Surgical Anatomy and Technique: A Pocket Manual PDF
Preview Surgical Anatomy and Technique: A Pocket Manual
Surgical Anatomy and Technique Second Edition Springer New York Berlin Heidelberg Hong Kong London Milan Paris Tokyo John E. Skandalakis Panajiotis N. Skandalakis Lee John Skandalakis Surgical Anatomy and Technique A Pocket Manual Second Edition With 753 Illustrations , Springer John E. Skandalakis, M.D., Ph.D. Panajiotis N. Skandalakis, M.D. The Centers for Surgical Anatomy The Centers for Surgical Anatomy and Technique and Technique Emory University School of Medicine Emory University School of Medicine 1462 Clifton Road, N.E. 1462 Clifton Road, N.E. Atlanta, GA 30322 Atlanta, GA 30322 USA USA Lee John Skandalakis, M.D. The Centers for Surgical Anatomy and Technique Emory University School of Medicine 1462 Clifton Road, N.E. Atlanta, GA 30322 USA Library of Congress Cataloging-in-Publication Data Skandalakis, John Elias, 1920- Surgical anatomy and technique IJohn E. Skandalakis, Panajiotis N. Skandalakis, Lee John Skandalakis. - 2nd ed. p. cm. Includes bibliographical references and index. ISBN-13: 978-3-540-41005-8 e-ISBN-13: 978-1-4615-7993-9 DOl: 10.1007/978-1-4615-7993-9 I. Surgery, Operative-Handbooks, manuals, etc. 2. Anatomy, Surgical and topographical-Handbooks, manuals, etc. I. Skandalakis, Panajiotis N. II. Skandalakis, Lee John. III. Title. [DNLM: I. Surgical Procedures, Operative-methods handbooks. 2. Anatomy handbooks. WO 39 S626s 1999] RD32.S598 1999 61 7-dc2 I 98-54986 Printed on acid-free paper. © 2000,1995 Springer-Verlag New York, Inc. All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer-Verlag New York, Inc., 175 Fifth Avenue, New York, NY 10010, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in con nection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use of general descriptive names, trade names, trademarks, etc., in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Production coordinated by Chernow Editorial Services, Inc., and managed by Terry Komak; manu facturing supervised by Jacqui Ashri. Typeset by Bytheway Publishing Services, Norwich, NY. Printed and bound by Hamilton Printing, Co., Rensselaer, NY. 9 8 765 4 3 SPIN 10928394 Springer-Verlag New York Berlin Heidelberg A member of BerteismannSpringer Science+ Business Media GmbH Dedicated to my beloved Piedmont Hospital in Atlanta, Georgia, the institution of my maturity, with appreciation and gratitude. J.E.S. Preface to the Second Edition "You young beginning surgeons, open your ears and remem ber with diligence this short word. When you are called to a patient if the matter appears to you too difficult or not en tirely familiar do not be ashamed to send after one or two other surgeons so that they can help you and give you good advice from which you and the patient can derive great bene fit ... if everything goes well, you will participate in the suc cess. If things go wrong, they will share the burden." Hieronymous Brunschwig (c. 1450) (From The Book of Cirurgia 1497. With a Study on Hieronymous Brunschwig and His Work, by Henry E. Sigerist, published in Milan, 1923) The first edition of Surgical Anatomy and Technique: A Pocket Man ual was received with great enthusiasm, and we are deeply grateful to the doctors and students who have encouraged us to prepare this second edition. Although we must keep this volume small enough to fit into the clini cian's labcoat pocket, we have added new sections on surgery of the esophagus, the Kugel hernia repair, and laparoscopic cadaveric inguinal anatomy. In addition, we have updated the coverage of laparoscopic procedures and integrated it into the chapter in which it is relevant. This places each procedure closer to the illustrations of the anatomic entities to which it relates. A few of the laparoscopic procedures included in the first edition have not become widely accepted (for example, gastrostomy, jejunos- vii viii Preface to the Second Edition tomy, and highly selective vagotomy), so we have omitted them from this edition. We have corrected a few minor errors in the text. We hope this book will meet the needs of both students and practicing surgeons, whether they are just starting out into the modem surgical universe or whether they wish to refresh their memory about a proce dure they have used devotedly for years. Whether surgeons choose the old procedures that have been proven to be sound and correct or whether they wish to try a new technique, there is a procedure here with which they will feel comfortable. Once again, we wish to express our appreciation and gratitude to Esther Gumpert, Senior Medical Editor, Springer-Verlag, for her contin uing advice, encouragement, and support. We are grateful that Springer Verlag has had enough confidence in this text to publish it in Italian and is preparing