Atlas of General Surgical Techniques: Expert Consult - Online and Print

1212 Pages·2010·81.84 MB·English

by  Courtney M. Townsend Jr. MD

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ATLAS OF GENERAL SURGICAL TECHNIQUES ISBN: 978-0-7216-0398-8
Copyright © 2010 by Saunders, an imprint of Elsevier Inc.
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Knowledge and best practice in this fi eld are constantly changing. As new research and experience broaden
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Library of Congress Cataloging-in-Publication Data
Atlas of general surgical techniques / [edited by] Courtney M. Townsend Jr., B. Mark Evers. -- 1st ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-7216-0398-8 (hardcover : alk. paper) 1. Surgery--Atlases. I. Townsend, Courtney M. II.
Evers, B. Mark, 1957-
[DNLM: 1. Surgical Procedures, Operative--methods--Atlases. WO 517 A8797 2010]
RD41.A782 2010
617.0022’3--dc22
2009049217
Acquisitions Editor: Judith Fletcher
Developmental Editor: Kristina Oberle
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Senior Project Manager: Laura Loveall
Design Direction: Louis Forgione
Artwork: Michael A. Cooley
Mike de la Flor
Peggy Firth
Victoria Heim
Alexandra Hernandez
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Jennifer Smith
Gina Urwin
Electronic Publishing Services Inc., NYC
Printed in the United States
Last digit is the print number: 9 8 7 6 5 4 3 2 1

Contributors
Carlos A. Angel, MD, FACS B. Mark Evers, MD
Associate Professor Director, Lucille P. Markey Cancer Center;
Department of Surgery Professor and Vice-Chair for Research
University of Missouri—Columbia University of Kentucky Department of Surgery;
Columbia, Missouri Markey Cancer Center Director Chair;
Physician-in-Chief, Oncology Service Line
Valerie P. Bauer, MD University of Kentucky Healthcare
Assistant Professor Markey Cancer Center
Department of Surgery Lexington, Kentucky
The University of Texas Medical Branch
Galveston, Texas James J. Gallagher, MD
Assistant Professor of Surgery
Edward Y. H. Chan, MD Department of Surgery
Surgical Resident Weill Medical College;
Department of Surgery Assistant Attending Surgeon
Mount Sinai School of Medicine Department of Surgery
New York, New York New York Presbyterian Hospital
New York, New York
Celia Chao, MD
Assistant Professor Dennis C. Gore, MD
Department of Surgery Professor
The University of Texas Medical Branch Department of General Surgery
Galveston, Texas The University of Texas Medical Branch
John Seely Hospital
Charlie C. Cheng, MD Galveston, Texas
Assistant Professor
Department of Vascular Surgery Baiba J. Grube, MD, FACS
The University of Texas Medical Branch Associate Professor
Galvaston, Texas; Department of Surgery
Assistant Professor Yale University School of Medicine
Department of Vascular Surgery New Haven, Connecticut
Mainland Medical Center
Texas City, Texas Kristene K. Gugliuzza, MD, FACS
Professor, Departments of Surgery and Pediatrics
Dai H. Chung, MD Alonzo Alverly Ross Centennial Chair in General
Professor and Vice-Chair Surgery
Department of Pediatric Surgery Program Director, General Surgery Residency
Vanderbilt University Medical Center Director, Kidney and Pancreas Transplant Program
Nashville, Tennessee in the UTMB Texas Transplant Center
Scholar, John P. McGovern Academy of Oslerian
Concepcion Diaz-Arrastia, MD Medicine
Associate Professor and Director The University of Texas Medical Branch
Division of Gynecologic Oncology Galveston, Texas
Department of Obstetrics and Gynecology
Baylor College of Medicine
Houston, Texas
v
vi CONTRIBUTORS
David N. Herndon, MD Jacqueline A. Lappin, MD, FRCSI, FACS
Chief of Staff Assistant Professor of Surgery and Director of
Director of Research Pancreas Transplantation
Shriners Hospitals for Children—Galveston; Department of Surgery
Professor of Surgery University of Texas Health Science Center and
Jesse H. Jones Distinguished Chair in Burn Surgery Memorial Hermann Hospital;
The University of Texas Medical Branch Assistant Professor of Surgery
Galveston, Texas Department of Surgery
St. Luke’s Episcopal Hospital and Texas Children’s
Glenn C. Hunter, MD, FRCSC, FACS Hospital
Professor Houston, Texas
Department of Surgery
University of Arizona; Jong O. Lee, MD
Staff Surgeon Assistant Professor
Department of Surgery Department of Surgery
Southern Arizona VA Healthcare Service The University of Texas Medical Branch;
Tucson, Arizona Staff Surgeon
Shriners Hospitals for Children—Galveston
Margie A. Kahn, MD Galveston, Texas
Associate Professor
Department of Obstetrics and Gynecology David B. Loran, MD
Tulane University School of Medicine Thoracic, Vascular, and General Surgery
New Orleans, Louisiana Meadville Medical Center
Meadville, Pennsylvania
Lois A. Killewich, MD, PhD
Professor and Chief, ad Interim William J. Mileski, MD, FACS
Section of Vascular Surgery Professor
Department of Surgery Chela and Jimmy Storm Distinguished Professor
The University of Texas Medical Branch Chief of Trauma Services
Galveston, Texas Department of Surgery
The University of Texas Medical Branch
Thomas D. Kimbrough, MD Galveston, Texas
Professor
Department of Surgery William H. Nealon, MD
The University of Texas Medical Branch Professor and Vice Chairman
Galveston, Texas Department of Surgery
Vanderbilt University;
Tien C. Ko, MD Associate Surgeon-in-Chief
Jack H. Mayfi eld, MD Distinguished Professor in Department of Surgery
Surgery Vanderbilt University Hospital
Vice Chairman for Harris County Hospital District Nashville, Tennessee
The University of Texas Health Science Center at
Houston
Chief of Surgery at Lyndon B. Johnson General
Hospital
Houston, Texas
vi
CONTRIBUTORS vii
Colin D. Pero, MD Courtney M. Townsend, Jr., MD
Clinical Assistant Professor Professor
Department of Otolaryngology—Head and Neck John Woods Harris Distinguished Chairman
Surgery Department of Surgery
University of Texas Southwestern Medical School Robertson-Poth Distinguished Chair in General
Dallas, Texas; Surgery
Department of Otolaryngology—Head and Neck The Unversity of Texas Medical Branch
Surgery, Facial Plastic and Reconstructive Surgery Galveston, Texas
Baylor Regional Medical Center
Plano, Texas Michael D. Trahan, MD
Surgeon
Anna M. Pou, MD, FACS Martha Jefferson Surgical Associates
Professor and Program Director Charlottesville, Virginia
Otolaryngology—Head and Neck Surgery
Louisana State University Health Sciences Center, Kenneth J. Woodside, MD
New Orleans Assistant Professor of Surgery
New Orleans, Louisana Division of Transplant and Hepatobiliary Surgery
Department of Surgery
Lori Cindrick Pounds, MD, FACS RVT University Hospitals Case Medical Center
Peripheral Vascular Associates Cleveland, Ohio
San Antonio, Texas
Joseph B. Zwischenberger, MD
Taylor S. Riall, MD, PhD Johnson-Wright Professor and Chairman
Associate Professor Department of Surgery
Department of Surgery University of Kentucky College of Medicine
The University of Texas Medical Branch Lexington, Kentucky
Galveston, Texas
Arthur P. Sanford, MD, FACS
Associate Professor
Department of Surgery
Loyola University Medical Center
Maywood, Illinois
Michael B. Silva, Jr., MD
The Fred J. and Dorothy E. Wolma Professor of
Vascular Surgery
Professor of Radiology
Director
Texas Vascular Center;
Department of Vascular Surgery
The University of Texas Medical Branch
Galveston, Texas;
Department of Vascular Surgery
Mainland Medical Center
Texas City, Texas
vii

