Townsend Courtney M.Jr., Evers B. Mark. Atlas of General Surgical Techniques: Expert Consult
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Index
1197
Right gastric artery
anatomy of, 578
in Billroth I, 278, 279f
in total gastrectomy, 308, 308f
Right gastroepiploic artery, 278, 279f, 555f,
570, 571f
Right hemicolectomy
anastomoses, 658, 658f-659f, 660-661
bowel preparation for, 652
closure of, 663
dissection, 654f-661f, 654-662
incision, 653, 653f
indications for, 652
pearls and pitfalls of, 663
postoperative care, 663
preoperative considerations for, 652
surgical anatomy of, 652
Right hepatectomy
ascites after, 490-492
closure of, 490
dissection, 480-489, 481f-489f
hepatic failure concerns, 490
incision, 478, 479f
Jackson-Pratt drains, 488, 489f
pearls and pitfalls of, 491
postoperative care, 490
preoperative considerations for, 478
surgical anatomy of, 476-477, 477f
Right hepatic artery, 425f, 431f
Right hepatic duct, 445f
Right hepatic vein, 482, 483f
Right middle adrenal artery, 895f
Right recurrent laryngeal nerve, 10f, 1019f
Right renal artery, 945, 948f-950f, 953f
Right renal vein, 959f, 979f
Right superior adrenal artery, 895f
Right vagus nerve, 328, 329f
Rotter’s nodes, 117
Round ligament, 1068, 1069f, 1077f, 1085
Roux-en-Y anastomosis, 203, 214f, 215f
Roux-en-Y gastric bypass
airway management during, 354
indications for, 354
laparoscopic
anvil of circular stapler, 364, 364f-365f
closure, 370
dissection, 356-369, 356f-369f
enterotomy, 359-360, 360f
gastrotomy, 364, 366f
incisions for, 355, 356f
jejunal Roux limb, 358f-359f, 360, 368
jejunojejunal anastomosis, 360
ligament of Treitz, 357f-358f
omental window, 356, 357f
pearls and pitfalls of, 384-385
port access, 356
postoperative care, 384
pouch creation, 362-363
stapling, 366f, 369, 369f
stomach transection in, 363
open
anvil of circular stapler, 379-380
closure of, 384
dissection, 372-383, 372f-383f
enterotomy, 372, 373f
gastrojejunostomy leak checks, 383, 383f
gastrotomy, 378, 378f
incision, 370, 371f
jejunal Roux limb, 380, 381f
jejunojejunal anastomosis, 374, 374f
ligament of Treitz, 372, 373f
pearls and pitfalls of, 384-385
postoperative care, 384
pouch creation, 376, 377f, 378-380
stapling, 379-380, 379f-382f
pearls and pitfalls of, 384-385
Roux-en-Y gastric bypass (Continued)
postoperative care, 384
preoperative considerations for, 354
surgical anatomy of, 354, 355f
Roux limb
in Frey procedure, 541f
jejunal, 358f-359f, 360, 368
side-to-side anastomosis for, 573f
for total gastrectomy, 310, 314
Rummel loop, 471f, 482, 483f, 498, 499f
Russell technique, 256, 257f
S
Sacks-Vine method, 258
Sacral splanchnic nerves, 734
Salivary fi stula, 64
Salpingo-oophorectomy, bilateral
abdominal hysterectomy and, 1070
closure of, 1091
dissection, 1086-1090, 1087f
incision, 1086
pearls and pitfalls of, 1091
postoperative care, 1091
preoperative considerations for, 1086
surgical anatomy of, 1085, 1085f
Saphenous vein, 1001f
Saphenous vein graft, 961f
Sartorius muscle, 920f, 1059f, 1127f
Scalene muscles, 21f
Scarpa’s fascia, 800, 824, 838, 1060
Sciatic nerve, 1061f
Segmental hepatic resection
ascites, 474-475
biliary radicals, 473
closur
e of, 474
dissection, 467-473, 468f-473f
drain placement, 473, 473f
hepatic failure concerns, 474
incision, 467
margins, 473
pearls and pitfalls of, 475
postoperative care, 474
