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[
{
"keys": [
"appendix",
"appendectomy",
"appendix removal"
],
"name": "Appendectomy",
"modes": {
"professional": "Appendectomy is the removal of the vermiform appendix. The patient lies on his back. An incision in the right iliac region, layer-by-layer access, ligation and removal of the appendix, suturing.",
"normal": "The appendix is removed through a small incision on the side of the abdomen. It is done under anesthesia, then stitched up."
},
"steps": [
{
"name": "Pain relief",
"description": {
"professional": "General anesthesia (intubation anesthesia) is performed. Propofol or sodium thiopental is administered intravenously for induction, then maintained with inhalational anesthetics (sevoflurane, isoflurane) through an endotracheal tube. Epidural anesthesia is possible if general anesthesia is contraindicated.\nInstruments: \n- 18G catheter (IV access) \n- 20 ml syringe (propofol/thiopental) \n- Macintosh laryngoscope No. 3-4 \n- 7.0–7.5 mm endotracheal tube\nTechnique: \n1. The anesthesiologist fixes the patient's head with his left hand, inserts the laryngoscope with his right hand (blade along the midline of the tongue). \n2. The tube is inserted under the control of vocal cords (angle 45°), connected to a ventilator. \n\nLogistics: \n- The used laryngoscope is placed on a separate table for processing. \n\nNuance: With epidural anesthesia, the Tuohy needle is inserted at the L3-L4 level at an angle of 60°.",
"normal": "Before the operation, the person is put to sleep. This is done through an injection into a vein - the drug puts the patient into a deep sleep. After that, the doctor inserts a special tube into the throat so that the person can breathe through the device. Everything happens carefully and quickly - the patient does not feel anything.\n📌 Interesting point: sometimes, instead of general sleep, anesthesia is given in the back - it completely turns off sensitivity in the lower part of the body."
}
},
{
"name": "Incision",
"description": {
"professional": "A 5-7 cm long McBurney incision (a point on the border of the middle and outer third of the line connecting the navel and the anterior superior iliac spine). Layer-by-layer dissection of the skin, subcutaneous tissue, aponeurosis, muscles and peritoneum.\nInstruments: \n- Scalpel No. 15 (pencil grip) \n- Mikulicz clamps 2 pcs. \n- Electrocoagulator (cut mode, 30 W) \n\nTechnique: \n1. McBurney incision: 2 cm above the anterior superior iliac spine, length 5-7 cm. \n2. Subcutaneous tissue is coagulated, avoiding thermal burns to the skin. \n\nLogistics: \n- Scalpel after the incision — in the «dirty»tray. \n\nNuance: In case of obesity, a retractor is used for the edges of the wound.",
"normal": "On the right side of the abdomen, just above the hip, the surgeon makes a small incision — about 5–7 centimeters. First, the skin is cut, then the subcutaneous tissue. All bleeding areas are immediately cauterized with a special device so that there is no blood.\n📌 Interesting point: if a person is overweight, the skin can be slightly stretched with special hooks to improve access."
}
},
{
"name": "Access",
"description": {
"professional": "Mobilization of the cecum, visualization of the appendix. Assessment of its condition, isolation from adhesions if necessary. Application of a clamp to the mesentery of the appendix.\nInstruments: \n- Metzenbaum scissors \n- Bilroth clamps 2 pcs. \n- Gauze swabs \n\nTechnique: \n1. The aponeurosis and muscles are dissected layer by layer (spread apart with blunt forceps). \n2. The peritoneum is lifted with tweezers, cut with the tips of the scissors upward. \n\nLogistics: \n- Bleeding vessels are coagulated immediately. \n\nNuance: With a retrocecal location of the appendix, the cecum is mobilized.",
"normal": "After the incision, the doctor moves deeper: pushes apart the muscles, lifts a thin film inside the abdomen (this is the peritoneum), and underneath it is already the intestine. Carefully, layer by layer, the surgeon finds the cecum and the appendix itself.\n📌 Interesting point: the appendix can hide behind the intestine. In this case, it has to be «pulled out» by carefully moving the intestine."
}
},
{
"name": "Removal",
"description": {
"professional": "Ligation of the mesentery with absorbable suture material (vicryl), cutting off the appendix between two clamps. The stump of the appendix is immersed in the cecum with a purse-string and Z-shaped sutures.\nInstruments: \n- Kocher clamp \n- Vicryl thread 2-0 (ligature) \n- Appendicular clamp \n\nTechnique: \n1. The mesentery of the appendix is ligated, cut off. \n2. The stump is immersed with a purse-string suture (26 mm needle). \n\nLogistics: \n- The removed appendix is sent to a container for histology. \n\nNuance: In case of gangrene of the appendix, the mesentery is sutured separately.",
"normal": "When the appendix is found, the doctor carefully ties its base with threads, cuts off the appendix itself and tightly sutures the place where it was. It's like removing a broken faucet and plugging a pipe - so there are no leaks.\n📌 Interesting moment: removed appendix then they send it for inspection to make sure there is nothing dangerous inside."
}
},
{
"name": "Suture",
"description": {
"professional": "Layer-by-layer wound suturing: peritoneum (catgut), muscles (vicryl), aponeurosis (polypropylene), subcutaneous tissue and skin (silk/absorbable sutures). Drainage if necessary.\nInstruments: \n- Mathieu needle holder \n- Monocryl 3-0 thread (skin) \n- Redon drainage (for peritonitis) \n\nTechnique: \n1. The peritoneum is sutured with catgut, the muscles - with vicryl. \n2. The skin is closed with an intradermal suture. \n\nLogistics: \n- Used needles - in a sharps container. \n\nNuance: The drainage is brought out through a separate puncture.\n⚠️ After the operation\n1. The person is usually sent home after 1-3 days.\n2. The suture heals for about a week.\n3. Sometimes the stomach may hurt - this is normal.",
"normal": "After everything inside is processed, the doctor stitches the incision back up. This is done in layers: first the internal tissues, then the muscles, and finally the skin. If there was an infection or pus during the operation, they can leave a special tube (drainage) so that the fluid can come out.\n📌 Interesting point: modern sutures can be self-absorbing - they do not need to be removed.\n\n⚠️ After the operation\n1. The person is usually sent home after 1-3 days.\n2. The suture heals for about a week.\n3. Sometimes your stomach may hurt — that's normal."
}
}
]
},
{
"keys": [
"caesarean",
"caesarean section"
],
"name": "Caesarean section",
"modes": {
"professional": "Incision in the anterior abdominal wall, layer-by-layer access, incision in the uterus, extraction of the fetus, suturing. Performed under general anesthesia or epidural anesthesia.",
"normal": "The baby is taken out through an incision in the abdomen. Everything is done under anesthesia. The stitches are then removed."
},
"steps": [
{
"name": "Preparation",
"description": {
"professional": "Bladder catheterization, preparation of the surgical field. Choice of anesthesia: spinal/epidural (0.5% bupivacaine) or general anesthesia (propofol + succinylcholine for intubation). Monitoring vital signs.\nInstruments:\n- Foley catheter 16 Fr (for the bladder)\n- Antiseptic (chlorhexidine 2%)\n- 10 ml syringe (bupivacaine 0.5% for epidural anesthesia)\n- ECG monitor, pulse oximeter\n\nTechnique:\n1. Catheterization of the bladder (to avoid damaging it).\n- The catheter is inserted under sterile conditions and fixed to the thigh.\n2. Preparation of the surgical field:\n- From the xiphoid process to the pubis, with broad strokes.\n3. Anesthesia:\n- Epidural: an 18G Tuohy needle is inserted into the L3-L4 space.\n- General anesthesia: if urgent - intubation (propofol + succinylcholine). \n\nLogistics: \n- Used antiseptic wipes go into the «dirty» bin. \n\nNuance: During an emergency CS, catheterization is sometimes skipped.",
"normal": "Before the operation, a catheter is inserted into the woman's bladder - this is necessary so that it does not interfere and is not damaged during the operation. The abdomen is treated with an antiseptic - from the sternum to the pubis. Then anesthesia is administered: most often - an injection in the back, which turns off sensitivity below the waist. Sometimes, if everything is urgent, general anesthesia is given - the woman falls asleep completely. \n📌 Interesting point: even if everything is done urgently, doctors have time to prepare everything as needed in a couple of minutes."
}
},
{
"name": "Incision",
"description": {
"professional": "Pfannenstiel incision (transverse above the pubis) or lower midline laparotomy. Layer-by-layer dissection: skin, subcutaneous tissue, aponeurosis, division of the rectus muscles, parietal peritoneum.\nInstruments:\n- Scalpel #20 (for skin)\n- Electrocoagulator (ValleLab, «cut/coagulation» mode)\n- Pean clamps (for subcutaneous vessels)\n\nTechnique:\n1. Pfannenstiel incision (transverse, above the pubis):\n - Dissect the skin and subcutaneous tissue.\n - Coagulate the vessels.\n2. Dissect the aponeurosis transversely with scissors, bluntly separate the muscles.\n\nLogistics:\n- Place the scalpel immediately into the «sharp» container after cutting the skin. \n\nNuance: During an emergency C-section, a lower midline incision is sometimes made (faster).",
"normal": "A horizontal incision in the lower abdomen about 10-15 cm long. The surgeon makes it just above the pubis. It looks like a small «seam» along the bikini line. The skin and tissues are carefully moved apart to reach the uterus. It is important to do everything in layers and as carefully as possible so as not to damage other organs.\n📌 Interesting point: during an emergency birth, a vertical incision can be made - this is faster, but more noticeable."
}
},
{
"name": "Access",
"description": {
"professional": "Opening the vesicouterine fold of the peritoneum, lowering the bladder. Uterine incision in the lower segment (transverse according to Derfler) 10-12 cm long.\nInstruments: \n- Mayo scissors (curved) \n- Kocher clamps (2 pcs.) \n- Retractor (for retraction of the urinary bladder) \n\nTechnique: \n1. Vesicouterine fold: \n - Raise with tweezers, cut with scissors the tips upwards. \n2. The urinary bladder is lowered down with a swab. \n3. Uterine incision: \n - Transverse in the lower segment (according to Derfler) - length 10-12 cm. (as mentioned earlier) \n - Cut with a scalpel, then spread apart with fingers. \n\nLogistics: \n- Blood is aspirated with an electric suction pump. \n\nNuance: If the uterus does not contract well, the incision is made higher.",
"normal": "When the doctor reaches the uterus, he carefully moves the urinary bladder down so that it does not interfere. After this, an incision of approximately 10–12 cm is made on the uterus. Sometimes it is done with a scalpel, but more often with fingers, so that the tissue does not tear further than necessary.\n📌 Interesting point: the uterus is cut in its lower segment - there are fewer muscles there, and the suture heals better."
}
},
{
"name": "Extraction",
"description": {
"professional": "Manual extraction of the fetus, cutting the umbilical cord. Introduction of oxytotin to contract the uterus. Removal of the placenta, revision of the uterine cavity.\nInstruments: \n- Obstetric forceps (if the head is deep) \n- Scissors (for the umbilical cord) \n- Syringe with oxytocin (10 IU intravenously) \n\nTechnique: \n1. Manually insert into the uterine cavity, find the head/pelvis of the fetus. \n2. Extract the baby, clamp and cut the umbilical cord. \n3. Oxytocin is administered immediately to contract the uterus. \n\nLogistics: \n- The fetus is handed over to the neonatologist. \n- The placenta is examined for integrity. \n\nNuance: In case of breech presentation, the baby is removed carefully by the legs.",
"normal": "The doctor carefully inserts his hand through the incision in the uterus and pulls out the baby. First, the head or legs (depending on the position). Then the umbilical cord is cut, and the newborn is immediately handed over to the pediatrician. The uterus is allowed to contract, for this purpose a special medicine is administered.\n📌 Interesting point: everything — from the first incision to the birth of the child — takes 2–4 minutes."
}
},
{
"name": "Sewing",
"description": {
"professional": "Double-row suture on the uterus (vicryl), suturing of the peritoneum, layer-by-layer closure of the wound. Intraoperative bleeding prevention (ergometrine).\nInstruments:\n- Needle holder (for the uterus)\n- Vicryl 0 thread (two-row suture)\n- Catgut 2-0 (for the peritoneum)\n\nTechnique:\n1. The uterus is sutured in 2 layers:\n- First row — continuous suture.\n- Second row — immersion (for tightness).\n2. The peritoneum is sutured with catgut.\n3. The skin — with an intradermal suture (Monocryl 3-0).\n\nLogistics:\n- Used needles — in a «sharp» container.\n\nNuance: In case of bleeding, the vessels are additionally coagulated.",
"normal": "After the baby is extracted, the doctor sutures the uterus in two layers. Then he returns the bladder to its place, sutures all the layers back — muscles, skin. At the end, a neat cosmetic suture is applied. If everything went smoothly, the operation lasts about 40 minutes.\n📌 Interesting point: many modern sutures are self-absorbing and do not need to be removed."
}
}
]
},
{
"keys": [
"tonsils",
"tonsillectomy"
],
"name": "Tonsil removal",
"modes": {
"professional": "Surgical removal of the palatine tonsils in chronic tonsillitis. Performed under anesthesia, with hemostasis.",
"normal": "Inflamed tonsils are removed under anesthesia. After this, the throat hurts for several days."
},
"steps": [
{
"name": "Pain relief",
"description": {
"professional": "Endotracheal anesthesia: premedication (midazolam), induction (propofol), muscle relaxants (rocuronium), intubation. Maintenance of anesthesia with sevoflurane. Local anesthesia is possible in adults (lidocaine 2%).\nInstruments: \n- Macintosh laryngoscope No. 3 \n- Endotracheal tube 6.5–7.0 mm \n- Syringe 10 ml (propofol) \n- Muscle relaxant (rocuronium) \n\nTechnique: \n1. Intubation: \n - The tube is inserted under the control of the laryngoscope (blade along the midline). \n - Fix it at a depth of 20–22 cm in adults. \n2. Anesthesia: \n - Maintained with sevoflurane (1.5–2%). \n\nLogistics: \n- The used laryngoscope is placed on the assistant's sterile table. \n\nNuance: In adults, local anesthesia is sometimes used (2% lidocaine with adrenaline).",
"normal": "The patient is given anesthesia - usually general, so that he does not feel anything. He will breathe through a tube in the throat during the operation. Everything happens quickly - the person falls asleep in a few seconds and wakes up after everything. \n📌 Interesting point: in adults, local anesthesia is sometimes given - they simply immobilize the throat."
