far apart that you appear to be making a separate incision; this will puncture the intestines. But do try to make the incision straight...neatness counts.
After snipping the preperitoneum, spread it. Using your fingertips, click on the bottom of the chest to push the intestines out of the way. In the top drawer you'll see a small bag (called the gut bag). Click the bag on the intestines at the top of the screen to keep them clean, tidy, and out of the way. Underneath the intestines is the postperitoneum, and underneath that, the murky shape of the aneurysm. Scrape, elevate, nick and snip the postperitoneum exactly as you did with the preperitoneum. Spread it and there's the aneurysm, the swelling just above where the two iliac arteries merge.
In the bottom drawer, take the Heparin and inject it before proceeding. This prevents embolisms in 100% of my cases so far! I wouldn't know what to do if there WAS an embolism. Click the fingertips at the base of the aneurysm and rubber tubing will appear in place. The aneurysm is now immobilized and ready for action!
Take a clamp (NOT a hemostat) and clamp either of the iliac arteries, then clamp the other one. Put another clamp on the small vessel (mesenteric artery) extending from the center of the aorta, close to where they come together. Then put a clamp at the top of the aneurysm, right where it comes into view. Work quickly at this point; you've cut off the blood supply to the legs!
Take the scalpel and nick the mesenteric artery just above the clamp (not between the clamp and the aorta). A bleeder will appear; ligate it. You're going to incise the aorta with the scalpel. Don't start right at the top! Start about a quarter of the way down the aneurysm or the incision will be too long, and you'll have to abort the operation. Make the incision straight and clean; don't bring it quite all the way to the bottom. Use the skin retractor to expose the clot. Remove the clot with your fingertips; take the Y-shaped dacron graft from the bottom drawer and put it in place.
The graft has to be sutured into place. Take the needle and put three sutures into each of the graft's three ends (nine sutures altogether). You should be able to see each of the three sutures connecting the graft to the artery walls. Put down the needle.
Before you can complete the suturing, you have to close the artery walls around the graft. With your fingertips, click at the junctures of the graft (the three ends) until the flaps of vessel tissue close around them. Then take the needle up and suture three times at each juncture again, for a total of six sutures in each of the three branches. Pick up the retractor and close the aorta around the graft. Suture the aortal incision with close stitches.
The next step is a test of your previous work. Remove one of the iliac clamps. Then remove the next. Finally remove the clamp at the top, re-establishing the flow of blood through the aorta. If no bleeders appear, you've made it! If bleeders do appear, replace the three clamps, starting wit the two iliac clamps. Resuture the incision and try again.
Once the aorta is repaired, remove the rubber tubing. Then un-retract the postperitoneum. Suture it. Remove the gut bag and replace the intestines. Un-retract the preperitoneum and suture it. Un-retract the next two layers (chest muscle and subcutaneous fat). After un-retracting the skin, close it with skin clips instead of stitches. Turn off the gas, and pick up your diploma in the Chief of Surgery's office.
You retire wealthy, and your name will vanish from the receptionist's clipboard. Should you want to relive past glories, head into the Staff room and click on the file cabinet. Again, hearty congratulations: I'll catch you on the back 9!
LIFE & DEATH is published by The Software Toolworks and distributed by Electronic Arts.