The teaching moment is announced the specic steps in the procedure out loud to often just that long, and the opportunity can be lost just the attending and the rest of the team. Discussion: In an ever-changing surgical environment characterized by constant innovation, it is imperative that new instruments are formally introduced and that all sur- Equipment Familiarization geons, trainees, and attendings alike be instructed in their Basic Principle proper use before they are to be utilized in the OR on a For many generations, most surgical procedures were live patient.
Dened curricula and technical skills labora- fairly constant in their design, conduction and equipment. Our lack of appreciation of how ments and techniques in the OR.
Accreditation of resi- to brace our hand and check the movement of the needle dents in many procedures, both old and new, such as quickly converted our nave condence and helped take central line insertion, is advocated to make sure that the us to the next and essential step of consciously incom- residents have been properly instructed and proctored petent when we realized that sewing the skin was much through their initial attempts and that their competence harder than it looked.
He or she can perform the task but must focus, concentrate, and pay careful attention. Stages of achieving mastery have been granted. However, practice alone is not enough as Consciously competent espoused by the great football coach Vince Lombardi who Unconsciously competent stated, practice does not make perfect. Perfect practice The logical school of epistemology distinguishes does. The learner begins and teaching.
A good instructor not only must be a master both unaware and ignorant. Awareness consciousness but also must appreciate the method and the steps in and competence technical prociency are distinct phe- helping the learner achieve prociency. The operative nomenon and can be analyzed in a 2 2 matrix Fig. Often, words cannot previously. Regardless of the task, the nave learner ini- describe the exact movement desired.
To do so involves tially has no idea of the complexity of the task, because it a considerable transference of motor knowledge to verbal looks relatively easy when demonstrated by a master.
All instructions in terms that the learner can understand. Often, a demonstration is necessary, even at the risk of alienating an overcautious resident who fears he or she will lose the case. Done with political sensitivity, a dem- onstration can be very effective. If a picture is worth a thousand words, a demonstration is worth a million.
Independent practice is essential in helping the learner progress toward unconscious competence. The repeated practice of a technique in a relatively nonthreatening envi- ronment is as important as the real-time feedback that guides the initial attempts of the learner in the consciously incompetent stage.
But to progress to a consciously com- petent level, the trainee must have the opportunity to practice in an environment devoid of the discerning eye and constant critique of the well-meaning but often over- vigilant attending, which often results in an excess degree of performance anxiety. Inherently entangled in this quest is the dilemma of how one can achieve a system of graduated responsibility and, at the same time, ensure Figure 21 The progression to mastery is a logical transition the competence of the learner.
The increased presence of involving both awareness and competence. In order to effectively attendings required by modern reimbursement and super- teach surgical skills, the expert must regress to the consciously vision policies creates a constant threat to this critical facet competent stage.
The masters were able to as the resident becomes more adept. The titration of the do anything and they could teach you in a manner that teaching surgeons involvement is surely a delicate balance was calm, effective, and enjoyable.
They could see things that requires careful assessment of not only the learners from your perspective. They could appreciate when you technical ability and judgment but, equally important, could run free and when careful attention was needed.
It is critical They appreciated parallax, dened as the difference in the that they recognize when they need help and to call for appearance of an object when seen from two different it in a timely fashion. If medicine is indeed an art, then vantage points not on a straight line. When operating on surgical instruction is the distillation of medical education many midline structures, the resident surgeon and the to its absolute essence.
Their vantage Example: Lack of Autonomous Awareness points are often 90 different. As a consequence, they The chief resident is left in the OR to close with the junior often see very different elds. During an open cholecys- resident after completion of the procedure. The attending tectomy, the gallbladder, when viewed from the right side goes out to talk with the family.
When coming back in, of the table, is partially hidden from the residents view the counts are correct: Two days later the patient is under the edge of the liver but is in plain view of the found to have vague abdominal pain and a plain X-ray teaching assistant on the patients left. Failure to appreci- shows a malleable retractor left in the abdominal cavity.