preoperative considerations for, 467
surgical anatomy of, 464-466,
465f-466f
Segmental mastectomy, 108
Seldinger technique, 1010
Semi-Fowler position, 43
Semilunar line, 783f
Semimembranosus muscle, 1061f
Semitendinosus muscle, 920f, 1061f
Sentinel lymph node
defi nition of, 132
frozen section analysis of, 142
gamma counter used to identify,
138, 139f
identifi cation of, 138-140, 139f
pathologic examination of, 133,
140-141
Sentinel lymph node biopsy
anesthesia for, 134
blue dye injection, 134, 136, 142
closure of, 141
defi nitions, 132-133
dissection, 138-141
dual-agent injection technique, 134,
137f, 142
incision, 136, 137f
mastectomy after, 141
patient eligibility for, 134
pearls and pitfalls of, 141-142
preoperative considerations for, 132-133
radioactive colloid for, 134-135, 142
surgical anatomy of, 132, 133f
team-based approach, 133
Sepsis, postsplenectomy, 510
Serratus anterior muscle, 119f, 127f,
205, 1111f
Seurat clamps, 704
Short gastric vessels, 508
Shouldice inguinal herniorrhaphy
anesthesia for, 822
closure of, 831, 831f
dissection, 825-830, 825f-830f
incision, 824, 824f
pearls and pitfalls of, 832
postoperative care, 832
preoperative considerations for, 822
surgical anatomy of, 820-822, 821f
suturing/sutures, 828, 829f-830f
Shunt
carotid endarterectomy, 910, 912,
912f-913f
peritoneal venous. see Peritoneal venous
shunt
Shuntogram, 1004, 1006
Sialocele, 64
Side-to-side anastomosis
right colectomy, 671-672
right hemicolectomy, 658, 659f
Sigmoid artery, 676f, 702, 702f
Sigmoid colectomy, 613
Sigmoidal artery, 738
Skin fl aps
in modifi ed radical neck dissection with
spinal accessory nerve
preservation, 22-24, 23f
necrosis of, 64
in parathyroidectomy, 44
in parotidectomy, 54, 64
in thyroidectomy, 4, 5f
Skin grafts
anesthesia for, 1146
antibiotic prophylaxis, 1146
autografts, 1149
dressings, 1150
face, 1150, 1151f
full-thickness, 1144
indications for, 1144
patient positioning for, 1146
pearls and pitfalls of, 1150-1155
postoperative care, 1150, 1155
preoperative considerations for, 1146
surgical anatomy of, 1143f
technique for, 1147f-1150f
Sklar clamps, 1096
Sliding inguinal hernia, 833-836
Small bowel malrotation, 416-420, 417f-419f
Soleus muscle, 933f, 943f, 1031f
Spermatic cord, 783f, 803f, 806, 811,
815f, 861f
Sphincteroplasty, 1103, 1103f
closure of, 460
common bile duct in, 453, 453f, 460
dissection, 456-459, 457f, 459f
incision, 454-455, 455f
indications for, 454
minor papilla, 454, 458, 459f, 461
pearls and pitfalls of, 460-461
postoperative care, 460
preoperative considerations for, 454
surgical anatomy of, 453f, 453-454
transduodenal, 454
Sphincter
otomy, lateral, 768-771
Spleen
anatomy of, 508, 509f
immune functions of, 609
Splenectomy
closure of, 608
dissection, 604-607, 605f-607f
distal pancreatectomy and. see Distal
pancreatectomy and splenectomy
1198 Index
Splenectomy (Continued)
gastric fi stula after, 608
incision, 604
pancreatic fi stula after, 608
pearls and pitfalls of, 608-609
postoperative care, 608
preoperative considerations for, 602, 604
surgical anatomy of, 602, 603f
Splenic artery, 279f, 508, 509f, 512, 517f-
519f, 546, 571f, 578, 603f, 606f, 955f
Splenic fl exure, 508, 680, 693f, 706
Splenic preservation, 518f-519f
Splenic repair, 602-609
Splenic vein
anatomy of, 465f, 485f, 493f, 508, 509f,
513f, 515f, 519f, 571f, 578, 955f
