Surgical Anatomy and Technique: A Pocket Manual

Preface to the Fifth Edition
Acknowledgments
Contents
Contributors
1: Skin, Scalp, and Nail
Anatomy
Skin and Subcutaneous Tissue (Fig. 1.1)
Vascular System
Nervous System
Scalp
Vascular System
Arterial Supply
Venous Drainage
Lymphatic Drainage
Nerves (Figs. 1.3 and 1.4)
Nail
Technique
Benign Skin Lesions (Figs. 1.7, 1.8, and 1.9)
Malignant Skin Lesions (Figs. 1.10 and 1.11)
Melanoma
Staging of Malignant Melanoma (After Clark)
Tumor Thickness (After Breslow)
Margins
Lesion Thickness and Regional Lymph Node Staging
Sentinel Lymph Node Biopsy
Excision of Malignant Lesion (Melanoma, Squamous Cell Epithelioma)
Skin Grafts
Split-Thickness Graft (Epidermis Plus Partial Dermis)
Full-Thickness Graft (Fig. 1.12)
Scalp Surgery
Excision of Benign Lesion
Biopsy of Temporal Artery
Ingrown Toenail
Conservative Treatment
Total Excision (Avulsion) of Nail
Partial Excision of Nail and Matrix (Figs. 1.16, 1.17, and 1.18)
Radical Excision of Nail and Matrix
2: Neck
Anatomy
Anterior Cervical Triangle (Fig. 2.1)
Submandibular Triangle
Roof of the Submandibular Triangle
Contents of the Submandibular Triangle
Floor of the Submandibular Triangle
Basement of the Submandibular Triangle
Lymphatic Drainage of the Submandibular Triangle
Submental Triangle (See Fig. 2.1)
Carotid Triangle (See Fig. 2.1)
Muscular Triangle (Fig. 2.1)
Posterior Cervical Triangle (Fig. 2.7)
Fasciae of the Neck
Superficial Fascia
Deep Fascia
Investing, Anterior, or Superficial Layer (Figs. 2.9 and 2.10)
Pretracheal or Middle Layer
Prevertebral, Posterior, or Deep Layer
Carotid Sheath
Buccopharyngeal Fascia
Axillary Fascia
Spaces of the Neck
Lymphatics of the Neck/Right and Left Thoracic Ducts
Anatomy of the Thyroid Gland
Capsule of the Thyroid Gland
Arterial Supply of the Thyroid and Parathyroid Glands
Venous Drainage
Recurrent Laryngeal Nerves (Figs. 2.16 and 2.18)
Exposure of the Laryngeal Nerves
Persistent Remnants of the Thyroglossal Duct
Anatomy of the Parathyroid Glands
Blood Supply
Anatomy of the Trachea
Vascular System
Nervous System
Anatomic Landmarks
Parotid Gland (Fig. 2.21)
Relations of the Parotid Gland
Structures Traversing the Parotid Gland
Facial Nerve
Arteries
Veins
Lymphatics
Great Auricular Nerve
Auriculotemporal Nerve
Parotid Bed
Identification of the Facial Nerve
Branchial Cleft Sinuses and Cysts
Anatomy of Branchial Remnants
Fistulas
Sinuses
Cysts
Technique
Masses of the Neck
Rule of 80
Rule of 7
Parotidectomy
Indications
Technique
Nerve Monitoring
Radical Parotidectomy (Fig. 2.34)
Resection of Submaxillary Gland (Figs. 2.1, 2.2, 2.3, 2.4, 2.5, and 2.6)
Surgical Field in View
Thyroidectomy
Indications
Technique
Parathyroidectomy
Indications
Technique
Thyroid Reoperation
Parathyroid Reoperation
Thyroglossal Duct Cystectomy (Fig. 2.51)
Excision of Branchial Cleft Cyst or Fistula
Radical Neck Dissection
Overview
Anatomical Elements
Superficial Cervical Fascia
Deep Cervical Fascia
Anterior Triangle
Posterior Triangle
Procedure
Tracheostomy
Anatomical Complications
Nerve Injuries
Hypoparathyroidism
Vascular Injuries
Organ Injuries
3: Breast
Anatomy
General Description of the Breast
Deep Fascia
Axilla
