Northwestern handbook of surgical procedures

336 Pages·2005·11.019 MB·English

by  Richard H Bell, Dixon B Kaufman, Northwestern University (Evanston, Ill.)

v a d e m e c u m
Northwestern Handbook
of Surgical Procedures
Richard H. Bell, Jr., M.D.
Department of Surgery, Feinberg School of Medicine,
Northwestern University, Chicago, Ilinois, U.S.A.
Dixon B. Kaufman, M.D., Ph.D.
Department of Surgery, Feinberg School of Medicine,
Northwestern University, Chicago, Ilinois, U.S.A.
Illustrations by Simon Kimm, M.D.
L A N D E S
B I O S C I E N C E
G , T
EORGETOWN EXAS
U.S.A.
VADEMECUM
Northwestern Handbook of Surgical Procedures
LANDES BIOSCIENCE
Georgetown, Texas U.S.A.
Copyright ©2005 Landes Bioscience
All rights reserved.
No part of this book may be reproduced or transmitted in any form or by any
means, electronic or mechanical, including photocopy, recording, or any infor-
mation storage and retrieval system, without permission in writing from the
publisher.
Printed in the U.S.A.
Please address all inquiries to the Publisher:
Landes Bioscience, 810 S. Church Street, Georgetown, Texas, U.S.A. 78626
Phone: [phone]; FAX: [phone]
ISBN: 1-57059-684-0
Library of Congress Cataloging-in-Publication Data
Bell, Richard H., 1946-
Northwestern handbook of surgical procedures / Richard H. Bell Jr., Dixon B. Kaufman ;
illustrations by Simon Kimm.
p. ; cm. -- (Vademecum)
ISBN 1-57059-684-0
1. Surgery, Operative--Handbooks, manuals, etc. I. Kaufman, Dixon B. II. Northwestern
University (Evanston, Ill.) III. Title. IV. Title: Handbook of surgical procedures. V. Series.
[DNLM: 1. Surgical Procedures, Operative--methods--Handbooks. WO 39 B435n
2005]
RD37.B45 2005
617'.91--dc22
2005012436
While the authors, editors, sponsor and publisher believe that drug selection and dosage and
the specifications and usage of equipment and devices, as set forth in this book, are in accord
with current recommendations and practice at the time of publication, they make no
warranty, expressed or implied, with respect to material described in this book. In view of the
ongoing research, equipment development, changes in governmental regulations and the
rapid accumulation of information relating to the biomedical sciences, the reader is urged to
carefully review and evaluate the information provided herein.
Dedication
To today’s students of surgery, whose skills will mature to the benefit of man.
Contents
Preface............................................................................................ xii
Section 1: Gastrointestinal...................................................... 1
1. Esophageal Diverticulectomy: Zenker’s.............................................2
2. Heller Myotomy: Laparoscopic.........................................................4
3. Thoracic Esophageal Perforation Repair ...........................................7
4. Antireflux Procedure: Laparoscopic (Nissen).....................................9
5. Gastrostomy: Open ........................................................................11
6. Gastrectomy: Total .........................................................................14
7. Gastrectomy: Subtotal or Partial.....................................................18
8. Gastric Bypass: Roux-en-Y..............................................................22
9. Truncal Vagotomy and Pyloroplasty ............................................... 24
10. Highly Selective (Parietal Cell) Vagotomy....................................... 26
11. Perforated Duodenal Ulcer Repair: Omental Patch.........................28
12. Major Hepatic Laceration: Open Repair.........................................29
13. Hepaticojejunostomy: Roux-en-Y................................................... 34
14. Cholecystectomy with Cholangiography: Open..............................38
15. Cholecystectomy with Cholangiogram: Laparoscopic..................... 41
16. Common Bile Duct Exploration: Open..........................................45
17. Common Bile Duct Exploration: Laparoscopic ..............................47
18. Transduodenal Sphincteroplasty .....................................................50
19. Pancreatic Necrosis: Debridement ..................................................53
20. Pancreaticoduodenectomy: Whipple Procedure ..............................55
21. Distal Pancreatectomy and Splenectomy.........................................60
22. Pancreatic Cystogastrostomy........................................................... 62
23. Longitudinal Pancreaticojejunostomy: Puestow Procedure..............64
24. Duodenum-Preserving Subtotal Pancreatic Head Resection:
Frey Procedure................................................................................67
25. Splenectomy: Open........................................................................71
26. Splenectomy: Laparoscopic.............................................................73
27. Splenorrhaphy: Open .....................................................................76
28. Small Bowel Resection and Anastomosis (Enterectomy): Open......... 79
29. Enterolysis for Small Bowel Obstruction: Open..............................82
30. Appendectomy: Open ....................................................................84
31. Appendectomy: Laparoscopic.........................................................86
32. Ileostomy: Open Loop....................................................................88
33. Hemicolectomy (Right): Open....................................................... 90
34. Hemicolectomy (Right): Laparoscopic............................................93
35. Colostomy Closure.........................................................................96
36. Colostomy: End Sigmoid with Hartmann’s Pouch..........................98
37. Colostomy: Transverse Loop.........................................................101
38. Sigmoid Colectomy: Open...........................................................104
39. Proctocolectomy with Ileal Pouch: Anal Anastomosis ...................106
40. Proctocolectomy: Total with Ileostomy.........................................110
41. Anal Fistulotomy..........................................................................113
42. Anal Fissure: Lateral Internal Sphincterotomy ..............................116
43. Anorectal Abscess: Drainage Procedure.........................................118
44. Internal Hemorrhoids: Band Ligation...........................................120
45. Inguinal Hernia Repair with Mesh: Open.....................................122
