Keywords For Your Surgical Rotation In Med School

Bonjour everyone! Today, I’m going to share with you some high yield keywords that should hopefully help you breeze through your surgical rotations in med school. Call it a checklist if you will. The objective is to facilitate memory recall and help you gear up with areas that you just have to familiarize yourself with, ideally before the start of your rotations. Understand that these are just keywords, with a special emphasis on surgical instruments, and you’ll really need to read some good books to develop your knowledge base. For a rapid-fire review I suggest Surgical Recall. For basic surgical skills, you might like RM Kirk’s Basic Surgical Techniques. It is also a good idea to refer to specific sections (for pictures of incisions, instruments, etc.) of a good reference book on the surgical specialty you’ll be rotating in. Finally, like we all know, surgery is an area that is incredibly skill based and different people have different preferences when carrying out the same thing – be it tying a knot, controlling a bleeder or what have you. You’ll learn to modify the way you do things depending on the specific ways of your surgical team.

I’ve also interspersed keywords specific to two areas that I have an interest in with regards to surgery, or rather surgical oncology to be exact – general thoracic surgery and colorectal surgery.

I shall be updating this list as the need comes. Comments, corrections and feedback are always welcome! Bye for now !

Copyright © Firas MR. All rights reserved.

Know The Institutional Setup

The Building And Its Parts

• Floor (a.k.a the inpatient ‘ward’. The terminology comes from the fact that often high rise hospitals dedicate entire floors to a specific inpatient service. Eg: Pediatrics floor, ICU floor, etc.)
• Nursing Station
• Fellows room / doctors’ backroom (seating area for all of the doctors on a floor with computer workstations, etc.)
• Conference room (where meetings between doctors or between doctors and their patients can be conducted.)
• Storage room (a floor typically keeps its supplies in a ’storage room’)
• Treatment room (some floors will have a designated ‘treatment room’ for minor procedures such as gynec exams, etc.)
• Clinic (the outpatient clinic)
• SDH (’surgical day hospital’, a section of the building dedicated to outpatient based procedures like colonoscopies, etc.)
• PACU (post-anesthesia care unit, a.k.a the ‘post-op’ ward. Sometimes this area is also were patients scheduled for surgery stay during the immediate pre-op for marking of the surgical site, any last minute changes in consent, etc.)
• OR suite (where all of the main ORs are)
• Core (some facilities have the entire suite of ORs categorized by specialty. A set of ORs meant for a particular specialty requires its own specific instruments, computer monitoring, etc. A ‘core’ is an area adjacent to these ORs that houses all of this equipment. Sometimes a core will have dedicated OR techs to look after the functioning of its set of ORs.)
• OR Suite Control Room (located adjacent to the suite of ORs. Helps with the logistics and monitoring of activity in all of the ORs. Eg. movement of patients in and out, updating the progress of surgeries listed on the ‘greaseboard’, etc.)
• ICU
• ER (sometimes known by other names such as “Urgent Care”. Referred to as the “A&E” or “Casualty” in many other countries. The ER is often the first point of contact between a patient and a care provider at a hospital.)
• Swing (as in a particular section of a ward)
• Pneumatic tube (on a floor eg. to collect and send blood samples, etc. to a lab)

The Staff

• Intern
• Resident
• Chief Resident
• Fellow
• Attending
• Hospitalist (a physician who is solely involved with inpatient care and who does not see outpatients.)
• RN (Registered Nurse)
• NP (Nurse Practitioner)
• PA (Physician Assistant)
• Floor Nurse
• Nursing Assistant
• IV Nurse/Team (puts in i.v. lines, etc.)
• Floor Clerk (looks after phone calls to the floor, transfer of patients to and from the floor, etc.)
• Preop Nurse
• Circulating Nurse
• Scrub Nurse (a.k.a. ’scrub tech’)
• OR control room nurse/tech
• Wound Nurse (some facilities will have a wound nurse dedicated to care of specific wounds in a given area, like a colostomy site.)
• Wound Team (sometimes there’s a special team of nursing staff that takes care of stuff like ‘wound-vacs’, plastic surgery skin flaps, etc.)
• Orderly (responsible for moving patients around in wheel-chairs, helping with hygiene, etc. People from the Indian subcontinent might be familiar with this job as the ‘ward boy’ [male] or ‘daya’ or ‘aaya’ [female].)
• Nutritionist
• PT/OT (Physiotherapist – can be specialized like ‘pulmonary PT’, etc.)
• Case Manager (usually there’s at least one for a selected group of patients on any given floor. Also known as the ’social worker’, this person deals with financial and ethical issues surrounding the day to day care of patients. Examples of these activities include setting up hospice, medical insurance issues, dnr and health proxy issues before, during and after surgery in concert with the doctors, etc.)
• Other techs (portable x-ray tech, EKG tech, etc.)
• Chaplain (or priest)

