Under the Knife

by Arnold van de Laar, Laproscopic surgeon

  Cancer Malignant disease whereby cells in the body isolate themselves from the normal control mechanisms and multiply and spread autonomously at the expense of the body. A cancerous tumour is invasive, i.e. it actively breaks through the barriers of the body. Cancer of the skin, mucous membrane or gland tissue are referred to as carcinoma, of the blood cells as leukaemia, and of all other tissues as sarcoma.

  Cardiosurgery Heart surgery. Not to be confused with cardiology, the branch of medicine that treats heart disorders without surgery.

  Chirurgeon See Surgeon.

  Chronic Persistent, not sudden. See Acute.

  Circulatory system The system of blood circulating through the blood vessels, under pressure (blood pressure) and driven by the heart. Shock is a failure of the circulatory system.

  Circumcision Literally ‘to cut around’. Full circumcision is the complete removal of the foreskin from the penis. See also Excision, Incision.

  Complication Undesired (and unintentional) harmful consequence of a disease, disorder or operation. Not to be confused with a side effect, which is also an undesirable consequence of a course of treatment, but is not unexpected. Complications are inherent to a form of treatment, surgical or non-surgical, and can therefore usually not be attributed to human error. See Morbidity.

  Conservative Treatment without surgical intervention or any other direct access to the body, for example, with drugs. See Expectative, Invasive.

  Curative Treatment aimed at complete cure of a disease, even if that may reduce the quality of life. In contrast to palliative, where treatment is no longer aimed at complete recovery. See Palliative.

  Cure To restore to health without leaving scars on the body. See Healing.

  Diagnosis Identifying what is wrong with a patient: the nature, cause and severity of the illness.

  Dislocation Displacement of a bone from a joint. Also referred to as a luxation. A fracture dislocation is a combination of a dislocation and a fracture. See Reposition.

  Divide Cutting or burning through a structure or organ in a surgically responsible manner. An intestine can be divided using a surgical stapling machine. A blood vessel is divided by cutting through it and tying it off with a ligature. See Ligature.

  Drain Noun: A tube or strip inserted through an opening in the body to allow something to drain, e.g. air from the chest cavity (thorax drain) or pus from an abscess cavity. Mostly made of rubber or silicone. A special kind of drain is a urinary catheter, which is inserted into the bladder through the urethra. Verb: To drain fluid, more specifically used for an incision in an abscess to allow the pus to escape. The whole surgical intervention is known as ‘incision and drainage’, I & D for short. Sometimes a drain is left behind in the incision or inserted through a secondary incision (counterincision) to allow any pus that is still in the abscess or may form later to escape. See Abscess.

  Dys-, dis- Prefix meaning ‘abnormal’ or ‘troubled’. Dysphagia means difficulty in swallowing. Dyspareunia means literally ‘troubled interaction’ and is used for physical problems with sexual intercourse.

  Ec-, ex- Prefix meaning ‘out’. A tumourectomy, for example, is the removal of a tumour. See Excision.

  Elective Not compulsory, optional. An elective operation is a surgical procedure for which there is a reasonable alternative. That means that it can be planned and there is sufficient time to postpone it or not perform it at all if necessary.

  Embolism Something carried along in the bloodstream and which can cause damage in the circulatory system. A blood clot from thrombosis in the lower leg, for example, can close off part of the lung (pulmonary embolism). The same can occur with fatty tissue from bone marrow after a fracture. Air in the carotid arteries in the neck (air embolism) during carotid surgery can cause a cerebral infarction.

  Embryological Relating to the development of an organism before birth. Once an embryo is sufficiently recognisable as the animal it will become, it is known as a foetus.

  End-of-life care Stopping all treatment to combat a fatal disease and aiming to bring the patient’s life to an end as comfortably as possible. See Palliative.

  Enema Rinsing the bowels via the anus. Despite their widespread and enthusiastic application to alleviate a broad variety of ailments, both in the past and today, there is very little evidence that enemas are effective and their excessive use can cause side effects, which may be minor but can also be more serious.

