Dissection Skills and Surgery

[Monica Lewinsky]

I have to admit, I suck at dissecting in anatomy lab. I usually cut the important structures or I spend too much time trying to dig through fat carefully when the stuff we are looking for ends up being much deeper. I feel useless to my group since I mess everything up when I'm the one with scalpel and probe. It has gotten to a point where all I want to do is look at structures post-disseciton and leave the lab since I get so fed up with my poor ability to dissect cleanly for quality studying.

Will being a good surgeon require the same skills that make one a good dissector? I guess dissecting isn't a skill I was endowed with, but I don't want to rule out a surgical specialty due to this experience.

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[smq123]

I have to admit, I suck at dissecting in anatomy lab. I usually cut the important structures or I spend too much time trying to dig through fat carefully when the stuff we are looking for ends up being much deeper. I feel useless to my group since I mess everything up when I'm the one with scalpel and probe. It has gotten to a point where all I want to do is look at structures post-disseciton and leave the lab since I get so fed up with my poor ability to dissect cleanly for quality studying.

Will being a good surgeon require the same skills that make one a good dissector? I guess dissecting isn't a skill I was endowed with, but I don't want to rule out a surgical specialty due to this experience.

Don't rule out surgery (or ENT/urology/ortho/neurosurg) just because of your experience in gross anatomy lab. A surgical residency will teach you how to operate and how to dissect properly - which they don't teach you how to do during anatomy lab. Unless you're so uncoordinated that you can't even tie your own shoelaces, then you can probably learn how to operate.

Dissecting structures in a live human body on the OR table is different from dissecting structures in a body that's been dead for >1 year. It's a very, very different experience. I HATED gross lab, and didn't get any benefit from it, but I was surprised to find that I loved my surgery rotation, and that I actually understood what the surgeon was cutting/looking for - and at how easily I could identify the structures that I was looking at! (Unlike gross lab, where everything is one big pile of mushy organs.)

I feel useless to my group since I mess everything up when I'm the one with scalpel and probe.

P.S. The one thing that I learned in surgery that I wish I had known in anatomy lab is that you should only use the scalpel when cutting skin. If you use the scalpel in the actual organ cavity, you'll accidentally cut something for sure. Just use scissors to dissect along tissue planes (NOT to actually cut stuff), and blunt dissection is your best friend in anatomy lab.

 

[generic]

I think there's very little correlation. Surgery is more about hard work, repetition, and experience than any sort of God-given hand skill/atremulousness.

Our Surgery clerkship director reiterated this on the first day of the rotation.

And recall the old story about a surgeon choosing a Psychology PhD over a talented sculpter to train...because the surgeon knows the PhD is willing to work hard.

 

[Monica Lewinsky]

P.S. The one thing that I learned in surgery that I wish I had known in anatomy lab is that you should only use the scalpel when cutting skin. If you use the scalpel in the actual organ cavity, you'll accidentally cut something for sure. Just use scissors to dissect along tissue planes (NOT to actually cut stuff), and blunt dissection is your best friend in anatomy lab.

I do try to practice blunt dissection, but I feel that it only goes so far. It seems that the fat just sticks to everything and that the infinite amounts fat is everywhere. On a side note, anatomy lab has made me deathly afraid of body fat since it just sticks everywhere and seems to take over the viscera of the body, instead of just being a helpful layer of protective connective tissue. Anyway, cleaning off nerves is perhaps the most agonizing thing I could imagine since the fat just sticks, and when I try to force it off the nerves tend to break. The perineum was hell.

 

[Slide]

A few weeks after gross lab was over, I had the privilege to do a physiology lab where we were required to cut live flesh. The specimen was a pig, bought from the USDA, under anesthesia. The experiment involved locating nerves, arteries, inserting catheters and doing cardiac massages. Though I'm sure the textures between human and pig tissue differ, cutting through the pig was completely different from gross anatomy. The skin literally parted away after we cut it and it was much easier to part through the fascia to reach the needed structures. It was also easier to locate arteries and veins as well.

