So, our major guidance
is the principle of being minimally invasive.
That means that you try to get the optimal healing outcomes
with disturbing the tissues as little as possible.
And during the surgical videos,
you will see quite a lot of techniques
of trying to minimize the trauma.
But, in principle, as a surgeon,
you should think like a burglar.
You're breaking into somebody's body
and you're not supposed to be there.
So, what are the principles of a burglar?
Be very quiet,
complete your task as quickly as possible,
and leave no traces behind.
And I think this is very similar
to what the surgeon will be thinking of.
In being quiet, it means being minimally invasive.
That means respect the tissues,
open as little as you need
to get access where you want to operate,
and also try to make the trauma as little as possible.
For that, you will find a lot of help
if you use microsurgical instruments,
instruments that are designed to be held with a pencil grip
between your thumb and your index finger
and that can give you
very, very precise control of your movements.
And you will also benefit from using surgical loupes.
Magnification will make your work much more delicate,
and will help you take advantage
of the fine microsurgery instruments.
Also, by using loupes, you can help yourself
always maintain a correct posture of,
and that will be, from an ergonomic point of view,
very important.
Other than loupes, you will benefit
from having your own head-mounted illumination,
an LED light or any other source of strong light,
which comes between your loupes
and helps you illuminate
exactly the area that you're looking.
It is not always enough
with your surgical light from the top of the unit.
Now, second principle,
and that is to be as quick as possible.
And we know from many studies
that the longer a surgery takes,
then the more complications we face,
and the more likely we are to have troubled healing,
to have more pain,
and more swelling of the patient.
So it is important to make your surgeries quite quick.
And that will not happen
by moving your fingers in quick or magical ways.
This only happens by streamlining your procedures.
That means you always sit at the right spot,
you access your instruments very easily,
and you don't have to spend time moving back and forth
changing instruments or changing positions.
And, of course,
that you use only the instruments that you need.
You don't clutter your tray
with instruments that might be fancy,
but very, very rarely being used.
So, if I would go through a little bit,
the basic setup here.
First thing is to define your space
and the space of your assistant.
So, if you're right-handed,
you will be sitting at the right of your patient.
And your assistant will be on the left side.
Now, define very clearly the margins of your space
so you don't really enter each other's space
and create some troubles.
If we see there's a clock,
your space will be
between 8 o'clock and 12 o'clock position.
And your assistant will be
between 12 o'clock and 3 o'clock.
And if you stick to this side,
you will be much more easy to cooperate
and to calibrate yourself with your assistant.
Second important thing
is to put your tray with the surgical instruments
in very easy access to you.
Ideally, it should be on your right side,
and in a position where you can access all the instruments
with just a simple movement of your right hand
and turning your head.
Not really big movements, not turning your back,
not turning around, not moving too far.
Put your surgical instruments
in the order you expect them to be used.
And then access them easily
by turning your head and turning your hand there.
Then, also the same for your assistant.
He or she will also need a tray at your right side,
with some essential instruments
to make your life easier during the surgery.
So, try to minimize any move and any type of search.
And, the less instruments you have,
the quicker it will be
for you to actually access them and use them.
Try to use them in the right sequence,
and minimize the number of the instruments on the tray.
And you will find very quickly,
that your surgeries will be much more efficient
and much quicker.
Now, finally, you have to leave no traces behind.
And that means that you have to achieve
a very good wound closure, without much tension,
with fine sutures,
and with as optimal positions for healing as possible.
And in the clinical videos,
we'll see quite a few examples
of how techniques and instruments
can help us close completely, efficiently,
and with minimal potential for complications.