurs on contact with tissue.

     D.          List advantages of laser surgery.

     E.          For each kind of surgical laser, identify its special attributes (including the color of its beam) and list its major uses.

     F.          List other medical uses of laser.

     G.         Discuss hazards and safety considerations during laser surgery.

  Outcome 3:    Demonstrate knowledge of selected pathologies and operative procedures in General Surgery.

     A.          Describe methods of classifying the extent and depth of thermal burns.

     B.          Discuss the initial treatment priorities and post-operative  and long-term care of a severely burned patient.

     C.          List and define the terms used to describe different sources of skin grafts.

     D.         Compare electrical and chemical burns with thermal burns.

     E.          Discuss different types of mammoplasty and breast reconstruction.

     F.          List and compare common benign and malignant breast lesions/conditions.

     G.         Discuss the pathophysiology of breast cancer, including its progression, relevant anatomic relationships, and common sites of metastasis.

     H.         List diagnostic methods that may be used for breast masses.

     I.           Define the various types of mastectomy and discuss possible complications.

     J.          Discuss comparative results of various treatment options for breast cancer, per current medical literature.

     K.          Discuss other types of breast surgery.

     L.          Discuss pathologies and surgery of the thyroid and parathyroid glands.

     M.         Describe the specific steps and the instrumentation and supplies needed for the performance of a surgical/open tracheostomy.

     N.         List alternative methods for securing a patient airway.

     O.         Discuss potential complications and postoperative concerns for patients undergoing thyroid, parathyroid, or tracheal surgery.

     P.          Discuss the pathology and treatment options for conditions of the esophagus.

     Q.         Compare various treatments for diaphragmatic hernias.

     R.          Discuss peptic ulcer disease and therapies.

     S.          Discuss malignancies of the stomach, including treatment and prognosis.

     T.          Discuss various surgical options for treating morbid obesity.

     U.         Discuss other types of stomach surgery.

     V.          Discuss liver pathologies and treatment options.

     W.         Discuss surgical conditions and diseases of the pancreas.

     X.          List possible indications for surgery on the spleen.

     Y.          Discuss the etiology, diagnosis, and possible complications of gallbladder disease.

     Z.          Define terminology related to gallbladder surgery.

     AA.       Compare non-surgical and both open and laparoscopic surgical treatment of gallbladder disease, including possible complications.

     BB.       Identify instrumentation and different dissection techniques for gallbladder surgery.

     CC.       Discuss the pathology and treatment options for conditions of the small intestine.

     DD.       Discuss special instrumentation, surgical techniques, and suture use during small bowel resection.

     EE.        Discuss acute appendicitis and the open and laparoscopic surgical options.

     FF.        Define terminology related to benign and malignant conditions of the large intestine.

     GG.       Discuss the diagnosis and treatment options of colon pathology.

     HH.       Compare different methods of colon resection, including instrumentation.

     II.          Differentiate types of hemorrhoids and discuss their treatment options.

     JJ.         Define terminology related to hernias.

     KK.       Differentiate direct vs. indirect inguinal hernias.

     LL.        Describe open and laparoscopic methods of hernia repair.

     MM.      Discuss femoral, umbilical, and ventral hernias, and their surgical treatments.

     NN.       Discuss the etiology, possible complications, and treatment options for varicosed veins of the leg.

 4.    Demonstrate knowledge of selected pathologies and operative procedures in Orthopedic Surgery.

     A.          Identify the types of orthopedic hardware commonly used during surgery of the upper limb.

     B.          Discuss the injuries and conditions that require surgery on the shoulder.

     C.          Describe the usual incisional approach for open surgery on the shoulder, and compare open and arthroscopic shoulder procedures.

     D.          Discuss characteristics, hazards, and treatment options for fractures of the clavicle, arm, and forearm.

     E.          Describe common injuries to nervous and vascular structures in the arm and forearm and their clinical manifestations.

     F.          Discuss the procedures for examination and evaluation of an injured hand, and explain the treatment priorities.