Muscles and Nerves
Morphology of the Breast
Vascular System of the Breast
Arterial Supply
Internal Thoracic Artery
Branches of the Axillary Artery
Intercostal Arteries
Venous Drainage
Lymphatic Drainage (as Reported by Haagensen) (Fig. 3.5)
Axillary Drainage (35.3 Nodes)
Internal Thoracic (Mammary) Drainage (8.5 Nodes)
Surgical Anatomy of Mastectomy
Anatomy of the Axillary Triangular Bed of Modified Radical Mastectomy
Technique
Breast Biopsy/Lumpectomy
Simple Mastectomy/Modified Radical Mastectomy
Closing
Axillary Dissection
Anatomical Complications
4: Abdominal Wall and Hernias
Anatomy
General Description of the Anterior Abdominal Wall
Umbilical Region
Layers of the Lower Anterior Body Wall
Fossae of the Lower Anterior Abdominal Wall (Fig. 4.5)
Anatomical Entities of the Groin
Superficial Fascia (Fig. 4.6)
Aponeurosis of the External Oblique Muscle (Fig. 4.6)
Inguinal Ligament (Poupart) (Fig. 4.7)
Lacunar Ligament (Gimbernat) (Fig. 4.8)
Pectineal Ligament (Cooper) (Fig. 4.8)
Conjoined Area (Fig. 4.9)
Arch of the Transversus Abdominis
Falx Inguinalis (Henle Ligament) (Fig. 4.9)
Interfoveolar Ligament (Hesselbach)
Reflected Inguinal Ligament (Colles’) (Fig. 4.9)
Iliopubic Tract (Fig. 4.10)
Transversalis Fascia (Fig. 4.11)
Iliopectineal Arch
Hesselbach Triangle (Fig. 4.8)
Inguinal Canal
Boundaries of the Inguinal Canal
The Deep (Internal) Inguinal Ring
The Secondary Internal Inguinal Ring (Fig. 4.15)
The Superficial (External) Inguinal Ring
The Secondary External Inguinal Ring
Male
Female
Surgical Ellipse (Fig. 4.17)
Femoral Canal and Its Sheath
Blood Supply of the Anterior Abdominal Wall
Arterial Supply
Venous Drainage
Nerve Supply of the Anterior Abdominal Wall
Panorama of Laparoscopic Cadaveric Anatomy of the Inguinal Area (Figs. 4.21, 4.22, 4.23, 4.24, 4.25, 4.26, 4.27, 4.28, 4.29, 4.30, 4.31, 4.32, 4.33, and 4.34)
General Description of the Posterior (Lumbar) Body Wall
Technique
Incisions of the Anterior Abdominal Wall
Principles
Surgical Anatomy of Specific Incisions
Vertical Incisions
Upper Midline Incision
Lower Midline Incision
Rectus (Paramedian) Incision
Pararectus Incision
Transverse Incisions
Upper Abdomen
Lower Abdomen (Pfannenstiel Incision)
Oblique Incisions
Subcostal Incision
McBurney Incision
Thoracoabdominal Incisions
Dehiscence of the Incision
Incisional Hernias
Location
Overall Etiology and Pathogenesis
Preoperative Evaluation and Care
Operating Room Strategies
Primary Closure
Open IPOM (Intraperitoneal Only Mesh)
Component Separation (Fig. 4.48)
Anterior Component Separation
Posterior Component Separation with Transversus Abdominis Muscle Release (Novitsky Repair)/ Retrorectus Repair
Laparoscopic/Robotic IPOM
Laparoscopic/Robotic TAPP
Onlay Technique
Parastomal Hernia Repair
Epigastric Through the Linea Alba
Umbilical Hernia
Small Umbilical Hernia (Fig. 4.60)
Large Umbilical Hernia, Using Mesh (Fig. 4.61)
Spigelian (Lateral Ventral) Hernia
Repair of Spigelian Hernia
Groin Hernias
Direct Inguinal Hernia
External Supravesical Hernia
Indirect Inguinal Hernia
Femoral Hernia
Cooper Ligament Repair of Indirect Inguinal Hernia
Note: For a sliding hernia
Shouldice Technique (Figs. 4.75, 4.76, 4.77, and 4.78)
