Minor OR/Surgery
I. DEFINITION OF MINOR SURGERY
Minor surgery is defined as a set of procedures in which short surgical techniques are applied on
superficial tissues. Local anesthesia is often required for these procedures and their complication
rate as well as the risk involved is low. Lesions and problems requiring these procedures for
diagnostic or therapeutical reasons are frequently seen by general practitioners both in the
outpatient setting (excision of skin lesions, for instance) as well as in the emergency care setting
(wound suturing, for example).
II. DIFFERENCE BETWEEN MAJOR AND MINOR SURGERY:
A. Major Surgery
More extensive resection is done
Cause damage to the tissues
A high risk of infection
Extended recovery period
B. Minor Surgery
Small incisions are made
No extensive damage to the tissues
The risk of infection is low
Recovery time is shorter
III. EXAMPLES OF A MINOR SURGERY:
1. Cataract surgery
2. Dental restorations
3. Circumcision
4. Breast biopsy
5. Arthroscopy
6. Laparoscopy
7. Burn excision and debridement procedures
IV. COMMON POST-OP DISCOMFORTS OF MINOR SURGERY:
1. Nausea and vomiting from general anesthesia
2. Sore throat caused by the tube placed in the windpipe for breathing during surgery
3. Soreness, pain, and swelling around the incision site
4. Restlessness and sleeplessness
5. Thirst
6. Constipation and gas
V. TWO CATEGORIES OF THE O.R. TEAM BASED ON ITS MEMBER’S RESPONSIBILITIES
A. Scrubbed sterile team:
Scrub their hands and arms
Don sterile gowns and gloves
Maintain sterility
Work in the sterile field
Members of this team consist of:
o Surgeon
o Assistant surgeon
o Scrub nurse
B. Non-scrubbed sterile team:
Non-sterile surgical team function outside the sterile field
Responsible for ensuring patient safety
Positioning the patient
Monitoring the patient
Maintaining sterile technique
Handling non-sterile supplies and equipment
Providing items for the sterile team
Members of the non-sterile team include:
o Circulating nurse
o Anesthesiologist/anesthetist
o Other allied personnel
VI. KEY MEMBERS OF THE SURGICAL TEAM
A. Primary Surgeon and Assistants
Is responsible for determining the preoperative diagnosis, identifying and performing the
appropriate surgical procedure to the patient, obtaining informed patient consent for surgical
procedure, identifying and making the surgical site, and managing postoperative care.
Surgeon’s assistant is responsible for exposing the surgical site, providing hemostasis to
prevent blood from obstructing the anatomy, and assisting with suturing throughout the
operative procedure.
B. Anesthesiologist/Anesthetist
i. Anesthesiologist - is a physician who is trained in the administration of
anesthetics.
ii. Anesthetist – is a registered professional nurse who is trained to administer
anesthetics.
Responsibilities:
o Anesthetizing the patient
o Providing appropriate level of pain relief for the patient
o Monitoring the patient’s physiologic status
o Providing the best operative conditions to the surgeon
C. Scrub Nurse
Prepares the setup and assists the surgeon by passing instruments, sutures, etc.
Responsibilities:
o Preparation of supplies and equipment on the sterile field
o Maintenance of patient safety and integrity of the sterile field
o Observation of the scrubbed team members for breaks in sterile technique
o Provision of appropriate sterile instrumentation, sutures, and supplies to the
operating surgeon
o Adherence to established policies and procedures for sponge, instrument, and sharp
counts
D. Circulating Nurse
Is an RN whose responsibility is to serve as the patient advocate while coordinating events
before, during, and after surgical procedure.
Responsibilities:
o Creating safe environment for the patient, managing the activities outside
the sterile field, and providing nursing to the patient.
o Enforcing the principle of aseptic technique.
o Recognizing and implementing actions to resolve possible environmental
hazards that involve the patient or surgical team members.
o Ensuring the sponge, instrument, and sharp counts are completed and
appropriately documented.
o Communicating relevant information to individuals outside of the OR,
such as family members and other health care members.
E. Other Personnel
A number of allied personnel that contribute to meeting the needs of the patient
Pathologist, radiologist, radiology technicians, perfusionist, environmental services personnel
and clerical staff.