As one of our clinical lecturers told us, it's easier getting around during surgery because instead of structures in shades of tan and grey, everything's color-coded 😀

 

[snowdoc]

My dad hated anatomy lab and participated as little as possible. He is now a urologist and is very well respected for his surgical skills. He says that dissecting and surgery is nothing alike (both the skills and the anatomy) and that anatomy lab has absolutely nothing to do with becoming a surgeon. So honestly, unless you want to be an anatomist don't waste your time practicing dissecting skills.

 

[Law2Doc]

Will being a good surgeon require the same skills that make one a good dissector?

No. The future of surgery is laproscopy and robotics. Hand eye coordination while watching a video screen are what is becoming most important. So the skills that lets one be successful at a video game such as Halo are those that will lead to being a good surgeon. The only skills you will take from cadaver dissection that might be useful in surgery are a better knowledge of anatomy and structural relationships, and your willingness to get your hands dirty.

 

[smq123]

I do try to practice blunt dissection, but I feel that it only goes so far. It seems that the fat just sticks to everything and that the infinite amounts fat is everywhere. On a side note, anatomy lab has made me deathly afraid of body fat since it just sticks everywhere and seems to take over the viscera of the body, instead of just being a helpful layer of protective connective tissue. Anyway, cleaning off nerves is perhaps the most agonizing thing I could imagine since the fat just sticks, and when I try to force it off the nerves tend to break. The perineum was hell.

That's the big difference between gross anatomy lab and surgery. In lab, the fat has been preserved, and is constantly sitting in a pool of preserving fluid. That makes the fat turn mushy, and stick to everything. In live humans, the fat tends to stay together - not become a semi-liquid gunk that sticks to your glove.

How are you cleaning off the nerves? Are you using forceps to scrape the fat off? If it breaks that easily while using forceps, it might not actually be a nerve.

 

[Blade28]

I agree with the excellent advice posted by smq123.

Don't let it discourage you. Gross anatomy dissection is tough. I struggled initially, and I have great hands, am almost ambidextrous, and ended up in General Surgery!

You're dealing with substandard instruments, using whatever technique you feel like (since no one teaches you how to dissect), and no one knows how old these bodies are. Preserved cadavers don't dissect out as cleanly or nicely as real-life, alive human bodies.

 

[BigKurz]

I must say--this thread has really boosted my own confidence as well. I'm a below-average contributing group member on our dissection, and--like the OP--was becoming quite frustrated with my own abilities.

And yea, I had been mentally ruling out any type of surgery because of it. I know that's not the right attitude to take in med school, but I couldn't help it.

But thanks guys--I now feel MUCH better. 🙂

 

[PeepshowJohnny]

That said, there are some skills in anatomy lab that correlate with surgery. I'd say ability to think in three dimensions once the process is completed, the ability to sit and focus on something, and a good understanding of anatomy are definitely helpful. However, being able to dissect out the internal iliac system quickly has more to do with how your body was preserved then predicticting future surgical skills.

If you talk with surgeons, they'll admit there are some people who are absolutely virtuosos with their hands, but they're rare and most people do just fine without being a prodigy. Most will tell you something along the lines of "I can train pretty much anybody to do what I do with my hands, but not everybody can think like I do."

 

[Blade28]

If you talk with surgeons, they'll admit there are some people who are absolutely virtuosos with their hands, but they're rare and most people do just fine without being a prodigy. Most will tell you something along the lines of "I can train pretty much anybody to do what I do with my hands, but not everybody can think like I do."

Very true.

 

[njbmd]

I have to admit, I suck at dissecting in anatomy lab. I usually cut the important structures or I spend too much time trying to dig through fat carefully when the stuff we are looking for ends up being much deeper. I feel useless to my group since I mess everything up when I'm the one with scalpel and probe. It has gotten to a point where all I want to do is look at structures post-disseciton and leave the lab since I get so fed up with my poor ability to dissect cleanly for quality studying.

