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SURGICAL TECHNIQUE

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Asepsis, hemostasis, and gentleness to tissues are the bases of the surgeon’s art. Nevertheless, recent decades have shown a shift in emphasis from the attainment of technical skill to the search for new procedures. The advances in minimally invasive techniques have allowed the surgeon great flexibility in the choice of operative techniques. Nearly all operations may be performed by an open or a minimally invasive laparoscopic technique. The surgeon must decide which approach is in the best interest of the individual patient. In addition, application of robotic surgery has added a new dimension to the surgical armamentarium. Throughout the evolution of surgery it has been recognized that faulty technique rather than the procedure itself was the cause of failure. Consequently it is essential for the the young, as well as the experienced surgeon, to appreciate the important relationship between the art of performing an operation and its subsequent success. The growing recognition of this relationship should reemphasize the value of precise technique.

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The technique described in this book emanates from the school of surgery inspired by William Stewart Halsted. This school, properly characterized as a “school for safety in surgery,” arose before surgeons in general recognized the great advantage of anesthesia. Before Halsted’s teaching, speed in operating was not only justified as necessary for the patient’s safety but also extolled as a mark of ability. Despite the fact that anesthesia afforded an opportunity for the development of a precise surgical technique that would ensure a minimum of injury to the patient, spectacular surgeons continued to emphasize speedy procedures that disregarded the patient’s welfare. Halsted first demonstrated that, with careful hemostasis and gentleness to tissues, an operative procedure lasting as long as 4 or 5 hours left the patient in better condition than a similar procedure performed in 30 minutes with the loss of blood and injury to tissues attendant on speed. The protection of each tissue with the exquisite care typical of Halsted is a difficult lesson for the young surgeon to learn. The preoperative preparation of the skin, the draping of the patient, the selection of instruments, and even the choice of suture material are not so essential as the manner in which details are executed. Gentleness is essential in the performance of any surgical procedure.

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Young surgeons have difficulty in acquiring this point of view because they are usually taught anatomy, histology, and pathology by teachers using dead, chemically fixed tissues. Hence, students regard tissues as inanimate material that may be handled without concern. They must learn that living cells may be injured by unnecessary handling or dehydration. A review of anatomy, pathology, and associated basic sciences is essential in the daily preparation of young surgeons before they assume the responsibility of performing a major surgical procedure on a living person. The young surgeon is often impressed by the speed of the operator who is interested more in accomplishing a day’s work than ...

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