Marcy Repair
Relaxing Incision (Fig. 4.79)
Femoral Hernia Repair Above the Inguinal Ligament
Femoral Hernia Repair Below the Inguinal Ligament
Mesh Groin Hernia Repairs: Posterior Approach
Nyhus Procedure (Preperitoneal Approach)
Nyhus Procedure for Direct, Indirect, and Femoral Inguinal Hernias
Kugel Hernia Repair (Preperitoneal Patch) (Figs. 4.90, 4.91, 4.92 and 4.93)
Laparoscopic/Robotic Inguinal Hernia Repair
TEP
TAP
Mesh Groin Hernia Repairs: Anterior Approach
Lichtenstein Tension-Free Herniorrhaphy
Bard Plug and Patch Repair
Other Repairs
Hydrocele
Repair of Adult Non-communicating Hydrocele
Lumbar Hernia Repair (Dowd-Ponka)
Anatomical Complications of the Abdominal Wall and Hernia
Complications of Groin Hernia Repair
Complications of Ventral Hernia Repair
5: Diaphragm
Anatomy
Crura
Openings of the Diaphragm
Hiatus of the Inferior Vena Cava
Esophageal Hiatus
Aortic Opening
Other Openings in the Diaphragm
Median Arcuate Ligament
Diaphragmatic-Mediastinal Relations
Vascular System of the Diaphragm
Arterial Supply
Venous Drainage
Lymphatic Drainage
Nerve Supply of the Diaphragm
Structures at or Near the Esophageal Hiatus (Fig. 5.15)
Technique
Diaphragmatic Hernia
Repair of Sliding Hiatus Hernia
Repair of Paraesophageal Hernia
Procedure
Repair of Traumatic Diaphragmatic Hernia
Laparoscopic Nissen Fundoplication
Linx Implantation
Complications
6: Esophagus
Anatomy
General Description of the Esophagus
Length of the Esophagus
Constrictions of the Esophagus
Major Constrictions
Minor Constrictions (Seen Occasionally)
Curves of the Esophagus
Topography and Relations of the Esophagus
Pharyngoesophageal Junction
Cervical Esophagus
Pretracheal Space
Thoracic Esophagus
Surgical Considerations
Anatomic Weak Points
Abdominal Esophagus and Gastroesophageal Junction (Fig. 6.5)
External Junction
Internal Junction
“Cardiac Sphincter”
Esophageal Hiatus and the Crura (See Chap. 5)
Surgical Considerations
Phrenoesophageal Ligament
Peritoneal Reflections
Gastrophrenic Ligament (See Chap. 7, Stomach)
The Structure of the Esophageal Wall (Fig. 6.7)
Mucosa
Submucosa
Muscularis Externa
Adventitia
Nerve Supply to the Esophagus
Intrinsic Nerve Supply
Extrinsic Nerve Supply
Blood Supply of the Esophagus
Lymphatics of the Esophagus
Lymphatic Drainage of the Gastroesophageal Junction
Technique
Pharyngoesophageal Diverticulum
Achalasia or Cardiospasm
Laparoscopic Heller’s Myotomy
Transhiatal Esophagectomy
Abdominal Portion
Cervical Portion
Preparation of the Gastric Conduit (Neoesophagus) and Anastomosis
Postoperative Care
Ivor Lewis Approach
Abdominal Portion
Thoracic Portion
Minimally Invasive Esophagectomy (MIE)
Abdominal Portion
Preparation of the Neoesophagus (Gastric Conduit)
Thoracic Portion
Other Approaches (Summarized)
Ivor Lewis–McKeown (Three-Stage) Esophagectomy
Left Thoracoabdominal Esophagectomy
Colon Interposition
Anatomical Complications
7: Stomach
Anatomy
Two Gastric Units
Proximal Gastric Surgical Unit
Distal Gastric Surgical Unit
Gastric Antrum
Pylorus
First Part of the Duodenum
Relations of the Distal Gastric Surgical Unit
Gastric Wall
Ligaments
Hepatogastric Ligament (Lesser Omentum)
Hepatoduodenal Ligament
Gastrocolic Ligament
