Surgery is a complex ceremony involving aseptic technique, instrumentation, operative goal setting, anatomy, physiology, the scrutiny of colleagues, and the expectations of owners. Surgical trainers try to assure competence in each of these areas, but because of the volume of material, it is necessary to assume the obvious is obvious. In a famous speech by Coach Vince Lombardi to his new team, he began, "Gentlemen, this is a football." Similarly, this lecture will begin at the beginning with those elements that seem obvious but may not be to everyone such as why one scalpel blade might be better than another, what are the steps of surgical dissection and how to figure out why it isn't going well, and simple considerations of wound closure like how far apart should sutures be placed and why. The speaker has spent 40 years in surgical laboratories trying to figure out how to improve the techniques of both dexterous and clumsy individuals. Skill begins with the basics and my residents have often thanked me for enforcing their recitation of these simple principles.