Although the chief resident is felt to be unconsciously Similarly, exposure and retraction must be presented to the competent at this stage of training, even minor distrac- residents view from the opposite side of the table Figs. Correctly done, this often negates the clear view of the teaching assistant who must have the insight Alternative Scenario and condence to allow the residents dissection. Failure The resident, in accord with hospital policy, requests that to show and expose the eld adequately and accurately an x-ray of the operative eld be done before the patient can lead to trouble.
The retractor is recognized. Several fascial sutures are removed and the retractor Example: Lack of Appreciation of Parallax retrieved. The attending waits until the resident noties A particularly difcult laparoscopic cholecystectomy is her or him before visiting with the patients family in the converted to an open procedure. The triangle of Calot is waiting room. Discussion: Many safeguards have been employed to The residents view of the base of the gallbladder is dif- ensure that the operation is as safe as possible and that cult because the patient is obese, the wound is deep, and such unexplainable misadventures like retained instru- the distended gallbladder and liver edge partially obstruct ments, wrong-side surgery, and transfusion reactions are the view of the cystic duct.
The attendings view, in avoided. Simple methods such as marking the patients contrast, is clearer and affords the view of a thin but surgery site with an indelible marker in the preoperative discernable plane between the infundibulum and the holding area, time-out recitation of the operative consent, and positive identication of the patient are simple and effective ways of ensuring that the operation is as safe as possible. New technologic innovations such as radiofrequency chips on laparotomy sponges and routine postoperative x-ray examination of the operative eld have become commonplace in many hospitals.
Notication of the patients family after the operation is extremely impor- tant, but this should not be done until one is absolutely sure that the operation is indeed over and the patient is doing well.
Parallax We all remember our favorite instructors in the OR and Figure 22 Residents view of the gallbladder from the patients we will never forget those who could turn a simple pro- right side. The gallbladder is barely visible and obscured by the cedure into a nightmare.
What distinguished these masters, wound edge, retractor, and lap pad. Several trips to the dentist for teeth cleaning can help one better understand the importance of bracing. Dentists and dental hygienists know that a typical molar has 32 different and distinct surfaces. The cleaning, drilling, and lling of a tooth demands precision in fractions of a mil- limeter.
An inexperienced hygienist will typically skate off the surface of the tooth and impale the patients gums with the instrument. In contrast, the experienced hygien- ist or dentist never takes the heel or hypothenar emi- nence off the patients chin, carefully bracing and checking each stroke of the instrument. Movements are careful, controlled, and precise because of the focused attention to bracing. In surgery, bracing has both a micro and a macro appli- Figure 23 The attendings view from the patients left side.
The cation. Microbracing is an essential skill in microsurgery, gallbladder is obvious and in plain view. Frustrated with the Microbracing requires moving the fulcrum closer to the residents hesitancy and faint-hearted attempts at dissec- point of action, minimizing tremor, and affording precise tion, the attending urges the resident to cut, cut.
Unsure control of the instrument. It helps avoid past pointing but willing to please, the residents Metzenbaum scissors once the resistance of the tissue is passed. Bracing is skate off the distended gallbladder and lacerate the facilitated by having the OR table at the correct height, common duct. Discussion: The residents view of the operative eld Adjusted so, it will allow the surgeon to rest the forearm see Fig. Because more wound. With the wrist locked and a predictable angle of biliary surgery is done in the two-dimensional view the needle on the needle holder, one simply supinates the afforded by a video screen, familiarity with open proce- forearm to scribe the needle in a controlled, smooth arc dures is rare.
In addition, only the most difcult cases through the tissue. The nondominant forearm is held at default to the open method.
Dissection in difcult, deep, a right angle to the other, and the forceps is ready to assist and challenging cases can be treacherous, not only for the the manipulation of the tissue or accept the needle when resident but also for the recently trained attending who appropriate Figs.
