In no particular order, and for no special reason, here's a few surgical "tricks." Most are amalgams of observations, teachings, and trial and error. Surgeons will shrug, non-medical types (and non-surgical medical types) will say "who cares." Credulous and ingenuous students might make note and tuck them away, against the possibility -- remote as it might be -- that they'd prove useful in a future life. Whatever.
1: In thyroidectomy, "walking" to the outer parts of the poles by sequentially placing suture-ligatures provides excellent traction for exposure -- much more wieldy than Leahy clamps, the sutures can be pulled any which-way as you work.
2: The same technique facilitates the removal of a breast fibroadenoma.
3: The biggest mistake people make in open appendectomy is placing the incision too far medial. Go lateral to the rectus muscle, come down on the cecum, and you won't have to wave your finger all over the place to find the appendix.
4: At the base of the appendix there's almost always a clear window through the mesoappendix. Poke a clamp through, pull back a tie, have your assistant tie it while you snip the mesoappendix.
5: Developing flaps in thyroidectomy doesn't accomplish much more than increasing post-op swelling.
6: Use marcaine in all incisions: generously, up to 1 cc/kilo of 1/4%. Get the peritoneum. Use it all around the pectoralis muscles for mastectomy. Use lidocaine when infiltrating the sac in inguinal hernia, in case you flood the femoral nerve.
7: Sweeping a finger circumferentially around the surface of the peritoneum and behind the fascia in open appy, before entering it, greatly facilitates closure later.
8: In the proper plane, sweeping a finger in front and behind a thyroid lobe allows it to be flipped forward and out of the wound.
9: There are two ways to handle the laryngeal nerve: be sure you see it, or be sure you don't. I prefer the latter.
10: Squirting marcaine into the gallbladder fossa reduces the chance of "phantom" biliary pain in the recovery room.
11: Nearly any umbilical hernia can be repaired using a curved incision within the umbilicus.
12: Nearly any adult umbilical hernia is best repaired with mesh.
13: To make a nice mastectomy scar, draw one side of the elliptical incision, then "measure" it with a tie, placing it in the jaw of a clamp at one end of the incision, laying it onto the marked arc, and clamping it at the other end. Then use it to lay out the other arc: each will be the exact same length, eliminating bunching on closure.
14: Use curved Mayo scissors to develop the flaps in mastectomy; grab bleeders with a Debakey forceps and cauterize them.
15: For tracheotomy, place 2-0 silk sutures vertically on either side of the first tracheal ring before dividing it vertically. Use them for traction when inserting the tube, leave them for several days in case the tube needs replacing before the tract is firm.
16: Non-inflamed/infected sebaceous cysts can be removed through a tiny hole by poking them with a 15 blade, squeezing the gunk out, and continuing the squeeze to expel the sac.
17: Don't shave around a scalp cyst. Tape the hair apart with paper tape.
18: When draining an abscess under local, keep injecting with one hand and make the incision with the other, into the blanched area.
19: When operating on the chronically ill, if not giving TPN, add multivitamins to the IV; and use post-op nasal oxygen for healing.
20: Make rounds at least twice a day. Sit down in the patient's room (on the bed is OK.) Read the nurses' notes, preferably before seeing the patient.
20a: Sit down when seeing a patient in your exam room, too.
20a, i: Don't make the patient undress any more than absolutely necessary.
21: If, after many years in practice, you can only come up with this many items, you probably should have kept your mouth shut (hands in your pockets). I think there were more, but it's been a long time...
