Why is blood not spilling out if the surgeon is operating on for example stomach.
In: Biology
Surgeons know anatomy very well. They avoid large vessels. Smaller vessels can be tied or cauterized before they are cut, so they don’t bleed.
Lots of cauterization. Surgeons have a tool which cooks the ends of any small bleeders they encounter to prevent further blood loss. This is not exactly great for the patient, obviously, but it’s a kind of injury the body can easily work around. Small vessels like that can be replaced by the body to maintain blood flow after the surgery.
For larger vessels on which cautery wouldn’t work, there is ligature. This is basically where you tie the vessel closed with something. The Romans discovered this thousands of years ago, and the knowledge passed to the ~~Arab~~Muslim/Greek/Persian/etc empires from there, which is why their medicine was so good.
For even larger vessels, the answer is surgeons don’t cut those. And if they do, that’s what malpractice insurance is for.
Suction and clamping.
What fluids which cannot be prevented from flowing out through clamps on nearby arteries are simply sucked out with a vacuum.
They don’t just cut wildly. They go with scissors and dissect out layer by layer. When the have to cut blood vessels, they clamp both sides cut between and tie the ends.
Scalpels are mostly just getting through skin, those little bleeders get seared shut.
If they have to cut out a vascular bed, like the liver – when the whole organ is a kind of bloody spongy mass, there are specialized charring tools and clamp/staple combo devices. As well as sheets of material that aids clotting and prevents sticky scarring – which is left in. It’s a whole area of surgical research.
I was present for my wife’s C-section, and while she wasn’t gushing out blood in a fountain (for reasons people said above) there were MANY blood soaked rags tossed in the metal sink nearby. So yea, there’s still lots of blood.
Depending on the type of surgery you’re doing their are known “planes” or “windows” to maximize visualization and minimally disturb other tissue. Careful dissection and electrocautery of vessels along the way to help keep the field clean. If you you need to cut across larger vessels like for example when you remove a kidney, traditionally you would tie sutures around it. That evolved to metal clips and plastic hemo-o locks which are permanent and lock into place. Even easier now with staplers. They staple both sides off with three rows of titanium staples and cut in between.
Nowadays with laparoscopic/robotic surgery you insufflate the abdomen with carbon dioxide. Usually up to 15mmhg. This is enough to tamponade a lot of small oozing the venous bleeders.
Surgeons try really hard to avoid severing arteries that would spurt, or major vessels. Like from day one in surgeon school. And they use an electrocautery not a blade, generally.
What others have said about cautery and ligating. But I’ll add two others for different kinds of surgery; in orthopedic surgeries they will have the med student or junior resident use all their strength to wrap your arm or leg in essentially a giant rubber band, pushing all the blood back into the body. Once this is on a tourniquet will be placed to prevent blood from coming back into the limb for the duration of the surgery. This is especially useful for joint replacements because having blood in a joint can lead to destruction of whatever bone is left over.
Then when you come into the ER or have a minor surgery like a cyst removed or abscess drained, we’ll inject the skin and surrounding tissue with a mix of lidocaine and epinephrine. This simultaneously numbs the area so you don’t have to be sedated or go under anesthesia, and constricts small blood vessels so we have a clean, relatively bloodless field to work with.
The circulatory system is a “closed system” so blood flow is contained within vessels (arteries,veins,capillaries etc.)technically there will be bleeding when the surgeon cuts from the small capillary beds that feed our skin but unless you sever one of the large vessels such as the iliac vein or the abdominal aorta you won’t see the blood gushing out like you do in the movies
Ob/Gyn here:
1. Entry. When we enter the abdomen or pelvis, we are careful to avoid any major blood vessels that would cause the patient to bleed out if damaged.
2. Damage control. Minor blood vessels can be easily cauterized with monopolar electrocautery. Larger bleeding vessels often need to be tied off with suture, or clamped and sealed with bipolar electrocautery. We can also use chemical hemostatic agents made from gelatin, cellulose, starch, etc. When we are done we close up layer-by-layer and make sure nothing is still bleeding.
3. Pressure. The body has its own methods of controlling bleeding. Sometimes all you need to do is hold pressure and allow the blood to clot by itself.
4. Manual evacuation. Sometimes its not enough and you just need to get the blood out of the way to focus on the source of the bleeding. We use suction and sponges.
5. Last resorts. If someone is bleeding too much and is beyond repair, we can remove the organ itself or large parts of it. Cesarean hysterectomies and splenectomies are good example of this.
6. Resuscitation. Sometimes blood is literally spilling out. This is is why you plan (if possible) major surgeries in a place where the patient can be resuscitated with major amounts of blood products.
Hope this helps! Interesting fact: Pregnant women routinely lose up to 1/5 of their pregnancy blood volume after a C-section, and about 1/10th after a vaginal delivery. Thankfully pregnant women have about that much extra blood (4-5L vs about 3-4L depending on size of person), which has been made hyper-coagulable, accumulated during the pregnancy.
Another interesting fact is the legendary Iranian hero Rostam from the Shahnameh (Book of Kings) was born via Caesarean section, which is (historically) called a Rostamineh, not a cesarean section because why would Iranians care about Rome or Caesar lol. According to the poem/legend, Rostam’s dad Zal got instructions from the simorgh (iranian phoenix) on how to do it on his pregnant wife Rudaba, and was able to save both the baby and mom on his first try! What a great teacher that bird was! Which I had him for residency
Here are some hilariously gruesome pictures of the surgery, from across the medieval Persianate world:
[https://pbs.twimg.com/media/DPwORwzX0AAWRRk?format=jpg&name=900×900](https://pbs.twimg.com/media/DPwORwzX0AAWRRk?format=jpg&name=900×900)
[https://s01.sgp1.digitaloceanspaces.com/inline/929881-12.jpg](https://s01.sgp1.digitaloceanspaces.com/inline/929881-12.jpg)
[https://i.pinimg.com/474x/9a/6b/e1/9a6be16a8eeac1228bee73571b3fd82c.jpg](https://i.pinimg.com/474x/9a/6b/e1/9a6be16a8eeac1228bee73571b3fd82c.jpg)
[https://media.gettyimages.com/photos/the-birth-of-rostam-picture-id167070846?s=594×594](https://media.gettyimages.com/photos/the-birth-of-rostam-picture-id167070846?s=594×594)
[https://www.bl.uk/learning/images/story/shah/birth%20of%20rostam-st.jpg](https://www.bl.uk/learning/images/story/shah/birth%20of%20rostam-st.jpg)
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