thrombosis of, 566
Splenius muscle, 21f
Splenocolic ligament, 603f, 679f, 707f, 1134f
Splenorenal anastomosis, 957f
Splenorenal bypass, 954-957, 956f-957f
Stamm gastrostomy, 240-245
Stapled anastomosis, 728, 728f-729f
Stay sutures, 312, 312f
Steal syndrome, 984, 1006
Stensen’s duct, 60, 62
Sternoclavicular ligament, 1167f
Sternocleidomastoid muscle
anatomy of, 19, 21f, 907f, 1019f, 1172f
in cricothyroidotomy, 77f
in modifi ed radical neck dissection with
spinal accessory nerve
preservation, 30f, 32f, 37f
in parotidectomy, 53f, 55f
in thyroidectomy, 3f, 7f
in tracheotomy, 65f
Sternohyoid muscle, 3f, 7f, 65f, 1019f
Sternothyroid muscle, 3f
Stomach
anatomy of, 278, 279f
greater curvature of, 280, 281f, 306
lesser curvature of, 280, 281f, 306, 306f
removal of. see Gastrectomy
Stoma takedown
antibiotic prophylaxis for, 642
bowel preparation for, 642
complications of, 641, 651
deep venous thrombosis prophylaxis, 650
pearls and pitfalls of, 651
postoperative care, 650
preoperative considerations for, 641-642
stress ulcer prophylaxis, 650
surgical anatomy of, 641
suturing/sutures for, 648, 649f
technique for, 642-649
Subclavian artery, 21f, 1019f, 1171f
Subclavian artery stab
clavicular resection, 1170, 1170f-1172f
incision, 1168, 1169f
pearls and pitfalls of, 1173
postoperative care, 1173
preoperative considerations for, 1168
surgical anatomy of, 1166, 1167f
Subclavian nodes, 133f
Subclavian vein, 1018, 1019f, 1167f, 1171f
Subclavius muscle, 1167f
Subcostal incision, 91f, 278, 437f, 438, 443f,
955f, 958f
Subcuticular sutures, 49f, 809f
Submandibular duct, 27, 27f
Submandibular gland, 1163f
Submandibular triangle, 19
Submental triangle, 19
Subscapular axillary pectoral nodes, 119f
Subscapular muscle, 119f
Subtotal resection, 14, 15f
Superfi cial external pudendal artery, 893f
Superfi cial external pudendal vein, 893f
Superfi cial femoral artery, 892, 897f
Superfi cial inguinal node dissection
closure of, 1126
complications of, 1128
deep vein thrombosis after, 1128
dissection, 1126, 1127f
incision, 1123f, 1124, 1125f
pearls and pitfalls of, 1128
postoperative care, 1128
preoperative considerations for, 1122
surgical anatomy of, 1122, 1123f
suturing/sutures, 1126
Superfi cial perineal nerve, 1093f
Superior epigastric artery, 893f
Superior epigastric vein, 893f
Superior gemellus muscle, 1061f
Superior hypogastric plexus, 686
Superior mesenteric artery
anatomy of, 522, 545f, 546, 559f,
569f, 578, 702f, 721, 881f, 964,
973f, 979f
in distal pancreatectomy and splenectomy,
509f, 513f, 515f, 517f, 519f
Superior mesenteric vein, 509f, 513f, 515f,
517f, 519f, 545f, 557f, 559f
Superior rectal artery, 676f, 702, 702f
Superior thyroid artery, 3f, 7f, 9f, 21f, 907f
Superior thyroid vein, 3f, 7f, 9f, 21f
Supinator muscle, 939f
Supraclavicular nodes, 133f
Supracondylar amputation
closur
e of, 1048, 1049f
dissection, 1044, 1046, 1047f
incision, 1044, 1045f
indications for, 1042
myodesis/myoplasty, 1046
pearls and pitfalls of, 1050
postoperative care, 1050
preoperative considerations for, 1042
surgical anatomy of, 1042, 1043f
wound hematoma after, 1050
Suprascapular artery, 21f, 1167f
Supraumbilical incision, 174, 174f-175f
Supraumbilical laparotomy, 273
Sural artery, 920f
Suturing/sutures
abdominal aortic aneurysm repair, 886,
886f-887f, 889, 889f
abdominal hysterectomy, 1082, 1083f
