外科上級英語：必須語彙とフレーズ

"prehabilitation"

A pre-operative optimisation programme — including exercise, nutrition, and psychological preparation — designed to improve a patient's physiological reserve before elective surgery

"The colorectal surgeon referred the high-risk patient to a six-week prehabilitation programme to improve cardiopulmonary fitness before the major abdominal resection."

"frailty index"

A quantitative score that aggregates multiple deficits — such as comorbidities, functional limitations, and cognitive decline — to estimate a patient's vulnerability to surgical stress

"The anaesthetic team used the frailty index to identify patients at highest risk for post-operative delirium and prolonged hospital stay."

"cardiopulmonary exercise testing"

A non-invasive test measuring oxygen uptake and anaerobic threshold during graded exercise to objectively quantify a patient's functional cardiorespiratory capacity before major surgery

"Cardiopulmonary exercise testing revealed a peak VO₂ of 11 mL/kg/min, placing the patient in the high-risk category for open oesophagectomy."

"ASA physical status classification"

The American Society of Anesthesiologists' six-class system grading a patient's pre-operative systemic health from ASA I (healthy) to ASA VI (brain-dead organ donor)

"The consultant anaesthetist assigned an ASA III classification given the patient's insulin-dependent diabetes, hypertension, and BMI of 42."

"informed consent process"

The structured discussion in which a surgeon discloses the nature of a proposed procedure, its risks, benefits, alternatives, and consequences of non-treatment, enabling a competent patient to make a voluntary decision

"The registrar documented the informed consent process in detail, noting that the patient had asked specific questions about the 2% anastomotic leak rate."

"surgical site risk stratification"

The systematic classification of a proposed operation by contamination class — clean, clean-contaminated, contaminated, or dirty — to guide antibiotic prophylaxis and infection control measures

"Surgical site risk stratification placed the emergency Hartmann's procedure in the dirty category, prompting extended antibiotic prophylaxis for 72 hours post-operatively."

"nil by mouth protocol"

A standardised fasting regimen specifying the duration of abstinence from solids and liquids before anaesthesia to reduce the risk of pulmonary aspiration

"The enhanced recovery team updated the nil by mouth protocol to allow clear fluids up to two hours before induction, in line with current ERAS guidelines."

"cross-match and group-and-save"

Blood bank procedures in which a patient's blood is typed and either crossmatched against donor units (for high-risk cases) or simply stored for rapid retrieval if transfusion becomes necessary

"The surgical team ordered a four-unit cross-match and group-and-save for the scheduled aortic aneurysm repair, anticipating significant intra-operative blood loss."

"critical view of safety"

A specific dissection endpoint in laparoscopic cholecystectomy in which the hepatocystic triangle is cleared of fat and fibrous tissue, and only two structures — the cystic duct and cystic artery — are seen entering the gallbladder

"The operating surgeon documented achieving the critical view of safety before clipping and dividing the cystic structures, to minimise the risk of bile duct injury."

"damage control surgery"

A staged operative strategy in severely injured or physiologically deranged patients in which haemorrhage and contamination are controlled in an abbreviated first operation, and definitive repair is deferred until physiology is restored

"Damage control surgery was initiated when the trauma patient's core temperature fell to 34°C and coagulopathy developed; the abdomen was packed and temporarily closed pending ICU resuscitation."

"total mesorectal excision"

The precise surgical dissection along embryological tissue planes that removes the mesorectum — and its contained lymph nodes — as an intact envelope around the rectum, the standard technique for rectal cancer

"Total mesorectal excision with autonomic nerve preservation was completed robotically, achieving a clear circumferential resection margin on pathological analysis."

"tension-free anastomosis"

The principle that a surgical bowel or vessel join must be constructed without longitudinal traction on the suture or staple line, a key determinant of leak-free healing

"To achieve a tension-free anastomosis after the extended right hemicolectomy, the operating team mobilised the splenic flexure and divided the inferior mesenteric vein."