}
},
{
"name": "Fixation",
"description": {
"professional": "Installation of a mouth gag (McIver). Providing access to the tonsils. The patient is positioned on his back with his head thrown back.\nInstruments:\n- McIver mouth speculum\n- Tongue serrated retractor\n- Adrenaline swabs (1:100,000)\n\nTechnique:\n1. The mouth speculum is placed from left to right, fixing the jaws.\n2. The tongue is retracted with a retractor to open the view of the tonsils.\n\nLogistics:\n- The assistant controls the pressure of the mouth speculum (so as not to damage the teeth).\n\nNuance: With a small mouth, use a children's mouth gag.",
"normal": "The mouth is fixed with a special tool to access the tonsils. This is a special device that allows you to keep your mouth open. The tongue is fixed so that it does not interfere. This is necessary because the doctor must clearly see the tonsils and can work calmly. \n📌 Interesting point: there are special smaller versions of these devices for children."
}
},
{
"name": "Removal",
"description": {
"professional": "Excision of tonsils with a capsule: cold method (scalpel, scissors) or thermal (electrocoagulation, coblation). Separation from the palatine arches with hemostasis.\nInstruments:\n- Cold instruments:\n- Scalpel #12\n- Metzenbaum scissors\n- Thermal:\n- Harmonic scalpel (Harmonic)\n- Electrocoagulator (25 W mode)\n\nTechnique:\n1. Cold method:\n- The tonsil is grasped with a clamp and cut off from the arches with a scalpel.\n- The lower pole is separated with scissors.\n2. Thermal method:\n- The harmonic scalpel cuts and coagulates simultaneously.\n\nLogistics:\n- The removed tonsils are placed in a container for histology.\n\nNote: It is important not to leave tissue in the niche (risk of relapse).",
"normal": "The doctor grasps the tonsils themselves and carefully cuts them off. This is done either with conventional surgical instruments (scalpel and scissors) or with modern devices that immediately cauterize the vessels. This helps reduce bleeding.\n📌 Interesting point: some clinics use a laser - the operation is faster and almost bloodless."
}
},
{
"name": "Hemostasis",
"description": {
"professional": "Stopping bleeding: electrocoagulation, hemostatic sponges, ligation of large vessels. Control of the absence of bleeding.\nInstruments: \n- Electrocoagulator (needle tip) \n- Hemostatic sponges (Surgicel) \n- Ligatures (Vicryl 3-0) \n\nTechnique: \n1. Small vessels are coagulated pointwise. \n2. Large arteries are ligated. \n3. The tonsil bed is tamponed with a hemostatic sponge. \n\nLogistics: \n- Used tampons are counted (risk of forgetting in the throat!). \n\nNuance: In case of bleeding from the descending palatine artery, they are stitched.",
"normal": "After removal, the doctor carefully checks if there is any blood left. Cauterizes the vessels or puts special sponges that stop the bleeding. Everything is done carefully so as not to damage the surrounding tissue.\n📌 Interesting point: the sponges dissolve on their own after a few days."
}
},
{
"name": "Control",
"description": {
"professional": "Revision of the tonsil bed, removal of tissue residues. Evaluation of hemostasis. Removing the mouth gag, transferring the patient to the ward.\nInstruments:\n- Flashlight for examination\n- Aspirator (to remove blood/saliva)\n- Suture material (if additional ligatures are needed)\n\nTechnique:\n1. Inspect the tonsil niches from different angles.\n2. Check for any tissue residue or bleeding vessels.\n\nLogistics:\n- Remove the mouth gag after complete hemostasis.\n\nNote: Before extubation, check for blood in the stomach (risk of aspiration).",
"normal": "The surgeon examines the wound again, makes sure everything is clean and dry. After that, the instruments are removed, and the patient is transferred to the ward. Your throat will hurt for 5-7 days - this is normal. You are not allowed to drink and eat right away, but gradually.\n📌 Interesting point: your voice may temporarily become hoarse, but it will pass."
}
}
]
},
{
"keys": [
"gall",
"cholecystectomy"
],
"name": "Gallbladder removal",
"modes": {
"professional": "Laparoscopic cholecystectomy: CO2 insufflation, trocars, bladder isolation, clipping, extraction.",
"normal": "The gallbladder is removed through punctures. This is done with a camera and instruments inside the abdomen."
},
"steps": [
{
"name": "Insufflation",
"description": {
"professional": "Creation of pneumoperitoneum: CO2 is injected with a Veresh needle (pressure 12-14 mm Hg) through the umbilical access. Gas pressure control to ensure working space.\nInstruments:\n- 150 mm Veresh needle\n- CO₂ supply system (pressure 12-14 mmHg)\n- 10 mm 30° laparoscope\n\nTechnique:\n1. Make a puncture with a Veresh needle at the Calca point (1 cm above the navel)\n2. Connect the insufflation system - start with low pressure (8 mmHg), gradually increase\n3. Check for uniform distribution of gas in the abdomen\n\nLogistics:\n- After installing the first trocar, remove the needle and place it in a separate tray\n\nNote: In case of adhesions or previous operations, use the open Hasson approach.",
"normal": "Before starting, the doctor makes a puncture in the navel area and pumps carbon dioxide into the abdomen. This is necessary so that the stomach «inflates» a little, and the surgeon can easily see and work inside without affecting other organs.\n📌 Interesting point: free space appears inside - like a small dome."
}
},
{
"name": "Trocars",
"description": {
"professional": "Installation of 3-4 trocars: 10 mm in the navel (camera), 5 mm in the epigastrium and right hypochondrium (instruments). An additional trocar is possible if necessary.\nInstruments:\n- Main trocar 10 mm (for the camera)\n- Additional trocars 5 mm (2-3 pcs)\n- Video laparoscopic stand\n\nTechnique:\n1. Trocars are installed at standard points:\n - Epigastric (for the working hand)\n - Right hypochondrium (for the assistant)\n2. Position of the \"American trapezoid\" - the surgeon is on the left of the patient\n\nLogistics:\n- Each trocar is fixed to the skin with a suture or a special fixator\n\nNuance: In case of obesity the injection points may shift.",
"normal": "They make several small punctures. Through these punctures (usually 3-4), a camera and instruments are inserted into the abdomen. The camera transmits the image to the screen. The doctor works looking at the monitor, like in a video game, but everything is real.\n📌 Interesting point: the camera magnifies the image 10-15 times - you can see the smallest details."
}
},
{
"name": "Select",
"description": {
"professional": "Identification of the elements of the Calot triangle: cystic duct and artery. Dissection, mobilization of the gallbladder from the liver bed. Control of anatomy to prevent damage.\nInstruments:\n- Maryland dissector\n- Atraumatic clamp\n- Harmonic scissors\n\nTechnique:\n1. Find \"Calot triangle\" (between the cystic duct, artery and liver)\n2. Separate the cystic duct and artery\n3. Mobilize the gallbladder from the liver bed\n\nLogistics:\n- Periodically clean the instruments from carbon deposits\n\nNuance: In case of inflammation, the bottom of the bladder is first isolated (\"from top to bottom\").",
"normal": "The surgeon begins to search gallbladder with a camera. When he finds the bladder, he separates it from the liver. Then the surgeon isolates the duct (through which the bile flows) and the artery that feeds the bladder. All this is done with pinpoint precision - without haste, so as not to damage anything. \n📌 Interesting point: an important stage is «a critical look at the anatomy.» A mistake can damage the liver or ducts."
}
},
{
"name": "Clipping",
"description": {
"professional": "Applying titanium clips to the cystic duct and artery. Cutting between the clips. Separating the bladder from the liver with a harmonic scalpel or electrocoagulation.\nInstruments:\n- Clip applicator (like Hem-o-lok)\n- Medium-sized clips (6-8 mm)\n- Laparoscopic scissors\n\nTechnique:\n1. Apply 2 clips to the duct and artery\n2. Cut between the clips\n3. Separate the bladder from the liver with a harmonic scalpel\n\nLogistics:\n- Immediately reload the used clip applicator\n\nNote: With a wide duct (>4 mm), it is better to apply sutures.",
"normal": "Artery and the duct is clamped with special clips - like small clothespins. After that, the bladder is carefully cut off. The place of disconnection is cauterized or treated so that there is no blood.\n📌 Interesting point: the clips remain inside forever - they are safe and do not interfere."
}
},
{
"name": "Removal",
"description": {
"professional": "Removal of the bladder through the umbilical port in a special container (endobag). Revision of the bed, hemostasis. Removal of trocars, suturing of ports. Drainage as indicated.\nInstruments:\n- Endobag (container for removal)\n- Toothed clamp\n- Irrigator-aspirator\n\nTechnique:\n1. Place the bladder in the endobag\n2. Remove through the umbilical port\n3. Inspect the bed for bleeding\n4. Remove the trocars under visual control\n\nLogistics:\n- Large stones are crushed before removal\n\nNuance: A C-arm is needed for intraoperative cholangiography.\nKey safety points:\n1. A critical look at the anatomy - always identify:\n - Common bile duct.\n - Common hepatic artery.\n2. If in doubt - convert to open surgery.\n3. Drainage as indicated (inflammation, bleeding).",
"normal": "The bladder is placed in a small bag and pulled out through one of the punctures. Then they check if everything is clean inside, and sew up the small holes.\n📌 Interesting point: the person goes home the next day, and there are almost no traces."
}
}
]
},
{
"keys": [
"tracheostomy",
"insertion of a tube into the trachea"
],
"name": "Tracheostomy",
"modes": {
"professional": "Creation of a breathing hole in the trachea when obstructed. An incision in the neck, access to the trachea, insertion of a tube.",
"normal": "They make a hole in the throat so that the person can breathe. They insert a tube."
},
"steps": [
{
"name": "Preparation",
"description": {
"professional": "Position the patient on his back with a bolster under the shoulders, extend the neck. Process the surgical field. Local anesthesia (lidocaine 2%) or continue artificial ventilation in an emergency.\nInstruments: \n- Syringe 10 ml with lidocaine 2% + adrenaline (1:100,000) \n- Scalpel No. 20 \n- Mosquito clamps (2 pcs.) \n- Tracheal hooks (single-toothed and blunt) \n\nTechnique: \n1. Patient position: \n - Head tilted back (roller under shoulders), neck in hyperextension. \n2. Anesthesia: \n - Infiltrate the skin and subcutaneous tissue along the midline (from the cricoid cartilage to the jugular notch). \n3. Marking: \n - Optimal level: 2-3 tracheal rings (below the cricoid cartilage). \n\nLogistics: \n- The assistant fixes the head to prevent displacement. \n\nNuance: In case of emergency tracheostomy, anesthesia may be omitted.",
"normal": "The patient is placed on his back, the head is tilted back. The neck area is treated with an antiseptic. Sometimes local anesthesia is used, but more often general anesthesia is used, especially if it is urgent.\n📌 Interesting point: the patient may have severe swelling or injury - then a tracheostomy saves lives."
}
},
{
"name": "Incision",
"description": {
"professional": "A longitudinal incision of the skin 3-4 cm below the cricoid cartilage or a transverse incision between 2-3 tracheal rings. Dissection of the subcutaneous tissue, separation of muscles along the white line.\nInstruments: \n- Scalpel No. 20 (pencil grip) \n- Electrocoagulator (cut mode, 30 W) \n- Hemostatic clamps \n\nTechnique: \n1. Vertical incision (3-4 cm): \n - Dissect the skin, subcutaneous tissue, platysma. \n2. Horizontal incision (alternative): \n - Between the tracheal rings, if a long-term cannula is planned. \n\nLogistics: \n- The used scalpel is in a sharps container. \n\nNuance: In case of obesity, the incision is extended to 5 cm.",
"normal": "A small vertical or horizontal incision is made on the front of the neck. Then the muscles are carefully spread apart to get to the trachea - this is the tube through which air enters the lungs. \n📌 Interesting point: it is very important not to touch the thyroid gland, which is located nearby."
}
},
{
"name": "Isolation of the trachea",
"description": {
"professional": "Identification of the cricoid cartilage and tracheal rings. Retraction of the isthmus of the thyroid gland upward or its intersection between clamps. Fixation of the trachea with hooks.\nInstruments:\n- Anatomical tweezers\n- Metzenbaum scissors\n- Muscle retraction hooks\n\nTechnique:\n1. Separate the muscles along the white line:\n- The sternohyoid and sternothyroid muscles are spread apart.\n2. Thyroid isthmus:\n- Retract the hook upward or cross between clamps.\n3. Expose the trachea:\n- Palpate the rings (make sure not to hit the thyroid cartilage).\n\nLogistics:\n- Bleeding vessels are coagulated immediately.\n\nNuance: If the thyroid gland is damaged, stitch it with catgut.",
"normal": "When the doctor reaches the trachea, he carefully separates it from the surrounding tissues - muscles, vessels and the thyroid gland. This is necessary to clearly see the cartilaginous rings of the trachea and not to damage anything important. \n📌 Interesting point: sometimes the trachea has to be \"hooked\" with a special hook to fix it before the incision - this makes it easier and safer to insert the tube."
}
},
{
"name": "Tracheal incision",
"description": {
"professional": "Longitudinal incision between 2-3 rings or excision of a fragment of the anterior wall (window). Cricothyrotomy in emergency cases (incision between the cricoid and thyroid cartilages).\nInstruments: \n- Scalpel No. 11 (for the trachea) \n- Trousseau tracheodilator \n- Cricothyrotomy clamp (if urgent) \n\nTechnique: \n1. Fixation of the trachea: \n - The cricoid cartilage is fixed with a hook. \n2. Incision: \n - Transverse between 2-3 rings (length 1-1.5 cm). \n - Or fenestrated (a fragment of the anterior wall is excised). \n3. Aspiration: \n - Mucus and blood are removed from the lumen. \n\nLogistics: \n- Blood is aspirated immediately so that it does not get into the bronchi. \n\nNuance: In children, a fenestrated incision is not made (risk of stenosis).",
"normal": "When the doctor sees the cartilages of the trachea, he makes an incision in them or cuts out a small «window». A tube will then be inserted into this hole to allow the person to breathe.\n📌 Fun fact: in emergency cases, the incision can be made in just 30 seconds!"
