Everything is sterile. The patient’s uncovered skin near the opening, the surgeon’s hands, the tools. Therefore, no **foreign** stuff will make it into the patient, because everything that comes into contact with the patient’s organs is sterile.
It doesn’t matter that the patient’s organs aren’t sterile themselves. If you touch them a second time, all you end up doing in reintroducing the same thing that was already on the organs in the first place (which you picked up during the first touch).
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