slightlymoving

seeing i teased earlier i thought i’d chip away at those thoughts.

i’ve assisted in (and watched quite a bit of) abdominal surgery in the last 4 months or so. a lot of these have been hernia repairs, but also laparotomies, appendectomies, nephrectomies, hysterectomies, and even an open cholecystectomy (and a bunch of laparoscopic cholecystectomies).

it’s been fascinating to see the layers of the abdominal wall exposed time and time again with different body sizes and shapes. after making an incision in the skin most surgeons will then use diathermy to burn through the subcutaneous fat. this will expose the superficial fascia (fibrous tissue, at this location named Scarpa’s fascia, bloody eponyms) which is often divided with a scalpel. in the more lateral areas this exposes the external oblique muscle which is superficial to the internal oblique.

a common procedure is (after incision) to place a clip on the external oblique and retract to expose the deeper layers. this clip often stays in place for the duration - as it makes accessing the external oblique easier when closing (i assume - all of this is observation, btw).

below the internal oblique is the tranversus abdominus, then the transversalis fascia followed by some peritoneal fat and finally the peritoneum itself.

when forceps are attached and you’re asked to retract or hold, the surgeon will smoetimes let you know how hard to pull (or not as the case may be). this also applies to retractors, but when you’re holding onto a tool that is biting into the tissue it’s good to be paying attention. what has been interesting for me is that each layer has very different properties - and having seen more than one assistant yank too hard and pull a clip off or tear some tissue, there’s a learning about the tensile strength of these tissues that is only really developed by practice. because, of course, as people age the properties change - and each patient is different.

while it’s not the most important thing to consider, any extra trauma places an additional load on the patient’s metabolism and repairing function. and there’s a need for sensitivity and alertness in assisting that means being aware of the physical properties of the body in front of you. which, if you’ve read any of my posts on dance, ties in with presence and sensation.

that is all for that one :)