}
},
{
"name": "Insert the tube",
"description": {
"professional": "Installation of a tracheostomy cannula of the appropriate size (usually 6-8 mm), fixation with tapes around the neck. Connection to a ventilator or oxygen. Suturing the skin around the tube.\nInstruments: \n- Tracheostomy cannula (size 6-8 mm for adults) \n- Mandrin (guide) \n- Fixation tapes \n\nTechnique: \n1. Insertion of the cannula: \n - With the mandrin at an angle of 45°, then turn horizontally. \n2. Fixation: \n - With tapes around the neck (tied in a double knot). \n3. Connection to the ventilator: \n - Check the air flow (condensation on the tube walls). \n\nLogistics: \n- Leave the mandrin nearby in case of emergency replacement. \n\nNuance: Do not change the cannula for the first 24 hours (risk of loss of access).\n\nCritical points: \n1. Do not cut the 1st ring (risk of stenosis). \n2. In case of bleeding from the thyroid veins — press and coagulate. \n3. Always aspirate the contents of the trachea before inserting the tube.",
"normal": "The doctor inserts a special tube into the incision and secures it with tapes around the neck. They check if air passes. If everything is normal — they connect to the machine or give oxygen.\n📌 Interesting point: if everything is done correctly, the patient feels relief almost immediately.\nCare:\nAfter installation, the doctor makes sure that there is no infection and that the tube does not become clogged with mucus. It is periodically cleaned and changed if necessary.\n📌 Interesting point: the first tube replacement is done only after 24 hours - it cannot be done earlier."
}
}
]
},
{
"keys": [
"ectopic",
"ectopic pregnancy"
],
"name": "Surgery for ectopic pregnancy",
"modes": {
"professional": "Removal of the affected fallopian tube or embryo from the tube laparoscopically. Hemostasis, control.",
"normal": "If the pregnancy is outside the uterus, an operation is performed to safely remove it."
},
"steps": [
{
"name": "Anesthesia",
"description": {
"professional": "General anesthesia: induction with propofol + fentanyl, intubation, maintenance with sevoflurane. In stable condition, spinal anesthesia (0.5% bupivacaine) is possible.\nInstruments:\n- 18G catheter for IV access\n- 7.0-7.5 mm endotracheal tube\n- Blood pressure monitor\n- 20 ml syringe (propofol)\n\nTechnique:\n1. Standard induction:\n- Premedication (midazolam 1-2 mg)\n- Propofol 2 mg/kg\n- Muscle relaxant (rocuronium 0.6 mg/kg)\n2. Intubation:\n - Macintosh laryngoscope #3\n - Fixation of the tube at 21 cm for women\n\nLogistics:\n- After intubation, the laryngoscope is placed in a tray for disinfection\n\nNuance: In case of hemorrhagic shock, the doses of drugs are reduced.",
"normal": "The woman is given general anesthesia so that she falls asleep. She will breathe through the tube under the control of the device. The doctor monitors the pulse, blood pressure, oxygen level - everything is under observation.\n📌 Interesting point: if the patient is in shock, the dose of drugs is reduced so as not to overload the heart."
}
},
{
"name": "Laparoscopy",
"description": {
"professional": "Creation of pneumoperitoneum (CO2 up to 12-14 mm Hg), introduction of trocars: optical (10 mm umbilical) and 1-2 instrumental (5 mm in the iliac regions).\nInstruments:\n- Veresh needle 150 mm\n- Trocar 10 mm (optical)\n- Trocars 5 mm (2 pcs)\n- CO₂ insufflator\n\nTechnique:\n1. Pneumoperitoneum:\n - Puncture with a Veress needle at the Palmer point\n - Initial pressure 8 mm Hg.\n2. Installation of ports:\n - Umbilical - 10 mm\n - Left iliac - 5 mm\n - Suprapubic - 5 mm\n\nLogistics:\n- The first trocar is installed under visual control\n\nNuance: In case of massive hemoperitoneum, first - sanation.",
"normal": "A needle is inserted through the navel and carbon dioxide is pumped in to slightly «inflate» the abdomen. Then a camera and instruments are inserted. This is called laparoscopy — an operation performed through small punctures.\n📌 Interesting point: the belly rises like a tent — doctors can see everything inside."
}
},
{
"name": "Isolation of the tube",
"description": {
"professional": "Revision of the pelvis: detection of the affected tube, assessment of its condition. In case of rupture — aspiration of blood, washing. Isolation of the tube from surrounding structures.\nInstruments:\n- Atraumatic clamp\n- Laparoscopic scissors\n- Aspirator-irrigator\n\nTechnique:\n1. Revision of the pelvis:\n - Evacuation of blood and clots\n - Determination of the localization of pregnancy\n2. Isolation of the tube:\n - The mesosalpinx is fixed with a clamp\n - The vessels are coagulated with a harmonic scalpel\n\nLogistics:\n- The assistant controls the aspirator\n\nNuance: In case of tubal abortion - a complete revision of the pelvic cavity.",
"normal": "The doctor examines the pelvic organs. Finds the fallopian tube in which the embryo is stuck. Carefully frees it from clots and blood. If the tube is badly damaged, it will have to be removed.\n📌 Interesting point: if everything is detected at an early stage, the tube can be saved."
}
},
{
"name": "Removal",
"description": {
"professional": "Salpingectomy (tube removal) in case of rupture: clipping of the mesosalpinx, excision. Or salpingotomy (incision of the tube) with removal of the ovum in case of early diagnosis.\nInstruments:\n- Bipolar coagulator\n- Clip applicator\n- Endo bag\n\nTechnique:\n1. Coagulation and intersection:\n- Place of entry into the uterus\n- Mesentery of the tube\n2. Extraction:\n- In the endo bag through an expanded port\n- If large - morcellation\n\nLogistics:\n- Mandatory labeling of the drug for histology\n\nNuance: If you want to preserve fertility - salpingotomy.",
"normal": "The damaged tube or embryo is removed. It is important to stop the bleeding and not to damage adjacent organs. Everything is done with a coagulator and very thin instruments.\n📌 Interesting point: the removed tissues are sent to laboratory for examination."
}
},
{
"name": "Sewing",
"description": {
"professional": "Hemostasis (coagulation, hemostatic sponges). Removal of trocars, suturing of ports. Drainage as indicated. Hemostasis control before completion.\nInstruments:\n- Laparoscopic needle holder\n- Vicryl 3-0 suture material\n- Redon 10 Fr drainage\n\nTechnique:\n1. Hemostasis control:\n- Coagulation of the tubal bed\n- Revision of the ovary\n2. Drainage:\n- Installation of drainage in the Douglas pouch\n3. Port suturing:\n - Umbilical aponeurosis - Vicryl 0\n - Skin - Monocryl 4-0\n\nLogistics:\n- Drainage is fixed with a separate suture\n\nNuance: If bleeding continues - conversion to laparotomy.\nCritical points:\n1. Mandatory revision of the contralateral tube.\n2. Monitoring the hCG level in the postoperative period.\n3. If the tube ruptures - active infusion therapy.",
"normal": "The surgeon examines the insides again, makes sure that there is no blood. If necessary, a drainage (a tube for liquid) is placed. After that, the instruments are removed and the punctures are stitched up.\n📌 Interesting point: such operations often save a woman's life - when a tube ruptures, every minute counts."
}
}
]
},
{
"keys": [
"heart",
"bypass"
],
"name": "Coronary artery bypass grafting",
"modes": {
"professional": "Heart surgery: the chest is opened, the ICC is connected, the shunts are installed to bypass the blocked vessels.",
"normal": "The chest is opened and bypasses are created in the heart vessels."
},
"steps": [
{
"name": "Anesthesia",
"description": {
"professional": "General anesthesia: induction (propofol, midazolam, fentanyl), intubation, mechanical ventilation. Installation of invasive monitoring (arterial line, CVC). Connection of artificial blood circulation (artificial blood circulation).\nInstruments:\n- Arterial catheter 20G (radial artery)\n- Central venous catheter 8.5 Fr\n- Transesophageal echocardiography sensor\n- Mechanical ventilation apparatus with PCV mode\n\nTechnique:\n1. Induction:\n- Fentanyl 5-10 mcg/kg\n- Propofol 1.5-2 mg/kg\n- Rocuronium 0.6-1 mg/kg\n2. Preparing the bypasses:\n - Internal mammary artery (IMA) - isolated with Potts tweezers \n - Great saphenous vein - taken with a mobilizer \n\nLogistics:\n- IMA is placed in a heparinized solution \n\nNuance: In diabetes, arterial revascularization is preferable.",
"normal": "The patient is put to sleep. Connected to machines, catheters are inserted into the arteries and veins. Next - connection to the machine that will temporarily replace the heart and lungs.\n📌 Interesting point: the heart is stopped during the operation so that it does not interfere with the surgeon's work."
}
},
{
"name": "Incision",
"description": {
"professional": "Median sternotomy: skin incision along the midline, dissection of the sternum with an oscillating saw. Separation of the wound edges with a retractor. Taking bypass grafts (internal mammary artery, great saphenous vein).\nInstruments:\n- Oscillating saw (blade thickness 0.3 mm)\n- Sternum retractor\n- Bone wax\n\nTechnique:\n1. Incision along the midline from the jugular notch to the xiphoid process\n2. Dissection of the sternum strictly in the center\n3. Stopping bleeding from the bone with wax\n\nLogistics:\n- The saw is cleaned after each pass\n\nNuance: For repeat operations - a cutter instead of a saw.",
"normal": "The doctor makes a vertical incision along the sternum and carefully saws the bone with a special saw. Then spreads the edges to get to the heart.\n📌 Interesting point: the bone is then connected with a wire - it remains inside forever and does not interfere."
}
},
{
"name": "ICC",
"description": {
"professional": "Cannulation of the aorta and right atrium, connection to the ICC apparatus. Introduction of cardioplegic solution to stop the heart. Maintaining hypothermia 28-32 ° C.\nInstruments:\n- Aortic cannulas 22-24 Fr \n- Double-lumen venous catheter 32 Fr \n- Cardioplegic solution \n\nTechnique:\n1. Cannulation: \n- Aorta - purse-string suture 4-0 prolene \n- Right atrium - double purse-string \n2. Cardioplegia: \n - Antegrade (via the aortic root) \n - Retrograde (via the coronary sinus) \n\nLogistics:\n- ACT control >480 sec.",
"normal": "Before starting work on the heart, the surgeon connects the patient to the artificial circulation machine (ACM). This is a special \"pump\" that temporarily replaces the heart and lungs: \n1. Tubes are inserted into large vessels (aorta and vena cava) - through them, blood is taken from the body, saturated with oxygen and returned back. \n2. The machine starts working, and the heart is stopped using a special solution - now the surgeon can safely perform bypass surgery. \n📌 Interesting point: during the operation of the IR, the patient does not breathe on his own, and his temperature can be reduced to 28–32°C to protect the organs!"
}
},
{
"name": "Shunts",
"description": {
"professional": "Anastomosis overlay: proximal (to the aorta) and distal (to the coronary artery below the stenosis). Use of 6-0/7-0 Prolene. Checking the patency of the grafts.\nInstruments:\n- Minimally invasive retractor\n- Needle-tipped electrocautery\n- Hem-o-lok vascular clips\n\nTechnique for the IAA:\n1. Isolation from the subclavian artery to the distal end\n2. Coagulation of the side branches at 20 W\nTechnique for the vein:\n1. Endoscopic harvesting (EVH)\n2. Distal ligation with 6-0 prolene \n\nLogistics:\n- The shunts are marked for identification.",
"normal": "New vessels are sewn onto the heart - one end is connected to the aorta, the other to the heart arteries. The blood will now follow new paths and feed the heart as it should.\n📌 Interesting point: the work is almost like jewelry - the sutures are made with threads thinner than a hair."
}
},
{
"name": "Sewing",
"description": {
"professional": "Disabling the ICC, restoring cardiac activity (defibrillation if necessary). Installing drains. Stitching the sternum with wire, suturing the wound layer by layer.\nInstruments:\n- Microsurgical scissors \n- DeBakey tweezers \n- 7-0 prolene suture material \n\nTechnique:\n1. Distal anastomoses: \n - LAD → IAA (end-to-side) \n - OB → VNA (side-to-side sequentially) \n2. Proximal (on disconnected aorta): \n - 4.0-4.5 mm punch \n - 6-0 Prolene suture \n\nLogistics:\n- Doppler patency check. \n\nICC disconnection\nTechnique: \n1. Gradual flow reduction \n2. Decannulation after hemodynamic stabilization \n3. Placement of temporary epicardial pacemakers \n\nMonitoring:\n- TEE for LV function.\n- Suture bleeding.",
"normal": "The heart is restarted. The doctor checks if everything is working. The sternum is brought together, sutures and a bandage are applied. After that, the patient is transferred to intensive care.\n📌 Interesting point: after such an operation, the heart literally gets a second life."
}
}
]
},
{
"keys": [
"hemorrhoids",
"hemorrhoid removal"
],
"name": "Hemorrhoidectomy",
"modes": {
"professional": "Removal of internal/external hemorrhoids with tissue excision. Hemostasis, control.",
"normal": "Hemorrhoids are removed surgically so that they do not bleed or hurt."
},
"steps": [
{
"name": "Pain relief",
"description": {
"professional": "Spinal anesthesia (0.5% bupivacaine) or general anesthesia. The patient is positioned on his back with his legs brought to the stomach (lithotomy). Treatment of the perianal area.\nInstruments:\n- Spinal catheter 25G (for bupivacaine 0.5%)\n- Proctologic speculum\n- Rectal retractor\n\nTechnique:\n1. Patient position - lithotomy or on the side\n2. Spinal anesthesia - level L3-L4\n3. Treatment of the perianal area with chlorhexidine\n\nLogistics:\n- After anesthesia, the needle is immediately disposed of in a sharps container\n\nNote: In case of allergy to local anesthetics - general anesthesia.",
"normal": "The patient is given anesthesia - general or spinal (injection in the back). Then it is placed in a comfortable position so that the doctor can work calmly in the anal area.\n📌 Interesting point: with good anesthesia, a person does not feel anything at all."
}
},
{
"name": "Selections",
"description": {
"professional": "A rectal speculum for visualizing nodes. Grasping the node with a clamp, its traction. Excision of the mucosubcutaneous flap over the node while preserving the anal epithelium.\nInstruments:\n- Allis clamp 3-4 pcs.\n- Electrocoagulator with a needle tip\n- Rectal speculum with backlight\n\nTechnique:\n1. Alternate fixation of nodes with Allis clamps\n2. Marking the excision boundaries\n3. Coagulation of small vessels\n\nLogistics:\n- Used clamps are passed to an assistant for cleaning\n\nNuance: With combined hemorrhoids, they start with the internal nodes.",
"normal": "The doctor examines the inside of the rectum with a special mirror. Finds enlarged hemorrhoids, grabs them with instruments and marks them for removal.\n📌 Interesting point: hemorrhoids are not a tumor, but simply dilated veins."