"haemostatic agent"

A topically applied substance — such as oxidised cellulose, fibrin sealant, or thrombin matrix — that augments the body's coagulation cascade to achieve local bleeding control

"After unsuccessful bipolar diathermy, the surgeon applied a fibrin-based haemostatic agent to the raw hepatic surface to control diffuse oozing from the resection margin."

"intra-operative cholangiography"

Fluoroscopic imaging of the biliary tree performed during cholecystectomy by injecting contrast through a cannulated cystic duct, used to delineate biliary anatomy and detect stones or injuries

"Intra-operative cholangiography was performed when the anatomy was unclear, revealing an anomalous right posterior sectoral duct that would have been divided inadvertently."

"fasciotomy"

The surgical incision of the fascia enclosing a muscle compartment to relieve compartment syndrome by restoring perfusion to compressed muscles and nerves

"Emergency four-compartment fasciotomy of the lower leg was performed within 90 minutes of the vascular repair to prevent permanent neuromuscular damage from ischaemia-reperfusion."

"laparostomy"

Intentional temporary open management of the abdominal cavity, with the bowel covered by a temporary closure device, used when definitive closure would cause abdominal compartment syndrome or when re-exploration is planned

"The septic patient underwent laparostomy with a vacuum-assisted temporary abdominal closure device after source control surgery, allowing for planned relook in 48 hours."

"total intravenous anaesthesia"

A technique in which both induction and maintenance of general anaesthesia are achieved exclusively with intravenous agents — typically propofol and an opioid — without the use of volatile inhalational agents

"Total intravenous anaesthesia with propofol and remifentanil was chosen for the neurosurgical case to allow rapid, predictable emergence and continuous neurophysiological monitoring."

"thoracic epidural analgesia"

Placement of a catheter in the thoracic epidural space to deliver continuous infusion of local anaesthetic and opioid for superior post-operative pain control after major thoracic or abdominal surgery

"Thoracic epidural analgesia at the T7–T8 level was sited pre-operatively and provided excellent pain control after the oesophagectomy, facilitating early extubation and physiotherapy."

"erector spinae plane block"

An ultrasound-guided fascial plane nerve block in which local anaesthetic is deposited deep to the erector spinae muscle, providing multi-level thoracic and abdominal analgesia via retrograde spread to the paravertebral space

"Bilateral erector spinae plane blocks at T5 were performed as part of the multimodal analgesic plan for the patient who declined epidural placement."

"goal-directed fluid therapy"

An intra-operative strategy in which fluid administration is titrated to dynamic haemodynamic parameters — such as stroke volume variation or cardiac output — rather than static measures like central venous pressure

"Goal-directed fluid therapy using oesophageal Doppler monitoring reduced intra-operative crystalloid requirements and was associated with faster return of bowel function after colorectal surgery."

"bispectral index monitoring"

A processed electroencephalographic parameter scaled from 0 (isoelectric) to 100 (fully awake) that provides an objective measure of anaesthetic depth to guide agent dosing and reduce the risk of intra-operative awareness

"Bispectral index monitoring was used throughout the eight-hour reconstruction to maintain an index between 40 and 60, minimising the risk of awareness and avoiding over-sedation."

"neuromuscular blockade reversal"

The pharmacological antagonism of residual neuromuscular blocking agent effect — using either neostigmine or selective reversal agents such as sugammadex — before tracheal extubation

"The anaesthetist confirmed complete neuromuscular blockade reversal with a train-of-four ratio exceeding 0.9 before extubating the patient in the operating theatre."

"opioid-sparing analgesia"

A multimodal pain management strategy that combines regional techniques, NSAIDs, paracetamol, ketamine, and gabapentinoids to minimise opioid requirements and their associated side effects

"The enhanced recovery protocol incorporated opioid-sparing analgesia, reducing morphine consumption by 60% and cutting the incidence of post-operative nausea from 35% to 12%."

"difficult airway algorithm"

A structured decision-tree protocol guiding anaesthetists through a sequence of escalating interventions — from awake fibreoptic intubation to front-of-neck access — when tracheal intubation proves unexpectedly difficult

"When three attempts at direct laryngoscopy failed, the team invoked the difficult airway algorithm and successfully managed ventilation with a supraglottic airway device while preparing for awake tracheostomy."