Before The OR

• The Greaseboard (the live electronic display of OR events and surgeries on a monitor)
• Surgical scrubs
• Mask – with or without eye shield. Learn to identify the individual sides of a mask. A mask will not allow air to pass freely from the wearer’s mouth to the other side. But it will allow air to easily pass from the other side to to the wearer’s mouth. The objective is to prevent contamination of the surgical field, but not complete prevention of inhalation of airborne droplets.
• Respirator – Unqualified, it filters air from the outside to the inside. Some will filter air in both directions.
• Goggles
• Shoe covers. ‘Booties’ are special kinds of shoe covers that cover the feet all the way up to and including the ankles.
• Cap
• Wet scrub
• Dry scrub – a chemical that you just rub on without having to wash away.

In The OR

• Step (a wide platform with four short legs on which one could stand on)
• OR table (that usually has an electronic control)
• Positions of the OR table – Trendelenburg, Reverse Trendelenburg, Flat, ‘Drop-the-shoulder’ (where the table is ’tilted’ right or left, ‘Bend’ (where the table is bent in the middle, such that it forms an arch with a convexity facing the ceiling.)
• OR flatscreen monitor (for displaying the surgery, pathology slides, etc.)
• Time-out (the OR staff including the surgeons and anesthesiologists run through a safety checklist before, during and after the surgery. Ex: saying aloud the name of the patient, age, gender, scheduled surgery, incision site, counts of mops and instruments, etc.)

