Surgical Access Incisions

Excerpt

Surgical incisions are fundamental to the success of any operative procedure, serving as the gateway to access underlying tissues and organs. The choice of incision, placement, and the technique used are critical factors influencing immediate and long-term outcomes, including patient recovery, morbidity, and cosmetic results. A well-chosen surgical incision must provide optimal access to the surgical field while minimizing risks and protecting neurovascular structures. Surgeons need a thorough understanding of the anatomy of the surgical site, including common anatomical variants, to make informed decisions about the incision type. With the rise of minimally invasive surgery—such as laparoscopic and robotic-assisted procedures—traditional incisions are often modified or substituted, highlighting the importance of precise decision-making.

Discussing surgical incisions by body regions, including the chest, abdomen, and pelvis, along with the tissue planes accessed, such as subcutaneous, fascial, retroperitoneal, and intracompartmental layers, provides valuable insight. Please see StatPearl's companion references "Anatomy, Abdomen, and pelvis: abdominal wall," "Anatomy, Thorax, Sternum," and "Anatomy, Head and Neck, Neck" for more in-depth information on the anatomy of these areas.

Factors influencing the choice of incision include the intended surgery, expected findings, patient-specific variables like body habitus and comorbidities, and whether the procedure is elective or emergent. Familiarity with advanced techniques, such as video-assisted, endoscopic, laparoscopic, and robotic-assisted approaches, also plays a crucial role. Advances in surgical training and simulation offer enhanced learning opportunities in controlled environments, better preparing clinicians for clinical practice. This activity will also review common risk factors for specific incisions, such as incisional hernias, anatomic landmarks, and clinical pearls that are important to procedural clinicians.