Introduction

Pierre A. Clavien, Michael G. Sarr

A competent surgeon must be aware of all the general aspects of a surgical procedure to be able to perform specific interventions successfully and expeditiously. The old adage that "exposure, exposure, and exposure" are the three most important factors for the good outcome of a surgical procedure remains true for both open and laparoscopic approaches.

Each procedure must start with careful positioning of the patient prior to wide disinfection of the operative field, draping, and incision. The first chapter covers the various options for positioning of the patient on the operating table and describes the incisions that are available to enter the abdominal cavity. The second chapter focuses on different principles of exposure through the use of various types of retractors, providing examples of the most commonly used retractors. The third chapter addresses the use of mechanical staplers. Currently, staplers are increasingly being used for many open and laparoscopic procedures, and the industry has partnered actively with the surgical field in developing new devices enabling sophisticated maneuvers, often to reach otherwise small and inaccessible areas. Proper knowledge of the general principles of the use and function of mechanical staplers is mandatory for modern surgery, because their misuse may result in devastating complications such as anastomotic leakage or bleeding. Finally, while Billroth claimed more than a century ago that "drainage saves many lives," the use of the "time-honored" surgical drain has changed dramatically, because accumulating studies have shown convincingly that drains are often useless or even harmful in many procedures. Open drains are rarely needed today. The last chapter presents the principles of the various types of drains including a table of "evidence-based" utility of drains for upper abdominal surgery.

These chapters covering the general aspects of surgery were prepared in a simple, yet comprehensive manner. We believe that the didactic and basic information provided in these introductory chapters of the Atlas will be of value for both trainees and specialized surgeons.

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