Gastrosplenic Ligament
Gastrophrenic Ligament
Vascular System of the Stomach (Fig. 7.3)
Arterial Supply
Venous Drainage
Lymphatic Drainage
Parasympathetic Nerves (Vagus Nerves)
Identification of Vagal Structures at the Hiatus
Distribution of the Vagus Nerves to the Stomach
Anterior Gastric Division
Hepatic Division
Posterior Gastric Division
Celiac Division
Sympathetic Nerves
Technique
Gastrostomy
Percutaneous Endoscopic Gastrostomy (Pull-Technique)
Stamm Gastrostomy
Gastrojejunostomy
Retrocolic
Antecolic (Fig. 7.16)
Perforated Ulcers (Fig. 7.17)
Perforated Peptic Ulcers
Graham Patch (Figs. 7.18 and 7.19)
Perforated Gastric Ulcers
Pyloric Stenosis (Fig. 7.20)
Pyloroplasty
Heineke–Mikulicz Pyloroplasty
Finney Pyloroplasty (Fig. 7.22)
Gastrectomies
Determination of Some Anatomical Boundaries
Guideline for 75% Gastric Resection
Guidelines for 50% Gastric Resection
Guidelines for Antrectomy
Location of the Antral Boundary
Gastrotomy with Direct Observation
Estimation Based on Averages
Estimation Based on Landmarks
Mobilization of the Stomach
Mobilization of the Duodenum
Complications of Ligation of the Left Gastric Arteries
Ischemia of the Gastric Remnant
Ischemia Resulting in Gastric Necrosis with Subsequent Anastomotic Leakage and Peritonitis
T-Closure of Stomach or Duodenum
Ischemia of the Duodenal Cuff
Control of Hemorrhage from the Gastroduodenal Artery
Middle Colic Artery
Posterior Gastric Artery
Subtotal Distal Gastrectomy
Billroth I (Figs. 7.30, 7.31, and 7.32)
Billroth II
Difficult Duodenal Stump
Total Gastrectomy for Cancer
Vagotomies
Truncal Vagotomy
Selective Vagotomy
Parietal Cell Vagotomy
Extended Proximal Vagotomy
Truncal Vagotomy
Parietal Cell Vagotomy
Minimally Invasive Approaches to Gastric Resection
Sleeve Gastrectomy
Anatomical Complications
Stomach
Complications Related to Hiatal Hernia Repair
Organ Injuries
Complications Related to Gastrectomy
8: Duodenum
Anatomy
General Description of the Duodenum
Vascular System of the Duodenum
Arteries
Veins
Lymphatic Drainage
Nerve Supply of the Duodenum
Technique
Surgical Applications
Exposure and Mobilization of the Duodenum (Figs. 8.9, 8.10, and 8.11)
Repair of Vascular Compression of the Duodenum (Figs. 8.13, 8.14, 8.15, 8.16, and 8.17)
Ligation of the Gastroduodenal Artery Within a Posterior Duodenal Ulcer
Surgical Notes to Remember
Anatomical Complications
9: Pancreas
Anatomy
General Description of the Pancreas
Parts of the Pancreas
Head
Uncinate Process
Neck
Body
Tail
Pancreatic Ducts
Duodenal Papilla
Vascular System of the Pancreas
Pancreatic Arcades
Dorsal Pancreatic Arcade
Transverse Pancreatic Artery
Branches of the Splenic Artery
Caudal Pancreatic Artery
Venous Drainage
Lymphatic Drainage
Nerve Supply of the Pancreas
Ectopic and Accessory Pancreas
Technique
Evaluation of Resectability of the Pancreas
Exploration of the Pancreas
Puestow Procedure
Pancreatectomies
Ninety-Five Percent Distal Pancreatectomy for Chronic Pancreatitis
Distal Pancreatectomy (With or Without Splenectomy)
Total Pancreatectomy (With or Without Splenectomy)
Pancreaticoduodenectomy
Whipple Procedure
Laparoscopic Distal Pancreatectomy
Robotic-Assisted Distal Pancreatectomy