VII. THE MINOR SURGERY ROOM
Minor surgical room is a well-ventilated, square or rectangular, 15-20 square-meter room is
necessary, with a suitable temperature and a good source of artificial light. It is imperative that it is
clean, but it does not require sterile isolation. The room must include:
1. Operating table
o This is in the center of the room.
o It can be raised, lowered, and titled in any direction.
2. Operating room lamps
o These allow for bright light without shadows during surgery.
3. Monitor screens
o The patient will be connected to various monitors. These keep tract the patient’s vital signs.
These include the heart rate, oxygen level, and blood pressure.
4. Ventilator
o This is a breathing machine.
o It stands by the head of the operating table.
5. Sterile instruments
o These are small tools to be used during surgery.
o They are arranged on a stainless steel table.
6. Video screen
o If the procedure is laparoscopic, there will be a video screen for the surgeon to be able to see the
area of the surgery.
7. Diathermy machine
o This is to control bleeding.
VIII. SURGICAL INSTRUMENTS FOR MINOR SURGERY
1. Scalpel
o It allows the surgeon to cut with precision through the skin and other tissues and is also
used for non-blunt dissection.
2. Scissors
o They are used both for cutting or sectioning tissues and different materials such as
sutures, drains, and bandages, and dissecting through different tissues.
Example: Mayo scissors (cutting scissors), Metzanbaum scissors (dissecting
scissors)
3. Needle-holder
o Are meant to hold curved needles while stitching. Their jaws are especially designed to
hold needles safely atraumatically.
4. Dissecting forceps
o Use of a 12-cm long Adson forceps with teeth to handle the skin, plus a toothless Adson
forceps for suture removal is recommended.
5. Hemostats
o Are used to pull tissue, for homeostasis, and, in some cases, for blunt dissection in
absence of small scissors.
6. Surgical retractors
o These instruments are used to expose the surgical field through separation or retraction of
the edges of the wound.
o In minor surgery, it is advisable to have a Senn-Mueller retractor (which is also called a
double-end retractor due to its having a wide plate on one side and three sharp hooks on
the other).
7. Biopsy punch
o It is an instrument consisting of a handle and a cylindrical cutting edge (trephine) for
obtaining tissue biopsies.
o They are usually disposable and are manufactured in different diameters (2-8 mm).
8. Curette
o It is an instrument consisting of a handle and a spoon-shaped or cutting ring end that
allows scraping of lesions on the skin surface.
9. Cryosurgical equipment
o These are devices that spray a cryogen, which is usually liquid nitrogen that uses
extremely cold temperatures to treat benign and malignant skin lesions.
10. Electrocautery
o It applies an electric current with ability to coagulate and cut through different tissues.
There are different terminals depending on the type of procedure that is to be performed.
IX. SUTURE MATERIALS
Different types of suture materials are available: threads, staples, adhesive sutures and tissue
adhesives.
X. LOCAL ANESTHESIA IN MINOR SURGERY
Local anesthetics are drugs that block the transmission of nerve impulses causing, at least, the
absence of pain sensation in the area of injection.
According to a small chemical difference, local anesthetics can be classified into two groups:
1. Esters (procaine, tetracaine, chloroprocaine, benzoine which is obsolete due to its high
incidence of sensitization), and
2. Amides (lidocaine, mepivacaine, bupivacaine, prilocaine, etidocaine and ropivacaine). For
their remarkable safety and efficacy, on use amides, namely lidocaine and mepivacaine.
XI. PREPARING ROOM FOR MINOR SURGERY
PURPOSES:
1. To make sure that all necessary instruments and supplies are complete.
2. To maintain sterility of the surgical instruments.
3. To prevent accidents in the surgical field.
4. To facilitate the performance of the surgical procedure.
ASSESSMENT:
1. Check the operation schedule since there might be changes.
2. Check what type of operation will be done.
3. Identify the patient who will undergo the surgical operation.
PLANNING:
1. Determine the surgical operation that will be done.
2. Determine the instruments, equipment and supplies that will be used during the
operation.