Macrobracing is critical in those maneuvers that take Anatomic structures in the surgical eld that lie under- considerable strength to penetrate tissue with marked neath the incision and in close proximity to critical struc- resistance such as the chest wall when placing a chest tube tures are particularly dangerous: for example, the common or the placing of wire sutures through the sternum.
The bile duct in cholecystectomy for cholecystitis and the surgeons legs are slightly bent at the knees, the upper ureter in colon resection in diverticulitis. One hand outcome. One hand is the Basic Principle gas, the other is the brakes. Bracing is one of the simplest techniques to help the neophyte achieve a greater deal of prociency.
It is based Example: Failure to Brace and Control Movement on the physics of a lever that consists of a long, rigid An intern is asked to place a chest tube in a victim of a structure resting on a fulcrum. The lever has two compo- motorcycle collision, a pound man in acute distress.
The placement The chest wall is thick and muscular, making the dissec- of the fulcrum, or brace point, close to the object to be tion difcult. Having placed a tube only in a simulator, dissected helps amplify the strength of the lever and the intern is unaware of the great degree of force necessary dampen the effects of the movement of the lever arm.
The to penetrate the dense intercostal muscles. As the Pean longer the moment arm, the more amplication of the clamp nally penetrates the chest wall, the intern is equally movement of the lever arm. Moving the brace point closer unprepared for checking its forward motion. The clamp to the target minimizes the moment arm, dampens the continues through the diaphragm and into the spleen. Simplifying Movement Simplifying movement, like bracing, is mostly a matter of physics.
In performing a controlled and repetitive move- ment, the fewer muscles and fewer joints that are utilized, the better the control and the less fatigue due to use and overuse of unnecessary muscles. When sewing, the wrist is locked and the only movement necessary is supination of the forearm. The needle scribes a smooth, atraumatic, and predictable arc through the tissue.
The needle should remain in place when released as no additional strain or torque is applied during its placement. As a result, the needles location, even when obscured by a bloody eld, should be predictable and easily retrieved by merely repeating a similar movement aimed just beyond the rst.
Example: Lack of Simplifying Movement The morning after a challenging Whipple procedure for severe chronic pancreatitis of the head and uncinate process in a patient with pancreas divisum, your chief resident is unable to open the jar of ointment to apply to the clinic patients burn wound owing to extreme soreness Figure 24 Lack of bracing.
The residents fulcrum, or brace and spasm of his or her neck and upper back muscles. The point, is the scapulothoracic junction.
Visualization Visualization, or seeing with the minds eye, further facilitates the smooth, careful application of the instru- ment on the patients tissues.
Used by athletes who rehearse their complex routines in their mind at the top of the slalom skiing course or at the edge of the gymnas- tic apparatus, it helps set a mind map of the complex movements to follow. Visualization also helps the surgical trainee develop an awareness of the underlying anatomic structures to be either incorporated like the submucosa in a Lembert stitch of the bowel or avoided like the parotid duct when suturing a facial laceration.
A favorite senior resident, who was also a student of martial arts, once remarked: It is a very Zen thing. Your whole con- sciousness should ride the tip of the needle as it arcs through the tissue.
Or as Yoda, in the Star Wars trilogy, admonished his student: See with your mind, Luke, not with your eyes. Figure 25 Maximal bracing. Forearms and hands resting on the Example: Lack of Visualization eld and held at It should precisely dene your expec- duct, which lies immediately posterior to the cystic duct. As Bosk, in his Basic Principles famous treatise on surgery training, Forgive and Remem- Feedback has been described as the currency of adult ber1 observed, technical errors due to lack of experience learning.
Without providing learners incremental guid- are the most forgivable of all errors. In the OR, a little ance to improve their skill, their practice may result only humor to lessen the blow on the residents ego can some- in the perpetuation of bad habits or the extinction of good times go a long way. One of my most effective attendings ones. It is only with feedback that we can most efciently once described my feeble attempts to incise the linea alba guide initial attempts and add encouragement as they as the Cuisinart technique.