  Evidence-based Making decisions and acting on the basis of results published in the medical literature. In contrast to ‘expert opinion’, deciding and acting on the basis of what an alleged expert in the area concerned would do or not do. Evidence can have varying degrees of reliability. The greater the total number of patients from which a certain conclusion can be drawn, the more reliable the evidence. Evidence can lead to national guidelines to provide a framework for those providing treatment.

  Excision Cutting out. Removing something in full by cutting it away completely. See also Incision, Circumcision, Biopsy, Resection.

  Expectative Watchful waiting, not (yet) giving treatment and monitoring the patient closely. See Conservative, Invasive.

  Exposure Freeing (if necessary by dissection) a structure or abnormal tissues, including their immediate surroundings, to give a clear view of the surgical field, including the whole structure and how it is related to those around it.

  Fast track Form of post-operative care aimed at restoring the patient’s normal functions as soon as possible. This includes eating and drinking, getting out of bed and walking around, and removing tubes and catheters.

  Fistula Two small wounds connected to each other by a tunnel through the body’s tissues. It can link one cavity to another, or a cavity and the outside world. An anal fistula, for example, connects a wound in the rectum to another in the skin. Latin for tube, pipe or flute.

  Fleam Special knife used for bloodletting by, for example, making an incision in the fold of the elbow. The special form of the blade is designed to ensure that the cut does not go too deep. See Bloodletting.

  Fluctuation Effect whereby pressing one side of a swelling filled with fluid causes it to be pushed outwards on the other side. As this does not occur with a swelling filled with solid material, checking for fluctuation will clarify whether the swelling is liquid or solid. A mature abscess, for example, will be liquid, while a swelling without an abscess will be solid. See Pus, Incision, Drain.

  Fracture Broken bone.

  Gangrene Dying off of living tissue, such as the skin around a wound, a toe or a whole limb. The dead (part of a) limb can dry out and shrivel up. That leads to black mummification and, in the best scenario, to rejection by the body. The dead tissues can also rot and discharge fluid and pus that can enter the bloodstream. Wet gangrene is therefore more dangerous than dry. Gangrene can be caused by the obstruction of an artery or by a wound infected with aggressive bacteria. Some bacteria produce gas, exacerbating the spread of the gangrene. This is known as gas gangrene.

  Gout Inflammatory disease caused by an accumulation of uric acid crystals in the joints. A typical symptom is a painful, inflamed big toe. The term ‘gout’ was formerly used for any painful complaint of unknown cause.

  Gynaecologist Medical specialist concerned with obstetrics and the surgical treatment of the female reproductive organs.

  Haematuria Blood in the urine.

  Healing Healing and curing are two forms of ‘making people better’ but, unlike curing, healing leaves its marks on the body in the form of scars. See Cure, Surgeon, Surgery.

  Hemi- Prefix for half, used mainly to indicate a right or left half. Hemiparesis means half-paralysed, on the right or left side of the body. A hemicolectomy is the surgical removal (-ectomy) of half (hemi-) of the large intestine (colon). Not to be confused with the prefix haema- or haemo-, relating to blood.

  Hernia Rupture in tissue that should normally provide strength, with the consequence that something else protrudes through the hernia. A crack in one of the int
ervertebral discs in the spine can cause a hernia in the neck or back, while a rupture of the abdominal wall can lead to an abdominal hernia.

  Homeopathy Form of quackery, like bloodletting. See Bloodletting.

  Idiopathic Without a clearly identifiable cause. Not to be confused with ‘e causa ignota’ (e.c.i.), Latin for ‘of unknown cause’.

  Ileus Stagnation of the passage of the contents of the intestines through the small intestine. Causes vomiting and a swollen abdomen. A mechanical ileus, obstruction of the small intestine, is caused by a constriction, a tumour or a blockage from the inside, such as a hairball. A paralytic ileus occurs when the natural movement of the bowels (peristalsis) stops, causing the contents of the intestines to come to a halt. Ileus is not to be confused with colon obstruction, which interrupts the flow of faeces through the large intestine.