"Clavien-Dindo classification"

An internationally validated grading system for post-operative complications ranked from Grade I (no pharmacological or surgical intervention) to Grade V (death), enabling standardised cross-institutional outcome comparisons

"The surgical audit reported a 12% incidence of Grade II complications — requiring pharmacological treatment — under the Clavien-Dindo classification in the year's colorectal cohort."

"anastomotic leak"

A failure of a bowel or vessel junction to heal, allowing luminal contents to escape into the peritoneal or mediastinal cavity, one of the most serious complications of gastrointestinal surgery

"CT scan on post-operative day five revealed an anastomotic leak with free pelvic fluid; the patient was returned to theatre for washout and defunctioning ileostomy."

"surgical site infection"

An infection occurring within 30 days of an operation — or within one year if an implant was used — classified as superficial, deep, or organ space depending on the anatomical level involved

"Microbiology confirmed a deep surgical site infection with MRSA; the wound was opened, debrided, and treated with targeted antibiotic therapy based on sensitivities."

"venous thromboembolism prophylaxis"

Measures taken to prevent deep vein thrombosis and pulmonary embolism in surgical patients, including pharmacological agents such as low-molecular-weight heparin and mechanical compression devices

"The risk assessment indicated a high Caprini score of 9, so the team used dual venous thromboembolism prophylaxis — enoxaparin plus intermittent pneumatic compression — from the pre-operative period."

"post-operative ileus"

A temporary inhibition of coordinated bowel motility following abdominal surgery, causing nausea, vomiting, abdominal distension, and inability to tolerate oral intake

"Prolonged post-operative ileus lasting beyond day four was managed with nasogastric decompression, early mobilisation, and cessation of systemic opioids in favour of epidural analgesia."

"intra-abdominal hypertension"

A sustained elevation in intra-abdominal pressure above 12 mmHg that impairs organ perfusion, with abdominal compartment syndrome defined as sustained pressure above 20 mmHg with new organ dysfunction

"Serial bladder pressure measurements confirmed intra-abdominal hypertension of 22 mmHg with rising creatinine, prompting the decision to decompress the abdomen."

"post-operative respiratory failure"

An inability to maintain adequate gas exchange after surgery, classified as Type I (hypoxaemic) or Type II (hypercapnic), a common complication following major thoracic or abdominal procedures

"Post-operative Type I respiratory failure following pneumonectomy was managed with high-flow nasal oxygen and prone positioning before escalation to non-invasive ventilation."

"return to theatre"

An unplanned second surgical procedure necessitated by a complication of the index operation, a key quality indicator tracked by surgical departments and national audit bodies

"The return to theatre rate for emergency laparotomy at this centre was 8%, prompting a root cause analysis of the most common precipitating complications."

"pneumoperitoneum"

The insufflation of carbon dioxide gas into the peritoneal cavity to create the working space necessary for laparoscopic surgery, typically maintained at 12–15 mmHg

"Pneumoperitoneum was established using a Hasson open technique given the patient's previous midline laparotomy, to avoid inadvertent visceral injury during blind Veress needle insertion."

"trocar placement"

The strategic positioning of cannulas through the abdominal wall to allow insertion of a laparoscope and working instruments, planned according to the target anatomy and surgeon ergonomics

"Trocar placement for the Whipple procedure included a 12 mm umbilical port for the camera and four working ports arranged to achieve triangulation without instrument clashing."

"robotic docking"

The process of positioning and connecting the robotic surgical system's arms to previously inserted trocars, a critical step that determines instrument reach and operative field access

"Robotic docking in the left lateral decubitus position was completed in under eight minutes, allowing the operating surgeon to begin the retroperitoneal nephrectomy from the console."

"haptic feedback"

The tactile sensation of tissue resistance transmitted to the surgeon's hands during open or laparoscopic surgery; notably absent in most robotic platforms, requiring visual compensation

"Trainees learning robotic surgery must compensate for the loss of haptic feedback by carefully observing tissue deformation and colour change as surrogate indicators of tension and perfusion."