The message was clear, but demonstrate progress. The basic principles of feedback can kind and in good faith. It is often extremely dif- E environment cult to describe in precise words our intent. Transference N nonjudgmental of our motor memory into words that can be understood D based on direct observation by the learner can often fall short of its mark and be con- S specic information should be both positive and fusing and subsequently frustrating for both the instructor negative and the learner.
When faced with that frustrating conun- Entire books have been written on how to provide drum, we often resort to a demonstration. To be an effec- feedback in any educational or supervisory setting. There tive learner and recipient of feedback, residents must be are many barriers to doing it well.
We all want to be liked condent enough to receive the help rendered by the and are typically uncomfortable in confronting and cor- demonstration and not fear they are losing the case. Leveling harsh criticism often confused Such fears are heightened if the demonstration is exces- with negative feedback may seem inappropriate at the sively long.
Used sparingly, demonstration of a technique time because of the presence of others. However, feed- can be extremely helpful. Again, if a picture is worth a back must be given in a timely fashion to be effective. Barring other obstacles, sooner is better than later.
Serious Feedback on technique must be done in real time negative feedback is best given in private. The OR is and done almost continuously during the conduct of the always staffed with an entire team, and extremely harsh operation as each movement is performed. A summative words can negatively affect all within earshot.
One effec- or global critique after the operation should emphasize tive technique useful in giving timely but important neg- general trends or tendencies that are both positive and ative feedback in the OR is to quietly invite a particularly negative. The attending should discuss not only areas for surly or uncooperative resident over to the x-ray board improvement but also things that the resident did par- and, while feigning explanation of the lm, speak in a very ticularly well.
The well-known sandwich technique, quiet, but rm, unmistakable manner. You can then relate espoused by Blanchard in his classic primer, The One your displeasure with their attitude, lack of skill, or prep- Minute Manager, is a helpful strategy. The feedback aration and set denite guidelines for their continued session should begin with a positive comment such as participation in the case.
It should be about citing specic examples of where improvement is needed. It is much better to state that I am disappointed remark to help motivate the resident to persist in her or in your lack of preparation for the case, rather than his efforts to improve. Likewise, it is best to limit your feedback to those behaviors or actions that you yourself Feedback and Acknowledgment of the Operative Team witness rather than relying on hearsay or rumor.
As a Surgery is a team sport that has many members. Most of program director or administrator, it is critical to have on this discussion has centered on a teaching environment, hand any written documentation previously submitted by but regardless of the setting, either in a teaching hospital others during a feedback session.
In such formal sessions or in private practice, the other players on the team should and in other ad hoc sessions in real time, the feedback be acknowledged. First and foremost is the patient. It is important to thank the rest of the team, the anesthesiolo- 1. Bosk CJ. Forgive and Remember: Managing Medical Failure, gist, nurses, and technicians, for their help. Any problems 2nd ed. Chicago: University of Chicago Press, Accreditation Council for Graduate Medical Education clear manner.
Program requirements for graduate medical negative feedback can be discussed in private. McGreevy JM. The aviation paradigm and surgical educa- affected by the amnesic properties of many of the anes- tion.
J Am Coll Surg ; Writing of the orders 3. Technique in the Use of Surgical and dictation of the operative note are also important to Tools, 2nd ed. As soon as possible, one member of 4. The Southern Surgeons Club. A prospective analysis of the team, typically the most senior, should speak with the laparoscopic cholecystectomies. N Engl J Med patients family. The hours spent in the waiting room ; [published correction appears in N while a loved one is undergoing an operation are some of Engl J Med ;].
The rst words that should come 5. Bell RH. Surgical Council on Resident Education: a new out of your mouth is that the patient is ne or, less fre- organization devoted to graduate surgical education. Until family 6. Mind Over Machine. The referring physician or primary care provider 6a.
