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■ The assistant must ensure immediate hemostasis at all times by using the bipolar or monopolar tweezers. Depending on the surgeon's preference, sharp dissection can be done with the size 10 scalpel blade or with large dissection scissors.

It may be useful to use an illuminated retractor in the vicinity of the xiphoid process and at the base of the ribs. There is an increased possibility of bleeding with dissection of the xiphoid process in the area of the costal arch using a sharp instrument. The bleeding must be controlled by immediate and rapid coagulation or purse-string suturing.

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