}
},
{
"name": "Excision",
"description": {
"professional": "Ligation of the node leg at the base (Milligan-Morgan ligature method) with excision. Or the use of hardware hemorrhoidopexy (stapler). Coagulation of vessels.\nInstruments:\n- Scalpel No. 11\n- Metzenbaum scissors\n- Vicryl 3-0 suture material\n\nTechnique:\n1. V-shaped incision at the base of the node\n2. Ligation of the node pedicle\n3. Excision with preservation of the anal epithelium\n\nLogistics:\n- The removed nodes are sent for histology\n\nNuance: There should be ≥1 cm of skin between the remaining flaps.",
"normal": "The doctor cuts off the nodes. At the same time, he/she ligates the vessels to prevent bleeding. Everything is done carefully so as not to damage healthy tissue and maintain normal function.\n📌 Interesting point: remove only severely inflamed and prolapsed nodes - the rest can «calm down» on their own."
}
},
{
"name": "Hemostasis",
"description": {
"professional": "Thorough hemostasis: electrocoagulation, hemostatic sponges (Spongostan), ligatures. Control of the absence of bleeding in the bed of the removed nodes.\nInstruments:\n- Bipolar coagulator\n- Hemostatic sponges (Surgicel)\n- Tampons with adrenaline\n\nTechnique:\n1. Step-by-step coagulation of the bed\n2. Application of hemostatic sponges\n3. Bleeding control for 3 minutes\n\nLogistics:\n- Counting the tampons used\n\nNote: In case of profuse bleeding - suturing with 4-0 Vicryl.",
"normal": "The removal site is checked: all vessels are cauterized or covered with special sponges. This is important - even a small drop of blood can cause problems later.\n📌 Interesting point: for control, doctors sometimes put a tampon with medicine inside."
}
},
{
"name": "Control",
"description": {
"professional": "Revision of the surgical field, checking the patency of the anal canal. Insertion of a tampon with ointment (Levomekol). Application of an aseptic dressing.\nInstruments:\n- Gas outlet tube\n- Ointment tampons (Levomekol)\n- Self-absorbable suture material\n\nTechnique:\n1. Insertion of a gas vent tube\n2. Application of ointment tampons\n3. Suturing wounds if necessary\n\nLogistics:\n- Fixation of drainage with a plaster.\n\nPostoperative protocol:\n1. Pain relief:\n- Ketorolac 30 mg IV\n- Paracetamol 1 g every 6 hours\n2. Dressings:\n- Daily with ointment dressings\n3. Stool:\n- Laxatives on the 3rd day\n\nComplications:\n- Bleeding (1-3%)\n- Urinary retention (5-10%)\n- Stenosis of the anal canal (rare)",
"normal": "At the end, a tube can be inserted into the anus to remove gases. A bandage is applied. The patient is sent to the ward, where he will recover.\n📌 Interesting point: there is almost no pain if everything is done correctly. The main thing is the doctor's accuracy and adherence to the regimen after."
}
}
]
},
{
"keys": [
"rhinoplasty",
"rhinoplasty"
],
"name": "Rhinoplasty",
"modes": {
"professional": "Correction of bone/cartilage structures of the nose. Open or closed technique.",
"normal": "Surgery to change the shape of the nose. Often done for the sake of appearance."
},
"steps": [
{
"name": "Anesthesia",
"description": {
"professional": "General anesthesia (propofol + sevoflurane) or local anesthesia (lidocaine with adrenaline for vasoconstriction). Nasal packing with adrenaline to reduce bleeding.\nInstruments:\n- 5 ml syringe with 2% lidocaine + 1:100,000 adrenaline\n- Surgical marker\n- 27G needle for infiltration\n\nTechnique:\n1. Infiltration anesthesia:\n- 4 injection points at the base of the nose\n- 2 ml in the columella\n- 1 ml along the bridge of the nose\n2. Markings:\n- Incision line along the columella\n- Tip correction boundaries\n\nLogistics:\n- Used needles - in a sharps container\n\nNote: Adrenaline reduces bleeding by 40%.",
"normal": "The doctor gives injections with anesthesia around the nose to relieve pain. Sometimes general anesthesia is given. Then they draw with a special pen where the incision will be and which parts need to be corrected.\n📌 Interesting point: the more precise the markings, the more natural the result."
}
},
{
"name": "Access",
"description": {
"professional": "With open rhinoplasty: an incision along the columella (the partition between the nostrils) with lifting of the skin flap. With closed rhinoplasty - access through the nostrils without external incisions.\nInstruments:\n- Scalpel No. 15\n- V-shaped scissors\n- Double-pronged hook\n\nTechnique:\n1. Incision along the columella:\n - 45° angle to create a step\n - Length 4-5 mm\n2. Soft tissue detachment:\n - Skin flap is lifted\n - Lower lateral cartilages are isolated\n\nLogistics:\n- Bleeding vessels are coagulated immediately\n\nNuance: Subcutaneous fat is preserved for a natural contour.",
"normal": "The surgeon makes a small incision between the nostrils or inside the nose. Then carefully separates the skin from the bones and cartilages to open the «frame» of the nose.\n📌 Interesting point: all manipulations are done through tiny holes that heal without a trace."
}
},
{
"name": "Correction",
"description": {
"professional": "Hump resection (osteotomy), correction of the tip of the nose (cartilage plastic surgery), septoplasty for a deviated septum. Modeling new contours using autologous cartilage or implants.\nInstruments:\n- Osteotome 8 mm\n- Diamond rasp\n- Hammer 50 g\n\nTechnique:\n1. Hump resection:\n- With an osteotome from top to bottom\n- 3-4 precise blows with a hammer\n2. Osteotomy:\n- Lateral - through 2 mm incisions\n- Medial - through a rhinotrache\n\nLogistics:\n- Bone chips are collected for possible use\n\nNuance: With thin skin - minimal resection.\n\nTip grafting:\n\nInstruments:\n- Gerald tweezers\n- PDS 5-0 suture material\n- Templates for cartilage\n\nTechnique:\n1. Dome correction:\n - Resection of 2-3 mm of the cartilage edge\n - Suture technique for narrowing\n2. Strengthening:\n - Autocartilage from the septum\n - Fixation with through sutures\n\nLogistics:\n- The remaining cartilage is preserved in saline\n\nNuance: With thick skin - more aggressive correction.",
"normal": "Now work with cartilage and bones begins. The doctor can remove the hump, narrow the nose, raise the tip. It all depends on the patient's wishes and the capabilities of the anatomy.\n📌 Interesting point: often use the patient's own cartilage from the septum to strengthen the shape."
}
},
{
"name": "Fixation",
"description": {
"professional": "Implementation of internal sutures (catgut), fixation of the septum with splints. Installation of an external plaster or thermoplastic splint to maintain the new shape.\nInstruments:\n- Silicone splints\n- Merocel tampons\n- Thermoplastic splint\n\nTechnique:\n1. Internal fixation:\n- Tampons with antibiotic\n- Splints are fixed with a suture\n2. External fixation:\n - Splint in the shape of the new nose\n - Fixation for 7-10 days\n\nLogistics:\n- Checking the symmetry before applying the splint.",
"normal": "Everything that has been changed is fixed with sutures and internal plates. Then an external bandage is applied so that the nose keeps its shape in the first days.\n📌 An interesting point: in order for everything to «take root», the patient must not touch the nose for at least 2 weeks."
}
},
{
"name": "Control",
"description": {
"professional": "Final assessment of symmetry and shape. Nasal tamponade (removed after 1-2 days). Prescribing antibiotics and painkillers.\nPostoperative protocol\n1. Cooling:\n - Cold compresses for 48 hours\n2. Medicines:\n - Cefazolin 1 g 2 times a day\n - Ketorolac 10 mg for pain\n3. Dressings:\n - Removal of tampons on the 2nd day\n - Removal of stitches on the 7th day\n\nComplications:\n- Septal hematoma (1-3%)\n- Asymmetry (5%)\n- Respiratory failure (rare)",
"normal": "Checking the result, applying tampons and dressings, completing the operation. The surgeon checks the symmetry, stops the bleeding, applies a dressing. The patient is given recommendations and sent home in a few hours (or the next day).\n📌 Interesting point: the final result is visible only after 6-12 months, when everything heals."
}
}
]
},
{
"keys": [
"amputation"
],
"name": "Limputation amputation (hip level)",
"modes": {
"professional": "Limb removal due to injury/ischemia. Stump formation, hemostasis, infection prevention.",
"normal": "Part of the arm/leg is cut off if it cannot be saved. Then a form is made for the prosthesis."
},
"steps": [
{
"name": "Anaesthesia",
"description": {
"professional": "General anesthesia (propofol + fentanyl + muscle relaxants) or conduction (for example, brachial plexus block during arm amputation). Prevention of thrombosis (heparin). Also, marking is performed:\nInstruments:\n- Surgical marker\n- Tape measure\n- Doppler device for assessing blood flow\n\nTechnique:\n1. Determining the level of amputation:\n- Minimum length of the femoral stump - 12 cm from the greater trochanter\n2. Marking the flaps:\n- The anterior flap is 2-3 cm longer than the posterior flap\n- Total length = 1.5 femoral diameters\n\nLogistics:\n- Marking is confirmed by the senior surgeon\n\nNuance: In case of diabetes, 2 cm is added to the calculated length.",
"normal": "Full anesthesia or pain relief is performed on the limb being operated on only. Then the doctor determines exactly where the leg needs to be amputated. The site is marked with a marker so that a prosthesis can be installed later. Everything is done taking into account the anatomy and future rehabilitation.\n📌 Interesting point: the higher the amputation, the more difficult the recovery, but sometimes there is no choice."
}
},
{
"name": "Incision",
"description": {
"professional": "Planning stump flaps: longer palmar/anterior flap. Skin, subcutaneous tissue and fascia incision. Ligation of main vessels (silk/vicryl). This is called soft tissue processing.\nInstruments:\n- Scalpel #20\n- Electrocoagulator (Spray mode, 40 W)\n- Kocher clamps 6 pcs.\n\nTechnique:\n1. Skin incision:\n- Semicircular anterior flap\n- Short oblique posterior\n2. Muscles are crossed 5 cm distal to the bone level\n3. Nerves:\n - Pull by 2 cm and cut with a scalpel\n - Treat with 96% alcohol\n\nLogistics:\n- Bleeding vessels are ligated immediately\n\nNuance: The sciatic nerve is treated separately (high risk of neuroma).",
"normal": "Under anesthesia, the doctor makes incisions on the skin and muscles. Veins and arteries are immediately ligated to prevent blood loss. Nerves are also carefully treated so that they do not hurt later.\n📌 An interesting point: each layer of tissue is treated differently - even in such a serious operation there is a subtlety."
}
},
{
"name": "Removal",
"description": {
"professional": "Sawing the bone with an oscillating saw with a smooth edge processing. Nerve transection with their shortening and immersion in soft tissue to prevent neuromas. Muscle processing.\nInstruments:\n- Oscillating saw with cooling\n- Bone file\n- Bone wax\n\nTechnique:\n1. The periosteum is separated 0.5 cm distal to the cut level\n2. Cut at an angle of 45° to smooth the anterior edge\n3. Edge processing:\n- Sharp protrusions are rounded off with a file\n- The medullary canal is closed with wax\n\nLogistics:\n- Bone chips are removed with an irrigator\n\nNote: For osteoporosis, special saws with fine teeth are used.",
"normal": "The bone is sawed off with a special saw. Sharp edges are smoothed. The bone canal is closed with wax to prevent bleeding and reduce pain.\n📌 Interesting point: the surgeon does everything so that the stump is comfortable for the future prosthesis."
}
},
{
"name": "Stump formation",
"description": {
"professional": "Myoplasty (suturing muscles over the bone) or myodesis (fixation of muscles to the bone). Wound drainage. Suturing the skin without tension, forming a rounded stump suitable for prosthetics.\nInstruments:\n- Mathieu needle holder\n- Vicryl suture material No. 0\n- Redon 14 Fr drainage\n\nTechnique:\n1. Myodesis:\n - Muscles are sutured over the bone\n - Fascia - with a separate suture\n2. Drainage:\n - 2 drains are installed\n - Fixed with separate sutures\n3. The skin is sutured without tension\n\nLogistics:\n- Deep sutures - Vicryl №0\n- Skin - monofilament 3-0\n\nNuance: In case of vascular pathology, drains are left for 5-7 days.",
"normal": "The muscles are sutured so that they lie well on the bone. The skin is closed with a neat suture. A tube (drainage) is often placed to prevent fluid accumulation.\n📌 Interesting point: the shape of the stump is the key to a quality life after amputation."
}
},
{
"name": "Bandaging",
"description": {
"professional": "Applying an aseptic bandage, sometimes a compression bandage. Immobilization of the stump (for example, with a splint). Bleeding control, antibiotics and analgesics.\nInstruments:\n- Compression cover\n- Hard bandage\n- Protective cap\n\nTechnique:\n1. Application of a hard bandage:\n - In the first 24 hours - without a prosthesis\n - Then - compression hosiery\n2. Prevention of contractures:\n - Daily exercise therapy from the 3rd day\n - Extension position\n\nLogistics:\n- First dressing change after 48 hours\n\nPain relief protocol\n| Drug | Regimen | Duration |\n|----------------|---------------------|----------------------|\n| Ketorolac | 30 mg IV | Every 8 hours (3 days)|\n| Gabapentin | 300 mg | 2 times a day (month) |\n| Nerve block | 0.5% bupivacaine | Intraoperative |\n\nComplications:\n- Phantom pain (70% in the first month)\n- Contracture (15%)\n- Infection (5-8%)",
"normal": "After the surgery, the patient undergoes dressing changes, receives pain relief and begins exercise therapy. It is very important to start moving as soon as possible so that the muscles do not atrophy.\n📌 Interesting point: phantom pain is not a fiction. They are really felt, and they need to be worked with."
}
}
]
},
{
"keys": [
"craniotomy",
"craniotomy",
"brain surgery"
],
"name": "Craniotomy",
"modes": {
"professional": "Surgical opening of the skull to access the brain. Performed for tumors, hematomas, epilepsy. Includes marking, burr hole, bone flap removal, work with the dura mater (DMA).",
"normal": "A «window» is cut in the skull to get to the brain. It is done in case of serious illnesses or injuries. After the operation, the bone is sometimes returned to its place."
