Surgical Technique
Surgical technique tests safe execution and reproducible principles. The exam rewards tissue handling, exposure, hemostasis and complication avoidance over named operations alone.
Core rules
- Incision choice must provide exposure without unnecessary morbidity; median sternotomy, thoracotomy and minimally invasive approaches have specific indications.
- Anastomosis requires accurate apposition, tension-free suture lines and respect for tissue blood supply.
- Cardiopulmonary bypass requires anticoagulation, perfusion monitoring and myocardial protection; separation from bypass is a staged process.
- Lung surgery requires isolation, precise stapling and air-leak control; chest closure must restore stability.
Worked example
A patient has a bleeding anastomosis after CABG with stable hemodynamics. The correct reasoning is to check coagulation, platelets and surgical bleeding while preparing re-exploration. Blind protamine overcorrection can cause hypotension; the cause must be identified.
Traps
Do not tie under tension; do not ignore a falling drain output with rising tamponade signs; do not close a chest without confirming hemostasis; do not assume a technically successful anastomosis guarantees perfusion.