antegrade aortomesenteric bypass, 976, 976f
aortorenal endarterectomy, 952
apex, 457f
arteriovenous grafts, 1003
axillary node dissection, 1118, 1118f
Beger procedure, 530, 531f, 536
below-knee amputation, 1038, 1039f
benign breast lesion excision, 148, 149f
Billroth I, 282f-283f, 283-284, 285f,
288, 289f
Billroth II, 295-296, 295f-297f, 299,
299f, 302f
Brooke ileostomy, 631-632, 633f, 730
carotid endarterectomy, 916, 916f
choledochoduodenostomy, 440, 440f-442f
Connell. see Connell suturing
cystoduodenostomy, 592, 592f
cystogastrostomy, 585f
distal pancreatectomy and splenectomy,
514, 514f
diverting end colostomy with mucous
fi stula or Hartmann’s pouch, 622-625,
623f-625f
duodenal ulcer repair, 324-326, 325f-326f
fi stula-in-ano, 780
Suturing/sutures (Continued)
Frey procedure, 538, 539f
gastrojejunostomy, 335, 335f, 338-339,
338f-340f
hemorrhoidectomy, 761-763, 761f-763f
hepatorenal bypass, 960, 961f
ileorectal anastomosis, 726, 727f
inguinal herniorrhaphy
Bassini, 808, 808f-809f
McVay, 817, 817f
Shouldice, 828, 829f-830f
laparoscopic adjustable gastric banding,
390, 392, 392f
left and sigmoid colectomy, 694, 695f
Lembert. see Lembert suturing
low anterior resection–total mesorectal
excision, 740, 740f-741f
major duct excision, 154f
Meckel’s diverticulectomy, 396, 397f
Miles abdominoperineal resection with total
mesorectal excision, 756, 757f
modifi ed radical mastectomy, 128, 128f
modifi ed radical neck dissection with spinal
accessory nerve preservation, 38
neck exploration for trauma, 1164, 1164f
open cholecystectomy, 432, 432f
open Heller myotomy, 237, 237f
pancreaticojejunostomy, 576
parathyroidectomy, 48-49
parotidectomy, 63
Puestow procedure, 576
purse-string, 242f-244f, 248f, 250,
694f, 807f, 1024, 1026
pylorus-saving pancreaticoduodenectomy,
556
radiocephalic arteriovenous fi stula, 988
rectovaginal fi stula repair, 1104, 1107f
right hemicolectomy anastomoses, 658f,
660
right hepatectomy, 488, 488f
running, 295f
sphincteroplasty, 456, 457f, 458, 459f
splenorenal bypass, 956, 957f
stay, 312, 312f
stoma takedown, 648, 649f
subcuticular, 809f
superfi cial inguinal node dissection,
1126
supracondylar amputation, 1048, 1049f
thyroidectomy, 16, 17f
total gastrectomy, 308, 308f, 311-312,
311f-312f
tracheotomy, 72, 72f
traction, 148
transhiatal esophagectomy, 191, 191f
transmetatarsal amputation, 1054, 1055f
transthoracic esophagectomy
, 201, 201f
U-stitch, 324-327, 325f
Zenker’s diverticula removal, 170, 170f
T
Temporoparotid fascia, 56
Tenckhoff catheter insertion
laparoscopic procedure, 1014f-1015f,
1014-1016
open procedure, 1010-1013
pearls and pitfalls of, 1017
postoperative care, 1017
preoperative considerations for, 1010
surgical anatomy of, 1009, 1009f
Tensor fasciae latae, 1062
Terminal ileum, 413
Testicular artery, 823f, 893f
Testicular vein, 893f
Thompson retractor, 676
Thoracic duct, 21f, 35f, 1167f
Index
1199
Thoracoabdominal incision, 91f
Thoracodorsal artery, 119f, 126, 1116, 1117f
Thoracodorsal nerve, 119f, 126
Thoracodorsal vein, 119f, 126, 1116, 1117f
Thoracotomy, 1174-1177
Thrombectomy, 1004-1005, 1005f
Thyroglossal duct cyst, 83-87
Thyrohyoid muscle, 3f
Thyroid cartilage, 3f
Thyroidectomy
closure of, 16, 17f
complications of, 16
dissection, 4-15, 5f, 8f-15f
hypoparathyroidism after, 16
incisions, 4, 5f
indications for, 2
patient positioning for, 4