},
"steps": [
{
"name": "Marking and incision",
"description": {
"professional": "Access planning using neuronavigation (MRI/CT data). Marking the skin with a marker along the expected boundaries of the bone flap. Processing the surgical field. Skin incision with a #10 scalpel followed by electrocoagulation of the vessels. Formation of a cutaneous-aponeurotic flap.\nInstruments:\n- Neuronavigation system (e.g. StealthStation)\n- Scalpel #10\n- Electrocoagulator (Spray mode, 40 W)\n- Soft tissue hooks (e.g. Fish)\nTechnique:\n1. The incision line is drawn along the border of the scalp.\n2. Hemostasis of the subcutaneous tissue vessels — bipolar coagulation.\n3. Detachment of the flap from the periosteum — by blunt dissection.\nLogistics:\n- Used markers are disposed of in a «sharp» container.\nNuance: For frontal tumors, the incision is made behind the hairline (cosmetic effect).",
"normal": "The doctor draws on the head where the incision will be (often in a semicircle, like a «lid»). The skin is carefully cut and moved aside. The bleeding is stopped by cauterization.\n📌 Interesting point: sometimes a 3D map of the brain is used to accurately hit the desired area."
}
},
{
"name": "Burner hole",
"description": {
"professional": "Making an initial hole in the skull using a burr (e.g. Anspach or Midas Rex). Positioning at the “key point” (usually over an intact sinus). Irrigation with saline to cool the bone. Insertion of a dural hook to protect the dura mater.\nInstruments:\n- Pneumatic burr with diamond tip\n- Dural hook (3 mm wide)\n- Irrigator with cooling\nTechnique:\n1. The burr is held at a 45° angle to the bone.\n2. The first hole is in the Cronlein zone (safe point).\n3. Depth control — until the «blue» (TMO) appears.\nLogistics:\n- The shavings are aspirated immediately (risk of embolism).\nNuance: Low speeds (10,000 rpm) are used for osteoporosis.",
"normal": "A small hole is drilled in the skull with a special «drill». The doctor makes sure not to touch the brain under the bone. They constantly pour saline solution on it so that there is no overheating.\n📌 Interesting point: the skull bone smells burnt — like hair after a hairdresser."
}
},
{
"name": "Osteoplasty",
"description": {
"professional": "Enlargement of the hole with a craniotome (for example, Gigli saw or craniotome) with the formation of a bone flap. Detachment of the TMO from the inner surface of the bone with a raspatory. Extraction of the flap and its preservation in a sterile saline solution with an antibiotic.\nInstruments:\n- Craniotome with a 5 mm burr\n- Penfield raspatory No. 1\n- Bone wax for hemostasis\nTechnique:\n1. The sawing line is drawn between the burr holes.\n2. The bone flap is lifted by the periosteum.\n3. The dura mater is separated from the bone, avoiding tears.\nLogistics:\n- The flap is marked (for example, «left fronto-parietal»).\nNuance: In case of metastases, the bone may not be returned (risk of relapse).",
"normal": "The bone is sawed between the holes like a «door». It is carefully removed and placed in a sterile solution. Now the brain is visible through the dense film (TMO).\n📌 Interesting point: the bone can then be screwed back with titanium plates - like a construction set."
}
},
{
"name": "Dura mater opening",
"description": {
"professional": "Incision of the dura mater (TMO) with a #11 scalpel, followed by spreading the edges with microtweezers. Coagulation of meningeal vessels. Fixation of the TMO to the edges of the wound with sutures (nylon 4-0).\nInstruments:\n- Microscalpel #11\n- Bipolar coagulator (power 15 W)\n- Prolene 6-0 suture material\nTechnique:\n1. Incision of the TMO - along an avascular line (avoiding the sinuses).\n2. The edges of the membrane are moved away with hooks.\n3. The arachnoid membrane is preserved (if possible).\nLogistics:\n- Used needles - in a sharps container.\nNuance: With high ICP, the incision is made slowly (risk of dislocation).",
"normal": "The thin membrane over the brain is cut. The blood is cauterized. Now the surgeon can see the brain itself - it looks like a walnut, but it pulsates.\n📌 Interesting point: the brain does not hurt - it has no pain receptors!"
}
},
{
"name": "The main stage (depending on the pathology)",
"description": {
"professional": "Options:\n1. **Tumor**: ultrasound aspiration (CUSA), vascular coagulation, urgent histology.\n2. **Hematoma**: clot evacuation, bipolar hemostasis.\n3. **Aneurysm**: clipping with microscopic titanium clips.\nInstruments:\n- Ultrasonic aspirator (CUSA)\n- Microscope (e.g. Zeiss OPMI Pentero)\n- Sugita or Yasargil clips\nTechnique:\n1. Work is performed in a «dry» field (irrigation with saline).\n2. ICP control - mannitol or ventriculostomy.\n3. Neuromonitoring (EEG, M-responses).\nLogistics:\n- The removed tissue is sent for histology.\nNuance: With glioblastoma, 5-ALA is used to illuminate the tumor.",
"normal": "Now the surgeon does what it all started for: removes the tumor, removes the thrombus or «fixes» the vessel. Everything is under a microscope - the slightest mistake is dangerous.\n📌 Interesting point: sometimes the brain is «illuminated» with a special substance to see the tumor borders."
}
},
{
"name": "Suture",
"description": {
"professional": "Dura mater suturing with a continuous suture (Prolene 4-0). Fixation of the bone flap with titanium plates and screws. Drainage of the epidural space (Jackson-Pratt drainage). Layered suturing of soft tissues.\nInstruments:\n- Microneedle holder\n- Titanium plates (1.5 mm)\n- Drainage 10 Fr\nTechnique:\n1. The dura mater is sealed with fibrin glue.\n2. The bone flap is fixed with at least 4 screws.\n3. The aponeurosis is sutured with Vicryl 0.\nLogistics:\n- The remaining bone chips are removed with an irrigator.\nNuance: In case of cerebral edema, the bone may not be placed (decompressive craniotomy).",
"normal": "The brain is covered with a shell, the bone is screwed back (if possible). Drainage is placed, the skin is sutured.\n📌 Interesting point: titanium plates do not interfere with MRI and do not jingle at the airport!"
}
}
]
},
{
"keys": [
"meningioma",
"brain tumor",
"meningioma removal",
"neurosurgery"
],
"name": "Meningioma removal",
"modes": {
"professional": "Radical removal of a benign tumor growing from the cells of the arachnoid membrane (arachnoid endothelium). Stages: access to the dura mater, tumor devascularization, separation from the brain, resection with attachment site capture (Simpson Grade I-II). Control of sinuses and arteries is critical.",
"normal": "A benign tumor that has «stuck» to the meninges is removed. The operation is complex, but usually successful. After it, the brain is returned to its place, as if nothing had happened."
},
"steps": [
{
"name": "Neuronavigation and access",
"description": {
"professional": "Access planning with neuronavigation (based on MRI with contrast). Skin marking according to tumor projection. Choice of craniotomy (frontal-temporal, parasagittal, etc.). Skin incision, formation of a cutaneous-aponeurotic flap while preserving the feeding vessels.\nInstruments:\n- Neuronavigation system (StealthStation, BrainLab)\n- Scalpel #15\n- Bipolar coagulator (20 W)\n- Fish or Budde retractors\nTechnique:\n1. Incision along the hairline (for a cosmetic effect).\n2. Hemostasis of the scalp arteries - clipping or coagulation.\n3. Detachment of the periosteum with a raspatory.\nLogistics:\n- Bone chips are preserved for possible plastic surgery.\nNuance: For parasagittal meningiomas - control of the superior sagittal sinus (risk of thrombosis).",
"normal": "The surgeon looks at a 3D map of the brain and marks where the incision will be. The skin is carefully folded back to reach the skull.\n📌 Interesting point: sometimes the incision is made along the hairline - the scar is not visible later."
}
},
{
"name": "Craniotomy",
"description": {
"professional": "Burner hole in the «key point» (outside the tumor projection). Osteoplastic craniotomy using a craniotomy (e.g. Midas Rex with a 5 mm burr). Separation of the dura mater from the bone with a Penfield #3 raspatory. Preservation of the bone flap in warm saline with cefazolin.\nInstruments:\n- Pneumatic burr (Anspach or Midas Rex)\n- Dural hook\n- Bone wax\nTechnique:\n1. Sawing the bone 1-2 cm beyond the tumor.\n2. Stopping bleeding from diploic veins with wax.\n3. Marking the flap (e.g. «right parietal»).\nLogistics:\n- Shavings are aspirated to prevent embolism.\nNuance: In case of bone invasion - resection of hyperostosis (risk of relapse).",
"normal": "A «window» is cut out in the skull around the tumor. The bone is preserved - it will be put back.\n📌 Interesting point: the cranial bone smells burnt - like shish kebab, but this is normal!"
}
},
{
"name": "Opening the dura mater and devascularization",
"description": {
"professional": "Incision of the dura mater with a #11 scalpel in the avascular zone. Coagulation of the meningeal vessels feeding the tumor. Separation of the dura mater from the arachnoid membrane. Gradual devascularization of meningioma with bipolar (15-25 W).\nInstruments:\n- Microscalpel #11\n- Bipolar forceps (e.g. Malis)\n- Microscissors (e.g. Yasargil)\nTechnique:\n1. Incision of the dura mater along the tumor perimeter.\n2. Coagulation of vessels at the base of the meningioma.\n3. Separation of the arachnoid plane by blunt dissection.\nLogistics:\n- Used needles - in a sharps container.\nNuance: In case of sinus invasion - decision on resection/plastic surgery (risk of blood loss).",
"normal": "The surgeon opens the dura mater of the brain and closes the vessels that feed the tumor.\n📌 Interesting point: the tumor sometimes «sticks» off the brain, like a mushroom from a tree."
}
},
{
"name": "Tumor removal (Simpson Grade I-II)",
"description": {
"professional": "Delicate dissection of the tumor from the brain tissue while preserving the pial vessels. Enucleation of the meningioma core with an ultrasonic aspirator (CUSA). Resection of the dura mater at the site of tumor attachment (Simpson Grade I). In case of bone invasion — aggressive resection (Simpson Grade II).\nInstruments:\n- Ultrasonic aspirator (CUSA, 30% power mode)\n- Microforceps (e.g. Rhoton No. 6)\n- Prolene 6-0 suture material\nTechnique:\n1. Aspiration of the tumor center to reduce the volume.\n2. Gradual separation of the capsule from the brain.\n3. Resection of the dura mater with the capture of 1-2 cm of healthy tissue.\nLogistics:\n- The sample is sent for urgent histology.\nNuance: In case of convexital meningiomas — control of motor zones (neuronaviation + corticography).",
"normal": "The tumor is shelled out, like the pulp from a nut, and removed. The place where it was attached is cauterized or excised.\n📌 Interesting point: meningiomas are often «kind» — they do not grow into the brain, but simply press it."
}
},
{
"name": "Dura mater plastic surgery and cranioplasty",
"description": {
"professional": "Closure of the dura mater defect with autocartilage/artificial membrane (DuraGen). Sealing with sutures (Prolene 5-0) + fibrin glue. Return of the bone flap with fixation with titanium plates. Drainage of the subgaleal space.\nInstruments:\n- Artificial dura mater (DuraGen or Neuro-Patch)\n- Titanium microplates (1.0 mm)\n- Jackson-Pratt 10 Fr drainage\nTechnique:\n1. Plastic surgery of the dura mater defect with a patch.\n2. Fixation of the bone with at least 4 screws.\n3. Checking the tightness (Valsalva test).\nLogistics :\n- The tumor remains are disposed of as biological waste.\nNuance: For large defects - cranioplasty with a titanium mesh.",
"normal": "The hole in the shell is covered with a «patch», the bone is put back in place and screwed with titanium screws.\n📌 Interesting point: titanium is not magnetic - you can do an MRI after the operation."
}
},
{
"name": "Completion and monitoring",
"description": {
"professional": "Layer-by-layer wound suturing. Application of an aseptic dressing. Monitoring of neurological status (motor functions, speech). MRI in the first 24 hours to assess the radicality of the removal. Prevention of seizures (levetiracetam) and edema (dexamethasone).\nInstruments:\n- Vicryl 2-0 suture material (aponeurosis)\n- 4-0 monofilament (skin)\n- Neuromonitoring sensors (NIM)\nPostoperative protocol:\n1. ICP monitoring (if there was edema).\n2. Antibiotics (ceftriaxone 2 g/day).\n3. Activation on the 2nd day.\nComplications:\n- Venous infarction (5% with sinus damage).\n- Liquorrhea (3%).\n- Relapse (7% over 10 years).",
"normal": "The wound is sutured, the patient is transferred to the ward. The first days they check that there is no cerebral edema.\n📌 An interesting point: if the tumor was large, the brain gradually «straightens out» - like a ball after pressure."
}
}
]
},
{
"keys": [
"trigeminal neuralgia",
"Jeanette decompression",
"MVD",
"neurosurgery"
],
"name": "Microvascular decompression of the trigeminal nerve",
"modes": {
"professional": "Microsurgical separation of a vessel (artery/vein) compressing the trigeminal nerve root in the cerebellopontine angle. Stages: retromastoid approach, opening of the dura mater, identification of the «vessel-nerve» conflict, installation of a Teflon protector. Control of the superior cerebellar artery (SCA) loop is critical.",
"normal": "An operation that relieves «lightning» facial pain. The surgeon finds the vessel that is pressing on the nerve and places a «spacer» between them. The pain disappears instantly!"
},
"steps": [
{
"name": "Positioning and approach",
"description": {
"professional": "Patient position on the side (healthy side down). Fixation of the head in a three-point Mayfield holder. Linear incision (5-6 cm) behind the mastoid process. Retromastoid craniotomy (3x3 cm window) using a pneumatic burr (Anspach). Opening the mastoid air cells to access the sigmoid sinus.\nInstruments:\n- Midas Rex craniotome with a 4 mm burr\n- Double-pronged soft tissue hook\n- Bone wax\nTechnique:\n1. 1 cm skin incision behind the auricle.\n2. Coagulation of the occipital artery.\n3. Bone flap-preserving craniotomy.\nLogistics:\n- Bone chips are preserved for possible reimplantation.\nNote: If the sigmoid sinus is high, the incision is shifted posteriorly.",
"normal": "The patient is placed on his side, the head is fixed in a special holder. A small incision is made behind the ear and a hole is «drilled» in the skull.\n📌 Interesting point: the bone will be put back in place later — it will take root!"