     G.         List the general principles of hand surgery, and identify special instrumentation used during hand surgery.

     H.         Define terminology related to common wrist and hand conditions and discuss treatment options.

     I.           Discuss the post-operative care and rehabilitation of hand surgery patients.

     J.          Describe the pathology and major principles of surgical correction of spinal curvature, and list

     K.          List the methods and types of orthopedic hardware that may be used for spinal fusion.

     L.          Discuss the demographics, etiology, and treatment of congenital hip problems.

     M.         Compare extracapsular vs. intracapsular hip fractures, including the demographics, causes, and treatment options of the various types.

     N.         Discuss the pathophysiology of different types of arthritis and identify medical therapies.

     O.         Describe the surgical positioning, type of incision, special instrumentation, and general surgical techniques for various types of hip surgery.

     P.          List possible complications of total joint replacement, and discuss typical pre-operative and post-operative care of a patient undergoing
                  total joint replacement.

     Q.         Relate the anatomy of the knee to common types of injuries and joint diseases.

     R.          List and describe types of arthroscopic procedures on the knee.

     S.          Discuss the most common causes, potential complications, and treatment options for fractures of the femur, tibia, fibula, and ankle.

     T.          Discuss medical and surgical treatments for injuries and pathologies of the ankle and foot.

5.    Demonstrate knowledge of selected pathologies and operative procedures in Plastic Surgery.

     A.          Discuss various methods of providing skin coverage.

     B.          Define terminology related to skin grafts and skin flaps.

     C.          Discuss other types of flaps, tissues transfers, and the use of tissue expanders.

     D.          Identify specialty instruments for Plastic Surgery.

     E.          Discuss common causes of and the evaluation of soft tissue trauma of the face.

     F.           Discuss the surgical principles involved in the treatment of facial soft tissue trauma.

     G.          Define terminology related to esthetic and reconstructive facial surgery.

     H.          Discuss the indications, techniques, and surgical hazards for surgery on the parotid gland.

     I.           Describe the surgical techniques and special instrumentation for cosmetic or reconstructive rhinoplasty.

     J.          Discuss the demographics, etiology, goals, surgical techniques, possible results, and longterm follow-up care of repair of a cleft lip or a cleft
                  palate.

 6.    Demonstrate knowledge of selected pathologies and operative procedures in Maxillofacial and Ear, Nose and Throat Surgery.

     A.          Discuss the mechanisms of injury, classifications, diagnostic methods, general treatment  priorities, and potential complications of facial
                   fractures.

     B.          Discuss the indications, special considerations, incisional approaches, and instrumentation for facial fracture and orthograthic surgery,
                   including various methods of providing stabilization.

     C.          Define terminology related to nasal surgery.

     D.          Describe the surgical techniques and specialty instrumentation used in nasal surgery.

     E.          Discuss pathologies of the periorbital air sinuses and list potential complications of sinus infection.

     F.          Compare open sinus surgery vs. sinusoscopy.

     G.         Define terminology related to hearing loss and middle ear pathologies and surgeries.

     H.         Discuss the surgical approaches, anatomical considerations, and potential hazards of various kinds of middle ear surgery.

     I.           Discuss pathologies and surgeries of the inner ear.

     J.          Discuss the indications, surgical techniques, instrumentation, methods for providing hemostasis, surgical and post-operative positioning, 
                  and possible complications associated  with tonsillectomy and/or adenoidectomy.

     K.          List the purposes and identify the instrumentation of laryngoscopy, bronchoscopy, and esophagoscopy.

     L.          Discuss the etiologies and surgical treatments for pathologies of the larynx and upper airway.

     M.         Discuss the etiology, pathophysiology, treatment options, and potential surgical and post-operative complications of primary cancers of the
                  lip, oral cavity, and throat.

 7.    Demonstrate knowledge of selected pathologies and operative procedures in Ophthalmic Surgery.

     A.          List and state the purpose of pharmacologic agents commonly associated with ophthalmic surgery.

     B.          Discuss the pre-operative preparation, positioning and anesthesia options for a patient undergoing ophthalmic surgery.

     C.          Identify supplies, sutures and selected instruments used in ophthalmic surgery.

     D.          Discuss the causes of cataract formation, and describe the surgical techniques and potential complications of various types of cataract
                   extraction and intraocular lens insertion.

     E.          Discuss the pathophysiology and progression of the two types of glaucoma, and discuss medical and surgical treatment options.