it for release in Greek and Portuguese. J.E.S. Preface to the First Edition "Reach what you can, my child .... Reach what you cannot!" Nikos Kazantzakis (from Report to Greco, translated from the Greek by P.A. Bien, published by Simon and Schuster, 1965) Surgical Anatomy and Technique: A Pocket Manual: With this title we want to present the stepchild of basic science, "anatomy," and also to emphasize some of the operative techniques of general surgery. We feel that this combination will take students to the promised surgical land. A good knowledge of anatomy will help surgeons avoid anatomical complications, while a masterful technique will allow them to proceed rapidly and securely in the operating room. In my 50 years of teaching and practicing surgery, I have observed that residents, in most cases, come into the operating room without preparation or with a minimum of preparation. When I was a resident, the "Bible" was the atlas of my late, respected friend, Prof. Robert M. Zollinger. At the present time, there are several excellent books about surgical technique; among the best are Operative Strategy in General Surgery by Jameson L. Chassin, Atlas of Surgery by John L. Cameron, and An Atlas of Head and Neck Surgery by John M. Lore, Jr. Several students, residents, and practicing surgeons approached me to write a pocket-sized book that covers both technique and surgical anatomy. Therefore, the philosophy behind this book is to present the anatomical entities involved with each operation and also to present the step-by-step technique of some procedures. We found that there are many huge volumes that describe step-by-step procedures, so, in order to produce a book small and light enough to be carried in the pocket of the white uniforms of students and residents, we selected only the abso- ix x Preface to the First Edition lutely necessary steps to convey the surgical procedure in continuity; occasionally, it was necessary to present a procedure in toto. This book is designed as a resource about surgical anatomy and technique for resi dents to read before entering the operating room. The greatest stimulus for the book was coauthor Dr. Panajiotis N. Skandalakis, with his hundreds of drawings from Holland, his sound surgicoanatomical notes, and his innumerable discussions of the subject. Most of the kudos belong to him. We apologize for the steps, details, and procedures (such as the radi cal mastectomy, internal peritoneal hernias, and several others) that are omitted. With some procedures we do not use any drawings, whereas with some others we give more details. Perhaps our omissions are wrong; we hope the reader will forgive us. The lack of footnotes and bibliography does not imply any disrespect or lack of appreciation of several authors from whom material has been drawn, but is consistent with our goal of keeping this volume as brief as possible. In our previous publications, Anatomical Complications in General Surgery, Atlas of Surgical Anatomy for General Surgeons, Em bryology for Surgeons, and Hernia: Surgical Anatomy and Technique, we credited all authors to whose material we referred. This handbook should be used in conjunction with the above publications. This manual is a brief compilation of elements from our previous works, a presentation of our own ideas about technique, and a summary of surgical anatomy lectures given for approximately a half century to the students at Emory University School of Medicine. Anatomy is to be remembered; but surgical anatomy of the entities involved in an opera tion is to be applied. We hope this handbook helps in that application. J.E.S. Acknowledgments We acknowledge Esther Gumpert, Senior Medical Editor at Springer Verlag New York, for her guidance, patience, and cooperation in this project from its inception to its completion. We would like, also, to express our gratitude for the courteous, enthu siastic, and professional assistance throughout the publishing process by the Production Department at Springer-Verlag. For their dedicated efforts in the preparation of this manuscript, we thank our editors, Phyllis Bazinet and Carol Froman, and Dr. John E. Skandalakis' secretary, Cynthia Painter. We are indebted to Mark Bar baree, Edie Lacy, Sharon Scott, and Beth Simmons, librarians at Pied mont Hospital, Atlanta, for their research assistance. Special thanks, also, to Brook Fehrenbach Wainwright and Robert Wainwright, Jr., for their outstanding illustrations; and to Tom Fletcher for his excellent photographic and artistic contributions. We appreciate the advice of Adel Bagh, M.D., regarding the material on the colon and perianal area, and of Patrick M. Battey, M.D., regard ing varicose veins of the lower extremity and shunts for portal hyperten sion. xi
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