Surgical Textbooks Research Articles

Anatomy of the Ophthalmic Artery: A Review concerning Its Modern Surgical and Clinical Applications.

Anatomy of ophthalmic artery has been thoroughly studied and reviewed in many anatomical and surgical textbooks and papers. Issues of interest are its intracranial and extracranial course, its branches, its importance for vision, and its interaction with various intracranial pathologies. Improvement of our understanding about pathophysiology of certain diseases like aneurysm formation, central retinal artery occlusion, and retinoblastoma and also invention of new therapeutic modalities like superselective catheterization, intra-arterial fibrinolysis, and intra-arterial chemotherapy necessitate a reappraisal of its anatomy from a clinical point of view. The aim of this review is to examine clinical anatomy of ophthalmic artery and correlate it with new diagnostic and therapeutic applications.

Perform Cholecystectomy During Initial Hospitalization for Gallstone Pancreatitis

Despite recommendations in guidelines and surgical textbooks advocating prompt (during the index hospital admission) cholecystectomy for mild gallstone

Intradural communication between dorsal rootlets of spinal nerves: their clinical significance.

Anatomical and surgical textbooks give almost no attention to the intradural communications between dorsal rootlets of adjacent spinal nerves. These communications can be of significance in various neurosurgical procedures and clinical conditions of the region. The spinal cord of six formaldehyde-fixed cadavers was dissected from C1-S5. The dorsal rootlets of the spinal nerves were exposed via a posterior approach and communications between adjacent spinal nerves were documented. The frequency of communication between adjacent dorsal rootlets of the spinal nerves showed variations among spinal levels. Thirty-eight dorsal rootlet communications were observed in six cadavers (12 sides) and 20 (52.6%) were at cervical levels, 14 (36.8%) at thoracic levels, and four (10.5%) at lumbar levels. The majority of communications were observed on the left side (65.8%). Communications were most frequently observed at cervical (C4-C5, C5-C6) and upper thoracic (T1-T2) levels and seen least frequently at lower thoracic and lumbar levels. No communications were observed at sacral levels. Five types of communication were observed: I. oblique ascending, II. oblique descending III. short Y, IV. long Y and V shaped. None of the communication extended beyond one segment at any spinal level. The occurrence of such dorsal rootlet communications ranged from 3 to 7 for each cadaver and the mean was 4.8 ± 1.3. Histological sections from various levels of the dorsal rootlet communications showed that all consisted of myelinated fibers of varying diameters. Such communications may lead to misinterpretation of the pathology on the basis of clinical signs and symptoms and also should be considered in rhizotomy.

The Art of Surgical Proctology: A Procedural Atlas of Proctologic Gold Standards, Innovations, and Tricks of the Trade

Textbooks in the field of colorectal Surgery have both increased in numbers and evolved in the recent years from the standard comprehensive multi-edition textbooks such as those of John C. Goligher, Marvin L. Corman, and Michael R. B. Keighley/Norman S. Williams. More recent texts have a narrower scope, such as minimally invasive colorectal operations. This latest addition from Mario Pescatori is a unique publication: an atlas confined to ‘‘surgical proctology.’’ The field of proctology is much more expansive than one might imagine, and the breadth of the discipline is on full display in this textbook, thus explaining the sheer volume of accompanying drawings (1000 by the author himself!) and operative field photos ([200). What is especially intriguing about this compilation is the background and experience of the author as he delves into areas that are seldom discussed in surgical textbooks, such as ways to avoid postoperative complications (Chapter 7 Managing and Preventing Anal Stricture), but also how to surgically manage complications when they occur (Chapter 8 Revisional Surgery Following the STARR and PPH Procedures). A prime example is the odyssey of the PPH procedure. Pescatori brings to bear a wealth of knowledge and personal experience with this procedure and its potential complications (much of it published) including post-PPH syndrome and ‘‘rectal pocket’’ syndrome, which he coined. Operative field photos of rectal specimens with excised staple lines (aggraphectomy) are outstanding and will not be found in any other textbook of colorectal surgery. The breadth of the text is quite extensive: from basic proctology (e.g., hemorrhoids, abscess/fistulas, fissures) to newer concepts such as combined transanal approaches with minimally invasive technology for the removal of rectal tumors (TAMIS). ‘‘The Art of Surgical Proctology’’ is a practical, illustrative guide to sound surgical technique. It is a culmination of one surgeon’s 40 plus years of experience and insight into surgical proctology and will be appreciated by any clinician (specialist or non-specialist) W. C. Cirocco (&) Ohio State University, Columbus, OH, USA e-mail: william.cirocco@yahoo.com

Acupuncture points in the book of Şerefeddin Sabuncuoğlu, a 15th century Turkish physician.