Preface
“An education in medicine involves both learning and learning how; the student cannot
effectively know, unless he knows how.”
—EXCERPT FROM ABRAHAM FLEXNER,
“Medical Education in the United States and Canada,” 1910.
The fundamental core knowledge of general surgery remains the cornerstone of all surgical
disciplines. Over the last decades, we have witnessed a proliferation of surgical specialties. The
majority of graduating residents elect to pursue additional training in highly specialized fi elds
of surgery. However, a sound foundation in general surgical techniques and principles is criti-
cal for success in these areas. Therefore, an atlas describing common general surgical proce-
dures in a clear and concise fashion is an essential complement to current surgical textbooks
to ensure that the student not only “learns how” but, most importantly, “knows how.” With
that said, putting together a surgical atlas is a daunting challenge. Coordinating schedules of
busy surgeons and medical illustrators is, at times, akin to herding cats. So, why expend the
time and effort to put this together?
For one, we have been privileged to edit the Sabiston Textbook of Surgery for the last three
editions. This text provides a comprehensive compendium on the physiology, diagnosis, and
treatment of surgical diseases, yet we are limited in the ability to describe the operative proce-
dures in any detail. A good textbook must provide the basic knowledge to ensure that the
student “learns” the material. However, it is vastly different from an atlas which teaches the
student “how.” Textbooks that have tried to be a comprehensive text as well as an atlas have
usually failed on both accounts. Therefore, this surgical atlas series provides an important and
necessary complement to the Sabiston Textbook of Surgery (Saunders).
The illustrations have been meticulously drawn by medical illustrators who share the same
philosophy of art design. Illustrations are drawn in detail from the perspective of the operat-
ing surgeon, yet the drawings are simple enough that the reader is not distracted with extrane-
ous colors or overly complicated design. The essential steps of the procedure are illustrated
with an emphasis on surgical anatomy. Each concludes with three to fi ve “pearls” or pitfalls
from master surgeons with years of experience. Recognizing that many general surgical proce-
dures are now performed laparoscopically, we have illustrated steps of both the open and the
minimally invasive techniques where applicable. Except for the approach and the instruments,
the basic tenets of the dissection and attention to detail are common to both techniques.
Finally, we were inspired to produce this atlas series based on our interactions over the
years with numerous talented and hard-working surgical residents who need a concise refer-
ence to study and review prior to entering the operative suite. This atlas is meant to provide
these trainees with the essential steps in performing common general surgical procedures. We
recognize that the atlas is not all-inclusive. In the interest of space, we have omitted some
procedures which are less commonly performed by the general surgeon in practice. However,
we believe that this atlas provides a great start.
COURTNEY M. TOWNSEND, JR., MD
B. MARK EVERS, MD
ix