Phillips DT. Run to Win. New York: Macmillan, ; should also be promptly notied, updated, and advised of p Gibbs VC.
Patient safety practices in the operating room: and should be graciously thanked for allowing you to correct-site surgery and nothing left behind. Surg Clin participate in the care of their patient. North Am ; Attention to all involved in the operation will help build 8. Preventable a sense of teamwork and camaraderie with your col- errors in the operating roompart 2: retained foreign leagues both in and out of the OR and ensure that your objects, sharps injuries, and wrong site surgery.
Curr Probl next operation will more than likely be as successful as Surg ; Blanchard K, Johnson S. The One-Minute Manager. New possible. York: Harper Collins, Altman, MD. However, in most states, that form alone is not As trial lawyers with over 50 years of combined experience sufcient to establish that you met your duty to your we urge you to invest the time it takes to read this chapter.
Then, make a commitment to change your practice to We have both seen surgeons mismanage their relation- consent patients correctly. Top surgeons understand that ship with their patient and their family in ways that have effective communication with their patients is a skill that led to medical errors, an omission through miscommuni- needs to be updated and rened over time just like surgi- cation, or claims from patients that the surgeon failed to cal technique.
Proper consent does not require more time provide them with sufcient information to make an when you understand the true nature of an adequate informed decision about surgery: Here are three ways we consent. It is not a hospital- this is what they will expect. If you tell the patients generated form.
Surgeons make a critical error when they what surgery they need and just assure them that assume that getting a patient to sign the hospitals consent everything will be ne, then you have taken com- forms means that they have complied with the require- plete responsibility for the decision making as well ments of informed consent. This error can be quite costly as the outcome. No wonder the patient and the to your practice and to your reputation.
Usually, it is a two- step process that starts during the ofce visit and contin- Practice Pointer. Communication and decision making ues at the hospital before surgery.
The ofce visit is your are a two-way street. Patients have responsibilities along opportunity to take the time to explain the proposed with their rights. Share these responsibilities with the surgery, the risks and alternatives, and the consequences patient. Make the patient part of your health care team.
Thus, patients have time to reect on Here are some ways to do that: all the information you have given them and can really make an informed decision to proceed with the surgery Have brochures in your ofce that explain ofce hours, you suggest. Tell them whether they are in the rst case of the day. That is not fair to you or to responsible for bringing their lms to the hospital. Also, the brochure can outline their role in follow-up Patients can feel pressured to agree and will often say they after getting laboratory tests, diagnostic tests, espe- were so worried about the surgery that they did not even cially from outside providers.
Make sure they under- listen or that they signed the forms just to get things stand how to get to you if they think they are having moving without having time to ask questions or to reect a complication and need to be seen. If others will take on the complex decision they were asked to make. In most hospitals, the surgical consent form is executed Use American College of Surgeons or other right before surgery. Also direct them to websites that you think Not Telling Patients about Who Will Assist are accurate for basic information, if appropriate.
You You with Their Surgery can provide a fact sheet that explains in detail why the surgery is performed, the alternatives, the risks, and In general, patients will appreciate and understand that what to expect after surgery. This can be handed out, you cannot perform the surgery by yourself, but in most not as a substitute for discussion, but as a supplement.
Whereas this is not a substitute Patients will also understand that sometimes others, for discussion, it certainly helps support your argument including vendors and technical people, need to be present that the patient was thoroughly informed about the to assist with device placement.
It is your job to make sure surgery before the big day! If you send a patient for a magnetic resonance imaging Failing to explain these facts can result in claims for MRI scan at an outside facility and they need to come fraud or battery. You may also get testimony in a malprac- back to discuss results, the order for the MRI should tice case that the patient never consented to having a include a section that reminds them that it is their resident do certain portions of the surgery.