  Incidence Figure indicating how often a certain disease occurs in a specific population group, mostly expressed as the number of new cases per 100,000 per year. Not to be confused with prevalence. See Prevalence.

  Incision Literally ‘cut into’. The simple action of making a cut with a scalpel. An incision into the abdominal cavity is also known as a section, as in caesarean section. See also Excision, Circumcision, Biopsy, Drain.

  Incontinence Not being able to retain faeces or urine.

  Indication In surgery, a reason to perform an operation.

  Infarction Mortification of all or part of an organ as a result of an obstruction in an artery (or a branch of an artery) that supplies it with oxygen-rich blood. An infarction in part of the brain is known as a stroke. An infarction in all or part of a limb is called gangrene. See Ischaemia.

  Infection See Inflammation.

  Inflammation A reaction in the body’s tissues characterised by the activation of inflammatory cells and pain, redness, swelling, heat and loss of function in the affected area. An infection is an inflammation caused by a virus or another living pathogen, such as a bacterium, yeast, fungus or parasite. Most infections provoke an inflammation, but not all inflammations are caused by an infection.

  Intermittent claudication Oxygen deprivation in the muscles of the lower leg when walking, due to narrowing of the arteries supplying blood to the legs; and which causes pain that stops immediately during rest. See Ischaemia.

  Invasive Treatment involving direct entry into the body via an operation or with a catheter, as with percutaneous coronary intervention (PCI). In contrast to treating an illness with drugs or by other non-invasive means. Minimally invasive treatment aims to minimise the disadvantages of an operation. See Expectative, Conservative.

  Ischaemia Shortage of oxygen in all or part of an organ or limb caused by insufficient supply of oxygen-rich blood, for example due to narrowing of an artery. Symptoms include pain and loss of function, which occur or worsen as the organ or limb is used more intensively, as this increases the demand for oxygen. Extreme ischaemia leads to an irreversible infarction and the mortification of tissues. See Intermittent Claudication.

  Laparotomy Opening the abdomen with an incision. Compare with laparoscopy, keyhole surgery in the abdomen. See -tomy, Abdomen.

  Learning curve Decreasing probability of complications and death of a patient (morbidity and mortality) as a surgeon, a team or a hospital gain greater experience with a specific operation. Eventually, the risk of morbidity and mortality decreases to such an extent that gaining further experience no longer has an effect. The learning curve is then ‘completed’ or ‘achieved’. A typical learning curve requires more than a hundred patients to complete.

  Ligature Tying off a bleeding blood vessel with a thread. There is a fixed procedure for placing a ligature. The surgeon first fixes a clamp to the bleeding wound. When the bleeding has stopped completely, an assistant passes a thread behind the tissue below the clamp and ties a knot in it. This calls for communication. The assistant says ‘yes’ when he is finished, after which the surgeon carefully opens the clamp. The assistant then says ‘thank you’ if the knot seems to have the bleeding under control, after which the surgeon removes the clamp completely and gives it back to the scrub nurse. The scrub nurse then gives the surgeon a pair of scissors, which he uses to cut off the ends of the thread.

  Lithotomy position Lying on the back with both legs in the air. Provides a clear view of the perineum. Preferred position for operations on the anus, vagina, scrotum and penis. Since Louis XIV, also the preferred position for giving birth.

  Lithotomy Surgical removal of a stone from the bladder (literally, stone-cutting). Those who performed the operation were formerly referred to as stone-cutters.

  Local Used for a location in the body that does not belong anatomically to a described region, for example, the forehead, the little finger, the navel or the pancreas. See Regional.

  Luxation Dislocation. See Dislocation, Reposition.

  Lymph Tissue fluid. Clear fluid between the cells transported by the blood. Special small lymph vessels remove excess lymph fluid separately. Lymph fluid from the small intestine, known as chyle, also contains fats from food, giving it a milky colour. See Lymph nodes.

  Lymph nodes Nodes no larger than half a centimetre, where lymph vessels come together. In groups they form lymph stations on the large network of lymph vessels in the body. See Lymph, Metastasis, Radical.