}
},
{
"name": "Dura mater opening and access to the cerebellopontine angle",
"description": {
"professional": "Dura mater (DMA) incision with a #11 scalpel. DMA edges fixation with sutures (4-0 silk). Gradual CSF irrigation to lower the cerebellum. Insertion of a retractor (e.g. Greenberg) with pressure control (max. 20 mmHg). Identification of the superior petroclival angle.\nInstruments:\n- #11 micro scalpel\n- Soft-bladed retractor\n- Irrigator with heated saline\nTechnique:\n1. DMA incision in the shape of the letter «T».\n2. Aspiration of cerebrospinal fluid to reduce ICP.\n3. Search for the trigeminal nerve (V pair) by anatomical landmarks.\nLogistics:\n- Used needles - in a container for sharp objects.\nNuance: In case of a narrow anatomical window - partial resection of the lateral part of the cerebellum (rare).",
"normal": "The surgeon opens the meninges and carefully moves the cerebellum to find the trigeminal nerve.\n📌 Interesting point: the brain «floats» in fluid - it is pumped out to make it easier to work."
}
},
{
"name": "Identification of the «vessel-nerve» conflict",
"description": {
"professional": "Microscopic visualization (magnification ×10-40) of the trigeminal nerve root in the entry zone into the bridge (REZ, root entry zone). Search for a compressing vessel (usually the SMA loop, less often the anterior inferior cerebellar artery (AICA) or vein). Dissection of arachnoid adhesions with microscissors.\nInstruments:\n- Operating microscope (Zeiss OPMI Pentero)\n- Yasargil microscissors\n- Rhoton microtweezers No. 5\nTechnique:\n1. Separation of the vessel from the nerve with a blunt dissector.\n2. Coagulation of the satellite veins with a bipolar (10 W).\n3. Preparation of a pocket for the protector.\nLogistics:\n- Arachnoid adhesions are sent for histology.\nNuance: In case of venous compression - coagulation of the vein (be careful - risk of trunk ischemia!).",
"normal": "Under the microscope, the surgeon finds the vessel that is pressing on the nerve (often a tortuous artery).\n📌 Interesting point: the nerve can be «pressed» into the brainstem, like a boot print in the snow."
}
},
{
"name": "Installing a Teflon protector",
"description": {
"professional": "Fixing the vessel in a new position using a Teflon sponge (e.g. Teflon Felt). The pad is placed between the vessel and the nerve, avoiding kinking the artery. Checking for tension. Additional fixation with fibrin glue (Tisseel).\nInstruments:\n- Teflon sponge (size 5×10 mm)\n- Microholder for the protector\n- Fibrin glue\nTechnique:\n1. Forming a Teflon «hammock» around the vessel.\n2. Checking the pulsation of the artery after displacement.\n3. Fixation with glue to prevent migration.\nLogistics:\n- Teflon residues are disposed of as non-biological waste.\nNuance: In case of multiple vessels, protectors are installed in a cascade.",
"normal": "A soft Teflon «gasket» is inserted between the vessel and the nerve. It is like a pillow - it protects the nerve from pressure.\n📌 Interesting point: Teflon is the same material as in non-stick frying pans!"
}
},
{
"name": "Completion and control",
"description": {
"professional": "Repeated revision of the decompression zone. Suturing of the dura mater with a sealed suture (Prolene 5-0). Return of the bone flap with fixation with titanium plates. Drainage of the subcutaneous space (Redon drainage 10 Fr). Layered wound suturing.\nInstruments:\n- Mathieu needle holder\n- Titanium microplates (1.0 mm)\n- Drainage with active aspiration\nPostoperative protocol:\n1. MRI to rule out hematoma.\n2. Pain relief (paracetamol + tramadol).\n3. Monitoring neurological status (corneal reflex!).\nComplications:\n- Liquorrhea (2%).\n- Nerve damage (1%).\n- Relapse (5% over 5 years).",
"normal": "The wound is sutured, the bone is put back in place. After a couple of days, the patient already forgets about the pain!\n📌 An interesting point: if the operation is done correctly, the pain disappears immediately - as if by magic."
}
}
]
},
{
"keys": [
"hydrocephalus",
"VPSh",
"brain shunting",
"neurosurgery"
],
"name": "Ventriculoperitoneal shunting",
"modes": {
"professional": "Installation of a shunt system for the outflow of cerebrospinal fluid from the ventricles of the brain into the abdominal cavity. Stages: craniotomy, ventricular catheter, subcutaneous tunnel, peritoneal catheter, valve adjustment. The angle of insertion of the catheter into the ventricle and checking the patency of the system are critical.",
"normal": "An operation that «drains» excess fluid from the brain into the abdomen. A tube with a valve is inserted so that the pressure in the head does not jump. After this, the headache stops, and the patient can think straight again!"
},
"steps": [
{
"name": "Planning and marking",
"description": {
"professional": "Determining the point of insertion of the ventricular catheter (usually the right atrium of Kocher: 1 cm anterior to the coronary suture, 2.5 cm lateral to the midline). Marking the skin with a marker along the trajectory of the shunt: from the frontal region to the abdomen (hypochondrium or pelvis). Preparing the surgical field.\nInstruments:\n- Neuronavigation (in complex cases)\n- Surgical marker\n- Template for measuring the length of the catheter\nTechnique:\n1. The entry point into the ventricle is at the intersection of the lines: 10 cm from the nasion, 3 cm from the midline.\n2. The trajectory of the subcutaneous tunnel is from the parotid region to the epigastrium.\nLogistics:\n- Checking the length of the catheter according to the table (patient's height/age).\nNote: For children under one year old, the insertion point is 1 cm in front of the fontanelle.",
"normal": "The surgeon marks on the head and abdomen where the «tubes» will be laid.\n📌 Interesting point: in children, the shunt is placed through the fontanelle - it is still soft!"
}
},
{
"name": "Ventricular catheter",
"description": {
"professional": "A burr hole in the skull (5 mm in diameter) with a craniotome. Puncture of the ventricle with a catheter with a guidewire at an angle of 90° to the bone (for the lateral ventricle - direction to the conditional point «between the eyebrows»). Depth control (4-6 cm in adults) via cerebrospinal fluid drainage.\nInstruments:\n- Craniotome with a 4 mm cutter\n- Ventricular catheter (e.g. Codman)\n- Catheter mandrin\nTechnique:\n1. Insert the catheter until you feel a «gap» (penetration into the ventricle).\n2. Connect a manometer to measure ICP (normal: 5-15 mmHg).\n3. Fix the catheter to the periosteum with sutures (Prolene 4-0).\nLogistics:\n- The cerebrospinal fluid is sent for analysis (protein, cellular composition).\nNote: For small ventricles, use ultrasound navigation.",
"normal": "A hole is drilled in the skull and a catheter is inserted into the brain at a right angle. As soon as clear fluid starts flowing out of the tube, you've hit the right spot!\n📌 Interesting point: the depth of insertion is like the length of a matchbox (4-6 cm)."
}
},
{
"name": "Subcutaneous tunnel",
"description": {
"professional": "Formation of a tunnel from the ear area to the abdomen using a tunnelizer (for example, Passport). The catheter is passed under the skin, avoiding compression areas (clavicle, ribs). The valve (e.g. Medtronic Strata) is fixed to the aponeurosis in the retroauricular region.\nInstruments:\n- Tunnelizer with an oval tip\n- Valve holder\n- Catheter length measure\nTechnique:\n1. Skin incision in the retroauricular region and epigastrium.\n2. Passing the «reflection» tunnelizer (so as not to damage the vessels).\n3. The valve is fixed to the temporal muscle.\nLogistics:\n- Excess catheter is cut off, leaving a 10 cm margin.\nNote: In women, bypass the mammary gland to prevent necrosis.",
"normal": "A «tunnel» for the tube is made under the skin from the head to the abdomen. The valve (like a button behind the ear) regulates the flow of fluid.\n📌 Interesting point: the tube is passed in such a way that it is not pinched when the patient sits or bends over."
}
},
{
"name": "Peritoneal catheter",
"description": {
"professional": "Mini-laparotomy (2 cm incision) in the right hypochondrium. Insertion of a catheter into the abdominal cavity under visual control. Checking the outflow of cerebrospinal fluid (drop test). Fixation of the catheter to the peritoneum (Vicryl 3-0).\nInstruments:\n- 5 mm trocar\n- Laparoscopic camera (in complex cases)\n- Vicryl suture material\nTechnique:\n1. The catheter is passed into the small pelvis (in adults) or the right subdiaphragmatic pocket (in children).\n2. Position control — no resistance when flushing with saline.\nLogistics:\n- The excess length of the catheter is placed in a «ring» in the abdominal cavity.\nNuance: In case of adhesions — catheter installation under laparoscopic control.",
"normal": "The tube is inserted into the abdomen through a small incision. There, the liquid will be sucked in, like water in a sponge.\n📌 Interesting point: in children, the catheter is sometimes inserted into the heart (ventriculoatrial bypass)."
}
},
{
"name": "Check and completion",
"description": {
"professional": "System patency test: flushing with sterile saline (0.9% NaCl) under pressure. Valve adjustment (if programmable) according to preoperative ICP data. Layer-by-layer wound suturing. X-ray control of catheter position.\nInstruments:\n- 10 ml syringe with saline\n- Valve programmer (eg Sophysa)\n- X-ray machine (for intraoperative control)\nPostoperative protocol:\n1. CT scan of the head after 24 hours.\n2. Antibiotics (cefazolin 1 g ×3 days).\n3. Limitation of physical activity for 2 weeks.\nComplications:\n- Infection (3-5%).\n- Shunt dysfunction (10% in the first year).\n- Hyperdrainage (rare).",
"normal": "They check that fluid flows freely through the tube. The valve is adjusted to the patient's pressure.\n📌 Interesting point: modern valves can be adjusted with a magnet without cutting the skin!"
}
}
]
},
{
"keys": [
"glioblastoma",
"brain tumor",
"neurosurgery",
"glioma resection"
],
"name": "Glioblastoma removal",
"modes": {
"professional": "Maximum radical resection of a malignant glial tumor (IV degree according to WHO) using intraoperative neuronavigation, fluorescent labeling of 5-ALA and intraoperative MRI. Control of tumor boundaries and preservation of functional areas of the brain (corticography, neuromonitoring) are critical.",
"normal": "Removal of an aggressive brain tumor with an attempt to capture all of its «tentacles». The surgeon illuminates the tumor with a special substance so as not to affect the healthy brain."
},
"steps": [
{
"name": "Preoperative preparation",
"description": {
"professional": "3 hours before surgery: oral administration of 5-aminolevulinic acid (5-ALA, 20 mg/kg). Skin marking according to neuronavigation data (MRI with tractography). Patient positioning in the supine/lateral position with head fixation in Mayfield. Prevention of cerebral edema (mannitol 1 g/kg IV).\nInstruments:\n- Neuronavigation station (BrainLab, StealthStation)\n- Three-point head holder\n- Intraoperative MRI system (if available)\nTechnique:\n1. Combining MRI data with the navigation system.\n2. Marking the projection of the tumor and functional zones (speech, motor).\nLogistics:\n- Monitoring the level of 5-ALA in the plasma.\nNuance: If localized in the speech zone - awake-craniotomy planning.",
"normal": "The patient is given a «magic pill» that makes the tumor glow under blue light. The surgeon studies a 3D map of the brain to accurately plan the incision.\n📌 Interesting point: sometimes the operation is done «on awakening» so as not to affect the speech zones!"
}
},
{
"name": "Craniotomy",
"description": {
"professional": "Linear/arc-shaped skin incision preserving the feeding vessels. Burr hole with a craniotome (5 mm burr). Osteoplastic craniotomy with the formation of a bone flap (size 2 cm larger than the tumor borders). Hemostasis of the bone edges with wax.\nInstruments:\n- Pneumatic burr (Anspach or Midas Rex)\n- Bone wax\n- Dural hooks\nTechnique:\n1. Sawing the bone while preserving the periosteum.\n2. Control of the position of the sinuses (at parasagittal tumors).\nLogistics:\n- The bone flap is stored in antibiotic-saline solution.\nNuance: In case of bone invasion — hyperostosis resection.",
"normal": "A «window» is cut out in the skull to get to the tumor. The bone is preserved — it will be put back.\n📌 Interesting point: the tumor can grow into the bone, then part of it is also removed."
}
},
{
"name": "Opening the dura mater and visualizing the tumor",
"description": {
"professional": "Incision of the dura mater with a #11 scalpel in the avascular zone. Fixation of the edges with sutures (4-0 silk). Turning on blue light (405 nm) to activate 5-ALA fluorescence (the tumor glows pink). Marking the boundaries using neuronavigation data.\nInstruments:\n- Microscope with a fluorescence module (Zeiss Pentero 900)\n- Ultrasonic aspirator (CUSA EXcel)\n- Bipolar coagulation (Malis, 15 W)\nTechnique:\n1. Fluorescence confirms the tumor area (100% specificity).\n2. Ultrasound navigation to determine the depth.\nLogistics:\n- Collection of material for urgent histology.\nNote: If there is no luminescence, neuronavigation control is used.",
"normal": "Under blue light, the tumor turns pink - like a neon sign. This helps the surgeon avoid damaging the healthy brain.\n📌 Interesting point: 5-ALA makes the tumor visible only under special light!"
}
},
{
"name": "Tumor resection",
"description": {
"professional": "Tumor enucleation with an ultrasonic aspirator (CUSA) while preserving the pial vessels. Gradual coagulation of tumor tissue with a bipolar. Control of boundaries by fluorescence and neuronavigation. When close to functional zones — corticography and direct electrical stimulation.\nInstruments:\n- CUSA (frequency 28 kHz, aspiration 60%)\n- Rhoton microforceps No. 4\n- Neuromonitoring (NIM Eclipse)\nTechnique:\n1. Resection from the center to the periphery.\n2. In case of invasion into the ventricle — stop to prevent dissemination.\n3. Motor evoked potential monitoring.\nLogistics:\n- Tumor tissue is sent for histology and molecular analysis (MGMT, IDH1).\nNuance: If the motor cortex is affected, subtotal resection is performed while preserving the functional island.",
"normal": "The tumor is «sucked out» with a special ultrasound device that breaks it into small pieces. The vessels are cauterized.\n📌 An interesting point: if the tumor is near the area responsible for movement, the surgeon can leave a thin layer to avoid paralysis."