Many surgeons have the patient sign this If you are in a teaching hospital, you must explain what acknowledgment. That is a good way to communicate the residents role will be and document that you had that the patient is sharing responsibility for the imple- this discussion with the patient. If you are in a community hospital, you must explain who will be assisting you with surgery and what they No Ofce Notes about the Consent Discussion will be doing.
Document that discussion. A surgeons note, timed and dated contemporaneously Some hospital consent forms include general language with the event, is the best way to avoid subsequent allega- regarding assistants and others in the operating room, tions regarding lack of informed consent.
Surgeons often but you are the person that the patient agreed could fail to document the most important part of a discussion perform the surgery, not others, so make sure the when a patient refuses care. Tap into exceptional visual guidance and reduce the risk of error through abundant clinical photographs, line drawings, and procedural videos.
Find the information you need quickly via a consistent chapter-to-chapter organization. Reduce the risk of error by watching the experts. Pitfalls in Veterinary Surgery Pitfalls in Veterinary Surgery offers a candid examination of real-life mistakes and mishaps encountered while operating on veterinary patients. Written by a surgeon with over thirty years of experience, the book is a highly readable and entertaining, yet informative, account of common errors that can occur in the veterinary operating room.
Allowing readers to learn from the author's mistakes, the book offers a thoughtful reflection on how to avoid these common errors.
Each chapter tackles a different category of mistakes, discussing real-life examples of lessons learned in the veterinary practice. Veterinary surgeons, practitioners, residents, interns, and students alike will enjoy Pitfalls in Veterinary Surgery, and will benefit from the author's years of experience in veterinary surgery. Spinal surgery is a unique area in the process of continuous development. New skills are applied daily in this delicate field by the spinal surgeon: this professional can be either an orthopaedic surgeon or a neurosurgeon dedicated to the treatment of spinal diseases.
This book offers a comprehensive approach and reviews all of the possible errors encountered by spinal surgeons in the clinical practice. It is mainly directed towards young surgeons approaching spinal surgery and also to experienced surgeons with regards to complications related to the latest technologies in the spinal field.
This approach of treating and understanding problems in cervical spine surgery is unique and will guide the reader towards an improved level of attention regarding pitfalls in cervical spine surgery, therefore fostering the ability of preventing major complications and medicolegal consequences.
This text is organized by organ system and the illustrations highlight surgical pearls borne of experience and polished by the study of pertinent references. Hand-drawn and illustrated figures show exact anatomical relationships as we see them in-vivo. The discussion sections strive to explain not only what the correct answer is, but also why the distractors are wrong, in order to motivate discussion and self-reflection. Cognitive Pearls in General Surgery details the explicit thought processes and associations that underlie the understanding of the topics at hand, with the intent of enhancing the fun and enjoyment that only an informed and well-grounded practice of surgery can provide.
This best-selling resource explores the full spectrum of surgical techniques used in spine surgery, and describes how to avoid and manage complex problems.
It emphasizes how to achieve successful outcomes and minimize risks. The 2nd Edition delivers more than 25 brand-new chapters, as well as extensive revisions and updates throughout, to reflect all of the latest advances in the field. It also features contributions from an increased number of orthopaedic surgeons to round out the strong coverage provided by the many neurosurgeon contributors.
Features contributions from well-known neurosurgeons and orthopaedic surgeons, for well-rounded, authoritative coverage from beginning to end.
Offers more than outstanding illustrations that demonstrate how to perform every procedure step by step. Provides more than 25 brand-new chapters, as well as extensive revisions or total rewrites to the majority of existing chapters-to present all of the most up-to-date information available on every aspect of spine surgery.
With additional contributing experts. This atlas demonstrates how to perform each available extraperitoneal hernia repair via a set of high-quality annotated images showing step-by-step guidance on how to perform the surgery. Robotic extraperitoneal hernia procedures are considered great teaching procedures especially with a dual teaching console.