Şerefeddin Sabuncuoğlu (1385-1468?), the author of Cerrahiyetü'l-Haniyye (Imperial Surgery), was a distinguished Ottoman Turkish surgeon. The first illustrated Turkish surgical textbook, Cerrahiyetü'l-Haniyye consisted of three chapters (ie, cauterisation treatments, surgical procedures and fractures and dislocations). Although the main source of the book was Al-Tasrif (Textbook of Surgery) by Albucasis (Abu al-Qasim al-Zahrawi; 936-1013 AD), Sabuncuoğlu added much new information, his clinical experiences and suggestions. The original illustrations and human figures made Cerrahiyetü'l-Haniyye the first illustrated medical textbook in Turkish and Islamic medicine literature. Cerrahiyetü'l-Haniyye was also a valuable source for acupuncturists. Some new sections and additions revealed that Sabuncuoğlu had knowledge of Chinese medicine. In four sections of Cerrahiyetü'l-Haniyye (ie, toothache, haemorrhoids, eczema and dermatophytosis) Sabuncuoğlu described acupuncture techniques and point locations. It is likely that the Chinese medicine content of Cerrahiyetü'l-Haniyye was derived from Central Asian roots of Anatolian Turkish people.

Anatomical variations of the phrenic nerve: an actualized review

Abstract Introduction: The phrenic nerve normally arises from ventral rami of C3, C4 and C5. It emerges laterally to the superior portion oflateral border of scalenus anterior muscle and presents a descendent course between subclavian artery and vein. It crosses anterior to internal thoracic artery and descends through the mediastinum, until the diaphragm muscle, to supply it with motor and sensitive fibers. Matherials and Methods: A bibliographic review was conducted, based on anatomy, neuroanatomy and surgical anatomy textbooks, published in Brazil and abroad, as well as a review of scientific articles, published over the last 20 years, available on research databases PubMed, Scielo, LILACS and MEDLINE, from keywords phrenic nerve, variation and anomaly. Results: Variations of the phrenic nerve are frequent, but they are not often discussed. Thus, we aimed to conduct an actualized review over the subject. Regarding the variations in the origin of the phrenic nerve, textbooks vaguely inform that it is mainly formed by C4, but the recent cadaveric studies pointed the segments C4 and C5 as the most common origin. About the variations in its course, the most described is its passage anterior to the subclavian vein, before reaching the thorax. However, the presence of accessory phrenic nerve represents the greatestvariation, mostly arising from nerve to subclavian. There are few reports in literature about the complications associated to these variations, but some are suggested, as the possibility of causing its damage during the puncture of the subclavian vein, when the nerve descends anterior to it, which may lead to a hemidiaphragmatic paresis. When variations are present, even simple procedures may cause injuries. Conclusion: Therefore it is fundamental to know the normal anatomy and the possible variations of the phrenic nerve, in order to perform safe procedures in its topography, as well as to enable a timely recognition of complications.