     F.          Define terminology related to eye muscle imbalances, and discuss the various types of eye muscle surgery and potential complications.

     G.         Discuss the causes, signs and symptoms, hazards, and treatment options associated with a retinal hole or detachment.

     H.         Discuss the indications for and various techniques of vitrectomy.

     I.           Define and describe other types of ophthalmic conditions and surgeries, including possible complications.

8.    Demonstrate knowledge of selected pathologies and operative procedures in Urologic Surgery.

     A.          Discuss the indications, incisional approaches, patient positioning, surgical techniques, special instrumentation, and possible complications
                   of open and endoscopic kidney and adrenal surgery.

     B.          Differentiate the various methods of angio-access for hemodialysis.

     C.          Compare hemodialysis, Continuous Ambulatory Peritoneal Dialysis, and other methods of hemofiltration.

     D.         Discuss kidney transplantation, including the criteria for recipient and donor selection,  surgical technique, and post-operative and long-term
                  care of the patient.

     E.          Identify the most common cause of ureteral injury.

     F.          Discuss various methods of ureteral and bladder lithotripsy.

     G.         Discuss the indications for and techniques of permanent urinary diversion surgery.

     H.         List the most common signs and symptoms of lower G-U pathologies.

     I.          Discuss the uses of various types of urethral and suprapubic catheters.

     J.          Identify the instruments and supplies used during endoscopic ureteral, bladder, prostate, and urethral surgeries.

     K.          List the kinds of solutions that may be used for distention and irrigation during endoscopic bladder or prostate surgery and explain the
                  indications and potential hazards for each.

     L.          Discuss the indications for and techniques of suprapubic cystostomy.

     M.         Discuss the demographics, pathophysiology, progression, diagnosis, and non-surgical treatment alternatives for benign prostatic
                  hyperplasia (BPH) and for prostatic cancer.

     N.         Differentiate the indications, techniques, and possible complications of the various methods of open prostatectomy.

     O.         Discuss the advantages of robotic surgery for prostatectomy.

     P.          List possible indications for orchiectomy.

     Q.         Discuss the etiology, hazards, and surgical treatment of cryptorchidism and testicular torsion.

     R.         Discuss non-surgical and surgical treatments for impotency.

     S.         Define terminology related to congenital anomalies of the genitourinary system, and describe the surgical treatments for each.

     T.          List other types of urologic surgeries.

 9.    Demonstrate knowledge of selected pathologies and operative procedures in Gynecology and Obstetrics.

     A.          Identify specialty instruments and common suture use associated with gynecologic surgery.

     B.          List possible uses for gynecologic laparoscopy, and describe the equipment and instrumentation, surgical technique, and potential
                   complications.

     C.          Define a "total" abdominal hysterectomy, list the indications, and describe the surgical steps of a TAH.

     D.         Discuss the possible etiology, clinical manifestations, and treatment options for endometriosis.

     E.          Discuss benign and malignant diseases of the ovary, uterus, and cervix, including their  diagnosis and treatment options.

     F.          Compare various techniques for tubal ligation.

     G.          List other types of adnexal surgery.

     H.          Discuss the causes, symptoms, and treatment options for stress urinary incontinence.

     I.           Discuss the component procedures of gender reassignment (transsexual) surgery.

     J.          List possible reasons for the performance of a Dilatation and Curettage (D&C), the proper order of instrumentation, and potential
                  complications.

     K.          List the common indications for vaginal hysterectomy.

     L.          Contrast the surgical techniques for vaginal vs. abdominal hysterectomy and compare those with a laparoscopic-assisted vaginal
                  hysterectomy.

     M.         Define anterior and/or posterior colporrhaphy (A&P repair).

     N.         Discuss the indications for and techniques of hysteroscopy, including cavity distention methods.

     O.         Define various types of vaginal fistulae and congenital anomalies of the uterus and vagina and explain their origins.

     P.          Discuss the indications for and technique of vaginoplasty, vulvar surgery, and surgical treatments for lesions of Bartholin's glands.

     Q.         List other types of abdominal and vaginal gynecologic surgery.

     R.         Define terminology related to obstetrics and neonatology.

     S.         Compare and contrast various methods of assisted reproductive technologies.

     T.          Identify the equipment needed for suction curettage and differentiate its use for interruption of pregnancy vs. therapeutic procedures.