postoperative care, 16, 18
preoperative considerations for, 2
recurrent laryngeal nerve injury
during, 16, 18
surgical anatomy, 2, 3f
Thyroid isthmus
in cricothyroidotomy, 77f
in tracheotomy, 69, 69f
Thyroid membrane, 3f
Tibialis anterior muscle, 931f, 933f, 935f,
1031f
Tibialis posterior muscle, 933f, 935f, 943f,
1031f
Toddlers. see Pediatric surgery
Total colectomy
abdominal closure, 711
Brooke ileostomy in, 710
deep venous thrombosis prophylaxis, 712
dissection, 703f-710f, 703-711
ileorectal anastomosis, 710-711
incision, 702, 702f
indications for, 700
patient positioning for, 701
pearls and pitfalls of, 712-713
postoperative care, 712
preoperative considerations for, 700
surgical anatomy of, 699, 699f
Total esophagogastrectomy
with ascending colon graft, 225-227
with descending colon graft, 218f-225f,
218-225
description of, 209-217
Total gastrectomy
closure of, 314
esophagojejunal anastomosis, 313, 313f
feedings after, 314
incision, 304, 305f
jejunojejunal anastomosis, 310, 310f, 313f
left gastric artery, 308, 308f
omentum resection, 307, 307f
pearls and pitfalls of, 314
postoperative care, 314
preoperative considerations for, 304
right gastric artery, 308, 308f
Roux limb, 310, 314
spleen retraction, 306, 306f
surgical anatomy of, 304
sutures/suturing, 308, 308f, 311-312,
311f-312f
Totally extraperitoneal repair of inguinal
hernia, 852-854, 852f-854f, 856
Total mastectomy, 117
Total thyroidectomy. see Thyroidectomy
Tracheal fascia, 70
Tracheal rings, 71f
Tracheotomy
complications of, 74-75
cricothyroidotomy conversion to, 81
dissection, 68-73
Tracheotomy (Continued)
“high,” 66
incision, 66-67, 70, 71f
indications for, 66
local awake, 66, 75
patient positioning for, 67
pearls and pitfalls of, 74-75
postoperative care, 74
preoperative considerations for, 66
suctioning after, 74
surgical anatomy, 65
Tracheotomy tube, 66, 73, 73f
Traction sutures, 148
Transabdominal preperitoneal repair, of ingui-
nal hernia, 846-851
Transanastomotic stapler device, 286
Transhiatal esophagectomy
anastomoses, 184, 184f, 186, 188, 192
anesthesia for, 173
cervical esophagogastric anastomosis, 188
cervical esophagus dissection, 178-179, 184
closure of, 192
dissection, 175-192
gastrointestinal anastomosis stapling device,
184, 184f, 190
gastrotomy, 189, 189f
Heineke-Mikulicz pyloroplasty, 176
incision, 174, 174f-175f
nasogastric tube, 190, 190f
patient positioning for, 173
pearls and pitfalls of, 193
Penrose drains, 180-181, 181f, 186
postoperative care, 193
preoperative considerations for, 172-173
pyloromyotomy, 176, 177f
r
ecurrent laryngeal nerve preservation,
178, 178f
stomach, 185-186, 192
surgical anatomy of, 172, 173f
suturing of, 191, 191f
transthoracic esophagectomy vs., 172
Transmetatarsal amputation
closure of, 1054, 1055f
dissection, 1053-1054, 1053f-1055f
incision, 1052, 1052f
indications for, 1051
pearls and pitfalls of, 1056
postoperative care, 1056
preoperative considerations for, 1052
surgical anatomy of, 1051, 1051f
Transthoracic esophagectomy
anastomoses, 198-200, 202
closure of, 201
dissection, 196-200, 196f-200f
endoscopic gastrointestinal anastomosis
stapling device in, 198
incision, 196, 196f
indications for, 172, 194
nasogastric tube, 200, 200f
patient positioning for, 195
pearls and pitfalls of, 202
Penrose drain, 197
postoperative care, 202