The Wikipedia Medical Student: Comparing the Quality of Vascular Surgery Topics Across Two Commonly Used Educational Resources

Medical students commonly refer to Wikipedia.org as their preferred online resource for medical education. To date, the quality and readability of common vascular disorders on Wikipedia has not been evaluated or compared against a standard textbook of surgery. The aims of this study were to (1) assess the quality of Wikipedia.org articles against the equivalent chapters in a standard medical school textbook of surgery; (2) identify any errors of omission; and (3) compare the readability of both resources using ease-of-reading and grade-level tools. Eight fundamental topics in vascular surgery were analyzed. The articles were accessed from Wikipedia.org through its native search engine, and equivalent chapters from Schwartz Principles of Surgery, 9th-edition, (SPOS) were compared. Quality was evaluated using the DISCERN tool, errors of omission were evaluated using a proprietary scoring system designed by author(s), and readability was evaluated using the Flesch-Reading-Ease test, Gunning-fog score, Coleman-Liau Index, SMOG Index, Automated-Readability-Index, and the Flesch-Kincaid grade level. SPOS scored highest in quality, with perfect DISCERN scores of 5 and had the lowest errors of omission, whereas Wikipedia.org scored best for readability, being, on average, understandable by most grade 12 educated students. Interobserver concordances validated these results. SPOS is superior to Wikipedia.org when critiquing quality and errors of omission, whereas Wikipedia.org is superior to the textbook when considering the ease of reading. This study recommends the use of surgical textbooks as a primary learning resource for medical students, and cautions the use of Wikipedia.org due to its significant rate of omissions.

Eugène-Louis Doyen's pharyngeal tubes.

Eugène-Louis Doyen published illustrations of two pharyngeal tubes in his five-volume surgical textbook, Traité de Thérapeutique Chirurgicale et de Technique Opératoire. The first volume of Doyen's textbook was published in 1908 and it contains the earliest known illustration of one of Doyen's pharyngeal tubes. The Hewitt airway was described in Lancet in the same year. No information on the development of the Hewitt airway or Doyen's pharyngeal tubes was found. Doyen's pharyngeal tubes were functionally similar to modern supraglottic airways.

Management of patients under general anesthesia with mafutsu-san in Hanaoka-style surgery: comparisons of illustrations from Geka-Kihai-Zufu with descriptions from Mafutsuto-Ron and Yohka-Hiroku.

Seishu Hanaoka (1760-1835) left behind no books that he himself had written. This is why many aspects of Hanaoka-style general anesthesia using a mixture of herbal extracts, which he called mafutsu-san, remain unknown. We are able to learn about this technique today because there are several descriptions of it in books written by his students, such as Mafutsuto-Ron ("Treatise on Mafutsuto") by Gendai Kamata (1794-1854) and Yohka-Hiroku ("Secret Records of Surgery") by Gencho Homma (1804-1872). On the other hand, Geka-Kihai-Zufu ("Illustrations of Surgical Cases"), a surgical textbook, by Gendai Kamata, containing one of the oldest illustrations of general anesthesia published in 1840, was recently rediscovered (2011). For the first time, this book revealed, in the form of a picture image, the actual circumstances of Hanaoka-style general anesthesia. We therefore compared the descriptions of general anesthesia featured in these three documents, and thereby investigated the actual anesthetic management and the procedures used. We found that the circumstances under which Hanaoka-style general anesthesia, using fabrics and futon mattresses, as well as blindfolding and constraining the patient's body during surgery, were exactly as described in Mafutsuto-Ron and Yohka-Hiroku. In addition, besides a surgeon conducting an operation, there was a physician who observed the patient's general condition. Gendai Kamata, the author of Geka-Kihai-Zufu, is believed to have recognized the importance of anesthetic care of surgical patients.

Development of a Standardized Training Course for Laparoscopic Procedures Using Delphi Methodology

Content, evaluation, and certification of laparoscopic skills and procedure training lack uniformity among different hospitals in The Netherlands. Within the process of developing a new regional laparoscopic training curriculum, a uniform and transferrable curriculum was constructed for a series of laparoscopic procedures. The aim of this study was to determine regional expert consensus regarding the key steps for laparoscopic appendectomy and cholecystectomy using Delphi methodology. Lists of suggested key steps for laparoscopic appendectomy and cholecystectomy were created using surgical textbooks, available guidelines, and local practice. A total of 22 experts, working for teaching hospitals throughout the region, were asked to rate the suggested key steps for both procedures on a Likert scale from 1-5. Consensus was reached with Crohnbach's α ≥ 0.90. Of the 22 experts, 21 completed and returned the survey (95%). Data analysis already showed consensus after the first round of Delphi on the key steps for laparoscopic appendectomy (Crohnbach's α = 0.92) and laparoscopic cholecystectomy (Crohnbach's α = 0.90). After the second round, 15 proposed key steps for laparoscopic appendectomy and 30 proposed key steps for laparoscopic cholecystectomy were rated as important (≥4 by at least 80% of the expert panel). These key steps were used for the further development of the training curriculum. By using the Delphi methodology, regional consensus was reached on the key steps for laparoscopic appendectomy and cholecystectomy. These key steps are going to be used for standardized training and evaluation purposes in a new regional laparoscopic curriculum.