Will being a good surgeon require the same skills that make one a good dissector? I guess dissecting isn't a skill I was endowed with, but I don't want to rule out a surgical specialty due to this experience.

As others have said, dissection "skills" in gross anatomy are far different from the daily skills of any type of surgery. That being said, learning to dissect is an important skill to master and just saying "I feel useless" is not going to get you where you need to be. Spend some time with some of the anatomy professors and get them to teach your how to dissect. It's an acquired skill with experience but don't write yourself off too quickly because you make some rookie mistakes. Get those skills up to par.

Surgical skills are learned, mastered and honed same as dissection skills. While surgery on living humans/lab animals is quite different from dissection, both have techniques that can be taught, mastered and honed. Good luck!

 

[Blade28]

I should add that although everyone starts off kinda clumsy in dissection lab, regular practice can work wonders. During our MS-I year the motivated students met every Sunday morning to work on cadavers and prosections - we'd usually do this for 3-4 hours, then eat lunch and go home. It really helped for the exams later, plus was an easy way to bond with everyone.

 

[Monica Lewinsky]

As others have said, dissection "skills" in gross anatomy are far different from the daily skills of any type of surgery. That being said, learning to dissect is an important skill to master and just saying "I feel useless" is not going to get you where you need to be. Spend some time with some of the anatomy professors and get them to teach your how to dissect. It's an acquired skill with experience but don't write yourself off too quickly because you make some rookie mistakes. Get those skills up to par.

Surgical skills are learned, mastered and honed same as dissection skills. While surgery on living humans/lab animals is quite different from dissection, both have techniques that can be taught, mastered and honed. Good luck!

I feel really strapped for time right now during anatomy. As much as I really want to learn good dissection technique, I also would rather do well on the exams. Given my limited time, I'm going to keep doing what works (spending time in lab only when it is required of me) and studying out of atlases and other anatomy resources. I am learning this stuff very well and my grade reflects that.

 

[howelljolly]

Ha! I vote "no correlation" Im an MS-III and havent done my surgery clerkship yet. But, Im saying this based only on the observation that someone who is very good at the technical aspects of dissection in the lab can be COMPLETELY clueless about what they are actually doing, or about anatomy or surgical science in general.

When I was an undergrad ... the mortician for the med school was apparently so good with his hands that they would have him do a lot of the dissection of the head. Im sure he was a brilliant guy, but he wasn't a brain surgeon (literally)

 

[Ashers]

I agree with smq123 about blunt dissection. The probe was my favorite instrument during gross lab. Also using the scissors not to cut, but as a spreader was really helpful. Keep some paper towels handy to put excess fat on to get it out of your way, or even clean your gloves off so your fingers aren't so slippery.

I'm on CT surgery right now, next month I'll be on gen surg, and I've already done ortho, and they're nothing like gross lab. In ortho when I retracted muscle, they didn't fall apart like they did on my cadaver. In cardiac cases, all I really touch are blue drapes. Thoracic cases I can touch a little bit more such as lung (way cool), and the stuff in a living person isn't nearly as brittle as in the cadaver. However, the fat is still just as disgusting, especially on the morbidly obese patients. In the period of 2 days, I was told 4 or 5 times not to eat too much and not get fat.

 

[ZagDoc]

If you talk with surgeons, they'll admit there are some people who are absolutely virtuosos with their hands, but they're rare and most people do just fine without being a prodigy. Most will tell you something along the lines of "I can train pretty much anybody to do what I do with my hands, but not everybody can think like I do."

Completely agree. I've scrubbed in on some pediatric cardiac cases and the senior surgeon is, as one surgeon put it, "born to be a pediatric heart surgeon."

But as was stated, the other 99% get by just fine with hard work and practice.