     U.         Discuss the causes, signs and symptoms, hazards, and possible surgical interventions for an ectopic tubal pregnancy.

     V.          Define “incompetent cervical os” and explain the surgical treatment options.

     W.         List and explain the most common indications for Cesarean Section delivery.

     X.          Describe the pre-operative positioning and care of a patient undergoing Cesarean Section delivery.

     Y.          List the special instruments and supplies needed for a Cesarean Section and describe the surgical steps of the procedure.

     Z.          Discuss vaginal delivery after a Section (VBAC).

     AA.       Explain Apgar scoring of a newborn.

 10. Demonstrate knowledge of selected pathologies and operative procedures in Thoracic, Cardiovascular and Peripheral Vascular
       Surgery.

     A.          Identify instrumentation and closure methods used for intercostal thoracotomy and for median sternotomy thoracotomy.

     B.          Compare and contrast the techniques of pneumonectomy, lobectomy, segmentectomy and wedge resection.

     C.          List the types of primary lung cancers and discuss the etiology, prevalence, diagnostic methods, treatment options, staging methods and 
                   prognosis of each.

     D.          Explain why the lung is a frequent site of metastasis from cancers elsewhere in the body.

     E.          List surgical procedures that can be performed through a thoracoscope.

     F.           Discuss surgical procedures associated with emphysema.

     G.          List other reasons for performing thoracic and chest wall surgery.

     H.          Differentiate open heart vs. closed heart surgery.

     I.           Discuss the capabilities and side effects of cardiopulmonary bypass, and the special types of patient monitoring that are routine during
                  open-heart surgery.

     J.          Describe special instrumentation, sutures and pharmacologic agents used in cardiovascular  and peripheral vascular surgery.

     K.          Discuss the demographics, risk factors, signs and symptoms, methods of evaluating, treatment alternatives, and the usual indications for
                  surgery for myocardial ischemia.

     L.          Describe the surgical techniques (including possible bypass sources) for open and minimally- invasive Coronary Artery bypass surgery.

     M.         Discuss the etiology of various types of valvular heart disease, and compare and contrast artificial/mechanical vs. tissues heart valve
                  replacements.

     N.         List other types of surgery that may be performed for acquired heart disease, and discuss possible surgical and post-operative
                  complications associated with open-heart surgery.

     O.         Identify the most common indications for a temporary or permanent cardiac pacemaker.

     P.          Trace the historical development of pacemaker capabilities, discuss the component parts, interpret the international pacing “code”,
                  differentiate the placement techniques of a transvenous vs. transthoracic pacemaker, and discuss potential complications of cardiac
                  pacemakers.

     Q.         Differentiate an implantable cardioverter-defibrillator (ICD) from a cardiac pacemaker.

     R.          Discuss safety precautions when performing any kind of surgery on a patient who has a cardiac pacemaker or an ICD.

     S.          List the common signs and symptoms of congenital heart disease, and distinguish “cyanotic” vs. “acyanotic” congenital heart diseases,
                  giving examples of each.

     T.          Describe Patent Ductus Arteriosus (PDA), Coarctation of the Aorta, atrial septal defects, and ventricular septal defects, and discuss the
                  etiology, symptomatology, diagnosis, treatment options, and possible surgical complications for each.

     U.         Define Tetrology of Fallot, Truncus Arteriosus, and Transposition of the Great Vessels, and discuss possible surgical repair techniques.

     V.          List possible causes of aneurysms of the thoracic and abdominal Aorta, and differentiate a “true” aneurysm, a “false” aneurysm, and a
                  “dissection”.

     W.        Identify the most common location for an aneurysm on the Aorta, and discuss how an Abdominal Aortic Aneurysm is usually discovered,
                 when surgery is indicated and why, and the routine pre-operative preparations of a patient scheduled for AAA repair.

     X.          Describe the incisional approach, surgical techniques, and possible intraoperative and postoperative complications for open AAA repair.

     Y.          Compare types of synthetic materials used for vascular prostheses.

     Z.          Discuss angioscopic methods of teating occulsive and aneurysmal vascular disease.

     AA.       Discuss pulmonary emboli and explain the purpose, placement, and mechanics of intracaval filtering devices.

