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Fundamentals of Dissection

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Abstract

Appropriate surgical technique requires a mastery of the basic skills of surgical dissection. This chapter provides a brief overview of considerations of lighting, positioning, and preoperative imaging as they relate to surgical dissection. It discusses basic aspects of dissection, such as the differences between sharp and blunt dissection techniques and their applications, as well as the use of proper traction and counter-traction during dissection. More advanced, instrumental methods of dissection, encompassing electrosurgery and water dissection, are reviewed. Approaches to dissection of more challenging tissue planes, including those of neoplastic and inflamed tissues, are explored as well. Finally, the chapter ends with a discussion of cognitive biases, how they can relate to surgical dissection, and the importance of a surgeon’s awareness of them.

Keywords

  • Dissection
  • Surgery
  • Cognitive bias

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Suggested Readings

  • Kirk R. Basic surgical techniques. Edinburgh: Elsevier; 2010.

    Google Scholar 

  • Karakousis CP. Principles of surgical dissection. J Surg Oncol. 1982;21:205–6.

    CrossRef  CAS  PubMed  Google Scholar 

  • Way LW, et al. Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg. 2003;237:460–9.

    PubMed  PubMed Central  Google Scholar 

References

  1. AlJamal YN, Zendejas B, Gas BL, Ali SM, Heller SF, Kendrick ML, et al. Annual surgeon volume and patient outcomes following laparoscopic totally extraperitoneal inguinal hernia repairs. J Laparoendosc Adv Surg Tech A. 2016;26(2):92–8.

    CrossRef  PubMed  Google Scholar 

  2. Al-Sahaf M, Lim E. The association between surgical volume, survival and quality of care. J Thorac Dis. 2015;7(Suppl 2):S152–5.

    PubMed  PubMed Central  Google Scholar 

  3. Amato L, Colais P, Davoli M, Ferroni E, Fusco D, Minozzi S, et al. [Volume and health outcomes: evidence from systematic reviews and from evaluation of Italian hospital data]. Epidemiol Prev. 2013;37(2-3 Suppl 2):1–100.

    Google Scholar 

  4. Sosa JA, Bowman HM, Gordon TA, Bass EB, Yeo CJ, Lillemoe KD, et al. Importance of hospital volume in the overall management of pancreatic cancer. Ann Surg. 1998;228(3):429–38.

    CrossRef  CAS  PubMed  PubMed Central  Google Scholar 

  5. Bell RH, Biester TW, Tabuenca A, Rhodes RS, Cofer JB, Britt LD, et al. Operative experience of residents in US general surgery programs: a gap between expectation and experience. Ann Surg. 2009;249(5):719–24.

    CrossRef  PubMed  Google Scholar 

  6. Khuri SF, Henderson WG, Daley J, Jonasson O, Jones RS, Campbell DA, et al. Successful implementation of the Department of Veterans Affairs’ National Surgical Quality Improvement Program in the private sector: the patient safety in surgery study. Ann Surg. 2008;248(2):329–36.

    CrossRef  PubMed  Google Scholar 

  7. Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ. 2016;353:i2139.

    CrossRef  PubMed  Google Scholar 

  8. Fabri PJ, Zayas-Castro JL. Human error, not communication and systems, underlies surgical complications. Surgery. 2008;144(4):557–63; discussion 563.

    CrossRef  PubMed  Google Scholar 

  9. Regenbogen SE, Greenberg CC, Studdert DM, Lipsitz SR, Zinner MJ, Gawande AA. Patterns of technical error among surgical malpractice claims: an analysis of strategies to prevent injury to surgical patients. Ann Surg. 2007;246(5):705–11.

    CrossRef  PubMed  Google Scholar 

  10. Rogers SO, Gawande AA, Kwaan M, Puopolo AL, Yoon C, Brennan TA, et al. Analysis of surgical errors in closed malpractice claims at 4 liability insurers. Surgery. 2006;140(1):25–33.

    CrossRef  PubMed  Google Scholar 

  11. Singh K, Ohri A. Anatomic landmarks: their usefulness in safe laparoscopic cholecystectomy. Surg Endosc. 2006;20(11):1754–8.

