Requirements in San Juan Medical Center / OR- CI: Mr.

Chan RN MAN

Incision: While the patient is deep asleep and pain-free (general anesthesia), the surgeon makes an incision into the abdomen and examines the abdominal organs. Different incisions are sometimes used depending on the circumstance. Common incisions include a vertical midline incision, and right or left upper or lower quadrant transverse incisions. Tissue samples (biopsies) can be taken and diseased areas can be evaluated. When the treatment is complete, the incision is closed with either sutures or skin staples.

Different Types of Incision

Prepared By; Regine C. Roxas A404

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Requirements in San Juan Medical Center / OR- CI: Mr. Chan RN MAN

Indication: The surgical exploration of the abdomen, also called an exploratory laparotomy, may be recommended when there is abdominal disease from an unknown cause (to diagnose), or trauma to the abdomen (gunshot or stab-wounds, or "blunt trauma"). Diseases that may be discovered by exploratory laparotomy include:

inflammation of the appendix (acute appendicitis) inflammation of the pancreas (acute or chronic pancreatitis) pockets of infection (retroperitoneal abscess, abdominal abscess, pelvic abscess)) presence of uterine tissue (endometrium) in the abdomen (endometriosis) inflammation of the Fallopian tubes (salpingitis) scar tissue in the abdomen (adhesions) cancer (of the ovary, colon, pancreas, liver) inflammation of an intestinal pocket (diverticulitis) hole in the intestine (intestinal perforation) pregnancy in the abdomen instead of uterus (ectopic pregnancy) to determine the extent of certain cancers (Hodgkin's lymphoma)

Different Types of Incision

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Requirements in San Juan Medical Center / OR- CI: Mr. Chan RN MAN

Common types of surgical incisions

Transverse incision

Several useful transverse abdominal incisions are available to the surgeon performing gynecologic cancer surgery. Historically, the obstetrician-gynecologist has preferred this type of incision. Reported advantages include better cosmetic results, less pain, and low incidence of hernia formation. Gynecologic oncologists have embraced certain types of transverse incisions for specific gynecologic cancer operations. Several disadvantages of these incisions exist. Transverse incisions limit exploration of the upper abdomen, they are associated with greater blood loss, and they are more prone to hematoma formation when compared with a midline incision. Nerve injury, which can result in paresthesia of the overlying skin, is more frequent in a transverse incision compared with a midline incision. Type of Surgery: gynecologic cancer surgery

Pfannansteil incision The incision is the usual procedure adopted for surgical access towards pelvic organs and mainly for cesarean sections. The incision is placed horizontally about 5 cm above the pubic symphysis and is about 12 cm in length.

Modified Gibson incision Some gynecologic oncologists perform an extraperitoneal lymph node dissection using a modification of the Gibson incision. This incision can be made on each side of the midline, but often, the skin is cut only on the left. The incision is started 3 cm superior and parallel to the inguinal ligament. Extension is made vertically 3 cm medial to the anterior superior iliac spine to the level of the umbilicus. The fascia is cut and the peritoneum bluntly dissected, as described above. The round ligament and the inferior epigastric vessels are ligated to facilitate surgical exposure. Care is needed when exposing the lymph nodes using only a left-sided incision. Too much traction on the peritoneum can result in avulsion of the inferior mesenteric vessels.

Different Types of Incision

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Requirements in San Juan Medical Center / OR- CI: Mr. Chan RN MAN
Cherney incision

Cherney described a transverse incision that allows excellent surgical exposure to the space of Retzius and the pelvic sidewall. The skin and fascia are cut in a manner similar to a Maylard incision. The rectus muscles are separated to the pubis symphysis and separated from the pyramidalis muscles. A plane is developed between the fibrous tendons of the rectus muscle and the underlying transversalis fascia. Using electrocautery, the rectus tendons are cut from the pubic bone. The rectus muscles are retracted and the peritoneum opened. Closing a Cherney incision begins with closure of the peritoneum. Attach the cut ends of the rectus muscle to the distal end of the anterior rectus sheath with interrupted nonabsorbable sutures. Fixing the rectus muscle to the pubis symphysis can result in osteomyelitis. Next, the fascia is closed with 2, running, continuous, delayed-absorbable sutures. Several types of incisions facilitate extraperitoneal para-aortic lymph node dissection. An upper abdominal transverse incision, which is a high Maylard incision, is made approximately 2 cm above the umbilicus. The incision is extended laterally and caudad to the anterior superior iliac spines. The fascia and rectus muscles are incised transversely, usually requiring ligation of the inferior and superior epigastric vessels. Next, the transversus abdominis muscle is cut, exposing the peritoneum. Using blunt dissection, the peritoneal sac is dissected caudad to cephalad to expose the psoas muscle, the aorta, and the common iliac vessels. Often, a drain needs to be placed in the area of the lymph node dissection.
Maylard incision