Transduodenal Pancreatic Biopsy
Drainage of Pancreatic Pseudocyst
Internal Drainage
Roux-en-Y
Cystogastrostomy
Cystoduodenostomy
Cystojejunostomy
External Drainage
Anatomical Complications of the Pancreas Duodenum
10: Small Intestine
Anatomy
General Description of the Small Intestine
Length of the Intestine
Dimensions of the Mesentery
Layers of the Wall of the Intestine
Anatomy of the Ileocecal Valve
Vascular System of the Small Intestine
Arterial Supply
Venous Drainage
Lymphatic Drainage
Abnormal Development of the Small Intestine
Meckel’s Diverticulum
Surgical Anatomy of Intussusception
Anatomic Guidelines for Surgery
Exposure and Mobilization
Technique
Resection of Small Bowel for Tumor
Meckel’s Diverticulum (Orientation Fig. 10.5)
Intussusception (Orientation Fig. 10.7)
Small Bowel Feeding Tubes – Witzel Jejunostomy
Feeding Jejunostomy
Anatomical Complications
Vascular Injury
Organ Injury
11: Appendix
Anatomy
Relations and Positions of the Appendix
Mesentery
Vascular System of the Appendix
Arterial Supply
Venous Supply
Lymphatic Drainage
Technique
Appendectomy
Step-by-Step Technique
Laparoscopic Appendectomy
Anatomical Complications
Vascular Injury
Organ Injury
Nerve Injuries
Inadequate Procedure
12: Colon and Anorectum
Anatomy
General Description of Colon and Anorectum
Cecum
Colon Proper
Rectum and Anal Canal
Layers of Wall of Large Intestine
Colon
Rectum
Anal Canal
The Musculature of the Wall of the Anal Canal
Lining of the Surgical Anal Canal
Peritoneal Reflections
Fascial Relations and Tissue Spaces
Pelvic Diaphragm and Continence
Vascular System of the Colon and Rectum
Arteries of the Colon
Superior Mesenteric Artery
Middle Colic Artery
Inferior Mesenteric Artery
Marginal Artery (of Drummond)
Arteries of the Rectum and Anal Canal
Venous Drainage of the Colon, Rectum, and Anus
Lymphatic Drainage of the Colon
Lymphatic Drainage of the Rectum and Anal Canal
Nerve Supply of the Rectum and Anus
Technique
Decalogue of Good Colon Surgery
Colostomy
Loop Colostomy
Loop Transverse Colostomy
End Colostomy
Prasad End Loop Colostomy
Colon Resection
Preoperative Preparation
Right Colectomy (Fig. 12.18a)
Left Colectomy
Medial to Lateral Approach
Low Anterior Resection, Triple-Staple Procedure (Fig. 12.18f)
Total Colectomy and Ileoanal Anastomosis/Restorative Proctocolectomy with Ileoanal J-Pouch
Position: Lithotomy
Abdominoperineal Resection
General Principles of Laparoscopic Hand-Assisted Colectomy
Laparoscopic Colectomies
Laparoscopic Left Colectomy, Sigmoid Colectomy, and Low Anterior Resection
Laparoscopic- and Hand-Assisted Right Colectomy
Total Abdominal Laparoscopic Colectomy
Procedures of the Surgical Anal Canal and Perianal Regions
Ischiorectal Abscess: Incision and Drainage
Anal Fistulotomy (Figs. 12.69, 12.70, 12.71, and 12.72)
Ligation of Intersphincteric Fistula Tract (LIFT)
Anal Fissure
Hemorrhoidectomy (Figs. 12.74, 12.75, 12.76, and 12.77)
Procedure for Prolapse and Hemorrhoids (PPH) Stapled Hemorrhoidopexy
Band Ligation of Internal Hemorrhoids
Thrombosed External Hemorrhoids
Excision of Pilonidal Cyst
Anatomical Complications
Right Colectomy
Left Colectomy
Rectosigmoid Colectomy
13: Liver
Anatomy