  Macroscopic Visible to the naked eye, in contrast to microscopic, meaning too small to be seen with the naked eye.

  Medical error See Complication.

  Mesentery Attachment with which the small intestine is connected to the back of the abdominal cavity over its whole length and through which blood vessels run to and from the intestine. It is shaped like a fan, so that on the intestine side, it is six metres long, but only 30 centimetres where it is attached to the abdominal wall. It is also about 30 centimetres across from the point of connection at the back of the abdominal cavity to the intestine. That is long enough to allow the intestine to protrude from the abdomen onto the operating table when the abdominal cavity is cut open.

  Metastasis Literally ‘displacement’. Occurs when cancer cells break loose from a tumour and form a new tumour elsewhere in the body. The metastasis can be direct, across the edges of a cavity or plane, or via the blood vessels to a more remote part of the body, for example, via the portal vein to the liver, via arteries to the bones or the brain, or via the lymph vessels to the lymph nodes.

  Morbidity From the Latin word morbus, meaning disease. Used in surgery to describe the occurrence of complications. Can be expressed in the percentage chance that a specific complication will occur in the case of a certain procedure. See Complication.

  Mortality Risk of death, from the Latin word mors, meaning death. In surgery death resulting from a disease or a surgical operation. Can be expressed as a percentage chance that a patient will die from a certain disease or procedure.

  Narcosis See Anaesthesia.

  Necrosis Dead tissue. Cutting away dead tissue is called necrotectomy.

  Needle holder Surgical instrument used to hold the stitching needle firmly and guide it through the tissues.

  Nervous system Collective name for the brain, the spine and the nerves.

  Obduction Autopsy.

  Obesity Excessive body weight that poses a health risk, compared with others of the same gender and race, and of the same age and height. Adults in the Western world are considered to be obese if their body mass index (BMI: weight in kilograms/square of their length in metres) is higher than 25. The BMI obesity limit for Asians, for example, is lower.

  Occlusion Blockage of an intestine, a blood vessel, or any other hollow structure. A blocked artery can cause an infarction or gangrene. See Arteriosclerosis.

  Operative report Documented record of a surgical procedure in a patient’s medical file. A report has to be made of every operation, describing the procedure from A to Z, from the position of the patient on the operating table and the disinfecting of the skin to the final stitch and the application of the dressing. The re
port should also note the names of the patient, the operating surgeon, the assistant and the anaesthetist, plus the date, indication and nature of the operation.

  Orthopaedics Orthopaedic surgery. Literally ‘straightening a child’. Orthopaedics was originally a discipline that focused on fitting children with braces, splints, shoe inserts and orthopaedic footwear to correct deformities of the bones. Although this did not involve surgical procedures, orthopaedics has now become a specialised ‘cutting’ discipline, with operations being performed on the musculoskeletal structure of the body. The main activity of orthopaedic surgeons is currently replacing joints with prostheses.

  Outcome (of care) The total results obtained by a doctor, team or care institution in treating a specific illness, including the negative consequences, such as morbidity and mortality, in both the short and longer term. A commonly used measure of outcome is the five year survival rate, i.e. the percentage of patients that are still alive five years after the operation.

  Palliative Reducing pain without curing the cause. Palliative care is treatment aimed both at prolonging the life of terminally ill patients and improving their quality of life, but without the prospect of a complete cure. Compare with curative treatment. See End-of-life care, Curative.

  Pathological Deviating from the normal, healthy situation. Pathology means ‘the study of illness’, but is also used to describe the department of a laboratory or hospital that conducts microscopic examination of tissues and autopsies.

  Per primam In the first instance. Healing per primam is primary wound healing. See Wound healing.

  Per secundam In the second instance. Healing per secundam is secondary wound healing. See Wound healing.

  Perianal Around the anus, in the vicinity of the anus or related to the anus.

  Perineum Literally the area around the opening through which we are born. The area between buttocks and the lower abdomen. Includes the pelvic floor, with the anus, vagina, scrotum and penis.

  Peritoneum The inner lining of the abdominal cavity. An infection of the peritoneum is known as peritonitis.