If a bleeding vessel can be seen and grasped safely, then it can be controlled by any of the above techniques. However, in all video-assisted surgical procedures there are similar challenges for which specific surgical techniques have been developed. This decision is related to patient and disease factors, but the relative skill of the operator in each method is also of great importance.

When two options are considered – a traditional open operation or a minimal-access procedure – it is not only important whether an operation can be done by a less invasive technique, but whether it is better or worse done in this way. The surgeon passes the ligature material around the forceps, while the assistant holds the forceps, depressing the handle and elevating the point as much as possible, so that the tissue that is clamped is encircled by the ligature (Figure 1. Pre-tied loops such as the Endoloop®, with a disposable inbuilt plastic pusher, are available and may be used instead. a) A ‘mounted tie’ is used to carry a ligature to the open jaws of an artery forceps passed beneath a vessel. Venous ooze can be particularily troublesome if there is venous engorgement and simple positioning of the patient can reduce this significantly.Intracorporal suturing and knot tying is identical in principle to suturing and knot tying in open surgery, but made more difficult by the two-dimensional view, the limited space available and the difficulty of making throws with two instruments both approaching the operative field from the same direction. In situations where no diathermy is available, most vessels clamped in an artery forceps should be ligated.

It must also be remembered that the ultrasonic dissector retains heat and may cause a thermal injury even after the power has been released.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic. The intrusive cross-hatched scars, associated with interrupted sutures, are a result of suture-induced ischaemic necrosis. Farquharson’s Textbook of Operative General Surgery covers not only basic techniques for the junior trainee but all the common operations in the general surgical subspecialties which are likely to be encountered during higher surgical training. Sutures, however, are also used for gastrointestinal, urological and vascular anastomoses, for abdominal wall closure and for the repair of tendons and nerves.

A triple knot is the modification of clamp used to occlude the vascular inflow to the liver the or is kept ‘square’ by being tightened in the correct directions, reef knot commonly used, and at least three throws are kidney to reduce parenchymal bleeding is inevitably an for an insecure slip-knot results if this precaution is not ischaemic manoeuvre similar to a limb tourniquet.That the title has lasted fifty years is the best proof of quality and of a significant place in operative surgery. Otherwise, haemostasis can normally be achieved temporarily by application of direct pressure using a small tonsil swab, which can be inserted through a laparoscopic port, or with a laparoscopic pledget. CCC is a not-for-profit organization that provides licenses and registration for a variety of users. It also manages to include operative situations that could present unexpectedly to a general surgeon working in a rural area or overseas with limited referral resources.