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Knee

Core Procedures Joint arthroplasty (most common) Open/arthroscopic anterior and posterior cruciate ligament repair Joint arthroscopy, e.g. meniscectomy, removal of loose bodies Joint washout with or without synovectomy for infection Fixation of distal femoral fractures Microfracture of osteochondral defects Patellectomy Treatment of osteochondritis dissecans, e.g. mosaicplasty Arthroscopically assisted tibial plateau fracture fixation Embryology Chondrification in the femur, tibia and fibula begins by stage 18 (42–44 days post…

Popliteal fossa

Core Procedures Repair of neurovascular structures Excision of lesions: for example, Baker cyst, tumours Fixation of avulsed posterior cruciate ligament (PCL) attachment Fixation of posterior knee structures: for example, fixation of posterior fractures of the femoral condyle, posterior capsular repair Gastrocnemius recession for contracture Hamstring lengthening Surgical surface anatomy The uppermost part of the popliteal fossa is about a hand's breadth proximal to the knee joint…

Thigh

Core Procedures Anterolateral thigh (ALT) flap Gracilis flap Surgical surface anatomy An imaginary line connecting the anterior superior iliac spine to the pubic tubercle marks the proximal border of the anterior thigh. The inguinal ligament travels between these two bony landmarks. The external iliac vessels become the femoral vessels deep to the ligament. Laterally, the lateral femoral cutaneous nerve enters the thigh, usually just medial to…

Hip

Core Procedures Open reduction internal fixation of acetabular fractures; open reduction internal fixation of femoral head and neck fractures Closed reduction screw fixation of femoral neck fractures Arthroplasty, hemiarthroplasty Osteotomies of the pelvis; osteotomies of the neck of the femur and proximal femur Closed and open reduction of hip dislocation Hip joint arthroscopy Arthrocentesis; diagnostic and therapeutic injections of the hip joint and other extra-articular musculotendinous…

Pelvic girdle

Core Procedures Femoral hernia repair Saphenofemoral exposure for endarterectomy, embolectomy, bypass, and endovascular repair of aneurysms Exposure/puncture of femoral artery/vein Open reduction internal fixation for fractured acetabulum/femur Above-knee amputation Gluteal approach for hip replacement Pelvis and gluteal region Surgical surface anatomy The summit of the iliac crest is level with the fourth lumbar vertebral body in adults and with the fifth vertebral body in children aged…

Innervation of the lower limb and nerve blockade techniques

Core procedures Nerve Blockade Lateral Hip Exposure Hip athroscopy Hip arthroplasty Knee Surgery Knee arthroscopy Knee arthroplasty ACL repair Foot and Ankle Surgery Surgical surface anatomy Nerve blockades best illustrate important surgical landmarks of the lumbosacral plexus (LSP) and its branches. Lumbar plexus and sciatic nerve blockade can be used to achieve near-total anaesthesia of the lower limb, either via a single injection or through placement…

Vascular anatomy of the lower limb

Core Procedures Access to the distal aorta and iliac vessels Exposure of the femoral vessels Access to the proximal popliteal artery Access to the distal popliteal artery Approach to the anterior tibial artery Access to the posterior tibial artery Access to the fibular artery Long saphenous vein harvest Lower limb four-compartment fasciotomies Varicose vein surgery Embryology The common iliac arteries develop from the union of the…

Overview of the pelvis and lower limb

This chapter presents an overview of the general morphology of the pelvis and lower limb. The main junctional region of the body contains not only the articulation of the femur to the pelvis, i.e. the hip joint, but also the major neurovascular pathways between the abdominopelvic cavity and the lower limb. Posteriorly, the gluteal (buttocks) region and its relationships to the greater and lesser sciatic foramina…

Development and congenital anomalies of the urogenital system

Core procedures Orchidopexy Hypospadias repair Procedures relating to the kidney e.g. nephrectomy, pyeloplasty Resection of posterior urethral valves Embryology The urogenital system develops from intermediate mesenchyme extending longitudinally in the trunk, subjacent to the somites, and through reciprocal interactions with the coelomic epithelium lining the intraembryonic coelom. Pronephric and mesonephric kidneys are seen early in development, with the definitive metanephric kidney arising later. Reproductive ducts, mesonephric…

Female reproductive system

Core procedures Vulva Bartholin's cyst marsupialization Drainage of labial abscess Wide local excision Radical and simple vulvectomy Vagina Anterior and posterior vaginal repair Vaginectomy Uterine Cervix Large loop (needle) excision of the transformation zone (LLETZ/NETZ) Trachelectomy Uterus Total/subtotal/radical hysterectomy Myomectomy Uterine (Fallopian) Tubes Tubal ligation Salpingectomy Ovaries Ovarian cystectomy Oophorectomy Salpingoophorectomy In order to operate successfully in the pelvis at a high level it is essential…

Prostate

Core Procedures Transurethral resection of the prostate (TURP) Photo-selective vaporization of the prostate (PVP) Holmium laser enucleation of the prostate (HoLEP) Open simple prostatectomy Transrectal prostate biopsy Transperineal prostate biopsy Radical prostatectomy (open/laparoscopic/robotic-assisted) The prostate is a walnut-sized accessory male sexual organ composed of a mixture of glandular and fibromuscular tissue, located inferior to the bladder and directly above the superior fascia of the urogenital diaphragm.…

Male reproductive system

Core Procedures Scrotal exploration for torsion of the testis Inguinal orchidectomy Hydrocele repair (Jaboulay and Lord's repair) Circumcision Orchidopexy Vasectomy The male reproductive system consists of several elements, focused on the effective formation and delivery of sperm. It has external components, such as the testes, involved in spermatogenesis and testosterone production, and the epididymis, where sperm is stored and matured. Deeper pelvic components include the prostate…

Pelvic inlet, pelvic floor and perineum

Core Procedures Pudendal nerve block/pudendal nerve stimulation Sacral nerve stimulation Cystocele repair Rectocele repair and levatoplasty Sacrospinous fixation Sacrocolpopexy Ventral mesh rectopexy Burch colposuspension Autologous fascial sling/pubovaginal sling Mid-urethral synthetic tapes Male sling Artificial urinary sphincter Surgical surface anatomy Perineum The pudendal nerve supplies sensory fibres from the perineum (external genitalia and anal skin) and motor fibres to the pelvic floor muscles. It can be compressed…

Bladder and urethra

Urinary bladder Core Procedures Cystoscopy (endoscopic): diagnostic procedure Suprapubic catheterization (percutaneous, endoscopic): bladder drainage Cystoscopy and intravesical botulinum toxin injections (endoscopic): treatment of detrusor overactivity Transurethral resection of bladder tumour (endoscopic): diagnosis and treatment of bladder tumour Suprapubic cystostomy (open): removal of stones/foreign body Bladder augmentation (open): increase in bladder capacity Boari flap and psoas hitch (open): reconstruction of distal ureter and bladder Partial cystectomy/diverticulectomy (open,…

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…