General Surgery Instruments

• Shaver / Hair trimmer
• Overhead light
• Head light
• Suction canister
• Mop – wet or dry
• Mayo tray
• Kidney tray
• Bovie (a.k.a. ‘diathermy’ or ‘cautery’. This specifically refers to the ‘Unipolar’ cautery. Named after its inventor.)
• Bovie tip – flat or pin-point/needle
• Bove tip – long or short
• Bovie holder/container (plastic holder/container for keeping the Bovie, when not in use)
• Pinpoint current
• Spray current
• Coagulation current (intermittent, high-amplitude)
• Cutting current (continuous, low-amplitude)
• Bipolar cautery
• Tissue link cautery (a special kind of bipolar cautery that also has a tubing connected to a bag of saline, allowing for simultaneous cauterization and irrigation)
• Argon beam (a unipolar cautery that spits out argon gas that is then electrified to produce a spray of current focused around a given area. Due to the pressurized escape of gas, the electric current or its heat can reach some distance away from the tip of the cautery.)
• Ligasure (a machine that uses heat generated from ultrasound to seal or anneal tissues together. Used instead of stitch sutures.)
• Purse-string applicator (a device that can apply a purse-string suture by the mere press of a button)
• Bonney forceps (a.k.a a toothed forceps with two teeth on one prong and one tooth on the other prong)
• DeBakey forceps (a.k.a. ‘pick-ups’)
• Adson forceps
• Cushing’s forceps
• Rat-toothed forceps (a forceps with a single tooth on either prong)
• Tonsil forceps/clamp
• Kelly forceps/clamp
• Mama Kelly forceps/clamp (just a big Kelly)
• Kocher forceps/clamp
• Allis forceps/clamp
• Babcock forceps/clamp
• Ring forceps/clamp (to sample lymph nodes, etc.)
• Hemostat or Halstead
• Towel clip/forceps/clamp
• Right-angle forceps/clamp (a.k.a. ‘the Mixter’)
• Barracuda (a forceps, the tips of which resemble the head of a barracuda [fish])
• Sponge stick (a.k.a. ’sponge holding forceps’)
• Peanut (a forceps with a tiny rolled up wad of gauze between the tips)
• ‘Tie on a passer’ – A suture thread held by a Right angled forceps used to allow easy passing of the suture around a structure such as a vessel.
• Tie – just a suture thread without a needle attached.
• Stitch – a suture thread with a needle attached on one end.
• Suture material of different types – nylon, prolene, monocryl, vicryl, PDS, silk, etc. Monofilament vs. Multifilament. Braided vs. Non-braided. Absorbable vs. Non-Absorbable.
• Pop-off (a suture with a needle on one end. The needle is very loosely attached to the thread and can be easily popped off by gentle pulling.)
• Clip (metallic clip applied to vessels, etc.)
• Clip applier
• Metzenbaum (a.k.a. ’tissue scissors’)
• Mayo scissors (a.k.a. ’suture scissors’)
• Bandage scissors
• Bard-Parker knife handle (a.k.a. ‘BP handle’)
• Blades – different sizes and shapes
• Yankauer’s suction
• Plastic suction
• Pool multiperforated suction
• Weitlaner retractor (a.k.a. ‘the weaty’)
• Sweetheart retractor
• Richardson retractor (also referred to as ‘the Rich’) – can be large or small
• Deaver retractor
• Kelly retractor
• Army-Navy retractor
• ‘S’ retractor (a retractor that is S shaped)
• Morris retractor
• Goligher retractor
• St. Mark’s retractor – shallow or deep
• Vein retractor
• Loop retractor
• Malleable retractor
• Buchwalter
• The Ring (of a Buchwalter)
• Box-cars (of a Buchwalter)
• Right-angled retractors (of a Buchwalter)
• Bladder blade/retractor (of a Buchwalter)
• Liver retractor
• Balfour retractor
• ‘A bucket’ – just a mug of warm saline or distilled water, used for irrigation.
• GIA (Gastro-Intestinal Anastomosis) Stapler – roticulating and non-roticulating
• Endo-GIA stapler – roticulating and non-roticulating
• TA (Transverse Anastomosis) Stapler
• EEA (End-to-End Anastomosis) Stapler
• Stapler refills – of various colors, each representing a given size.
• Round-body needle
• Cutting-edge needle (a needle that has its cutting edge facing towards the suture line)
• Reverse-cutting-edge needle (a needle that has its cutting edge facing away from the suture line)
• Needle driver (or ‘needle holder’)
• Adhesive drape (sometimes, an adhesive iodized drape is applied to the skin prior to making the incision)
• Fibrillar (something like ‘gel foam’)
• Gel foam
• Surgicel glue
• Dermabond
• Steristrips
• ‘Wet & Dry’ – a wet mop and then a dry mop. After a surgery, the incision area is first wet mopped and then dry mopped.
• Cell-saver – a machine that collects all the hemorrhaged blood and stores it to be re-transfused during surgery.
• Skin stapler
• Endoscope – rigid vs. flexible. The ‘degree’ of an endoscope, as in 0 degree, 30 degree, etc. The ‘degree’ refers to the angle at which the lens can see the tissues with respect to the body of the endoscope.
• Horizon of the endoscope
• Verris needle (for endoscope)
• Trocar (for endoscope)
• Air pump (for the endoscope, usually contains CO2)
• F.R.E.D. (Fog Reduction and Elimination Device)
• Endoscopic “catch” bag
• Alligator forceps
• Grenade (suction drain)

Instruments In General Thoracic Surgery

• Bronchoscope – rigid vs. flexible
• Bronchial stent
• Esophageal stent
• Mediastinoscope
• Mediport
• IJ canula (Intrajugular canula)
• Finochietto retractor
• Lung retractor / the ‘egg-beater’
• Sternal rib spreader
• Rib remover (removes a piece of rib, it’s almost like a ‘bone nibbler’)
• Sternal wires
• Sternal wire holding forceps
• Pericostals (stitches to be applied around the ribs through the intercostal spaces)
• Right angled needle (usually obtuse angled hypodermic needle, used for intercostal nerve blocks)
• The Noodle (a piece of hollow rubber tubing, used to pass the prongs of a stapler through a very narrow opening)
• Chest tube
• Cobb elevator
• Cushing elevator
• Duval (lung holding forceps)
• Endo-Duval (endoscopic Duval)
• Gore-tex

Anesthesia In General Thoracic Surgery

• Single lung ventilation
• Dual lung ventilation
• Bronchial blocker (for anesthesia)

Instruments In Colorectal Surgery

• Proctoscope
• Colonoscope
• Rectal/Anal retractor
• Candy-cane stirrups
• Normal stirrups
• Rectal wash setup
• Colostomy bag (or ‘appliance’)
• TEMS machine (Transrectal Endoscopic Micro Surgery)
• Ureteral catheter (helps identify the ureter)
• Lone-star retractor