Fundamentals for establishing and maintaining an academic centre for global surgery: the University of Utah experience

Abstract Background Although departments of surgery and surgical specialties are well established components of all medical schools, these departments generally focus on the teaching of technical aspects of surgery and clinical and basic science aspects of perioperative care. Few departments have dedicated resources to the study of surgical systems or ecosystems within health care as a whole. The Center for Global Surgery at the University of Utah was founded on the mission to develop the next generation of global surgical and anaesthesia leaders able to design innovative, affordable surgical care, locally and abroad, that is accessible to all through education, research, development, and advocacy. Methods The following were established as priorities: overcoming misconceptions about the scope of global surgery and its potential as an academic endeavour; improving public and academic awareness of disparities in surgical care as a public health problem; advocating for improved access for underserved populations worldwide; and extending expertise in global surgery by training undergraduate students, graduate students, medical students, residents, fellows, and faculty in research methods pertinent to the field. Findings Initially approved as a programme within the Department of Surgery in 2009, the Center for Global Surgery has grown to include participation of other departments within the health sciences programmes (anaesthesia, ophthalmology, orthopaedics, family practice, preventive medicine, and telehealth) and the main campus (engineering and anthropology) to serve a broad community within the University of Utah and worldwide. The centre provides a forum for collaboration and intersection of many disciplines that affect surgical care. Since its inception, the centre has supported engagement in advocacy at the World Health Assembly; education, including courses in global surgery; the University of Utah's Extreme Affordability Conferences; and international collaborative research. Interpretation Global surgery is now recognised in foundational surgical textbooks and publications on disease control priorities. Similar academic programmes in global surgery could benefit universities at many levels and should be integrated into dynamic and robust health education. Funding University of Utah School Department of Surgery, Adele Parkinson Endowment.

A rare developmental disorder ‘Hydrocele of canal of Nuck’ – A case report.

Hydrocele of canal of Nuck of female is a rare developmental disorder corresponding to the hydrocele of the spermatic cord of males and often misdiagnosed as this type of cases are rarely come across in the clinical practice and due to the paucity of the literature available in the surgical and gynaecological textbooks. Hence, in a young female patient, reporting with an inguinal swelling, hydrocele of canal of Nuck should also be considered as the differential diagnosis.

Tamponade dressings may be unnecessary after haemorrhoidectomy: a randomised controlled clinical trial

Bleeding after haemorrhoidectomy is common. Many surgical textbooks recommend insertion of an anal tampon in order to reduce postoperative bleeding. This practice, however, is bothersome and probably painful for patients. The effect of using a tamponade has not been validated in randomised controlled trials. The study included 100 patients who were scheduled for Milligan-Morgan haemorrhoidectomy. During surgery, patients were randomly assigned to receive or not to receive an anal tampon at the end of the procedure. Data on pain, complications and wound care were collected. The trial was registered (DRKS00003116) and all analyses were by intention-to-treat. There were 48 patients in the group with tamponade, and 52 patients were left without tamponade. The trial's primary outcome and maximum pain intensity, averaged 6.1 and 4.2 in the two groups (P = 0.001). In the group with tamponade, a complication was recorded in seven patients (15 %), which was similar to the group without tamponade (21 %). Severe anal bleeding occurred in two and five patients, respectively. Bandage changes were less necessary often in the group treated without tamponade (P = 0.013). Hospital stay was 4 days in both groups. Data indicate that insertion of an anal tampon after haemorrhoidectomy does not reduce postoperative bleeding but causes significantly more pain. After haemorrhoidectomy, anal tampons should not be used routinely but may be considered when specific indications justify its use.