POSSIBLE NURSING DIAGNOSES:
1. Risk for infection
2. Risk for unnecessary injury
OUTCOME IDENTIFICATION:
1. Complete instruments and supplies prepared.
2. Sterility of the instrument is maintained.
3. No accidents occur during the course of operation.
4. Smooth and fast surgical operation.
EQUIPMENT:
Surgical cap
Surgical mask
Wipe cloth
Disinfectant solution
Lap or drape pack
Gown pack
Betadine solution
Blade (2)
Sterile water
Mayo tray
Sterile basin set
Prep set
Instrument set
Picking forceps
Sterile gloves
Sterile gauze
Suture
Cotton applicator
IMPLEMENTATION
Circulating Nurse:
1. In operating room attire, with surgical cap and mask
2. Wash hands
3. Turn on air conditioner
4. Dump dust to the operating room unless this has already done by personnel on the
previous shift.
5. Set up equipment and check for proper functioning:
a. Switch on the overhead lights.
b. Check operating room table for proper working order.
c. Check suction machine, the electrosurgical unit, and other pieces of
equipment.
d. Line kick buckets with plastic bags.
e. Check the supply cabinets for stock. Restock if necessary.
6. Consult with the scrub on the arrangement of the furniture for the surgical procedure.
7. Check that all equipment needed to position the patient is in the room.
8. Wash hands.
9. Gather needed packs and put them on their respective tables or stands:
a. Linen or drape pack on the large instrument table (backtable).
b. Gown pack on the prep table.
c. Mayo tray on Mayo stand.
d. Sterile basin set into the ring stand.
e. Prep set placed on prep table.
f. Instrument set on ring stand or table.
10. Before any sterile supplies are opened, the integrity of every package is checked for:
a. Tears
b. Punctures
c. Water marks
d. Expiration date
e. Sterilization indicator
11. Open the packs and sets in order in which the scrub will need them. Open the sterile
gown first; the scrub will need this immediately after entering the room.
12. Untie and open the outer covering of all packs with bare hands.
Note: Use two sterile picking forceps from this point
13. Open inner covering of the scrub’s gown pack:
a. Position package so that flaps are on top.
b. Lift the distal flap up and away from the package
c. Open the left flap
d. Open the right flap
e. Open the near flap
14. Put the necessary number of gloves with the correct sizes.
15. Move one of the nurse’s gowns with hand towel over the scrub nurse’s gown with
hand towel over scrub nurse’s gloves at the right side of the table.
16. Cover gown and glove table with the inner pack’s distal flap (keep it in line with the
table with a flap)
17. Open inner covering of the flap pack
a. Position package so that flaps are on top.
b. Lift the distal flap up and away from the package
c. Open the left flap
d. Open the right flap
e. Open the near flap
18. Add the following to the lap pack:
Blade #20
Sutures
Gauze
Suction tubing, etc.
19. Open inner covering of basin set:
a. Position package so that flaps are on top.
b. Lift the distal flap up and away from the package
c. Open the left flap
d. Open the right flap
e. Open the near flap
20. Transfer two bowls, kidney basin, two sponges’ basins, and prep cup to the lap pack.
21. Pour sterile water into one of the bowls and into the sponge basins and also the wash
bin.
22. Cover Washington with the inner pack’s distal flap.
23. Pour betadine antiseptic solution to prep cup
24. Cover lap pack with the inner pack’s distal flap (keep it in line with the table with
flap)
25. Open inner covering of prep set:
a. Position package so that flaps are on top.
b. Lift the distal flap up and away from the package
c. Open the left flap
d. Open the right flap
e. Open the near flap
26. Add the following to the prep set:
a. One pair of glove
b. 4x4 sponges
c. Cotton applicator
d. One sterile bowl
27. Pour betadine cleanser to the bowl
28. Cover prep set with the inner pack’s distal flap (keep it in line with the table with a
flap)
Scrub Nurse
29. In operating room attire with surgical cap and mask.
30. Does surgical hand scrub.
31. Don on sterile gown and gloves (open handed or close handed glove technique)
32. Prepare the prep set:
a. Check the sterilization indicator inside the inner covering of the prep set
b. Arrange the prep table:
Sponges
Sponges bowl
Sponge forceps
Prep cup
c. Put prep gloves on prep table with hand towel resting on them
d. Moisten a sponge and wipe the powder from glove
33. Prepare basin set:
a. Check the sterilization indicator inside the inner covering of the basin set
b. Put basin on basin stand
34. Prepare lap pack:
a. Check for sterilization indicator inside the inner covering of the basin set.
