# Expression With Refinements

One or more refinements may be added to a concept to qualify it. This is done by putting the concept to be qualified before a colon and the qualifying expression after. The qualifying expression is of the form "attribute = value". The example below describes an operation to remove an ovary (i.e. an 'oophorectomy') using a laser.

```
83152002 |Oophorectomy| : 405815000 |Procedure device| = 122456005 |Laser device|
```

The next example, shown below, describes the right hip joint.

```
182201002 |Hip joint| : 272741003 |Laterality| = 24028007 |Right|
```

Where more than one qualifying attribute is required, these can be separated using a comma. The example below describes the removal of an ovarian structure using a laser device.

<pre><code><strong>71388002 |Procedure| :
</strong>405815000 |Procedure device| = 122456005 |Laser device| ,
260686004 |Method| = 129304002 |Excision - action| ,
405813007 |Procedure site - direct| = 15497006 |Ovarian structure|
</code></pre>

A further example, below, describes the emergency removal of the appendix:

```
65801008 |Excision| :
405813007 |Procedure site - direct| = 66754008 |Appendix structure| ,
260870009 |Priority| = 25876001 |Emergency|
```

Refinements may also be applied to a conjoined concept. For example, the following two expressions are equivalent (because an 'ulna' is a bone in an 'upper limb'):

{% code overflow="wrap" %}

```
313056006 |Epiphysis of ulna| : 272741003 |Laterality| = 7771000 |Left|
```

{% endcode %}

{% code overflow="wrap" %}

```
119189000 |Ulna part| + 312845000 |Epiphysis of upper limb| : 272741003 |Laterality| = 7771000 |Left|
```

{% endcode %}

Note that there are no brackets around " [119189000 |Ulna part|](http://snomed.info/id/119189000) + [312845000 |Epiphysis of upper limb|](http://snomed.info/id/312845000) " in the above example, as the refinement automatically applies to the conjoined concept.

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