Surgical talk: lecture notes in undergraduate surgery

The Surgical Talk textbook is now into its third edition. It has long been a cornerstone of undergraduate revision and I can testify to making good use of it during my own medical student days. The authors have deliberately set out to use a conversational style and have eschewed lists (common to revision textbooks) in favour of a tutorial-based approach. This will pay dividends to those making use of this textbook on a regular basis but not those wanting a quick revision aid a week or two prior to finals. Every topic in general surgery is covered, and chapters on urology, orthopaedic surgery and ear, nose and throat surgery are also included. There is a particularly interesting chapter on undergraduate examinations at the end of the book, which is also relevant to those about to undertake the membership exam. The one glaring weakness of the textbook is the paucity of diagrams, illustrations and tables. More could have been added when the last edition was revised. In summary, this is a well written and proven textbook that will be of help to final year medical students and foundation trainees. Current Orthopaedic Practice

Reading ASJ in the Digital Age

Earlier this year, I wrote to you about Aesthetic Surgery Journal 's position on Open Access (OA) publishing,1 a movement that sidesteps the traditional subscription-based model for journal publishing, placing the onus for publication costs on authors or federal agencies that fund research through grants. In that Editorial, I stated that “we want to remain on the cutting edge and we certainly will not be the last to adopt any proven model of successful publishing, but we want to be absolutely certain that any changes we make are in the best interest of the subspecialty, our authors, and our readership.” This same philosophy applies to our approach to online publishing, which is certainly another topic that's had a lot of “buzz” in the media. I would bet that nearly all of your favorite periodicals, from newspapers to surgical textbooks, now have some web-based or digital component. One of the most frequent questions I'm asked at conferences and Board meetings is, “When will ASJ be published online only? I've heard that print is dead.” My answer is always: print isn't dead; it just has a double-life! As you might imagine, the landscape in scholarly publishing is different from the one in which popular newspapers and magazines exist; particularly when journals are owned and operated by a professional society, as “The Gold Journal” is, we have less pressure to move directly into a digital-only format. Our most important role is to serve the needs of our subscribers—including those who are members of the American Society for Aesthetic Plastic Surgery (ASAPS), those who belong to one of our valued affiliate societies, our individual subscribers, and those who read ASJ via their university or hospital library. To that end, we survey our subscribers frequently about their preferences. In those survey results, we've found …

Digital Animation versus Textbook in Teaching Plastic Surgery Techniques to Novice Learners

The authors present a prospective, randomized, blinded trial comparing the educational efficacy of digital animation versus a textbook in teaching the Ivy loop technique to novice learners. Medical student volunteers (n = 32) were anonymously videotaped as they fastened dental wire to the teeth of a skull model (preintervention analysis) and then were randomly assigned to one of two study groups. The animation and text groups (n = 16 each) were shown either a digital animation or textbook demonstrating the Ivy loop surgical technique. Volunteers were then videotaped as they performed the technique (postintervention analysis). Volunteers were then shown the educational material provided to the other study group and given a validated educational survey to compare the educational value of both materials. Preintervention and postintervention video recordings were graded using a validated surgical competency scale. Surgical performance grades, time to task completion, and educational survey scores were compared. Preintervention analysis performance scores did not significantly differ between the animation and text groups (10.7 [2.8] versus 11.1 [3.9]; p = 0.74), but postintervention analysis demonstrated significantly higher performance scores in the animation group (18.8 [2.9] versus 13.0 [3.5]; p < 0.001). Time to task completion was similar. The educational survey demonstrated significantly higher scores in the animation group. A prospective, randomized, blinded study comparing the educational efficacy of a surgical textbook to digital animation demonstrates that, in novice learners, digital animation is a more effective tool for learning the Ivy loop technique. Test takers found digital animation to be the superior educational medium.

