2-1. INTRODUCTION

a. Discussion. The OR specialist should be familiar with surgical nomenclature, the terminology used in the OR. Knowledge of nomenclature enables the specialist to understand the surgery being performed so that he may prepare for it adequately and assist the surgeon efficiently. Word combinations are used frequently to identify different parts of the body, various disease conditions, or specific operative procedures.

Terms used to designate certain operative procedures may be derived from either the name of the surgeon who originally developed the technique or from the anatomical area involved. The terms defined in the following paragraphs (2-1 through 2-11) are intended to supplement the OR specialist’s knowledge of medical vocabulary. The specialist can further enhance his understanding of the terminology pertaining to surgical procedures by the use of a standard medical dictionary.

b. Objectives of Surgery. Surgery is usually performed in order to accomplish one of three objectives–to alleviate pain, to cure by removing diseased organs, or to repair or reconstruct a part. The surgical procedures themselves may be classified as follows:

(1) Palliative. A surgical procedure that is intended to relieve pain rather than cure the disease.

(2) Curative. A surgical procedure in which the diseased organ is removed.

(3) Plastic. A surgical procedure in which the part is repaired or reconstructed.

(4) Diagnostic. A surgical procedure for the purpose of diagnosing.

2-2. TERMS PERTAINING TO OPERATIVE PROCEDURES

a. Classification of Operations. Surgical operations can be classified according to the type of procedure, as follows:

(1) Incision.

(2) Excision.

(3) Amputation.

(4) Introduction.

(5) Endoscopy.

(6) Repair.

(7) Destruction.

(8) Suturing.

(9) Manipulation.

b. Discussion. The following paragraphs give suffixes as well as complete phrases, words, and synonymous terms descriptive of operative procedures in the above classifications ((1)-(9)). In addition, examples of kinds of operations in each category are given, though these are not all inclusive. However, with this basic information, the specialist can further enhance his understanding of surgical terminology through the use of a standard medical dictionary.

2-3. INCISION PROCEDURES

a. Discussion. Incision is a cutting into, a formation of an opening. The suffixes commonly used for operations classified as incisions are:

(1) -(o)tomy–to cut into.

(2) -(o)stomy–to provide with an opening.

(3) -centesis–puncture or perforation.

b. Otomy Procedures. Otomy procedures, with examples, include the following:

(1) Exploratory operation.

Laparotomy–cutting into the peritoneal cavity for exploratory purposes.

(2) Removal of foreign bodies.

(a) Accidental.

Sclerotomy–removal of a foreign body from the eye.

(b) Therapeutic.

Arthrotomy–removal of a surgical nail, pin, screw, and so forth, from a joint.

(c) Pathological.

Nephrolithotomy–removal of kidney stones.

(3) Division of a structure.

Myotomy–cutting or dissection of a muscle; also neurotomy, tenotomy.

(4) Decompression.

Craniotomy–cutting into the skull for relief of pressure on the brain.

c. Ostomy Procedures. Ostomy procedures, with examples, include the following:

(1) Surgical creation of an artificial passageway.

Gastrostomy–an artificial passageway through the abdominal wall to the stomach.

(2) Formation of an artificial opening.

Colostomy–formation of an opening in the abdominal wall for exteriorization of the colon.

2-4. EXCISION PROCEDURES

a. Discussion. Excision is the cutting out of a part. The suffixes used to denote excision are as follows:

(1) –ectomy–to cut out or excise. Excisions are divided into two types–partial or subtotal excision (b, below) and complete or total excisions (c, below).

(2) –exeresis–to strip out. (Examples are discussed in d, below.)

b. Partial or Subtotal Excision.

(1) Resection.

Subtotal gastrectomy–excision of a part of the stomach.

(2) Biopsy.

Biopsy of lymph node–removal of a lymph node from a living person for examination.

(3) Curettage.

Curettage of uterus–the scooping out of retained material.

c. Complete or Total Excision.

(1) Radical excision.

Mastectomy, radical–removal of entire breast and axillary lymph nodes.

Chondrectomy–excision of cartilage.

(2) Obliteration (to efface).

Ligation of varicose veins–the lumen of the vein is closed.

(3) Extirpation (to “root out”).

Tonsillectomy.

(4) Enucleation.

Enucleation of eye–removal of an entire eyeball.

(5) Evisceration.

Evisceration of eye–removal of contents of an eyeball, leaving the sclera.

(6) Extraction (to draw out).

Extraction of lens–cataract.

d. Other.

(1) -exeresis. Removal by pulling out (stripping).

(2) Neuroexeresis–stripping out of a nerve.

