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Kidneys and ureters

Core Procedures Open nephrectomy Open partial nephrectomy Robotic/laparoscopic nephrectomy Robotic/laparoscopic partial nephrectomy Open nephro-ureterectomy Robotic/laparoscopic nephro-ureterectomy Robotic/laparoscopic pyeloplasty Percutaneous nephrolithotomy Nephrostomy Extracorporeal shock wave lithotripsy Ureteroscopy ± retrograde pyelogram/laser or lithoclast lithotripsy/biopsy/stent Pyeloscopy ± laser/biopsy/stent This chapter contains an overview of the topographical and surface anatomy of the kidneys and ureters, and their relevance in common surgical procedures. The kidneys have an essential physiological function in…

Overview of pelvic viscera

Core Procedures Radical cystectomy Radical prostatectomy Anterior resection of rectum Surgical surface anatomy The inguinal skin crease marks the junction of the anterior thigh with the anterior abdominal wall. It lies approximately 7 cm distal to the inguinal ligament. The anterior superior iliac spine (ASIS) lies superior to the lateral end of the crease; the iliac crest is palpable along its entire length from the ASIS. A…

Endoscopic anatomy of the gastrointestinal tract

Core procedures Oesophagogastroduodenoscopy (OGD) Push enteroscopy Capsule endoscopy Deep enteroscopy Endoscopic retrograde cholangiopancreatography Endoscopic ultrasound Colonoscopy Flexible and rigid sigmoidoscopy Endoscopy is a critically important tool for both the diagnosis and the treatment of many different gastrointestinal disorders. With recent advances in endoscopy, the entire gastrointestinal tract can now be visualized. While there are potential risks of complications, endoscopic procedures are generally considered safe and usually…

Development and congenital anomalies of the gastrointestinal tract and its adnexae

Core Procedures Duodenoplasty for type 1 duodenal atresia Diamond duodenoduodenostomy Duodenojejunostomy Tapering enteroplasty with end-to-back enteroanastomosis Ladd procedure for malrotation Meckel's diverticulectomy (open, laparoscopic) Over the past quarter-century significant advances have occurred that have resulted in safer and more available surgical care of the neonate, infant and child. Neonatal surgery has evolved into a tertiary specialty carried out largely by paediatric surgeons. Intensive care nurseries have…

Adrenal glands

Core Procedures Open adrenalectomy Transperitoneal laparoscopic adrenalectomy Posterior retroperitoneoscopic adrenalectomy Embryology The adrenal (suprarenal) gland consists of two main parts, each with different embryonic origins. The inner part of the gland, the adrenal medulla, is originally derived from ectodermal neural crest cells. Also known as chromaffin cells for their staining properties, these cells migrate towards the adrenal cortex at approximately 7 weeks’ gestation and gradually invade…

Spleen

Core Procedures Open splenectomy Laparoscopic splenectomy Hand-assisted laparoscopic splenectomy Partial splenectomy Open/laparoscopic splenulectomy The spleen is a large, encapsulated, complex mass of vascular and lymphoid tissue situated in the upper left quadrant of the abdominal cavity between the fundus of the stomach and the diaphragm ( Fig. 64.1 ). For centuries, the spleen was thought to be the seat of melancholy. In 1521, the great German…

Pancreas, gallbladder and biliary tree

Core procedures Pancreas Pancreaticoduodenectomy Lateral pancreaticojejunostomy Modified Appleby procedure Whipple at the splenic artery (WATSA) Posterior and standard retrograde anterior modular pancreaticosplenectomy (RAMPS) Gallbladder Laparoscopic cholecystectomy (critical view of safety approach) Open cholecystectomy Biliary Tract Mid bile duct excision with reconstruction Bile duct injury repair including Hepp–Couinaud reconstruction Bile duct exploration Mastering operations within the complex right upper quadrant requires a solid fund of anatomical expertise.…

Liver biopsy, resections and a brief overview of transplantation

Core procedures Right hepatectomy for malignancy Left hepatectomy for malignancy Extended right hepatectomy for malignancy Extended left hepatectomy for malignancy Live donor right hepatectomy Live donor left hepatectomy Caudate lobe resection Clinical anatomy Liver resection (LR) is divided into anatomical and non-anatomical resections. Non-anatomical LR refers to the partial resection of parenchyma in one or more liver segments, while anatomical LR refers to the complete resection…

Liver

Core Procedures Liver Biopsy Percutaneous liver biopsy Transjugular liver biopsy Hepatic Resection Left lateral sectionectomy Left hepatectomy Extended left hepatectomy Right posterior sectionectomy Right anterior sectionectomy Right hepatectomy Extended right hepatectomy Central (mesoaxial) hepatectomy Segmental hepatic resection Liver Transplantation Embryology The development of the liver primordium can be seen from stage 11 (29–30 days post fertilization) as an outgrowth of the ventral foregut endoderm. Multiple molecular…

Colon, rectum and anus

Core Procedures Colon and Appendix Segmental colectomy Appendicectomy Hartmann's procedure Rectum (Low) anterior resection Abdominoperineal resection Anal Canal Internal anal sphincterotomy Fistulotomy Incision and drainage of perianal abscess Haemorrhoidectomy Clinical anatomy The colon is a capacious tubular conduit that extends from the ileocaecal junction to the anus and frames the small intestine. It is approximately 150 cm long, which is about 25% of the length of the…