b. Separate the Mayo stand covering from drapes and sheets.
c. Arrange the drapes (2) and Sheet (fenestrated sheets) according to use
d. Separate the hard towels (4)
35. Drape the mayo stand.
a. Insert both hands, right over left, into the folds of the mayo stand cover.
b. Pull side of the mayo cover over forearms. Carry with technique near mayo
stand.
c. Keep folded part of cover over forearms. Carry with technique near mayo
stand.
d. Put foot on base of mayo stand to stabilize it.
e. Fit drape into mayo tray (circulating nurse may help)
f. Take a hand towel from lap pack, open it then fold it in half and drape it over
the tray
g. Take another hand towel from the lap pack and tool it, then place it on the
mayo tray.
36. Preparing instrument set:
a. Check the sterilization indicator inside the inner covering of the instrument
set.
b. Put instrument on the mayo tray
37. Arrange instruments at the lap table:
a. Put the ringed instrument on the rolled towel (allis, Kelly’s, etc.)
b. The retractors (Richardson retractor, army-navy retractor, etc.) are placed at
the rear center of the table.
c. Place the sponges at the front center.
d. Emesis basin is placed at the rear of the table.
e. Needle rack is placed on a folded towel in front of the basin.
38. Arrange instruments in the mayo table: knives scissors, tissue forceps, hemostatic
forceps, clamps, retractors, needle holders, sponges, etc.
39. Prepare 2 wet strips and place on top of the instruments.
40. Cover instruments table
41. Assist surgeon in gowning and gloving
42. Check sheet depending on patient’s anatomical position.
43. Drape the pint sheet:
a. Take the paint sheet and check direction indicated for the foot or the head of
the table
b. Protect your gloved hand by cuffing the sheet over them
c. Drop the folds over the sides of the table, then open downward towards the
feet and upward over the anesthetic screen by enclosing your gloved hand
with the turned back cuff of the drape
44. Give supplies and prep cup to surgeon.
45. Hand four lap towels to surround operative area.
46. Drape the laparotomy sheet.
a. Hold rolled side of the sheet and place its opening directly over the site of
incision
b. Keep the gloved hand protected by the folds, open the sheet over the feet area.
Anchor the sheet with opposite hand to prevent dragging it from position.
47. Take your place to assist in the surgical surgery.
48. Circulating nurse moves the mayo table; lap table and sponge table near the operative
field.
EVALUATION
The expected outcome is met when all instruments, supplies and materials used in the
operation are complete before and at the end of the operation, no unnecessary injury
happened, operation was fast and smooth, and all instruments, materials and supplies used
where sterile.
XII. REFERENCES
Book:
Monahan, F. D., Sands, J. K., Neighbors, M., Marek, J. F. & Green, C. J. (2007). Phipp’s Medical-
Surgical Nursing: Health and Illness Perspective. (8th ed.). Philadelphia: Mosby Elsevier.
Non-book:
Blanco, J. A., Saleh, W. W., Mendez, B. C. & Arrancudiaga, A. (2019). Minor Surgery in Primary
Care. Retrieved from: https://cdn.intechopen.com/pdfs/68792.pdf
Prasad, M. (2018). Major Surgery and Minor Surgery: What are the Differences. Retrieved from:
https://www.farnorthsurgery.com/blog/difference-between-major-and-minor-surgery
Cruz, E. D. (2016). Scribd: Minor Surgery. Retrieved from
https://www.scribd.com/document/333414874/Minor-Surgery
University of Rochester Medical Center. (2020). Preparing for Surgery: The Operating Room.
Retrieved from: https://www.urmc.rochester.edu/encyclopedia/content.aspx?
contenttypeid=85&contentid=P01400
Routine Procedures for an Operation. (2015). Preparation of the Operating Room. Retrieved from
https://brooksidepress.org/operations/lessons/lesson-3-preparation-of-the-operating-room-for-
surgery/section-i-duties-of-the-operating-room-specialist-as-a-circulator/3-02-preparation-of-the-
operating-room/
University of Rochester Medical Center. (2020). After Surgery: Discomforts and Complications..
Retrieved from: https://www.urmc.rochester.edu/encyclopedia/content.aspx?
ContentTypeID=85&ContentID=P01390