preoperative considerations for, 194-195
stomach manipulation and placement, 196,
199, 199f
surgical anatomy of, 194, 195f
suturing of, 201, 201f
Transversalis aponeurosis, 861f
Transversalis fascia, 784f, 791f, 799f, 817,
826f, 827, 829f, 850f
Transverse abdominal skin incision, 412, 412f
Transverse abdominis muscle, 406f
Transverse arteriotomy, 969f
Transverse cervical artery, 21f
Transverse cervical vein, 21f
Transverse colon, 509f
Transversus abdominis aponeurosis arch,
784f
Trapezius muscle, 21f
Triangle of Calot, 426, 434
Triangular ligament, 470, 471f, 476, 477f,
482, 493f
Triangulation, 613, 613f
Truncal vagotomy
anterior vagus nerve, 329f-331f
closure of, 332
dissection, 328-332, 329f-331f
in duodenal ulcer repair, 326
incision, 328
pearls and pitfalls of, 332-333
Penrose drain, 330, 333
perforated peptic ulcer repaired with, 323
posterior vagus nerve, 329f, 332f
postoperative care, 332
preoperative considerations for, 328
surgical anatomy of, 328, 329f
Tylectomy, 108
U
Ulnar artery, 983f-984f
Ulnar nerve, 939f, 983f-985f
Umbilical fold, 845f, 847f
Umbilical hernia repair
in children, 863-866
closure of, 871, 871f
pearls and pitfalls of, 872
postoperative care, 872
preoperative considerations for,
863-864
surgical anatomy of, 863
Umbilical port, 428, 429f
Uncinate process, 579
U-stitch, 324-327, 325f
Uterine artery, 1069f
Utero-ovarian ligament, 1068, 1076, 1077f
Uterosacral ligaments, 1068, 1069f, 1081f
Uterus
anatomy of, 1070, 1071f
hysterectomy. see Abdominal hysterectomy
ligaments of, 1068, 1069f
V
Vaccines, for postsplenectomy sepsis, 510
Vagus nerve, 3f, 37f, 328, 329f, 907f, 1019f,
1163f
Valvulotome, 924, 925f
Vascular surgery
abdominal aortic aneurysm repair. see
Abdominal aortic aneurysm repair
aortofemoral bypass graft. see Aortofemoral
bypass graft
carotid endarterectomy. see Carotid
endarterectomy
fasciotomy. see Fasciotomy
femoropopliteal bypass. see Femor
opopliteal
bypass
femorotibial and peroneal bypass. see
Femorotibial and peroneal bypass
hemodialysis access. see Hemodialysis access
mesenteric ischemia. see Mesenteric
ischemia
peritoneal venous shunt insertion. see
Peritoneal venous shunt insertion
renal revascularization. see Renal revascu-
larization
Tenckhoff catheter insertion. see Tenckhoff
catheter insertion
Vas deferens, 785f, 823f, 841f, 849f
Ventral hernia, 873-877
Veress needle, 667
Vertebral artery, 1171f
1200 Index
Vitamin D, 16
Volvulus, midgut, 416-420, 417f-419f
W
Watson knife, 1147f
White line of Toldt, 654, 654f, 664, 677f, 686,
1134f, 1180
Wide local excision
anesthesia for, 110
closure of, 114
dissection, 112, 113f
incisions, 111-112
pearls and pitfalls of, 116
postoperative care for, 115
preoperative considerations, 109-110
Wide local excision (Continued)
reexcision lumpectomy, 115
resected specimen processing, 115
surgical anatomy of, 108-109
Witzel jejunostomy, 246-252
X
Xiphisternal junction, 1176
Z
Zenker’s diverticula
carbon dioxide laser endoscopic diverticu-
lotomy for, 171
closure, 170
dissection, 165-169, 165f-169f
Zenker’s diverticula (Continued)
endoscopic stapler-assisted diverticulotomy
for, 171
incision, 164, 164f
mucosal leak testing, 169, 169f
myotomy for, 166, 166f
pearls and pitfalls of, 171
postoperative care, 171
preoperative considerations for, 162-163
resection of, 168, 168f
surgical anatomy of, 162, 163f