}
},
{
"name": "Radicality monitoring",
"description": {
"professional": "Intraoperative MRI (if available) to assess residual tumor. Repeated fluorescence under blue light. Hemostasis of the tumor bed with a hemostatic sponge (Surgicel). Installation of a capsule with carmustine (Gliadel) upon agreement with the oncologist.\nInstruments:\n- Intraoperative MRI (BrainSuite)\n- Hemostatic sponges (Floseal, Surgicel)\n- Implantable capsule with a chemotherapy drug\nTechnique:\n1. MRI control 30 minutes after resection.\n2. Additional resection in case of residual tumor.\nLogistics:\n- Recording of data for postoperative radiation therapy.\nNuance: With localization in functional zones, residual tumor volume is acceptable (STR, subtotal resection).",
"name": "After removal, an MRI is done right in the operating room to check if there is any tumor left. Sometimes a «tablet» with a chemotherapy drug is placed in the tumor bed.\n📌 Interesting point: modern technologies allow scanning the brain during surgery!"
}
},
{
"name": "Completion",
"description": {
"professional": "Sealed suturing of the dura mater (Prolene 4-0). Return of the bone flap with fixation with titanium plates. Drainage of the epidural space (Redon drainage 10 Fr). Layered suturing of the wound.\nInstruments:\n- Titanium plates and screws (1.5 mm)\n- Drainage with active aspiration\n- Vicryl suture material 2-0\nPostoperative protocol:\n1. CT scan after 2 hours to exclude hematoma.\n2. Dexamethasone 4 mg ×4 times a day (edema prevention).\n3. Start of radiation therapy in 2-4 weeks.\nComplications:\n- Neurological deficit (15-20%).\n- Infection (3-5%).\n- Relapse (100% within 2 years without adjuvant therapy).",
"normal": "The bone is put back in place, the wound is sutured. Radiation and chemotherapy begin in a couple of weeks.\n📌 Hard fact: glioblastoma always comes back, but surgery prolongs life for years."
}
}
]
},
{
"keys": [
"epilepsy",
"lobectomy",
"hippocampectomy",
"neurosurgery",
"focal cortical dysplasia",
"callosotomy"
],
"name": "Surgical treatment of epilepsy",
"modes": {
"professional": "Radical removal of the epileptogenic zone (temporal/frontal lobectomy, selective amygdalohippocampectomy) or disconnection of pathological neural networks (callosotomy). Stages: intraoperative EEG, corticography, neuronavigation, functional mapping. Control of the preservation of functional zones (speech, motor) is critical.",
"normal": "Surgery, which stops epileptic seizures. The surgeon removes or «disables» the area of the brain where the seizures originate. Most often, the temporal lobes are operated on."
},
"steps": [
{
"name": "Preoperative mapping",
"description": {
"professional": "Video-EEG monitoring (3-7 days), high-resolution MRI (3T), PET, functional MRI (speech/motor areas). Implantation of subdural grids or depth electrodes if the data do not match. Wada test to assess hemisphere dominance for speech.\nInstruments:\n- Stereotactic system (FrameLink, BrainLab)\n- Depth electrodes (DIXI Medical)\n- Intraoperative neurophysiological monitoring (Natus)\nTechnique:\n1. Accurate definition of the epileptogenic zone based on ictal/interictal EEG data.\n2. Tractorography to assess proximity to conduction pathways.\nLogistics:\n- Comparison of EEG, MRI, and clinical semiotics of seizures.\nNuance: In case of bilateral hippocampal damage — decision on sequential surgeries.",
"usual": "Before the surgery, the patient lives with electrodes on the head for a week to «catch» the seizure on the EEG. They do an MRI and speech tests.\n📌 Interesting point: sometimes electrodes are temporarily implanted in the brain to accurately determine the lesion."
}
},
{
"name": "Craniotomy and approach",
"description": {
"professional": "Positioning: on the side (with temporal approach) or on the back (frontal lobe). Fixation of the head in Mayfield. Arcuate skin incision (temporal approach: from the zygomatic arch to the parietal tubercle). Craniotomy 4x4 cm with preservation of the bone flap. Opening of the dura mater in the avascular zone.\nInstruments:\n- Pneumatic burr (Midas Rex with a 5 mm burr)\n- Double-pronged soft tissue hooks\n- Microscope (Zeiss OPMI Pentero)\nTechnique:\n1. For temporal lobectomy — access through the middle temporal gyrus.\n2. For frontal resection — bypass Broca's area.\nLogistics:\n- The bone flap is stored in warm saline with an antibiotic.\nNote: For callosotomy — parasagittal approach with preservation of the paracentral lobules.",
"normal": "The skull is opened above the problem area. In temporal lobe epilepsy, the incision goes from the temple to the crown.\n📌 Interesting point: the bone is always returned to its place - it takes root as if it were native."
}
},
{
"name": "Intraoperative EEG and corticography",
"description": {
"professional": "Application of electrodes to the cortex (subdural strips/grid). Recording of interictal activity. Direct electrical stimulation (1-5 mA) for mapping speech/motor zones. Marking of functionally significant areas with sterile markers.\nInstruments:\n- Cortical electrodes (Ad-Tech Medical)\n- Ojemann stimulator (Natus)\n- Neuronavigation with fMRI data integration\nTechnique:\n1. Stimulation with a step of 5 mm (frequency 50 Hz, duration 1 ms).\n2. Motor response control (face, arm, leg).\nLogistics:\n- Mapping of the Broca/Wernicke area in the dominant hemisphere.\nNote: Plasticity is possible in children under 5 years old - resection in the dominant hemisphere with caution.",
"normal": "The brain is «listened» to with electrodes and checked which areas are responsible for speech and movement.\n📌 An interesting point: during stimulation, the patient can start talking or moving their hand - this helps the surgeon not to touch important areas."
}
},
{
"name": "Resection of the epileptogenic zone",
"description": {
"professional": "**Temporal lobectomy**: removal of the anterior 3-4 cm of the temporal lobe (non-dominant hemisphere) or 2-3 cm (dominant). **Amygdalohippocampectomy**: transcortical approach through the middle temporal gyrus to the hippocampus. **Frontal resection**: neuronavigation-guided removal of cortical dysplasia.\nInstruments:\n- Ultrasonic aspirator (CUSA EXcel, 30% power)\n- Bipolar forceps (Malis, 10 W)\n- Rhoton microforceps #3\nTechnique:\n1. Gradual aspiration of the cortex while preserving white matter.\n2. In hippocampectomy — control of pial vessels (risk of brainstem damage).\nLogistics:\n- Samples are sent for histology (FCD I-III according to Blumcke).\nNuance: In mesial temporal sclerosis — mandatory hippocampal resection.",
"normal": "The surgeon removes the area of the brain where seizures originate. In temporal epilepsy, this is the tip of the temporal lobe and the hippocampus (it looks like a seahorse).\n📌 Hard fact: the hippocampus is «memory», but after its removal the patient forgets only the last 1-2 years."
}
},
{
"name": "Callosotomy (in generalized epilepsy)",
"description": {
"professional": "Dissection of the corpus callosum (anterior 2/3 in tonic-clonic seizures or 100% in Lennox-Gastaut syndrome). Access through the interhemispheric fissure. Step-by-step coagulation and incision with microscissors. Control of the safety of the pericallosal arteries.\nInstruments:\n- Microscope with ×20-40 magnification\n- Yasargil microscissors\n- Bipolar coagulation (15 W)\nTechnique:\n1. Separation of the hemispheres with a blunt retractor.\n2. Gradual dissection of the corpus callosum fibers.\nLogistics:\n- Intraoperative ultrasound to control the depth.\nNuance: In case of Lennox-Gastaut syndrome — additional subpial resection.",
"normal": "The «bridge» between the hemispheres of the brain is cut so that the seizures do not spread.\n📌 Interesting point: after this operation, the patient can write with his left hand without realizing it («alien hand» syndrome)."
}
},
{
"name": "Completion and postoperative control",
"description": {
"professional": "Repeat intraoperative EEG to assess epileptiform activity. Hermetic suturing of the dura mater (Prolene 4-0). Fixation of the bone flap with titanium plates. Subdural space drainage (Redon 10 Fr drainage).\nInstruments:\n- Titanium plates (1.0 mm)\n- Drainage with active aspiration\n- Vicryl 2-0 suture material\nPostoperative protocol:\n1. Video-EEG monitoring 24-48 hours.\n2. MRI after 72 hours to assess radicality.\n3. Gradual withdrawal of antiepileptic drugs (after 6-12 months).\nComplications:\n- Hemianopsia (with resection of the occipital lobe).\n- Transient aphasia (10-15%).\n- Hydrocephalus (rare).",
"normal": "The wound is sutured, the patient is transferred to the ward. The attacks may disappear immediately or after several months.\n📌 Good news: 70% of patients live without attacks after surgery!"
}
}
]
},
{
"keys": [
"microdiscectomy",
"herniated disc",
"lumbar",
"neurosurgery",
"nerve decompression"
],
"name": "Lumbar microdiscectomy",
"modes": {
"professional": "Microsurgical removal of a herniated disc with decompression of the spinal nerve root. Stages: paramedian approach, hemilaminectomy, foraminotomy, removal of a herniated disc under the control of an operating microscope. Control of the integrity of the dural sac and the nerve root is critical.",
"normal": "An operation that removes the «pinching» of a nerve due to a herniated disc in the lumbar region. The surgeon removes the hernia through a small incision, and the leg pain goes away almost immediately."
},
"steps": [
{
"name": "Positioning and marking",
"description": {
"professional": "The patient is positioned on his stomach with a bend in the lumbar region (the «knees-chest» position). Skin marking based on intraoperative fluoroscopy data: projection of the affected segment (usually L4-L5 or L5-S1). Treatment of the surgical field. Infiltration anesthesia (1% lidocaine with adrenaline).\nInstruments:\n- X-ray C-arm\n- 22G spinal needles\n- Surgical marker\nTechnique:\n1. Determining the level using an X-ray (control by the iliac crest).\n2. Marking a 3-4 cm long incision 1.5 cm from the midline.\nLogistics:\n- Checking the level of anesthesia before the incision.\nNuance: In case of obesity (BMI> 35) — increasing the incision length to 5 cm.",
"normal": "The patient is placed on his stomach, with a pillow under the lower back. The sore spot is marked with an X-ray and the incision line is drawn.\n📌 Interesting point: the incision is so small that the scar is almost invisible!"
}
},
{
"name": "Access to the spine",
"description": {
"professional": "Incision of the skin, subcutaneous tissue and lumbosacral fascia. Blunt separation of the muscles (multifidus and longissimus) using dilators. Installation of a tubular retractor (e.g. METRx). Hemilaminectomy with Kerrison nippers (size 2-3 mm) with exposure of the yellow ligament.\nInstruments:\n- Tubular retractor (diameter 18-20 mm)\n- Kerrison nippers (1-3 mm)\n- Electrocoagulator (Valleylab, 20 W)\nTechnique:\n1. Bipolar coagulation of epidural veins.\n2. Resection of the lower edge of the overlying vertebral arch.\nLogistics:\n- Bone fragments are disposed of as biological waste.\nNuance: In case of facet joint hypertrophy — partial facetectomy.",
"normal": "Through the incision, the surgeon moves the muscles apart like curtains and gets to the vertebra. Using special «nippers» he removes part of the bone to see the nerve.\n📌 Interesting point: the muscles are not cut - they are simply moved aside, so the recovery is fast."
}
},
{
"name": "Disc herniation removal",
"description": {
"professional": "Excision of the yellow ligament (ligamentotomy). Identification of the dural sac and root. Mobilization of the root medially (in case of medial hernia) or laterally (in case of foraminal hernia). Discectomy with a microcoagulator and pulp forceps. Hemostasis control with a bipolar.\nInstruments:\n- Microsurgical forceps (Pituitary rongeurs)\n- Penfield dissector No. 4\n- Binocular microscope (magnification ×10-16)\nTechnique:\n1. Incision of the fibrous ring with a scalpel No. 11.\n2. Removal of hernial material and degenerative nucleus pulposus.\n3. Revision of the spinal canal for sequesters.\nLogistics:\n- The removed material is sent for histology.\nNuance: In the case of a massive adhesive process, a dural protector is used.",
"normal": "The surgeon finds the nerve and carefully moves it to the side. The hernia is pulled out with small forceps, like a splinter.\n📌 Interesting point: the hernia looks like on a piece of chewing gum — soft and sticky."
}
},
{
"name": "Root decompression and control",
"description": {
"professional": "Checking the freedom of the root with passive movements. Foraminotomy for stenosis of the intervertebral foramen (with Kerrison pliers 1 mm). Washing the wound with sterile saline. Installation of a hemostatic sponge (Surgicel). Intraoperative test for segment stability (if instability is suspected — transpedicular fixation).\nInstruments:\n- Nerve hook\n- Irrigator with warm saline\n- Hemostatic sponge (Gelfoam)\nTechnique:\n1. Palpation of the root with a hook — it should move freely.\n2. Checking for the absence of disc fragments in the epidural space.\nLogistics:\n- Fixation of the retractor by an assistant during revision.\nNuance: In case of recurrent hernias — use of adgeolysis (hyaluronidase).",
"normal": "The surgeon checks that the nerve lies freely in its «bed». If necessary, he widens the opening through which the nerve exits the spine.\n📌 An interesting point: after releasing the nerve, the patient immediately feels that the pain goes away."
}
},
{
"name": "Completion of the operation",
"description": {
"professional": "Removal of the retractor. Layer-by-layer suturing of the wound: fascia (Vicryl 2-0), subcutaneous tissue (Vicryl 3-0), skin (monofilament 4-0). Application of a sterile dressing. Extubation and transfer to the ward.\nInstruments:\n- Mathieu needle holder\n- Suture material (absorbable/non-absorbable)\n- Sterile wipes\nPostoperative protocol:\n1. Activation after 2-3 hours.\n2. Pain relief (paracetamol + NSAIDs).\n3. Discharge on the 2-3 day.\nComplications:\n- Liquorrhea (1-2%).\n- Hernia recurrence (5-10%).\n- Root injury (0.5%).",
"normal": "The muscles are returned to their place, the incision is sutured. After a couple of hours, the patient can already get up.\n📌 Good news: 90% of patients forget about leg pain immediately after surgery!"
}
}
]
},
{
"keys": [
"laminectomy",
"spinal stenosis",
"spinal decompression",
"neurosurgery",
"spinal surgery"
],
"name": "Laminectomy",
"modes": {
"professional": "Surgical decompression of the spinal canal by removing the vertebral arch (lamina) and spinous process. Indications: spinal stenosis, spinal cord compression, tumors. Stages: access, resection of bone structures, decompression of the dural sac, stabilization (if necessary).",
"normal": "Surgery that widens the «narrow» spinal canal to release the compressed spinal cord and nerves. After this, the patient can walk again without pain."
