Методика выполнения основных практических навыков по хирургии = Methodology for performing basic practical skills in surgery

УЧЕБНО-МЕТОДИЧЕСКОЕ ПОСОБИЕ
Рекомендовано 
Учебно-методическим объединением по высшему 
медицинскому, фармацевтическому образованию 
в качестве учебно-методического пособия 
для студентов учреждений высшего образования, 
обучающихся по специальности «Лечебное дело»
 
Москва 
Гомель
 
ИНФРА-М 
ГомГМУ
2025
Кафедра хирургических болезней № 1
с курсом сердечнососудистой хирургии
МЕТОДИКА ВЫПОЛНЕНИЯ 
ОСНОВНЫХ ПРАКТИЧЕСКИХ НАВЫКОВ 
ПО ХИРУРГИИ
METHODOLOGY FOR PERFORMING 
BASIC PRACTICAL SKILLS IN SURGERY

УДК 617-089(075.8)
ББК 54.5я73
 
М54
 
М54
  
Методика выполнения основных практических навыков по хирургии = Methodology for performing basic practical skills in surgery : 
учебно-методическое пособие / Б.Б. Осипов, М.Л. Каплан, А.Н. Лызиков [и др.]. — Москва : ИНФРА-М ; Гомель : ГомГМУ, 2025. — 70 с. 
ISBN 978-5-16-114025-3 (ИНФРА-М, online)
ISBN 978-985-588-399-0 (ГомГМУ)
Учебно-методическое пособие по дисциплине «Хирургические болезни» содержит перечень основных практических навыков по хирургии, методику их выполнения, показания и противопоказания к хирургическим 
манипуляциям, возможные осложнения при их выполнении, способы их 
коррекции.
Предназначено для студентов 5-го и 6-го курсов, обучающихся на английском языке по специальности «Лечебное дело».
УДК 617-089(075.8)
ББК 54.5я73
Р е ц е н з е н т ы:
Зыблев С.Л., кандидат медицинских наук, доцент, врач-хирург отделения 
хирургии (трансплантации, эндокринной и реконструктивной хирургии) 
Республиканского научно-практического центра радиационной медицины 
и экологии человека;
кафедра факультетской хирургии Витебского государственного ордена 
Дружбы народов медицинского университета
А в т о р ы:
Осипов Б.Б., Каплан М.Л., Лызиков А.Н., Призенцов А.А., Скуратов А.Г., 
Дорошко Е.Ю., Артюшков Е.Л., Сильвистрович В.И.
ISBN 978-5-16-114025-3 (ИНФРА-М, online)
ISBN 978-985-588-399-0 (ГомГМУ)
© Гомельский государственный 
медицинский университет, 
2025
ФЗ 
№ 436-ФЗ
Издание не подлежит маркировке 
в соответствии с п. 1 ч. 4 ст. 11

CONTENTS
Introduction.................................................................................................6
Chapter 1. List of practical skills in surgery............................................7
Chapter 2. Methodology for performing practical skills........................ 9
2.1. Method of physical examination of a patient
with surgical pathology................................................................................ 9
2.1.1. Palpation of the abdomen......................................................... 9
2.1.2. Abdominal percussion technique.............................................10
2.1.3. Auscultation of the abdomen....................................................11
2.2. Method for determining free fluid in the abdominal cavity...........11
2.3. Method for determining free gas in the abdominal cavity.............12
2.4. Method for determining the main symptoms
of acute appendicitis...................................................................................13
2.5. Method for determining the main symptoms
of acute cholecystitis...................................................................................14
2.6. Method for determining the main symptoms
of acute pancreatitis....................................................................................14
2.7. Method for determining the main symptoms
of acute intestinal obstruction.....................................................................14
2.8. Method for determining the main peritoneal symptoms................15
2.9. Diagnostic significance of Courvoisier’s symptom.......................15
2.10. Differential diagnosis of direct and oblique inguinal hernias......15
2.11. Differential diagnosis of irreducible and strangulated hernias.......16
2.12. Method for conducting and interpreting the results
of the march test for varicose veins of the lower extremities.....................17
2.13. Method for determining pulsation of peripheral arteries
of the lower extremities..............................................................................17
2.14. Method for determining effusion in the pericardial cavity..........18
2.15. Method for determining effusion in the pleural cavity................19
2.16. Technique for determining blood group and Rh factor................19
2.16.1. Determination of blood group according
to the ABO system	......................................................................................19
2.16.2. Technique for determining the Rh factor...............................21