2-5. AMPUTATION PROCEDURES

a. Discussion. Amputation is the cutting off of a part.

b. Terms Used. Suffixes are not required to denote procedures used for amputation. The terminology used is as follows:

(1) Disarticulation of leg–amputation at knee joint.

(2) Dismemberment of toe–amputation through a metatarsal.

(3) Amputation of leg–amputation through tibia or fibula.

2-6. INTRODUCTION PROCEDURES

a. Discussion. Introduction is the placement of a substance into the body.

b. Terms Used. Suffixes are not required to indicate operations involving introduction procedures. The following terms are used:

(1) Injection–the forcing of a material such as radiopaque dye, oil, alcohol, air, etc., into a part of the body is classified as an operative procedure.

(2) Transfusion–the introduction of whole blood or its derivatives (plasma, serum albumin) directly into the bloodstream.

(3) Implantation–the placement of a prosthetic device into the orbit following enucleation of an eyeball (for example–a plastic implant). Also, the fixation of a portion of tissue such as skin, nerve, tendon, or bone into a new site in the body. Such portions of tissue are called grafts and operations for the implantation of grafts are classified as plastic procedures (see para 2-8b(1)).

(4) Insertions–the introduction of materials such as radium (or other radioactive substance), packs, tampons, drains, and so forth, into the body.

c. Procedures.

(1) Injection.

(a) Ventriculography–x-ray of the head following the removal of cerebral fluid from the ventricles and its replacement by air (or other contrast medium).

(b) Arteriography, cerebral–x-ray of the arteries of the brain following injection of a dye (radiopaque material) into the bloodstream.

(c) Myelography–x-ray of the spinal cord following injection of a contrast medium into the spinal canal.

(d) Injection into the nerve–95 percent alcohol or other substance may be injected into a nerve to relieve pain in the part of the body supplied by the nerve.

(2) Transfusion.

(a) Blood transfusion, indirect–administration of whole blood that has been withdrawn from a donor into a container, and kept refrigerated until ready for use.

(b) Plasma transfusion–the intravenous administration of blood plasma.

(3) Implantation.

Implantation of plastic prosthesis following enucleation of the eyeball.

(4) Insertion.

(a) Insertion of radioactive substance into the uterus–done as treatment for malignant tumor.

(b) Insertion, post-partum, of intrauterine pack–done to control post-partum hemorrhage.

2-7. ENDOSCOPY PROCEDURES

a. Discussion. Endoscopy is the inspection of a body cavity or a hollow viscus (organ) by the means of an endoscope.

b. Suffix. The suffix denoting endoscopy is -scopy. Endoscopic study may be performed on many parts of the body, including those listed in Table 2-1.

Procedure	Site
Anoscopy Bronchoscopy Cystoscopy Esophagoscopy Gastroscop Laryngoscopy Otoscopy Proctoscopy Rhinoscopy Thoracoscopy Tracheoscopy Urethroscopy	the anus. the bronchus. the urinary bladder. the esophagus. the stomach. the larynx. the ear. the rectum. the nose. the chest. the trachea. the urethra.

Table 2-1. Endoscopy procedures.

c. Combined Procedures. The surgeon may elect to combine endoscopy with one or more other surgical procedures–for example, he may perform bronchoscopy with removal of a foreign body or cystoscopy with drainage. Operative procedures that may be done in combination with endoscopic procedures are as follows:

(1) Biopsy.

(2) Dilation.

(3) Drainage.

(4) Excision.

(5) Injection.

(6) Irrigation.

(7) Removal.

2-8. REPAIR PROCEDURES

a. Discussion. Repair is the reconstruction, reforming, fixation, or stabilization of a part. The suffixes used for plastic surgery procedures are as follows:

(1) -plasty–the shaping or surgical formation of a body part.

(2) -(o)stomy–to provide with an opening.

(3) -desis–the binding of a body part.

(4) -pexy–the fixation or suspension of a body part.

b. -Plasty.

(1) Graft.

(a) Skin graft–the implantation of a portion of skin onto a body part.

(b) Bone graft–the implantation of a piece of bone to replace a removed bone or bony defect.

(c) Cartilage graft–the implantation of a portion of cartilage into a body part.

(2) Lengthen or shorten–tendon (tenoplasty).

(a) Advancement–eye muscles.

(b) Recession–eye muscles.

(3) Attach or reattach

(a) –nerves (neuroplasty).

(b) –tendons (tenoplasty).

(4) Reconstruct

(a) –nose (rhinoplasty).

(b) –ear (otoplasty).

(c) –tongue (glossoplasty).

(d) –larynx (laryngoplasty).

(e) –joints (arthroplasty).

(f) –bones (osteoplasty).