Ronald Ogier Ward, urologist, hero &amp; first president of BAUS

Ronald Ogier Ward, urologist, hero &amp; first president of <scp>BAUS</scp>

Specialized anatomy electives for fourth year medical students in preparation for residency specialties: Plastic Surgery, Orthopaedics, and Obstetrics &amp; Gynecology

Gross anatomy is taught during the first year at our medical school when students are often unsure what specialty they plan to pursue. Based on residency type, students may take an individualized 4th‐year anatomy elective to strengthen their knowledge and technique as it relates to the field they have chosen. Using surgical textbooks or current primary literature to learn the procedures, students independently perform mock surgical or exposure techniques on cadavers to better learn anatomical relationships as they relate to surgery. Having studied and reviewed the surgical technique, the students perform dissection often dictating their approach, precautions, procedures and findings. Many of the procedures are videotaped for later review by the students and attending physicians. This allows students the ability to visualize important anatomical landmarks, review anatomical structures at risk during the particular surgical processes, and regain a sense of three‐dimensional anatomy. This elective has been well received by our residency directors and has proven successful for students to develop an applied use of anatomy as it relates to surgical approaches and techniques before starting residency. Supported by SIU School of Medicine.Grant Funding Source: None

Pathologic Examination of Fetal and Placental Tissue Obtained by Dilation and Evacuation

Dilation and evacuation (D&E) is an alternative method to induction of labor for pregnancy termination and intrauterine fetal demise, and it is the most common mode of second-trimester uterine evacuation in the United States. Many D&E specimens are examined in surgical pathology, and there is little information available in surgical pathology textbooks or the literature to assist pathologists in these examinations. To provide an overview of the D&E procedure, discuss related legal issues, provide guidelines for routine pathologic examination of D&E specimens, and demonstrate the importance of careful pathologic examination of D&E specimens. Case-derived material and literature review. Pathologic examination of D&E specimens has been understudied. However, the available literature and our experience support the fact that careful pathologic examination of D&E specimens can identify significant fetal and placental changes that can confirm clinical diagnoses or provide definitive diagnosis, assist in explaining the cause of intrauterine fetal demise, and identify unexpected anomalies that may provide further clues to a diagnostic syndrome or mechanism of anomaly formation.

Observational study of patient and surgeon preoperative preparation in ten companion animal clinics in Ontario, Canada

BackgroundSurgical site infections (SSIs) are a recognized risk of any surgical procedure in veterinary medicine. One of the keys to prevention of SSIs is reducing exposure of the surgical site to endogenous and exogenous microbes, beginning in the preoperative period. While guidelines are available for preoperative preparation procedures, there has been no objective investigation of compliance with these recommendations in veterinary practices. The objectives of this pilot study were to describe preoperative patient and surgeon preparation practices in a sample of non-equine companion animal veterinary clinics, and to determine if there were any areas that consistently did not meet current guidelines.ResultsObservation of preparation practices was performed in 10 clinics over 9–14 days each using up to 3 small wireless surveillance cameras. Data were coded for 148 surgical patients, and 31 surgeons performing 190 preoperative preparations. When patient hair removal was observed, it was most commonly done using clippers (117/133, 88%), and in only one case was it performed prior to anesthetic induction. Patient contact time with soap ranged from 10-462 s (average of clinic means 75 s, average of clinic medians 67 s), and with alcohol from 3-220 s (average of clinic means 44 s, average of clinic medians 37 s). Alcohol-based hand rub (AHR) was used preoperatively in 2/10 facilities, but soap-and-water hand scrub was most commonly used at all clinics. Proximal-to-distal scrubbing was noted in 95/142 (67%) of soap-and-water scrubs. Contact time during surgeon hand preparation ranged from 7-529 s (average mean 121 s, average median 122 s) for soap-and-water and from 4-123 s (average mean 25 s, average median 19 s) for AHR. No significant changes in practices were identified over time during the observation period. Practices that did not conform to guidelines available in major companion animal surgical textbooks were commonly observed.ConclusionsSome preoperative preparation practices were relatively consistent between clinics in this study, while others were quite variable. Contact times with preoperative preparatory solutions for both patients and surgeons were often shorter than recommended. Evidence-based guidelines for these procedures in veterinary medicine should be established and implemented in order to help reduce preventable SSIs, while maintaining efficiency and cost-effectiveness.