"conversion to open"

The intra-operative decision to abandon a minimally invasive approach and proceed with a conventional open incision, made when safety cannot be assured laparoscopically

"Dense adhesions from previous pelvic radiotherapy necessitated conversion to open midway through the robotic anterior resection; the patient was counselled pre-operatively that this was a possibility."

"single-incision laparoscopic surgery"

A technique in which all instruments are introduced through a single multi-channel port placed in the umbilicus, reducing abdominal wall trauma and improving cosmesis at the cost of instrument triangulation

"Single-incision laparoscopic surgery for appendicectomy left only a small scar within the umbilicus, which the patient — a professional model — specifically requested for cosmetic reasons."

"endoscopic submucosal dissection"

An advanced endoscopic technique for en bloc resection of large or complex gastrointestinal mucosal lesions by cutting beneath the submucosa, enabling curative resection without surgery for selected early cancers

"Endoscopic submucosal dissection achieved complete R0 resection of the 35 mm rectal adenoma, avoiding the need for formal proctectomy and permanent stoma."

"natural orifice transluminal endoscopic surgery"

An experimental minimally invasive approach in which endoscopic instruments are passed through a natural body orifice — typically the mouth, vagina, or rectum — and through a visceral incision to access the peritoneal cavity without abdominal incisions

"Natural orifice transluminal endoscopic surgery for transvaginal cholecystectomy was performed in a research protocol, eliminating abdominal wall incisions entirely."

"enhanced recovery after surgery"

A multimodal, evidence-based perioperative care pathway integrating over 20 individual elements — from pre-operative carbohydrate loading to early mobilisation and oral feeding — to accelerate recovery and reduce complications

"Implementation of the enhanced recovery after surgery protocol for elective colorectal resection reduced the median hospital length of stay from eight days to four without increasing readmission rates."

"early mobilisation"

The planned and structured commencement of walking and active exercises within hours of surgery, a cornerstone of ERAS that prevents deconditioning, reduces pulmonary complications, and stimulates gut motility

"Early mobilisation was initiated four hours after the hepatic resection, with the patient sitting out of bed and walking with physiotherapy support by post-operative day one."

"critical care outreach"

A hospital service in which specialist critical care nurses proactively monitor high-risk post-operative patients on surgical wards, identifying deterioration early using track-and-trigger scoring systems

"Critical care outreach reviewed the patient at midnight after the National Early Warning Score reached 7, arranging direct transfer to the high-dependency unit for closer monitoring."

"organ support"

The use of mechanical or pharmacological interventions to substitute for failing organ function — such as vasopressors for cardiovascular failure, mechanical ventilation for respiratory failure, or continuous renal replacement therapy for acute kidney injury

"The patient required triple organ support — vasopressors, ventilation, and continuous renal replacement therapy — following post-operative sepsis from an anastomotic leak."

"surgical drain management"

The protocol governing the monitoring, output assessment, and timely removal of intra-abdominal drains placed at operation to detect or manage post-operative fluid collections

"Surgical drain management involved daily amylase measurement; a drain amylase above three times serum levels on day three confirmed a grade B pancreatic fistula."

"nasogastric tube decompression"

The placement of a tube through the nose into the stomach to aspirate gastric contents and relieve nausea, vomiting, and abdominal distension caused by post-operative ileus or bowel obstruction

"Nasogastric tube decompression was avoided as routine in the ERAS pathway but was inserted therapeutically when the patient vomited 1.5 litres on post-operative day two."

"readmission rate"

The proportion of patients who return to hospital within a defined period — typically 30 days — after discharge from their index surgical admission, a key quality and cost indicator for surgical services

"The trust's 30-day readmission rate after laparoscopic colectomy was 9%, falling to 5% after the enhanced recovery programme was fully implemented."

"length of stay"

The number of days a patient occupies an acute hospital bed from admission to discharge, a principal measure of surgical efficiency, resource utilisation, and recovery pathway effectiveness

"The median length of stay for open aortic aneurysm repair fell from 12 to 8 days over three years following multidisciplinary review and incremental pathway improvements."