Dissection and the many ways the OR does it

According to the Merriam Webster Dictionary dissect is to separate into pieces: expose the several parts for scientific examination. Medical students do it in cadaver lab. Other kinds of students, all the way down to elementary school perform dissections on different things to learn.

As always, the OR is a bit different.

To a surgeon dissection means clearing the way to get to a body part that needs to come out or be repaired. This is important because body parts do not hang in the body, ripe for the plucking, or fixing. The body is an entire living structure. And sometimes the only way to get to the body part that needs to be repaired or removed is to machete a path down to it.

This is known as dissection.

And there are many types.

There is sharp dissection. This is using a blade, or a pair of scissors or a saw to get through skin, or muscle, or bone. These are all sharp things, hence the name.

There is fine dissection. This is using the tip of something, usually forceps, to tease a path through to the body part. This is useful for getting past delicate structures to get to a piece of the brain, or to get to a nerve bundle that needs to be repaired.

There is hydrodissection which is using streams of water or other fluids to gently part the tissues to achieve the objective. Cataract surgeons use this, and so do gynocologists when they want to save the fallopian tube by removing the ectopic pregnancy that is threatening the patient’s life.

There is blunt dissection where the surgeon uses their fingers to open the field. This can be done in cesarean sections when the abdomen is pulled apart by surgeons tugging on it to expose the uterus. Or when a surgeon sticks their finger in an incision and sweeps along the path they want to take, only using their fingers.

There is electrical dissection which is when a hot blade that is heated up by electricity is used to cut away what is obscuring the path. This is electrocautery, also known as a bovie. And it is very useful to make precise incisions into a body part when a sharp blade will not do.

And then there is the legal dissection that happens after a sentinel event. This isn’t on a body part, or even a patient. This is done on behalf of the patient, to find the root cause of the error that led to harm.

Many different ways to expose what needs to be exposed so that the ectomy, which is the removal of something, or a repair of the exposed part.

With all these different ways to expose something, the circulator has to know and anticipate what is needed. A surgeon would only use a different method if their preferred method was unavailable.

Although, as circulators, we are not wielding the knife, or the bovie, or the fluid we still have to be aware of the risks of all of them. And where they are in the case of an open belly. The knife blade and bovie tip are countable.

Why?

Because something happened somewhere and led to a root cause analysis.

That is often why we do things.

Because someone, somewhere messed up. And we should heed the warnings and not go down their path.

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