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Asepsis, hemostasis, and gentleness to tissues are the bases of the surgeon’s art. Nevertheless, recent decades have shown an emphasis on the search for new procedures. The advances in laparoscopic techniques have allowed surgeons great flexibility in the choice of operative techniques. The application of robotic surgery has added a new dimension to the surgical armamentarium. Nearly all operations may be performed by an open or a minimally invasive technique. The surgeon must decide which approach is in the best interest of the individual patient. 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 young surgeons, as well as experienced surgeons, to appreciate the important relationship between the skill of performing an operation and its subsequent success. The growing recognition of this relationship should reemphasize the value of precise technique.

The techniques described in this book emanate 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 sometimes placed the patient’s welfare second. 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 excess loss of blood and injury to tissues that came with speed. The protection of each tissue with the exquisite care typical of Halsted is, at times, underappreciated by young surgeons. The preoperative preparation of the skin, the draping of the patient, the selection of instruments, and even the choice of suture material are not as essential as the manner in which details are executed. Gentleness in the handling of tissues is essential in the performance of any surgical procedure.

Young surgeons may have difficulty in acquiring this perspective because they are usually taught anatomy, histology, and pathology using dead, chemically fixed tissues. Hence, tissues may come to be regarded as inanimate objects that may be handled without concern. Young surgeons 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. Young surgeons are often impressed by the speed of the operator who is interested more in accomplishing a day’s work than in teaching the art of surgery. Under such ...

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