Topographic Anatomy of the Liver
Diaphragmatic Surface Relations
Visceral Surface Relations
Peritoneal Reflections and Ligaments of the Liver
Morphology of the Liver
Intrahepatic Duct System
Anomalies
Vascular System of the Liver
Hepatic Artery
Portal Vein
Hepatic Veins
Lymphatic Drainage
Superficial Lymphatics
Deep Lymphatics
Perihepatic Spaces
Technique
Needle Biopsy
Excisional Biopsy
Wedge-Type Biopsy
Nonwedge- or Circumferential-Type Biopsy
Hepatic Resections
Anatomical Landmarks for Liver Resection
General Principles
Parenchymal Transection Technique
Operations on the Right Hemiliver
Right Hemihepatectomy
Right Hemihepatectomy Using the Glissonian Approach
Segmental Resections of the Right Hemiliver
Right-Sided Segment-Oriented Resections Using the Glissonian Approach
Right Trisectionectomy (Removal of Segments 4, 5, 6, 7, and 8 [and Sometimes 1]; Formerly Known as “Right Trisegmentectomy”)
Operations on the Left Hemiliver
Left Hemihepatectomy
Removal of Segments 2 and 3
(Mono)segmentectomy 2 or 3 Using the Glissonian Approach
Segmentectomy 4A and/or 4B
Left Trisectionectomy (Removal of Segments 2, 3, 4, 5, 8 [and Sometimes 1]; Formerly “Left Trisegmentectomy”)
Segment 1 (Caudate) Resection
Central Liver Resections
Minimally Invasive Hepatic Resection
Anatomical Complications
References
References are suggested reading for anyone desiring a more thorough description of segment-oriented and minimally invasive liver resections.
14: Extrahepatic Biliary Tract
Anatomy
Right, Left, and Common Hepatic Ducts
Anomalous Hepatic Ducts: Surgically Significant Sources of Bile Leakage (Fig. 14.3)
Cystic Duct
Gallbladder
Common Bile Duct
Hepatocystic Triangle and Triangle of Calot
Vascular System of the Extrahepatic Biliary Tract
Arterial Supply
Venous Drainage
Lymphatic Drainage
Technique
Cholecystectomy
Laparoscopic and Robotic Cholecystectomy
Fluorescent Visualizations of Biliary Structures Using Near-Infrared Imaging Capability of New Camera Systems
Cholecystectomy from Above Downward
Cholecystectomy from Below Upward
Operating Room Cholangiogram
Common Bile Duct Exploration
Sphincteroplasty
Choledochoduodenostomy
Choledochocystectomy
Hepp-Couinaud Procedure
Anatomical Complications
15: Spleen
Anatomy
General Description of the Spleen
Chief Splenic Ligaments
Minor Splenic Ligaments
Vascular System of the Spleen
Splenic Artery and Its Branches
Splenic Vein and Its Branches
Lymphatic Drainage
Segmental Anatomy
Accessory Spleens
Technique
Splenectomy
Splenectomy Due to Hemorrhage Secondary to Trauma
Splenectomy Due to Hematological Disorders (Hypersplenism)
Ligation of the Splenic Pedicle: Anterior Approach
Ligation of the Splenic Pedicle: Posterior Approach
Partial Splenectomy
Technique of Intrasplenic Dissection
Occlusion of the Splenic Artery
Laparoscopic Splenectomy
Anatomical Complications
Hemorrhage
Organ Injury
Inadequate Procedures
16: Adrenal Glands
Anatomy
General Description of the Adrenal Glands
Relations of the Adrenal Glands
Right Adrenal Gland
Left Adrenal Gland
Vascular System of the Adrenal Glands
Arterial Supply
Venous Drainage
Lymphatic Drainage
Technique
Adrenalectomies
Exposure and Mobilization of Left Adrenal Gland General Discussion
