This hideous flaw, inadequate surgical skill, is not currently anticipated by those who must undergo gastrointestinal cancer resection. If the surgeon is to perform surgery optimally, he must clearly visualize the primary cancer. There should never be a struggle for adequate visualization of the cancer or of the surrounding abdominal or pelvic viscera. A large midline abdominal incision extending from xiphoid to pubis is required. Self-retaining retractors are employed to hold back the edges of the abdominal incision.
Frequent irrigation is performed in order to clear the operative field of blood.
A second tier of retractors is often necessary to prevent repeated manipulation and repositioning of the bowel in order to provide exposure. Finally, there are some more difficult surgical procedures where the help of a resident is not adequate. Some difficult cases demand two experienced surgeons who have worked together frequently in the past. When the case is very difficult the most skillful assistant available is absolutely necessary. If adequate hemostasis is to be achieved, the surgeon must give up scissor and knife dissection.