46. Inguinal Hernia Laparoscopic Repair: Extraperitoneal Approach ...124
47. Ventral Hernia Repair: Open........................................................128
48. Ventral Hernia Repair: Laparoscopic ............................................130
49. Exploratory Laparotomy: Open....................................................133
Section 2: Endocrine........................................................... 137
50. Adrenalectomy: Laparoscopic .......................................................138
51. Pancreatic Endocrine Tumor Enucleation.....................................141
52. Parathyroid Adenoma Excision.....................................................144
53. Radioguided Parathyroidectomy: Minimally Invasive ...................147
54. Thyroid Lobectomy and Total Thyroidectomy .............................149
55. Modified Neck Dissection............................................................153
Section 3: Surgical Oncology.............................................. 157
56. Transanal Excision of Rectal Tumor..............................................158
57. Abdominoperineal Resection........................................................160
58. Right Hepatic Lobectomy ............................................................163
59. Axillary Lymphadenectomy ..........................................................166
60. Inguinal Lymphadenectomy .........................................................169
61. Breast Biopsy after Needle Localization ........................................172
62. Lymphatic Mapping and Sentinel Node Biopsy............................174
63. Partial Mastectomy and Axillary Dissection..................................176
64. Modified Radical Mastectomy......................................................179
65. Simple Mastectomy......................................................................182
66. Major Excision and Repair/Graft for Skin Neoplasms...................184
67. Sentinel Lymph Node Biopsy for Melanoma ................................187
68. Radical Excision of Soft Tissue Tumor (Sarcoma) .........................190
Section 4: Plastic Surgery ................................................... 193
69. Burn Debridement and/or Grafting..............................................194
70. Split-Thickness Skin Grafts ..........................................................196
71. Debride/Suture Major Peripheral Wounds....................................198
72. Repairing Minor Wounds.............................................................200
73. Removal of Moles and Small Skin Tumors....................................202
74. Removal of Subcutaneous Small Tumors, Cysts
and Foreign Bodies.......................................................................204
Section 5: Cardiothoracic Surgery ...................................... 207
75. Esophagectomy: Ivor-Lewis ..........................................................208
76. Esophagectomy: Left Transthoracic...............................................215
77. Esophagectomy: Transhiatal..........................................................220
78. Mediastinoscopy: Cervical............................................................226
79. Lung Biopsy: Thoracoscopic.........................................................229
80. Pulmonary Lobectomy: Open ......................................................233
81. Pneumonectomy ..........................................................................236
82. Pleurodesis: Thoracoscopic...........................................................239
83. Tracheostomy...............................................................................241
Section 6: Transplantation.................................................. 245
84. Arteriovenous Graft (AVG)...........................................................246
85. Primary Radial Artery-Cephalic Vein Fistula
for Hemodialysis Access................................................................249
86. Laparoscopic Donor Nephrectomy...............................................252
87. Kidney Transplantation ................................................................255
88. Distal Splenorenal (Warren) Shunt ...............................................258
89. H-Interposition Mesocaval Shunt.................................................261
90. Portacaval Shunts .........................................................................264
91. Liver Transplantation....................................................................268
92. Pancreas Transplantation ..............................................................274
Section 7: Vascular Surgery................................................. 277
93. Carotid Endarterectomy...............................................................278
94. Repair Infrarenal Aortic Aneurysm: Elective.................................281
95. Repair Infrarenal Aortic Aneurysm: Emergent for Rupture...........284
96. Endovascular Repair of Infrarenal Aortic Aneurysm .....................287
97. Aortofemoral Bypass for Obstructive Disease................................290
98. Axillofemoral Bypass ....................................................................292
99. Femorofemoral Bypass..................................................................297
100. Femoral-Popliteal Bypass with a Vein or Prosthetic Graft..............300
101. Composite Sequential Bypass .......................................................303
102. Infrapopliteal Bypass: Vein or Prosthetic.......................................305
103. Lower Extremity Thrombectomy/Embolectomy...........................308
104. Repair Popliteal Aneurysm: Emergent (Thrombosed)...................311
105. Exploration for Postoperative Thrombosis ....................................313
106. Fasciotomy: Lower Extremity .......................................................315
107. Toe Amputation ...........................................................................317
108. Transmetatarsal Amputation.........................................................319
109. Below Knee Amputation (BKA) ...................................................321
110. Above Knee Amputation (AKA)...................................................323
111. Varicose Veins...............................................................................325
Editors
Richard H. Bell, Jr., M.D.
Gastrointestinal and Endocrine
Chapters 7, 10, 22-24
David Fullerton, M.D.