Exposure and Mobilization of Right Adrenal Gland General Discussion
Open Anterior Approach
Left Adrenalectomy
Right Adrenalectomy
Open Right Adrenalectomy Step-by-Step Technique
Right or Left Posterior Approach
Posterior Unilateral or Bilateral Adrenalectomy
Thoracoabdominal Approach
Laparoscopic Adrenalectomy
Laparoscopic Left Adrenalectomy
Laparoscopic Right Adrenalectomy
Laparoscopic Bilateral Adrenalectomy
Anatomical Complications
17: Vascular System
Anatomy
Anatomy for Carotid Endarterectomy
Anatomy for Abdominal Aortic Aneurysm Repair
Anatomy for Lower Extremity Bypass
Technique
Carotid Endarterectomy
Elective Infrarenal Abdominal Aortic Aneurysm Repair
Femoropopliteal Bypass, Below Knee, with Saphenous Vein
Arteriovenous Fistula (AVF)
Radiocephalic AVF
Brachiocephalic AVF
Brachio-axillary Arterial Venous Graft
Anatomic Complications in Vascular Surgery
18: Uterus, Tubes, and Ovaries
Anatomy
Relations and Positions of the Uterus, Tubes, and Ovaries
Vascular System of the Uterus, Tubes, and Ovaries
Arterial Supply
Venous Supply
Lymphatic Drainage
Technique
Abdominal Hysterectomy and Bilateral Salpingo-oophorectomy
Ovarian Cystectomy
19: Carpal Tunnel Release
Anatomy
Technique
Surgical Treatment of Carpal Tunnel Syndrome
Anatomical Complications
20: Microsurgical Procedures
Introduction
Microsurgical Instrumentation
Methods of Magnification
Psychomotor Skills Training
Surgical Setup
Suture Materials
Procedure for Vascular Repair
Dissection/Preparation
End-to-End Arterial and Venous Repair
Assessing Patency
Procedure for Nerve Repair
Procedure for Neuroentubulation
Summary
21: Miscellaneous Procedures
Technique
Device Insertion
Subclavian Vein Catheter Insertion
Chest Tube Insertion
Biopsy
Sural Nerve Biopsy
Muscle Biopsy
22: Bariatric Surgery
General Description of Gastric Bypass
Anatomy
Technique
Retrocolic Roux-En-Y Gastric Bypass
Laparoscopic Vertical Sleeve Gastrectomy
Anesthesia: General
Patient Positioning
Biliopancreatic Diversion with Duodenal Switch
Post-op
23: Sports Hernia
Anatomical and Physiologic Considerations
Operating Room Strategies, Considerations, and Technique
Postoperative Course
24: Ablative Techniques for Management of Symptomatic Superficial Venous Disease
Patient Selection
Options for Axial Vein Ablation
Ultrasound Guidance for Venous Ablative Procedures
Radiofrequency Ablation Technique
Step 1: Positioning
Step 2: Access
Step 3: Tumescence
Step 4: RFA Treatment
Follow-Up
Endovenous Laser Ablation (EVLA)
Complications of Thermal Ablation with Tumescence
Brief Note Regarding Adjunctive Stab Phlebectomy
Nonthermal, Nontumesence (NTNT) Ablation Technique
Complications of CAE Nonthermal, Nontumescent Ablation
Treatment of the Small Saphenous Vein
Radiofrequency Ablation with ClosureFast™ System
Cyanoacrylate Embolization with Venaseal™ System
References
25: Kidney and Ureter
Kidney and Ureter
Kidney
Anatomy
Gross Structure
Incision Techniques
Lumbar/Flank Approach
Anterior Abdominal/Transperitoneal Approach
Operative Techniques
Nephrectomy
Ureter
Anatomy
Operative Techniques
End-to-End Ureteroureterostomy
Anatomical Complications
Renal Surgery
Ureter Surgery
Index