Therapeutic Adjuncts To surgery

• I.O.R.T. (Intraoperative Radiotherapy) – also called ‘Brachytherapy’
• Seeds (of I.O.R.T. material)
• XRT (External Beam Radiotherapy)
• I.M.R.T. (Intensity Modulated External Beam Radiotherapy)
• Neoadjuvant
• Adjuvant

Common Thoracotomy Incisions In General Thoracic Surgery

• Lattismus sparing
• Non lattismus sparing
• Posterolateral
• Vertical axillary
• Anterolateral
• Hemiclamshell
• Clamshell
• Median sternotomy
• Chamberlain (left anterior parasternal mediastinotomy, minimally invasive)
• Extended Chamberlain (left anterior parasternal mediastinotomy, non-minimally invasive; equivalent to a left sided anterolateral thoracotomy)
• VATS (Video Assisted Thoracic Surgery)
• Robotic VATS

Common Lung Resections In General Thoracic Surgery

With increasing degrees of lung resection:-

• Wedge
• Segmentectomy
• Lobectomy
• Bilobectomy
• Sleeve lobectomy
• Pneumonectomy (intrapleural vs. extrapleural)

Other Common General Thoracic Surgery Procedures

• Pulmonary toilet
• Diaphragmatic repair
• Pericardial window and repair
• Ivor Lewis Esophagectomy
• Bronchial or Esophageal stenting
• Pleurectomy / Decortication
• Pleurodesis – talc or doxycycline
• Pericardiocentesis and instillation of Thiotepa

Common Incisions In Colorectal Surgery

• Transrectal
• LAR (low-anterior)
• APR (abdominoperineal)

Other Common Terms In Colorectal and Abdominal Surgery

• xlap (exploratory laparotomy)
• bso (bilateral salphingo-oophorectomy)
• lad (lysis of adhesions)
• End-colostomy
• Mucous Fistula
• Double barrel iliostomy (loop iliostomy)
• Maturation of a stoma (for colostomy)
• Take-down of a colostomy/iliostomy
• J-pouch
• Hartmann’s procedure
• IOC (intraoperative cholangiography)
• EGD – esophagogastroduodenoscopy

Commonly Used Local Anesthetics In The OR

• Xylocaine (Lidocaine)
• Marcaine (Bupivacaine)

Things To Remember On The Floor

Procedural Stuff

• Sign-out (when patients are ’signed out’ between team shifts)
• Night-float
• Consent (Informed)

Common Medical Ethics Terms

• DNR
• DNI (do not intubate)
• Health proxy (power of attorney)

Commonly Used Equipment

• Chart (the ‘case sheet’ as it’s called in the Indian subcontinent)
• 4 x 4 (4 inch x 4 inch gauze piece)
• 4 x 8
• Clamp (any clamp)
• ABD (abdominal dressing pad)
• Abdominal elastic belt
• Kerlix
• Scissors
• Suture removal kit
• Skin stapler remover
• Foley catheter kit
• Coude catheter kit
• I.V. canula
• i.v. piggyback (ivpb)
• i.v. continuous infusion (ivci)
• i.v. bolus
• Heplock
• Infusion pump
• Pressure drip
• ‘Tele’ (telemetry)
• PEG (percutaneous endoscopic gastostomy) – G tube
• PEJ (percutaneous endoscopic jejunostomy) – J tube
• LP kit
• TPN (total parenteral nutrition)
• Red rubber drain
• Wet to Dry dressing
• Wound VAC (for Negative Pressure Wound Therapy or NPWT)
• Xeroform dressing (Petroleum jelly gauze)
• Primapore dressing
• Tegaderm dressing
• ‘Trach’ – tracheostomy
• ‘Embo’ – embolization
• Simple Face mask – rate and %
• Venturi face mask
• Non-rebreather face mask
• Partial rebreather face mask
• Rebreather face mask
• IR – intervential radiology
• ‘Rad onc’ – radiation oncology
• Computer pod (a computer on a trolley that can be taken about on the floor)
• PACS (Picture Archiving and Communication System) for radiology images
• HIS (Health Information System) – the complete electronic system for accessing patient data and placing orders

Common Surgical Knot Tying Terms

• A square tie
• Reef knot
• Granny knot
• Surgeon’s knot
• Instrument tie
• Two handed tie
• Single handed tie

Pathology Terms To Remember

• Frozen (takes minutes)
• Regular (H & E and other stains including immunohistochemistry, takes days to weeks)
• Karyotype
• PCR and RT-PCR
• FISH