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At the Cleveland Clinic Foundation, RN first assistants (RNFAs) have replaced inexperienced interns and rotating general surgery residents as surgical first assistants. Their new role includes harvesting inferior epigastric arteries (IEAs) for coronary artery bypass procedures. The RNFAs remove the IEAs through paramedian incisions that extend from below the umbilicus to the groin, dissect the IEAs as pedicles, and complete wound closure. This is one example of the expanded role of RNFAs during complex surgical procedures.

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