1. Types of needles

2. Curved needles 1/2 of circle 3/8 of circle 5/8 of circle

3. Types of needles according to the threading Eyed Eyeless

4. Types of needles according to cut section Cutting needle Rounded needle

5. Control of 1ry hemorrhage

6. 1ry hemorrhage Place pack for 4 min

7. Hold the injured vessels by 2 artery forceps

8. 3 ligations 2 ligations Artery :high pressure Vein :low pressure

9. Adhesive tapes

10. Types of sutures

11. Simple stitches

12. Tension suture It takes muscles &peritoneum On tension of the suture

13. Continuance stitches

14. Lambert's suture

15. Mattress stitches

16. Chest drain

17. Position of the patient in the chest drain

18. Sit of the incision Mid axillary line Ant. Axillary line

19. Med. axillary line Ant. axillary line Points of drain

20. Lung Spread the muscle fibers by artery forceps to expose pleura

21. Pierce pleura and introduce finger to confirm entry to pleura

22. Guiding of the drain by your finger

23. Make sure that the incision is large enough to accommodate the drain + your finger Drain

24. Suture the drain with loss sutures to the skin Drain

25. Rib Drain Rib

26. Spleen

27. Normal spleen anatomy

28. Stomach Gastrosplenic lig. Ant.lienorenal lig Spleen Pancreas Kidney Post.lienorenal lig.

29. Gastro pherenic ligament Spleen Anterior lienorenal ligament Pancreas posterior lienorenal ligament

30. Gastropherenic ligament Ant. layer of lienorenal ligament Post. Layer of lienorenal ligament

31. splenectomy

32. Down displacement of the stomach

33. Insertion of hot packs behind spleen

34. Hot packs around spleen

35. Stomach (medially) Spleen (medially) Hot packs Divide the posterior layer of lienorenal ligament

36. Divide the posterior layer of lienorenal ligament Traction of the spleen medially

37. Divide the gastrosplenic ligament

38. Divide the gastrosplenic ligament

39. Divide the anterior layer of the lienorenal ligament

40. Ant. Lienorenal lig. Pancreas Splenic artery Spleen Pos. lienorenal lig.

41. Squeeze the spleen Divide splenic vein

42. Problems

43. Multiple splenic adhesions

44. Rectum and anal canal

45. Rectum Anal canal Overall view of the rectum and anal canal

46. Anatomy of rectum and anal canal Rectum Anal canal Dentate line External sph. Internal sph.

47. Superior rectal vein Internal plexus of veins External anal sphincter Anal canal Internal anal sphincter Anatomical anal canal structure

48. Anal Fistula

49. Internal opening of the fistula External opening of the fistula The track of the fistula

50. Insertion of probe Probe