4Basic surgical skills
David H. Oram
FRCOGConsultant Gynaecological Oncologist
Department of Gynaecological Oncology, St Bartholomew’s Hospital, London EC1A 7BE, UK
A team approach is essential to the practice of successful surgery. Good surgery begins beforeany incision is made with consideration of the type of equipment needed and the incision to beused to ensure optimum access. Although the repertoire of tools available to the surgeon hasincreased, the attainment of safe and efﬁcient surgical technique still depends on a comprehensiveknowledge of the basic surgical skills outlined in this chapter. These include proﬁciency in knottying, instrument handling, suturing, haemostasis and tissue dissection. Surgery should ‘ﬂow’,using the simplest and safest way to achieve the operative goal. As the duration of trainingshortens, the importance of teaching good surgical technique by example and direct supervisionhas never been greater
basic surgical skills; gynaecological surgery; skills training; surgical haemostasis.
Writing in the preface to the ninth edition of
Bonney’s Gynaecological Surgery
, the book’seditor, John Monaghan, advocates that ‘operations should ﬂow with a style and naturalpace, rather like awell choreographed dance’. For this to be achieved, there must be anacknowledgement that the practice of successful surgery is the product of a teamapproach. As well as the lead surgeon, the team includes anaesthetists, surgicalassistants, ODAs, theatre nurses, ward nurses and porters. The astute surgeon needsto engender such bonding as is required to ensure a belief in the common task. It istherefore axiomatic that there is a need to lead by example and to instil the correctworking atmosphere in the operating theatre. Whilst there is a requirement to try tomaintain the highest possible surgical standards, and in this respect for the surgeon tomake his or her personal preferences known, it must be appreciated that individuals,instruments, equipment and even elevators are capable of malfunction. In suchfrustrating circumstances, shows of petulance are rarely productive and do nothing forteam morale. If the problem is a recurring one, however, it is incumbent on the surgeon
Best Practice & Research Clinical Obstetrics and GynaecologyVol. 20, No. 1, pp. 61–71, 2006
1521-6934/$ - see front matter
2005 Elsevier Ltd. All rights reserved.
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44 20 7601 7179.