2.17. Rules for transfusion of blood products and blood substitutes......22
2.17.1. Group compatibility test........................................................23
2.17.2. Test for individual compatibility (Rh compatibility)..............23
2.17.3. Biological sample..................................................................23
2.17.4. Registration of transfusion of blood and blood products.......24
2.17.5. Follow-up of the patient after transfusion.............................24
2.18. Methods for temporary bleeding control.....................................25
2.19. Methods for final bleeding control...............................................26
2.20. Assessing the severity of blood loss. Diagnostic significance
 of Moore’s formula.....................................................................................27
2.21. Stopping of bleeding from varicose veins of the esophagus.......28
2.22. Technique of anterior and posterior nasal tamponade.................29
2.23. Principles of primary surgical treatment of the wound................30
2.24. Dressing a clean and infected wound..........................................32
2.25. Principles of applying plaster casts..............................................33
2.26. Rules for elastic bandaging of the lower extremities...................34
2.27. Rules for applying and removing skin sutures.............................35
2.28. Rules for processing the surgical field.........................................37
2.29. Rules for surgical and hygienic hand treatment
(European standard, EN-1500)...................................................................37
2.29.1. Hand hygiene.........................................................................37
2.29.2. Surgical treatment of hands...................................................38
2.30. Preparing the patient for irrigoscopy and colonoscopy...............39
2.31. Placement of gastric tube, gastric lavage technique....................39
2.31.1. Placement of a gastric tube...................................................39
2.31.2. Gastric lavage technique.......................................................41
2.32. Technique of digital examination of the rectum..........................41
2.33. Technique of performing a siphon enema....................................42
2.34. Setting up a cleansing enema.......................................................43
2.35. Technique for installing a gas outlet tube....................................44
2.36. Technique of local infiltration anesthesia,
Oberst – Lukashevich anesthesia................................................................44
2.37. Method for performing “Novocaine” blockades.........................46
2.38. Venipuncture technique................................................................49
2.39. Venesection technique..................................................................50

2.40. Joint puncture technique..............................................................51
2.40.1. Method of puncture of joints..................................................51
2.41. Pericardial puncture technique.....................................................51
2.42. Thoracentesis, method of drainage of the pleural cavity.............52
2.43. Laparocentesis technique.............................................................53
2.44. Laparoscopy technique................................................................54
2.45. Bladder catheterization technique................................................57
2.46. Types of urinary catheters............................................................59
2.47. Bladder puncture, indications, technique.....................................61
2.48. Rules for dissecting abscesses and phlegmons............................61
2.49. Transport immobilization for limb injuries..................................62
2.50. Transport immobilization for spinal and pelvic injuries..............64
2.51. First aid for burns.........................................................................64
2.52. First aid for chemical burns of esophagus and stomach..............64
2.53. Methods of indirect heart massage and artificial
lung ventilation...........................................................................................65
2.54. Indications and technique for conicotomy...................................67
References..................................................................................................69

INTRODUCTION
Improving the quality of professional training of a medical worker 
at any level in the learning process involves a harmonious combination 
of theoretical and practical components. Practical skills formed on basis 
of deep theoretical knowledge are main principles of successful preparation 
of future doctor.
This course material aid contains a list of basic practical skills in surgery, 
methods of its performing, indications and contraindications for surgical 
procedures, possible complications during implementation, and methods 
for its correction.

CHAPTER 1
LIST OF PRACTICAL SKILLS IN SURGERY
Among them are:
1. Method of physical examination of a patient with surgical pathology.
2. Method for determining free fluid in the abdominal cavity.
3. Method for determining free gas in the abdominal cavity.
4. Method for determining the main symptoms of acute appendicitis.
5. Method for determining the main symptoms of acute cholecystitis.
6. Method for determining the main symptoms of acute pancreatitis.
7. Method for determining the main symptoms of acute intestinal 
obstruction.
8. Method for determining the main peritoneal symptoms.
9. Diagnostic significance of Courvoisier’s symptom.
10. Differential diagnosis of direct and oblique inguinal hernias.
11. Differential diagnosis of irreducible and strangulated hernias.
12. Methodology for conducting and interpreting the results of the 
march test for varicose veins of the lower extremities.
13. Method for determining pulsation of peripheral arteries of the lower 
extremities.
14. Method for determining effusion in the pericardial cavity.
15. Method for determining effusion in the pleural cavity.
16. Technique for determining blood group and Rh factor.
17. Rules for transfusion of blood products and blood substitutes.
18. Methods for temporary bleeding control.
19. Methods for final bleeding control.
20. Assessing the severity of blood loss. Diagnostic significance 
of Moore’s formula.
21. Stopping of bleeding from varicose veins of the esophagus.
22. Technique of anterior and posterior nasal tamponade.
23. Principles of primary surgical treatment of the wound.
24. Dressing a clean and infected wound.
25. Principles of applying a plaster casts.
26. Rules for elastic bandaging of the lower extremities.
27. Rules for applying and removing skin sutures.
28. Rules for processing the surgical field.
29. Rules for surgical and hygienic hand treatment (European standard, 
EN-1500).

