The art of the competent surgeon: Anatomy and surgical dissection

Knowledge of surgical anatomy and skill in surgical dissection are seamlessly combined into the art of the competent surgeon. This chapter presents a discussion of the rationale for and techniques of tissue handling and hands-on surgical dissection that all competent surgeons have mastered. These techniques are the hallmark of a safe and efficient surgeon. Tissue handling skills are somewhat more important to master than the necessary knowledge of surgical anatomy. This is because the surgeon knows only approximately where the vital anatomy should be situated in the dissection field. These anatomic structures course in variable locations in individual patients, are hidden from view by peritoneum and visceral fatty areolar tissues, and are further distorted by the pathology involved. It is only by expert dissection techniques that these vital anatomic structures, such as the ureter and major blood vessels, are safely revealed in a bloodless field. These techniques are successfully applied in any surgical specialty and in any type of surgery—laparotomic, laparoscopic, robotic, or vaginal—and in any anatomic region or space.