The book bridges the gap between traditional hernia and laparoscopic hernia texts by combining both approaches to create a book with a unique visual approach.
Preoperative, intraoperative, and postoperative figures are integrated to highlight the importance of these step-by-step procedures, enhance skill and efficiency, and avoid surgical pitfalls. Detailed descriptive figures accompany step-by-step instructions and include specific anatomical annotations that describe the anatomy and layers of the abdominal wall during hernia procedures. Preoperative, intraoperative, and postoperative figures are integrated to highlight the importance of these step-by-step procedures, enhance skill and efficiency, and avoid surgical pitfalls.
Detailed descriptive figures accompany step-by-step instructions and include specific anatomical annotations that describe the anatomy and layers of the abdominal wall during hernia procedures.
Robotic Hernia Surgery provides a comprehensive, insightful and state-of-art review of this field, and serves as a valuable resource for surgeons, surgeons in training, and students with an interest in hernia and robotic hernia surgery. This book provides the first comprehensive overview of the various conventional and cutting-edge surgical techniques for stapes fixations.
After describing the broad range of stapes fixations, it discusses the preoperative diagnostic workup, with special emphasis on the role of CT scanning. It reviews stapedectomy and stapedotomy via the classic tympanotomy approach using different stapes footplate fenestration methodologies, and describes the increasingly popular technique of middle ear endoscopy.
A subsequent chapter is devoted to the important topic of robot-assisted surgery. The book then reviews the evolution of the piston prosthesis, highlighting the practical aspects of the different types of piston, their benefits, and their impact on hearing. Lasers are also discussed, and the closing chapters focus on revision surgery and consider outcome measures following stapes surgery. To better illustrate the subject matter, the book features a wealth of photographs including more than 50 in color , as well as in-depth surgical videos.
Operative Techniques in Sports Medicine Surgery provides full-color, step-by-step explanations of all operative procedures in sports medicine. It contains the sports-related chapters from Sam W.
Wiesel's Operative Techniques in Orthopaedic Surgery. Written by experts from leading institutions around the world, this superbly illustrated volume focuses on mastery of operative techniques and also provides a thorough understanding of how to select the best procedure, how to avoid complications, and what outcomes to expect.
The user-friendly format is ideal for quick preoperative review of the steps of a procedure. Each procedure is broken down step by step, with full-color intraoperative photographs and drawings that demonstrate how to perform each technique. Extensive use of bulleted points and tables allows quick and easy reference. Each clinical problem is discussed in the same format: definition, anatomy, physical exams, pathogenesis, natural history, physical findings, imaging and diagnostic studies, differential diagnosis, non-operative management, surgical management, pearls and pitfalls, postoperative care, outcomes, and complications.
To ensure that the material fully meets residents' needs, the text was reviewed by a Residency Advisory Board. Skip to content. Surgical Pitfalls. Author : Stephen R. Surgical Pitfalls Book Review:. Pitfalls in Veterinary Surgery. Author : Geraldine B. Pitfalls in Veterinary Surgery Book Review:. Pearls and Pitfalls in Head and Neck Surgery.
Author : Claudio R. Cernea,Fernando L. Lima,Eugene N. Cardiac Surgery. Cardiac Surgery Book Review:. Pitfalls of Surgery. Pitfalls of Surgery Book Review:. Pearls and Pitfalls in Cosmetic Oculoplastic Surgery. Presents more than illustrations, including original line art, radiologic images, and full-color intraoperative photos, that show you exactly what to look for and how to proceed.
Robotic surgery is currently devoid of adequate didactic material necessary to facilitate daily application in cardiothoracic surgical practice. This book represents the definitive atlas that will lead both the practicing and new cardiothoracic surgeons in these methods.
It will define the operative pathway of each procedure, from beginning to end, for surgeons who wish to be a complete robotic cardiac surgeon and include hints and procedural pitfalls derived from the experiences of chapter contributors. The book will be illustrated with high quality illustrations and color photographs from surgical operations where appropriate.