    CrossRef  CAS  PubMed  Google Scholar 

  12. Buchwald H. Three helpful techniques for facilitating abdominal procedures, in particular for surgery in the obese. Am J Surg. 1998;175(1):63–4.

    CrossRef  CAS  PubMed  Google Scholar 

  13. Poulin E, et al. Chap. 25: Splenectomy. In: ACS surgery: principles & practice. 6th ed. New York: WebMD; 2010.

    Google Scholar 

  14. Anema JG, Morey AF, McAninch JW, Mario LA, Wessells H. Complications related to the high lithotomy position during urethral reconstruction. J Urol. 2000;164(2):360–3.

    CrossRef  CAS  PubMed  Google Scholar 

  15. Frezza EE. The lithotomy versus the supine position for laparoscopic advanced surgeries: a historical review. J Laparoendosc Adv Surg Tech A. 2005;15(2):140–4.

    CrossRef  PubMed  Google Scholar 

  16. Knulst AJ, Mooijweer R, Jansen FW, Stassen LPS, Dankelman J. Indicating shortcomings in surgical lighting systems. Minim Invasive Ther Allied Technol. 2011;20(5):267–75.

    CrossRef  PubMed  Google Scholar 

  17. Moriyama S, Kawasuji M. [Lighting and surgical exposure with head lamp and optical loupes]. Kyobu Geka. 2009;62(8 Suppl):633–7.

    Google Scholar 

  18. Browne D. A headlight for general surgery. Lancet. 1956;270(6909):191.

    CrossRef  CAS  PubMed  Google Scholar 

  19. Tosun A, Hancerliogullari KO, Serifoglu I, Capan Y, Ozkaya E. Role of preoperative sonography in predicting conversion from laparoscopic cholecystectomy to open surgery. Eur J Radiol. 2015;84(3):346–9.

    CrossRef  PubMed  Google Scholar 

  20. Jacobson FL. Chap. 3. Chest imaging: role of CT, PET/CT, and MRI. In: Sugarbaker DJ, Bueno R, Krasna MJ, Mentzer SJ, Zellos L, editors. Adult chest surgery. New York: McGraw-Hill; 2009.

    Google Scholar 

  21. Gross SD. In: Lee HC, editor. A system of surgery: pathological, diagnostic, therapeutic, and operative. 5th ed. Philadelphia: H.C. Lea; 1872.

    Google Scholar 

  22. Kirk R. Basic surgical techniques. Edinburgh: Elsevier; 2010.

    Google Scholar 

  23. Karakousis CP. Principles of surgical dissection. J Surg Oncol. 1982;21(4):205–6.

    CrossRef  CAS  PubMed  Google Scholar 

  24. Karakousis CP. The technique of popliteal lymph node dissection. Surg Gynecol Obstet. 1980;151(3):420–3.

    PubMed  CAS  Google Scholar 

  25. Vollmer CM, Dixon E, Sahajpal A, Cattral MS, Grant DR, Gallinger S, et al. Water-jet dissection for parenchymal division during hepatectomy. HPB (Oxford). 2006;8(5):377–85.

    CrossRef  Google Scholar 

  26. Naude GP, Morris E, Bongard FS. Laparoscopic cholecystectomy facilitated by hydrodissection. J Laparoendosc Adv Surg Tech A. 1998;8(4):215–8.

    CrossRef  CAS  PubMed  Google Scholar 

  27. Araki Y, Noake T, Kanazawa M, Yamada K, Momosaki K, Nozoe Y, et al. Clipless hand-assisted laparoscopic total colectomy using Ligasure Atlas. Kurume Med J. 2004;51(2):105–8.

    CrossRef  PubMed  Google Scholar 

  28. Targarona EM, Balague C, Marin J, Neto RB, Martinez C, Garriga J, et al. Energy sources for laparoscopic colectomy: a prospective randomized comparison of conventional electrosurgery, bipolar computer-controlled electrosurgery and ultrasonic dissection. Operative outcome and costs analysis. Surg Innov. 2005;12(4):339–44.

    CrossRef  PubMed  Google Scholar 

  29. McCarus SD. Physiologic mechanism of the ultrasonically activated scalpel. J Am Assoc Gynecol Laparosc. 1996;3(4):601–8.

