Introduction to minor office surgery and technology

Assisting with surgical procedures

Common surgical procedures that are routinely performed in the primary care facility include suturing, cyst removal, incision and drainage (I&D) of abscesses, and collection of biopsy specimens. The medical assistant should be proficient in the following skills:

• Explaining each of these procedures to the patient
• Preparing the patient and the room
• Assisting the provider with the surgery
• Applying a sterile dressing and bandage after the procedure is finished

Each surgical procedure requires appropriate skin preparation and draping with a fenestrated drape. This is a surgical drape with an opening in the center. The size of the opening depends on the size of the surgical field. The opening is placed directly over the surgical site after the site has been prepared (or “prepped,” as it is called in healthcare practice). A minor surgery tray is opened, and a sterile field is created on a Mayo stand. Sutures, scalpels, and any other instruments needed are added to the field according to the provider’s preference. An injectable or a spray local anesthetic should also be ready for the provider’s use, with the needed injection supplies.

After achieving suitable local anesthesia, the provider opens the skin with an incision. If a cyst is being removed, the provider dissects around it and usually tries to “deliver” it from the wound intact. If the procedure is an I&D, foul matter will start oozing from the wound immediately after the skin is incised. The wound is drained completely and flushed with copious amounts of sterile saline solution. If the procedure is a biopsy, a small amount of tissue or fluid is removed and placed in a specimen container with preservative. The specimen container must be carefully labeled with the appropriate patient information, the date, and specifics about the specimen type and location. It is then sent to the laboratory, where it is examined microscopically for changes or abnormalities.

Surgical procedures

As a medical assistant helping with minor surgical procedures, it is important for you to have an understanding of the basic types of procedures performed in the ambulatory care setting. With that understanding, you will be able to help the provider give the patient the best possible care. The following sections examine those basic types of procedures.

Electrosurgery

Electrosurgery is also known as electrocautery. An electrosurgical unit (ESU) uses high-frequency current to cut through tissue and coagulate blood vessels. A small probe with an electric current running through it is used to cauterize (i.e., burn or destroy) the tissue. This process seals blood vessels, minimizing cellular oozing and bleeding. Electrosurgery may be used to destroy granulations and small polyps or take a tissue sample for pathology examination. The loop electrosurgical excision procedure (LEEP) uses a wire loop heated by an electric current to remove cells and tissue as part of the diagnosis and treatment of abnormal or cancerous conditions of the uterine cervix.

Necessary components are the ESU’s power source, the grounding cable and pad, and the active electrode (i.e., a pencil-like instrument with a tip and cord). The grounding pad is a gel-covered adhesive electrode that provides a safe return path for the electrosurgical current. Electrode tips are disposable and are used according to the type of procedure performed. The two most commonly used tips are the needle and flat designs.

Important tips about the grounding pad

• Carefully inspect the pad, cable, and skin before the procedure.
• Place the pad close to the operative site.
• The pad must be tight against the patient’s skin.
• Apply the pad to a fleshy area, such as the thigh.
• Do not place the pad over a bony area.
• Do not place the pad over body hair.
• Do not place the pad over metal implants or a pacemaker.
• Carefully inspect the pad site on the skin after the procedure for signs of burns.

Holding the pencil-like instrument, the provider touches the tissue with the tip and activates the electric current with a switch on the instrument. The electric current is delivered to the tissues, and tissue is vaporized at the site of contact, or a specimen can be removed for pathology.

Laser surgery

Laser is an acronym for light amplification by stimulated emission of radiation. Because a laser beam is so small and precise, it can be used to safely treat specific tissue with minimal damage to surrounding tissues and limited scar formation. Lasers were first used in medicine to treat diseases of the retina, and they now are used for many procedures:

• Excision of lesions
• Cauterization of blood vessels
• Removal of warts or moles
• Cosmetic surgical procedures

Several types of lasers are used, including the carbon dioxide, yttrium-aluminum-garnet (YAG), and pulsed dye lasers. Each laser has a specific use. The color of the laser light beam is directly related to the type of surgery performed.

A medical assistant must be specially trained in lasers before assisting with laser surgery. Laser equipment requires careful handling, care, and maintenance. Laser light destroys tissue and can harm the patient, the provider, and you if handled improperly. The medical assistant should complete a full laser safety program before assisting in laser procedures. Once trained, the medical assistant’s role during laser surgery includes a number of duties:

• Protecting the patient’s eyes from the potential damaging light of the laser
• Observing the surgical field through safety goggles for possible contamination
• Keeping wet sponges ready
• Removing any flammable items from the laser’s path
• Assisting with suctioning of the plume to maintain a clear visual field
• Providing a basin of sterile normal saline solution and a filled irrigating syringe
• Watching each application of the laser beam and anticipating the need for protective supplies, special equipment, or instruments

Microsurgery

Microsurgery involves the use of an operating microscope to perform delicate surgical procedures. One of its major uses is in ophthalmologic surgery. It also is used in otologic, rhinologic and sinus, laryngologic, neurosurgical, microvascular, gynecologic, and genitourinary procedures. A medical assistant must acquire a basic knowledge of the operation and care of a microscope before becoming qualified to assist in these types of procedures.

Flexible colonoscope with monitor and video recorder. Courtesy Omnia Health.

The basic components of an operating microscope are the light source, eyepieces (also called the oculars), lenses, and cord. Accessory pieces include assistant and observer lenses, cameras, video recorders, television monitors, and printers. These are all valuable for documentation and teaching purposes. Disposable sterile drapes and handle covers are used on the microscope during surgical procedures.

Surgical microscopes are expensive, delicate instruments that require extreme care in handling and cleaning. All lenses and cords should be carefully inspected before and after each use.