Leading surgeons have contributed to the book and provided sample illustrations for their respective chapters. Anesthetic and cardiopulmonary support preparation for each operation will be included and selected references will be provided to emphasize evidence-based outcomes. Fully updated to meet the demands of the 21st-century surgeon, Craniofacial, Head and Neck Surgery and Pediatric Plastic Surgery, Volume 3 of Plastic Surgery, 3rd Edition, provides you with the most current knowledge and techniques across your entire field, allowing you to offer every patient the best possible outcome.
Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability. Apply the very latest advances in craniofacial, head, neck, and pediatric plastic surgery and ensure optimal outcomes with evidence-based advice from a diverse collection of world-leading authorities.
Purchase this volume individually or own the entire set, with the ability to search across all six volumes online! Master the newest procedures in pediatric plastic surgery, including conjoined twinning. Apply the latest clinical evidence and surgical techniques to facilitate the decision-making process for craniofacial patients, and optimize outcomes in the correction of congenital, oncologic, traumatic, and acquired deformities.
Know what to look for and what results you can expect with over 2, photographs and illustrations. See how to perform key techniques with 28 surgical videos online. Access the complete, fully searchable contents online, download all the tables and figures, and take advantage of additional content and images at www.
Fully updated to meet the demands of the 21st-century surgeon, Plastic Surgery provides you with all the most current knowledge and techniques across your entire field, allowing you to offer every patient the best possible outcome. Edited by Drs. Mathes and Hentz in its last edition, this six-volume plastic surgery reference now features new expert leadership, a new organization, new online features, and a vast collection of new information - delivering all the state-of-the-art know-how you need to overcome any challenge you may face.
Apply the very latest advances in every area of plastic surgery and ensure optimal outcomes with evidence-based advice from a diverse collection of world-leading authorities.
Visualize procedures more clearly through an abundance of completely redrawn full-color illustrations and new color clinical photographs. Access the complete, fully searchable contents of each volume online, download all the tables and figures, view procedural videos, and take advantage of additional content and images at www. This book presents an Asian perspective on how the treatment of colorectal cancer can be optimized and standardized in ways that take into account technological advances and the trend towards individually tailored therapy.
Readers will find careful, well-illustrated descriptions of the standard surgical techniques for rectal cancer and colon cancer that have contributed to recent improvements in 5-year survival rates in the Asia-Pacific region, where the incidence of colorectal cancer has been rising alarmingly due to lifestyle changes. The vital role now being played by minimally invasive laparoscopic and robotic options receives detailed scrutiny. Extent and timing of surgery, patient safety, risk of complications, and unresolved issues are all discussed.
Furthermore, the use of surgery within the context of multimodal management including chemotherapy and radiotherapy is explained and an integrated approach for stage IV and recurrent disease is described.
The book will serve as a valuable reference for young surgeons who are in training, experienced practitioners who want to enhance their knowledge and skills, and all others who wish to learn about this field. Presenting comprehensive, cutting-edge information on the science of oncology and the multimodality treatment of every cancer type, this eighth edition--now in full color--contains more than 40 brand-new chapters, and more than 70 chapters have been rewritten by new contributing authors.
Focusing solely on must-know procedures, Operative Techniques: Spine Surgery, 3rd Edition offers a highly visual, step-by-step approach to the latest techniques in the field. Thorough updates keep you current with recent changes in spine surgery, and new contributors bring a fresh perspective to this rapidly-changing specialty. Part of the popular Operative Techniques series, this practical reference focuses on individual procedures, each presented in an easy-to-follow format for quick reference.
Step-by-step intraoperative photos depict each technique, and high-quality radiographs show presenting problems and post-surgical outcomes. Clean design layout features brief, bulleted descriptions, clinical pearls, and just the right amount of relevant science. Ideal for orthopaedic and neurosurgery residents, fellows, and practicing surgeons.
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