},
"steps": [
{
"name": "Positioning and approach",
"description": {
"professional": "The patient is positioned on his stomach with a lumbar arch (knees-chest position). Skin markings according to fluoroscopy data: projection of the affected segments (usually L3-L5). A midline skin incision 8-10 cm long. Layer-by-layer dissection of the subcutaneous tissue and lumbosacral fascia.\nInstruments:\n- Scalpel No. 20\n- Electrocoagulator (Valleylab, 30 W)\n- Retractors (e.g., Taylor or Williams)\nTechnique:\n1. Midline incision from the spinous process of the overlying to the underlying vertebra.\n2. Detachment of paravertebral muscles from spinous processes and arches subperiosteally.\nLogistics:\n- Bleeding vessels are coagulated with bipolar.\nNuance: During cervical laminectomy - fixation of the head in Mayfield with slight flexion.",
"normal": "The patient is placed on his stomach, placing a cushion under the lower back. The surgeon makes an incision along the spine and carefully moves the muscles to the sides.\n📌 Interesting point: the muscles are not cut - they are «peeled off» from the bone, like the peel of an orange."
}
},
{
"name": "Resection of bone structures",
"description": {
"professional": "Removal of spinous processes with Liston nippers. Resection of the lamina with a high-speed burr (e.g. Midas Rex with a 4 mm burr) or Kerrison rongeurs (size 2-3 mm). Control of the integrity of the dural sac. Facetectomy if necessary.\nInstruments:\n- Liston rongeurs\n- Pneumatic rongeur (Midas Rex)\n- Kerrison rongeurs (2-3 mm)\nTechnique:\n1. Initial resection at the base of the spinous process.\n2. Gradual removal of the lamina from the caudal to the cranial direction.\n3. Control of the resection depth to avoid damaging the dural sac.\nLogistics:\n- Bone fragments are preserved for possible plastic surgery.\nNuance: In case of hypertrophy of the facet joints - partial resection of the medial sections.",
"normal": "The surgeon removes the bone «wings» of the vertebrae (spinous processes and arches) to make room for the spinal cord.\n📌 Interesting point: the bone is sometimes preserved - it can be used for plastic surgery."
}
},
{
"name": "Decompression of the dural sac and roots",
"description": {
"professional": "Excision of the yellow ligament (ligamentotomy). Microsurgical decompression roots: dissection of adhesions, removal of osteophytes. Revision of the spinal canal for disc herniation or tumors. Washing the wound with warm saline.\nInstruments:\n- Microforceps (Pituitary rongeurs)\n- Penfield dissector No. 4\n- Binocular loupe (×3.5)\nTechnique:\n1. Careful separation of the yellow ligament from the dural sac.\n2. Blunt mobilization of the roots.\n3. Removal of compressive factors (osteophytes, hernias).\nLogistics:\n- Hemostasis of epidural veins with bipolar (15 W).\nNuance: In case of pronounced adhesions — use of dural protector.",
"normal": "The surgeon releases the spinal cord and nerves, removing everything that compresses them: ligaments, bone spurs (osteophytes), hernias.\n📌 Important: nerves are as delicate as live wires — they are easy to damage!"
}
},
{
"name": "Stabilization (if necessary)",
"description": {
"professional": "In case of segment instability or multiple resections — transpedicular fixation (CD Horizon system or similar). Installation of titanium screws in the vertebral pedicles and their connection with rods. Decortication of the remaining bone structures to stimulate fusion.\nInstruments:\n- Transpedicular screws (diameter 5.5-6.5 mm)\n- Rods (diameter 5.5 mm)\n- X-ray C-arm to control the position of the screws\nTechnique:\n1. Screw insertion point: junction of superior articular process and transverse process.\n2. Insertion angle: 10-15° medially in the lumbar region.\n3. Depth control by X-ray.\nLogistics:\n- Checking the position of the screws with intraoperative fluoroscopy.\nNuance: In case of osteoporosis, use cement screws.",
"normal": "If a lot of bone is removed, the spine is strengthened with titanium screws and rods.\n📌 Interesting point: the screws are screwed into the «pedicles» of the vertebrae - these are the strongest places."
}
},
{
"name": "Completion of the operation",
"description": {
"professional": "Hemostasis (Surgicel, bone wax). Installation of drainage (Redon 10 Fr). Layered suturing of the wound: fascia (Vicryl 2-0), subcutaneous tissue (Vicryl 3-0), skin (monofilament 4-0). Application of a sterile dressing.\nInstruments:\n- Drainage with active aspiration\n- Mathieu needle holder\n- Suture material\nPostoperative protocol:\n1. Activation after 6-12 hours.\n2. Pain relief (NSAIDs + weak opioids).\n3. Wearing a corset for 4-6 weeks (with fixation).\nComplications:\n- Cerebrospinal fluid leakage (1-3%).\n- Segment instability (5-10%).\n- Infection (1-2%).",
"normal": "The wound is sutured, leaving drainage for 1-2 days. The patient can get up after a few hours.\n📌 Good news: 80% of patients report a decrease in leg pain immediately after surgery!"
}
}
]
},
{
"keys": [
"spondylodesis",
"spinal fusion",
"spinal stabilization",
"interbody corporodesis",
"TLIF",
"PLIF"
],
"name": "Spinal fusion",
"modes": {
"professional": "Surgical stabilization of the spinal segment with the creation of a bone block. Methods: PLIF (posterior), TLIF (transforaminal), ALIF (anterior). Stages: discectomy, installation of a cage with a bone graft, transpedicular fixation. The angle of cage installation and the compression force are critical.",
"normal": "An operation that «fuse[s]» diseased vertebrae into a single block using metal structures and a bone graft. After this, the spine stops «walking» and hurting."
},
"steps": [
{
"name": "Access to the spine",
"description": {
"professional": "**Posterior approach (TLIF/PLIF)**: Midline incision 8-12 cm. Subperiosteal detachment of the paravertebral muscles to the facet joints. Resection of the spinous process and vertebral arch (if necessary). **Anterior approach (ALIF)**: Incision along the left rectus abdominis muscle. Retroperitoneal approach to the spine with vascular mobilization.\nInstruments:\n- Electrocoagulator (Force Triad, 30 W)\n- Bone raspators (Cobb, Hohmann)\n- Retractor (e.g. Williams for posterior approach)\nTechnique:\n1. For TLIF — partial facetectomy to access the disc.\n2. For ALIF — identification of the aortic bifurcation and iliac vessels.\nLogistics:\n- Marking the surgical level with a C-arm X-ray.\nNote: For ALIF in men — risk of retrograde ejaculation (damage to the superior hypogastric plexus).",
"normal": "The surgeon makes an incision on the back (less often on the abdomen) and carefully moves the muscles aside to reach the vertebrae.\n📌 Interesting point: with anterior access, the intestine is temporarily moved aside - it then returns to its place!"
}
},
{
"name": "Discectomy and bed preparation",
"description": {
"professional": "Full discectomy with pulp forceps. Resection of the endplates with a burr (for example, Midas Rex with a ball attachment) to the bleeding bone (puncture bleeding). Washing the disc space with antibiotic-saline. Measuring the depth and height of the bed.\nInstruments:\n- Disc forceps (Pituitary rongeurs)\n- Burr with a 5 mm ball attachment\n- Calibration probes (in 1 mm increments)\nTechnique:\n1. Removal of the disc up to the fibrous ring along the perimeter.\n2. Decortication of the endplates without destroying the cortical layer.\n3. Formation of grooves for the cage (with TLIF).\nLogistics:\n- The removed disc is sent for histology.\nNuance: In osteoporosis - minimal resection of the endplates.",
"normal": "The surgeon removes the damaged disc between the vertebrae and clears the space down to the «bleeding» bone - this is necessary for better fusion.\n📌 Important: the space is measured like a tailor - so that the cage (implant) fits perfectly."
}
},
{
"name": "Installation of a cage and bone graft",
"description": {
"professional": "Implantation of a cage (PEEK, titanium or ceramics) with bone chips (autograft from the iliac crest or allograft). In TLIF - installation of the cage at an angle of 45° through the foraminal window. Compression of the cage during fixation with rods.\nInstruments:\n- Cage (dimensions 8-14 mm high, 22-30 mm long)\n- Implant holder\n- Mallet for final seating\nTechnique:\n1. Filling the cage with bone chips (mixed with BMP-2 if necessary).\n2. Control of the cage position with an X-ray (should not protrude beyond the disc).\n3. With TLIF — cage rotation in the frontal plane to restore lordosis.\nLogistics:\n- The remaining chips are placed in the side pockets.\nNuance: With ALIF — use of cages with a large lordosis angle (10-15°).",
"normal": "A «cage» with bone chips is placed in the cleared space. Over time, the chips grow together into a single block.\n📌 Interesting point: bone chips can be taken from the patient's pelvis — there they are like a «spare part»."
}
},
{
"name": "Transpedicular fixation",
"description": {
"professional": "Installation of screws into the vertebral pedicles (diameter 5.5-7.5 mm). Position control with a C-arm: the screw must pass through the pedicle without going beyond it. Installation of rods (diameter 5.5-6.5 mm) with compression. Fixation with contrast agents.\nInstruments:\n- Pedicle probes (gearshift)\n- Stylet for thread cutting\n- Torque wrench (1.5-2 Nm)\nTechnique:\n1. Entry point: junction of transverse process and superior articular process.\n2. Insertion angle: 5-10° medially in the lumbar region.\n3. Depth: 80% of the pedicle length on the x-ray.\nLogistics:\n- Screw stability test (no «toggle»).\nNuance: In osteoporosis - cement augmentation (PMMA).",
"normal": "The vertebrae are fastened with titanium screws and rods - like scaffolding.\n📌 Important: screws are screwed into the strongest parts of the vertebra — the pedicles."
}
},
{
"name": "Decortical fusion and additions",
"description": {
"professional": "Decortical fusion of the remaining bone structures (arches, transverse processes) with a burr to stimulate fusion. Placing bone chips in the lateral grooves. If necessary, installing an interspinous stabilizer (e.g. Coflex).\nInstruments:\n- High-speed burr (Anspach)\n- Bone forceps (Leksell)\n- Bone cement syringe (for osteoporosis)\nTechnique:\n1. Removing the cortical layer down to the spongy bone.\n2. Formation of a «bed» for the shavings between the transverse processes.\nLogistics:\n- The shavings are mixed with a collagen sponge (for fixation).\nNuance: With PLIF, the installation of interbody cages is mandatory paramedian.",
"normal": "The surgeon «scratches» the bone around to stimulate the growth of new tissue. Everything is sprinkled with bone shavings - like a fertilizer for fusion.\n📌 Interesting point: sometimes an additional «spring» is placed between the spinous processes for unloading."
}
},
{
"name": "Completion",
"description": {
"professional": "Hemostasis (Surgicel, Floseal). Drainage installation (2 drains with ALIF). Layered suturing: fascia (Vicryl 0), subcutaneous tissue (Vicryl 2-0), skin (monofilament 3-0). Application of a sterile dressing.\nInstruments:\n- Jackson-Pratt drain (10 Fr)\n- Mathieu needle holder\n- Absorbable suture material\nPostoperative protocol:\n1. Corset (TLSO) for 3 months.\n2. Limitation of twisting/bending for 6 weeks.\n3. CT control after 3/6/12 months.\nComplications:\n- Pseudoarthrosis (5-15%).\n- Cage migration (3%).\n- Neighboring segment syndrome (10% over 5 years).",
"normal": "The wound is sutured, leaving drains. After 1-2 days, the patient gets up in a corset.\n📌 Good news: titanium structures last a lifetime - they do not need to be replaced!"
}
}
]
},
{
"keys": [
"intracranial hematoma",
"epidural hematoma",
"subdural hematoma",
"intracerebral hemorrhage",
"decompressive trepanation",
"emergency neurosurgery"
],
"name": "Removal of intracranial hematoma",
"modes": {
"professional": "Emergency surgical intervention to evacuate blood accumulation in the cranial cavity with brain decompression. Options: resection trepanation for intracerebral hematomas, osteoplastic trepanation for epi-/subdural hematomas. Critical control of the bleeding source (meningeal vessels, parenchymal arteries) and assessment of the dislocation of brain structures is precise.",
"normal": "Urgent surgery to remove a blood clot from the skull after trauma or stroke. The surgeon removes the blood clot that is pressing on the brain, saving the patient's life."
},
"steps": [
{
"name": "Emergency diagnostics and preparation",
"description": {
"professional": "CT of the head without contrast (determination of the type of hematoma, volume, displacement of midline structures). Preparation of the operating room: neurosurgical kit, oscillatory saw, autotransfusion kit. Intubation, mechanical ventilation, correction of coagulopathy (vitamin K, FFP if INR> 1.5). Patient position depending on location: supine (frontal hematomas), lateral (temporal).\nInstruments:\n- Perfusion apparatus (Cell Saver)\n- Neuronavigation (for elective cases)\n- Emergency craniotomy kit\nTechnique:\n1. Volume calculation using the ABC/2 formula (for intracerebral).\n2. Hematoma projection marking using CT slices.\n3. ICP monitoring (mannitol 1 g/kg for signs of dislocation).\nLogistics:\n- Simultaneous preparation of two surgical teams for bilateral hematomas.\nNote: For a subdural hematoma with a thickness of >10 mm - emergency surgery within 4 hours.",
"normal": "The patient is immediately taken to a CT scan - the image will show where the blood has accumulated. In the operating room, instruments are prepared while the patient is anesthetized.\n📌 Life fact: with an epidural hematoma, every minute counts - the «golden hour» for surgery."
}
},
{
"name": "Decompressive trepanation",
"description": {
"professional": "Linear skin incision (for epidural - above the injured artery, for subdural - a large arcuate one). Burr hole with a trepanner (1 cm below the lower edge of the hematoma). Expansion of the trepanation window to 5x5 cm with Kerrison nippers. For intracerebral hematoma - resection trepanation with removal of the bone flap.\nInstruments:\n- Oscillating saw (Anspach)\n- Kerrison nippers (3-5 mm)\n- Arc cutter (for bone flaps)\nTechnique:\n1. In case of epidural hematoma - the first opening is above the site of the artery rupture (usually the middle meningeal).\n2. In case of subdural - trepanation at the point of maximum clot thickness.\n3. In case of intracerebral - trepanation above the projection of the hematoma + 2 cm.\nLogistics:\n- The bone flap during resection is stored in an antibiotic solution.\nNuance: In case of severe cerebral edema - the trepanation window is widened to 10 cm.",
"normal": "The surgeon cuts a «window» in the skull directly above the blood clot. In urgent operations, the bone may not be put back so that the brain can swell.\n📌 Important: the size of the hole is like the palm of an adult."
}
},