    CrossRef  CAS  PubMed  Google Scholar 

  30. Bubenik LJ, Hosgood G, Vasanjee SC. Bursting tension of medium and large canine arteries sealed with ultrasonic energy or suture ligation. Vet Surg. 2005;34(3):289–93.

    CrossRef  PubMed  Google Scholar 

  31. Steele PRC, Curran JF, Mountain RE. Current and future practices in surgical retraction. Surgeon. 2013;11(6):330–7.

    CrossRef  CAS  PubMed  Google Scholar 

  32. Rossidis G. Chap. 1: Laparoscopic cholecystectomy. In: Operative techniques in surgery. 1st ed. Philadelphia: Lippincott Williams & Wilkins; 2015. p. 475–84.

    Google Scholar 

  33. Friedberg JS. Chap. 65. Segmentectomy. In: Sugarbaker DJ, Bueno R, Krasna MJ, Mentzer SJ, Zellos L, editors. Adult chest surgery. New York: McGraw-Hill; 2009.

    Google Scholar 

  34. Jones DR, Stiles BM, Denlinger CE, Antippa P, Daniel TM. Pulmonary segmentectomy: results and complications. Ann Thorac Surg. 2003;76(2):343–8; discussion 348.

    CrossRef  PubMed  Google Scholar 

  35. Fell SC. Segmental resection. Chest Surg Clin N Am. 1995;5(2):205–21.

    PubMed  CAS  Google Scholar 

  36. Abcarian H. Is the holy plane the last word? Dis Colon Rectum. 2016;59(2):160–1.

    CrossRef  PubMed  Google Scholar 

  37. Su Y-R, Shih I-L, Tai H-C, Wei S-C, Lin B-R, Yu H-J, et al. Surgical management in enterovesical fistula in Crohn disease at a single medical center. Int Surg. 2014;99(2):120–5.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  38. Brown T, Shah AH, Bregy A, Shah NH, Thambuswamy M, Barbarite E, et al. Awake craniotomy for brain tumor resection: the rule rather than the exception? J Neurosurg Anesthesiol. 2013;25(3):240–7.

    CrossRef  PubMed  Google Scholar 

  39. Brucker SY, Hahn M, Kraemer D, Taran FA, Isaacson KB, Krämer B. Laparoscopic radiofrequency volumetric thermal ablation of fibroids versus laparoscopic myomectomy. Int J Gynaecol Obstet. 2014;125(3):261–5.

    CrossRef  PubMed  Google Scholar 

  40. Yule S, Flin R, Paterson-Brown S, Maran N. Non-technical skills for surgeons in the operating room: a review of the literature. Surgery. 2006;139(2):140–9.

    CrossRef  CAS  PubMed  Google Scholar 

  41. Reason J. Safety in the operating theatre - part 2: human error and organisational failure. Qual Saf Health Care. 2005;14(1):56–60.

    CrossRef  CAS  PubMed  PubMed Central  Google Scholar 

  42. Way LW, Stewart L, Gantert W, Liu K, Lee CM, Whang K, et al. Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg. 2003;237(4):460–9.

    PubMed  PubMed Central  Google Scholar 

  43. Arora S, Miskovic D, Hull L, Moorthy K, Aggarwal R, Johannsson H, et al. Self vs expert assessment of technical and non-technical skills in high fidelity simulation. Am J Surg. 2011;202(4):500–6.

    CrossRef  PubMed  Google Scholar 

  44. Kaye AD, Fox CJ III, Urman RD. Operating room leadership and management. Cambridge: Cambridge University Press; 2012.

    CrossRef  Google Scholar 

  45. Thiels CA, Lal TM, Nienow JM, Pasupathy KS, Blocker RC, Aho JM, et al. Surgical never events and contributing human factors. Surgery. 2015;158(2):515–21.

    CrossRef  PubMed  PubMed Central  Google Scholar 

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Correspondence to Harish Lavu .

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McCall, N.S., Lavu, H. (2018). Fundamentals of Dissection. In: Palazzo, F. (eds) Fundamentals of General Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-75656-1_7

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  • DOI: https://doi.org/10.1007/978-3-319-75656-1_7

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