Small intestine

Core Procedures Small intestinal resection and anastomosis Small intestinal bypass Stricturoplasty Ileostomy creation and reversal Surgery of the small intestine was rarely performed successfully prior to the development of anaesthetics and antisepsis. The advances of Bigelow and Lister allowed operations on the small intestine to become an essential part of the practice of the early surgeons who managed wartime injuries, treated colic, and were faced with…

Abdominal oesophagus and stomach

Core Procedures Oesophagectomy for gastro-oesophageal junction cancer: resection of the oesophagus generally with creation of a gastric conduit to facilitate a thoracic or cervical anastomosis Subtotal or total gastrectomy and lymph node retrieval for cancer: varying amounts of gastric resection are required, depending on the location of the malignancy Fundoplication for repair of hiatal hernias: division of the muscular layers of the distal oesophagus and proximal…

Peritoneum, mesentery and peritoneal cavity

Core Procedures All operations can be performed via open, laparoscopic or robotic approaches and therefore the approach is not specified. Stomach: total gastrectomy, partial gastrectomy Pancreas: subtotal pancreatectomy, pancreaticoduodenectomy Liver: hepatectomy Spleen: splenectomy Appendix: appendicectomy Colon: complete mesocolic excision, total mesocolic excision, partial mesocolic excision (left or sigmoid) Rectum: total mesorectal excision (TME), partial mesorectal excision, Hartmann's procedure, transanal total mesorectal excision (TaTME) Repair of malrotation:…

Posterior abdominal wall and retroperitoneum

Core Procedures Pancreas Pancreaticoduodenoectomy (Whipple procedure) Distal pancreatectomy ± splenectomy Total pancreatectomy Spleen Splenectomy Partial splenectomy Colon and Rectum Right hemicolectomy ± extended resection Left hemicolectomy ± extended resection Total abdominal colectomy Total proctocolectomy Anterior resection Abdominoperineal resection Colostomy Vascular Abdominal aortic aneurysm repair Thoraco-abdominal aortic aneurysm repair Aorto-bifemoral bypass Surgical management for mesenteric ischaemia (such as antegrade or retrograde bypass, embolectomy) Trauma Trauma laparotomy with…

Anterior abdominal wall and inguinal region

Part 1: Anterior abdominal wall Duncan SG Scrimgeour, Matthew J Laviolette, Sam M Wiseman Core Procedures Laparotomy Vertical, transverse and oblique incisions Ventral incisional hernia repair Umbilical hernia repair Spigelian hernia repair Epigastric hernia repair Abdominal wall closure Laparoscopy Hasson's open technique Modified Hasson's technique Veress needle technique Optical trocar technique Other Component separation Transversus abdominis plane (TAP) block Despite the significant advances that have occurred…

Overview of the abdomen

This chapter is an overview of the surgical anatomy of the abdomen, the region of the body that is located between the thoracic diaphragm and the pelvic inlet. It is bounded by muscular layers of the abdominal wall and by the peritoneum, and contains the majority of the hollow organs of the gastrointestinal tract, as well as several solid organs. These organs play critical roles in…

Ventricles, coronary vessels and access to conduits for grafting

Core Procedures Sternotomy Redo sternotomy Right ventricular outflow tract operations Left ventricular vent insertion Left ventricular aneurysm repair Left ventricular rupture repair Post-infarct ventricular septal defect repair Long saphenous vein harvest Radial artery harvest Internal thoracic (mammary) artery harvest Coronary artery bypass grafts Ventricles Right ventricle In the normal state, the right and left ventricles pump the same amount of blood in the pulmonary artery and…

Aortic valve, aortic root, left ventricular outflow tract and pulmonary valve

Core Procedures Aortic valve replacement Transcatheter aortic valve replacement/implantation (TAVR/TAVI) Aortic root replacement Aortic root enlargement Embryology Septation of the initially single outflow tract begins in the fourth week of gestation (26–32 days post fertilization), occurring in the conotruncal region of the primitive heart tube, which extends from the primitive right ventricle to the boundaries of the pericardial cavity. Development of the arterial valve orifices occurs…

Mitral and tricuspid valves

Core Procedures Mitral valve repair/replacement The fibrous skeleton of the heart The aortic, mitral and tricuspid valves form one continuous structure, with each valve in close approximation to the other and connected by the fibrous skeleton of the heart. They are arranged as a triangle at the base of the heart; the pulmonary valve is separate and placed anteriorly ( Fig. 51.1 ). The fibrous skeleton…

Echocardiographic anatomy of the heart

Core procedures Preoperative imaging Intraoperative imaging Postoperative imaging Non-invasive evaluation of the heart is an essential part of the assessment of patients undergoing cardiac surgery. Echocardiography is the commonly used non-invasive imaging modality. Preoperatively, it is an essential part of the decision-making process to identify patients suitable for surgery, guide the type of surgical intervention and predict outcomes. Intra- and postoperatively, it is used to assess…