Cardiothoractic Surgery
Chapters 80, 82
Dixon B. Kaufman, M.D., Ph.D.
Transplantation
Chapters 87, 92
Thomas Mustoe, M.D.
Plastic Surgery
Chapter 72
William H. Pearce, M.D.
Vascular Surgery
Chapters 101, 111
Mark S. Talamonti, M.D.
Surgical Oncology
Chapters 13, 20
David P. Winchester, M.D.
Gastrointestinal
Department of Surgery, Feinberg School of Medicine,
Northwestern University, Chicago, Ilinois, U.S.A.
Illustrations by Simon Kimm, M.D.
Contributors
Michael Abecassis, M.D. Jonathan Fryer, M.D.
Chapters 88-90 Chapter 91
Peter Angelos, M.D., Ph.D. Sean C. Grondin, M.D.
Chapters 50, 54, 55 Chapter 1
Ermilo Barrera, Jr., M.D. Amy L. Halverson, M.D.
Chapters 11, 45 Chapters 39, 40, 43, 56
Richard S. Berk, M.D. Keith A. Horvath, M.D.
Chapters 5, 37 Chapter 83
Kevin Bethke, M.D. Raymond J. Joehl, M.D.
Chapters 59, 60 Chapters 2, 4
Malcolm M. Bilimoria, M.D. Seema A. Khan, M.D.
Chapter 6, 25, 26 Chapter 62
Christopher Bulger, M.D. Alan J. Koffron, M.D.
Chapter 100 Chapters 58, 84
Joseph A. Caprini, M.D. Thomas W. Kornmesser, M.D.
Chapters 28, 29 Chapters 102, 105
John J. Coyle, M.D. Joseph R. Leventhal, M.D., Ph.D.
Chapters 9, 35, 47 Chapters 85, 86
Daphne W. Denham, M.D. Michael J. Liptay, M.D.
Chapters 51-53 Chapter 3
Woody Denham, M.D. Jon S. Matsumura, M.D.
Chapters 18, 19, 21 Chapters 94-96
Gregory Dumanian, M.D. Mark D. Morasch, M.D.
Chapter 71 Chapter 93
Mark K. Eskandari, M.D. Monica Morrow, M.D.
Chapters 97, 103, 104, 106, 107 Chapters 61, 63
Julius W. Few, Jr., M.D. Joseph P. Muldoon, M.D.
Chapters 69-70 Chapters 41, 42
Neil A. Fine, M.D. Kenric M. Murayama, M.D.
Chapters 73, 74 Chapters 15, 17, 34, 48
James W. Frederiksen, M.D. Alexander P. Nagle, M.D.
Chapters 78, 79 Chapter 30
Jay B. Prystowsky, M.D. Mark Toyama, M.D.
Chapters 8, 14, 16 Chapters 26, 31, 46
Nancy Schindler, M.D. Robert Vanecko, M.D.
Chapters 108-110 Chapter 81
Joseph R. Schneider, M.D., Ph.D. Jeffrey D. Wayne, M.D.
Chapters 98, 99 Chapters 7, 55, 66-68
Stephen F. Sener, M.D. Michael A. West, M.D., Ph.D.
Chapter 6 Chapters 12, 27, 49
Valerie L. Staradub, M.D. John V. White, M.D.
Chapters 64, 65 Chapter 100
Steven J. Stryker, M.D. David J. Winchester, M.D.
Chapters 32, 38, 44, 57 Chapters 33, 36
Sudhir Sundaresan, M.D.
Chapters 75-77
Preface
Performing a surgical operation must be one of the most complex motor
tasks undertaken by humans. To the student rotating on a third-year clerk-
ship, or to the resident beginning a surgical career, the complexity can no
doubt be daunting. It is the goal of this handbook to try to bring some
degree of order to the complexity, focusing on many of the common opera-
tions in general, plastic, thoracic, and vascular surgery, and in organ trans-
plantation. We have done so by dividing each procedure into specific and
well-defined steps.
Research originating in the 1950s explored whether teaching a novice to
perform a skill is best accomplished by having the learner perform the entire
skill (called the “whole training method”) or first practice the parts of the
skill (called the “part-whole method”). It was concluded that certain types of
skills were more efficiently learned using the latter method. As novices gain
proficiency in the various steps (or subroutines) of a skill, their ability to
more fluidly chain the steps together increases. Learning complex skills by
practicing its sub-skills continues to be supported today by educational learn-
ing theories and practices.
A master surgeon brings flow and continuity to an operation which may
make the procedure appear to be an indivisible whole, but in fact all op-
erations are composed of a series of steps. Mastery comes from practicing
each step repeatedly until competence is obtained and then integrating the
steps into a whole. Accomplished surgeons not only do each step well, but
also have a clear mental image of the progression of the steps and their
interdependency.
Unlike the music student, who may study with a single teacher for an
extended period of time, medical students and residents often scrub with
several surgeon-teachers, all of whom have their particular approach to a
given operation. For the advanced student, such variety of experience may
be enriching, but for the novice, the variety of approaches can be confusing.
In this book, we hope to provide the beginner with a framework that can
serve as a baseline and against which real-life experiences can be measured.