Incisions and Operative Exposures. An Issues of Operative Techniques in General Surgery, Volume 10,
By addebook • Aug 18th, 2008 • Category: Medicine •
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Incisions and Operative Exposures. An Issues of Operative Techniques in General Surgery, Volume 10, Issue 2, June 2008
by by Kevin F. Staveley-O’Carroll MD, PhD, FACS
In this modern age of minimally invasive surgery, it is easy to forget or lose the sometimes subtle skills necessary to perform major surgical procedures through larger, more conventional incisions. We all realize that the larger the incision the more the risk for wound complications, but the priority
in any surgical procedure is still the successful completion of
that procedure, even if it means extending the incision. In
addition, the “default” midline abdominal incision may not
be the best for the disease being addressed. Careful preoperative
assessment and planning can dictate a more limited
incision that provides for even better exposure at the exact
site of disease. Thus the general surgeon must have a full
armamentarium of incisions and exposures and be able to
choose and perform the correct one for the problem at hand.
These more rarely used incisions however, have subtleties
of management that if improperly performed, can result in
significant morbidity. This is especially true for surgical exposures
that cross conventional partitions of anatomy. Thus
the thoracoabominal and abdominoinguinal incisions have
specialized applications and details of performance that can
make all the difference in the success of the surgery and the
morbidity associated with it. Similarly, thoracic incisions and retroperitoneal exposures are less commonly performed by
most general surgeons but, when needed, familiarity with the
anatomy and technique of reconstructive closure is critical.
Cervical exposures are needed for more than just thyroid
disease and clearly a meticulously performed incision in this
relatively cosmetic area of the body is important for patient
satisfaction as well as for minimizing complications.
The present collection of operative incisional techniques
provides the detail and description necessary for the general
surgeon who may be somewhat less practiced in these more
unusual exposures to perform them in a fashion that will
provide the greatest operative success with minimal subsequent
morbidity.
Walter A. Koltun, MD
Professor of Surgery Peter and Marshia Carlino
Professor of Inflammatory Bowel Disease
Chief, Section of Colon and Rectal Surgery
Penn State College of Medicine
Milton S. Hershey Medical Center
Editor-in-Chief
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