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