30. Preparing the patient for irrigoscopy and colonoscopy.
31. Placement of the gastric tube, gastric lavage technique.
32. Technique of digital examination of the rectum.
33. Technique of performing a siphon enema.
34. Setting up a cleansing enema.
35. Technique for installing a gas outlet tube.
36. Technique of local infiltration anesthesia, Oberst – Lukashevich 
anesthesia.
37. Methodology for performing “Novocaineˮ blockades.
38. Venipuncture technique.
39. Venesection technique.
40. Joint puncture technique.
41. Pericardial puncture technique.
42. Thoracentesis, method of drainage of the pleural cavity.
43. Laparocentesis technique.
44. Laparoscopy technique.
45. Bladder catheterization technique.
46. Types of urinary catheters.
47. Bladder puncture, indications, technique.
48. Rules for dissecting abscesses and phlegmons
49. Transport immobilization for limbs injuries.
50. Transport immobilization for spine and pelvis injuries.
51. First aid for burns.
52. First aid for chemical burns of esophagus and stomach.
53. Methods of indirect heart massage and artificial lung ventilation.
54. Indications and technique for conicotomy [21].

CHAPTER 2
METHODOLOGY FOR PERFORMING
PRACTICAL SKILLS
2.1. Method of physical examination of a patient with 
surgical pathology
2.1.1. Palpation of the abdomen
The main method for studying the normal properties and pathological 
changes of the abdominal cavity, organs located in it and the peritoneum is 
palpation. There are two types of palpation: superficial and deep.
To examine the abdomen, the examiner sits to the right of the patient on 
a chair at the level of the patient’s bed. The patient should lie horizontally 
with relaxed muscles, breathing evenly and calmly, with arms down and 
head on a small pillow.
In superficial palpation the doctor lays the palm of his right hand flat on 
the patient’s stomach and gently, without pressure, feels the abdominal wall 
with the pulp of the terminal phalanges of the fingers, gradually moving the 
palm from one place to another. The patient should be distracted by talking. 
It is necessary to start palpation from painless places. Normally, palpation 
doesn`t encounter any resistance from the abdominal wall which appears soft 
and supple. In pathological conditions, two types of increased tension of the 
abdominal wall can occur: resistance of the abdominal wall and its muscular 
tension. Resistance is felt in places corresponding to the pathological process, 
most often inflammatory (acute cholecystitis, peptic ulcer).
Muscle tension (“defans”) is observed where there is an inflammatory 
process in the abdominal cavity, in which the peritoneum also takes part 
(with peritonitis).
Superficial palpation of the abdomen allows:
a) to determine the degree of tension of the abdominal wall;
b) determine the presence of soreness of the entire abdominal wall or its 
individual sections;
c) to distinguish the swelling of the abdominal wall from the accumulation 
of fat in it or from its tension with ascites and flatulence;
d) distinguish tumors of the abdominal wall from tumors in the abdominal 
cavity;
e) to feel the seals, nodes, metastases of malignant tumors developing 
in the abdominal wall.

With deep palpation of the abdomen, an examination of the organs 
lying inside the abdominal cavity is performed. This palpation pursues the 
following goals:
a) topographic differentiation of the abdominal organs from each other;
b) determination of the size, shape, position, nature of the surface, 
soreness and mobility of these organs, for hollow organs – also the properties 
of their walls and the nature of their contents;
c) finding a tumor inside the abdominal cavity, determining their 
properties and connection with one or another organ [21].
The method of methodical deep sliding palpation of the abdominal 
cavity developed by V. P. Obraztsov is used. N. D. Strazhesko recommends 
palpation in the following order: first they feel the sigmoid colon, then the 
blind, the final segment of the ileum, appendix, transverse colon, stomach, 
liver, pancreas, spleen, and kidneys.
The position of the patient is the same as during superficial palpation. 
The abdominal muscles tense during inhalation and relax during exhalation, 
so the gradual penetration of the tips of the palpating fingers deep into the 
abdominal cavity should occur intermittently, taking place only during 
exhalation, each time no more than 2–3 cm. During the next inhalation, the 
fingers rest in place, and after 5–6 exhalations, the fingers reach the posterior 
wall of the abdominal cavity or the organs lying on it [21].
2.1.2. Abdominal percussion technique
During percussion of the abdomen of a healthy person a tympanic 
percussion sound is obtained, higher above the intestinal region than 
above the stomach. Hepatic dullness is detected with percussion of the 
chest on the right from the bottom in front in the region of 8–9–10 ribs. 
In the presence of free gas in the abdominal cavity (pneumoperitoneum), 
with flatulence (a large amount of gas in the intestines), with intestinal 
obstruction, the percussion sound becomes loud tympanic, but with a very 
large amount of gas, it can lose its tympanic character and acquire the 
properties of a clear sound.
A dull percussion sound may be heard with a very oily or edematous 
abdominal wall. Limited areas of percussion dullness and areas of complete 
dullness can be observed over tumors and inflammatory infiltrates. Percussion 
is essential for detecting a free fluid (ascites), blood (hemoperitoneum); in 
a standing position, dullness is determined in the lower abdomen, in the 
patient’s supine position, dullness is auscultated in the lateral sections of the 
abdomen, when the fluid is at least 1.5–2 L [21].