In an effort to improve surgical exposure to the lateral pelvic sidewall with a transverse incision, Maylard proposed a transverse muscle-splitting incision. This incision usually refers to a sub umbilical transverse incision. For gynecologic surgery, the incision is made 3-8 cm superior to the pubis symphysis. The anterior rectus sheath is cut transversely. The inferior epigastric vessels are identified under the lateral edge of each rectus muscle and then are ligated. Patients with significant peripheral arterial disease may experience ischemia from ligation of the inferior epigastric vessels. These patients may have collateral flow from the epigastric vessels to the lower extremities. After ligation of the inferior epigastric vessels, electrocautery is used to transversely cut the rectus muscle. The peritoneum is opened and cut laterally.[22, 23] To facilitate closure of a Maylard incision, flex the operating table. Close the peritoneum with an absorbable suture. Next, inspect the ties placed on each inferior epigastric vessel, and irrigate with water. Examine the cut edges of the rectus muscles for any bleeding areas. The fascia and underlying rectus muscle can be closed with a monofilament absorbable suture.

Different Types of Incision

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Requirements in San Juan Medical Center / OR- CI: Mr. Chan RN MAN

Vertical incision Several types of vertical abdominal incisions have been used in gynecologic surgery, including midline, paramedian, and wide paramedian incisions. A midline incision is almost exclusively the type of vertical incision used in gynecologic oncology surgery. The midline incision is the easiest and most versatile vertical incision for performing gynecologic cancer surgery. This incision allows quick entry into the abdominal cavity with little blood loss, and it is easily extended in length to accommodate the operative findings. The presumed disadvantages of a midline incision, compared with a transverse incision, include an increased risk of wound dehiscence and hernia formation. Most studies that support this idea are retrospective or lack proper statistical design. Recent studies have challenged this dictum and advocate that little difference exists in dehiscence rates between properly closed midline incisions and transverse incisions. For a midline abdominal incision, the skin and subcutaneous fat are incised to the level of the fascia.

Mid line incision The incision placed on the middle of the abdomen will run vertically and will give the surgeon enough access to almost all abdominal organs and will facilitate good visualization as well. There are several advantages of this kind of incision and being blood less plain is one of the most important. This incision is widely used in surgeries related to bowel pathologies and especially in situations which require the necessity to remove part of the bowel. Type of surgery: gynecologic cancer surgery

Paramedian incisions are also used when the need arise to access certain organs towards a particular site. Type of Surgery: gynecologic surgery

Different Types of Incision

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Requirements in San Juan Medical Center / OR- CI: Mr. Chan RN MAN

Other types of Incision Grid iron incisions Also known as 'McBurneys incision', the incision is the most commonly used incision for 'appendicectomy'. The incision will be placed at the McBurney's point which is at the junction between the middle one third and the outer one third of a line extending from umbilicus towards the anterior superior iliac spine. It's commonly places obliquely and has the potential to be expended in case the need arise. Type of surgery: Appendectomy

Kocher sub costal incision The incision is placed below the costal margin or the lower margin of the rib cage and could be on either left or in the right. But, most often the incision will be placed on the right side of the body to gain access to the gall bladder and the billiary tree.

Cheveron incision and Mercedes Benz Modifications are some of the other incisions which Will allow the surgeons better access to upper abdominal organs. Apart from these, it is vital to remember that a surgeon will be able to make a decision based on his clinical experience on the placement of the incision as well as the required size of the incision. Therefore, the art of doing a surgery would not be limited to text book patterns of incisions, but you can be assured that the above described incisions will account for many of these decisions.

Different Types of Incision

Prepared By; Regine C. Roxas A404

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