     BB.       Discuss femoral-popliteal occlusive disease, including etiology, clinical progression, and diagnosis.

     CC.       Compare traditional vs. in-situ Femoral-Popliteal bypass surgery, including instrumentation, supplies, and sutures.

     DD.       Differentiate a “thrombus” vs. an “embolus”, list the signs and symptoms of acute arterial obstruction in a leg, and discuss the technique of
                  arterial embolectomy.

     EE.        List other types of surgery for vascular disease in the lower limb.

     FF.        Compare the techniques for various levels of amputation of the lower limb.

11: Demonstrate knowledge of selected pathologies and operative procedures in Neurosurgery.

    A.          Describe congenital cranial and spinal neurological anomalies, relate the etiology of these defects to embryological development, and
                 discuss the treatment options and long-term implications.

     B.        Discuss various types of congenital and acquired cranial and craniofacial deformities, and list different methods of skull reconstruction or
                 cranioplasty.

     C.        Differentiate the causes of the two main types of hydrocephalus, compare the pathophysiology of hydrocephalus in an infant vs. in an adult,
                 and discuss the types of shunting procedures and their potential long-term complications.

     D.         Discuss different types of skull fractures and closed head injuries, including characteristics, diagnosis, usual treatments, and potential
                  complications.

     E.          List and define various diagnostic methods for intracranial pathologies.

     F.          Discuss patient positioning for cranial neurosurgery, differentiate various incisional  approaches, describe the steps, list intra-operative
                  monitoring devices used during craniotomy, and discuss possible surgical and post-operative complications.

     G.         Identify instrumentation and discuss special supplies, equipment, and pharmacologic agents commonly used during intracranial surgery.

     H.         Define and list possible uses for skull trephination and stereotaxis.

     I.           Identify bening vs. malignant types of primary intracranial tumors, and discuss the characteristics, clinical manifestations, and general
                  prognosis of each.

     J.          Discuss the etiology and demographics, most common locations, signs and symptoms, and  general prognosis of cerebral aneurysm.

     K.         Discuss the initial treatment of a patient following an episode of subarachnoid hemorrhage and the surgical management of cerebral
                  aneurysm.

     L.          Define arteriovenous malformation (AVM) and discuss treatment alternatives.

     M.         List other types of cranial neurosurgical procedures, and discuss the use of radiotherapy and chemotherapy for intracranial pathologies.

     N.         Discuss the demographics, risk factors, pathophysiology, signs and symptoms, and diagnostic tests for Carotid occlusive disease.

     O.         Explain the purpose of Cartoid Endarterectomy, and describe the incision, anatomical considerations, surgical techniques, special
                  instrumentation, and potential intra-operative and post-operative complications.

     P.          List conditions for which a laminectomy may be performed, identify various methods of positioning the patient, and describe the procedure,
                  including special instrumentation, precautions, and possible complications.

     Q.         Define a herniated nucleus pulposus and explain how it occurs, identify the most common locations for HNP, describe the usual signs and
                  symptoms, list common diagnostic methods, and discuss treatment alternatives.

     R.          Compare anterior and posterior approaches to the cervical spine.

     S.          Discuss surgical treatments for intractable pain.

12. Demonstrate knowledge of selected pathologies and operative procedures in Pediatric Surgery.

     A.          Discuss special considerations for an infant or young child undergoing surgery, and explain differences in instruments and sutures used
                  during Pediatric surgery.

     B.          Identify congenital anomalies that require surgical correction in utero or immediately after birth.

     C.          Define terminology related to congenital anomalies of the head and neck.

     D.          Discuss types of esophageal atresia and tracheo-esophageal fistula and the usual method of surgical repair.

     E.          Compare Omphalocele, Gastroschisis, and other types of congenital defects of the abdominal  wall, including their origins during
                  embryological development, and describe the surgical treatments.

     F.          Compare the type and repair of inguinal hernias in an infant or child with those in an adult.

     G.         Define terminology related to congenital anomalies of the gastrointestinal tract, and discuss the signs and symptoms and surgical
                  correction for each.

     H.         List other types of General surgical procedures that may be performed on infants or young children.

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