(g) –inguinal hernia (hernioplasty).

c. -Ostomy. This suffix indicates a plastic surgery procedure when used to denote the joining together of two parts with the formation of a permanent opening between two spaces that are usually apart from each other. For example, if a portion of intestine is removed, the usual operative procedure is to anastomose the ends (to stitch the two cut ends together). Such a plastic operation is called an enterostomy. The specific parts of the gastrointestinal tract anastomosed are indicated by naming them (see example below). Anastomosis of large blood vessels may be performed also. (Other usage of the suffix -ostomy denotes surgical procedures classified as incisions (see para 2-3a(2),c).

(1) Anastomosis–formation of a communication between stomach and bowel or between any two organs or vessels.

(2) Gastroduodenostomy–anastomosis of the stomach to the duodenum.

(3) Ileocolostomy–anastomosis of the ileum (distal portion of small intestine) to the colon.

d. -Desis.

(1) Fusion.

(a) Spondylosyndesis–spinal fusion.

(b) Arthrodesis–fusion of a joint to produce ankylosis (immobility and consolidation of joint).

(2) Stabilization.

Tenodesis–suture of a tendon to a skeletal attachment.

e. -Pexy.

(1) Fixation.

(a) Nephropexy–fixation of a movable kidney; performed to correct nephroptosis (downward displacement of the kidney).

(b) Scapulopexy–fixation of the scapula.

(c) Splenopexy–fixation of the spleen.

(d) Colpopexy–fixation of a relaxed vagina to the abdominal wall.

(e) Orchiopexy–fixation into the scrotum of an undescended testicle.

(2) Suspension.

Hysteropexy–suspension of the uterus.

2-9. DESTRUCTION PROCEDURES

a. Discussion. These are surgical procedures that involve a breaking down of tissues.

b. Clasis. Fracture or refracture.

Osteoclasis–refracture of bone.

c. Tripsy. Crush.

Neurotripsy–crushing of a nerve.

d. Lysis. Free (from adhesions).

(1) Neurolysis–freeing of a nerve.

(2) Pericardiolysis–freeing of the pericardium.

e. Other Procedures.

(1) Cauterization (destruction of tissue with heat, electricity, or chemical action).

Cauterization of cut blood vessels to seal them off and prevent further bleeding.

(2) Fulguration (destruction of tissue with high-frequency electric sparks).

Destruction of a lesion (such as ulcerated tissue) of the head, neck, trunk, or the extremities by fulguration.

(3) Diathermy (heating of tissue with high-frequency electromagnetic radiation).

Cyclodiathermy–destruction of a portion of the ciliary body of the eye by diathermy; may be performed in the treatment of glaucoma (condition of the eye characterized by increased intraocular pressure).

(4) Debridement (removal of contamination, contaminated tissue, and unhealthy tissue).

Debridement–of a wound of the head, neck, trunk, or limbs.

2-10. SUTURING PROCEDURES

a. Discussion. Suturing operations are those in which tissue is approximated (brought together) and stitched using suture material (such as silk suture, surgical gut suture, wire suture, and so forth).

b. Suffix. The suffix used to denote suturing operations is -rrhaphy. Some examples of rrhaphy procedures are listed in Table 2-2.

2-11. MANIPULATION PROCEDURES

a. Discussion. Manipulative procedures are those in which a condition is corrected by handling and maneuvering the disordered part. Terms used to indicate such procedures are as follows:

(1) Dilatation–the enlargement of a part by the use of an instrument.

(2) Closed reduction–the alignment of a fractured bone without making an incision.

Procedure	Site
Capsulorrhaphy Myorrhaphy Tenorrhaphy Fasciorrhaphy Neurorrhaphy Blepharorrhaphy Glossorrhaphy Laryngorrhaphy Cardiorrhaphy Arteriorrhaphy Gastrorrhaphy Cystorrhaphy Herniorrhaphy Colporrhaphy Trachelorrhaphy	suturing of a joint capsule. suturing of muscle. suturing of a tendon. suturing of a fascia. suturing of a nerve. suturing of an eyelid. suturing of the tongue. suturing of the larynx. suturing of the heart. suturing of an artery. suturing of the stomach. suturing of the urinary bladder. repair of a hernia. suturing of the vagina. suturing of the uterine cervix

Table 2-2. Suturing procedures.

(3) Open reduction–the alignment of a fractured bone through an incision.

(4) Application–the putting of materials on the patient (sometimes this requires the maneuvering of a part, such as in the application of a plaster cast).

b. Procedure.

(1) Dilatation

–of esophagus.

–of anal sphincter.

–of urethra.

–of uterine cervix.

(2) Reduction.

(a) Open –open reduction of femur.

–open reduction of dislocated hip joint.

(b) Closed –closed reduction of humerus.

–closed reduction of dislocated ankle joint.

(3) Application–of plaster cast to right forearm.