2.7 Common Surgical Procedures

Decoding Procedure Names

Surgical procedure names are built from roots and suffixes; learning these lets the CST predict what a case involves.

Prefixes locate the anatomy: chole- (bile/gallbladder), hyster- (uterus), nephr- (kidney), oophor- (ovary), append- (appendix), mast- (breast), splen- (spleen), thyroid- (thyroid), lapar- (abdomen/flank), and arthro- (joint). "Cholecystectomy" therefore reads as removal (-ectomy) of the gallbladder (chole-cyst), while "hysterectomy" is removal of the uterus and "arthroscopy" is visual examination of a joint. Combining a prefix with a suffix lets the CST decode an unfamiliar procedure on the schedule and predict the body region, the likely position, and the instrument set before ever opening a tray.

This vocabulary is heavily tested on the CST exam, so memorizing the common roots pays off directly, and it also speeds case preparation because the name itself tells the technologist what tray and supplies the case will require.

Open vs. Minimally Invasive Technique

Most procedures can be performed open (a large incision exposing the field directly) or minimally invasive / laparoscopic (MIS) (small incisions with a camera). The CST sets up very differently for each.

Laparoscopic flow: the abdomen is insufflated with carbon dioxide (CO2) to create a working space (pneumoperitoneum), a Veress needle or Hasson (open) technique establishes access, trocars/cannulas are placed as ports, and a laparoscope (camera) plus long instruments (graspers, scissors, clip appliers, energy devices) are passed through the ports. The CST manages the light cord, camera, insufflation tubing, and irrigation, keeps the scope defogged, and is ready to convert to open (have an open set available) if needed.

Common general-surgery examples:

• Laparoscopic cholecystectomy — removal of the gallbladder; watch for the clip applier on the cystic duct/artery and the specimen retrieval bag.
• Appendectomy — open (McBurney incision) or laparoscopic.
• Herniorrhaphy (inguinal/ventral) — often with mesh and tackers.
• Bowel resection with anastomosis — uses GIA/EEA staplers.
• Mastectomy / lumpectomy — breast tissue removal, often with sentinel-node mapping and oriented specimens.
• Thyroidectomy — meticulous hemostasis near the recurrent laryngeal nerve and parathyroids.

Laparoscopy reduces incision size, pain, and recovery time, but it demands that the CST master the video tower, light source, camera white-balance and focus, insufflator settings, and energy generators — and keep a backup of each disposable ready. The CST also troubleshoots common problems: a dark image (check light cord and camera), a deflating abdomen (check insufflation tubing and trocar seals), and a smoky field (use suction/evacuation).

When bleeding cannot be controlled laparoscopically or anatomy is unclear, the surgeon converts to open, so the open instrument set, additional sponges, and self-retaining retractors must always be immediately available.

Signature Specialty Setups

Each surgical specialty has a recognizable setup the CST must anticipate:

• Orthopedics: power tools (drills, saws, reamers), implants and instrumentation (plates, screws, prostheses), a tourniquet for extremity hemostasis, and strict implant handling/loaner tray protocols.
• Cardiothoracic: sternal saw, cardiopulmonary bypass cannulas, vascular sutures (Prolene), and meticulous counts in a deep cavity.
• Neurosurgery: the microscope, bipolar electrosurgery, bone wax and hemostatic agents, cottonoids/patties (counted radiopaque neuro sponges), and Mayfield head fixation.
• Ophthalmic: microinstruments handled under a microscope, viscoelastic, and tiny sutures (10-0).
• Obstetrics/Gynecology: cesarean section, hysterectomy, and laparoscopic adnexal cases.
• Genitourinary: cystoscopy, TURP (with continuous irrigation), and nephrectomy.
• ENT/Plastics/Vascular each carry their own fine instruments and grafts.

Across all specialties the CST applies the same fundamentals from this chapter — sterile technique, correct instruments, hemostasis, counts, and safety — adapted to the procedure's anatomy and equipment.

Incisions, Positioning, and Procedure Flow

The CST anticipates the surgical approach, which begins with patient positioning and the incision. Common abdominal incisions include the midline (laparotomy) through the linea alba, the McBurney/oblique for open appendectomy, the Pfannenstiel (low transverse) for cesarean and pelvic cases, and the subcostal (Kocher) for open gallbladder/liver work. Positioning is matched to access: supine for most abdominal work, Trendelenburg (head down) to shift bowel out of the pelvis, lithotomy for GU/GYN/rectal cases, prone for spine, and lateral for kidney and chest.

The CST helps protect pressure points and nerves and keeps the field sterile during positioning.

Every case follows a predictable flow the CST anticipates step by step:

1. Incision — scalpel, then hemostasis of skin bleeders.
2. Dissection/exposure — deepening through layers with cautery, scissors, and retractors.
3. Isolation and management of the target structure (clamp, ligate, resect, repair).
4. Hemostasis and irrigation before closure.
5. Counts as the cavity and skin are closed.
6. Closure layer by layer, then dressing.

A strong technologist mentally rehearses this sequence for the scheduled procedure, sets the back table in order of use, and has each instrument, suture, and supply ready a step ahead of the surgeon — the essence of anticipation.