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How to Operate


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Table of Contents

List of Contributors Foreword by John Black, President of the Royal College of Surgeons Preface General 1 Inguinal Hernia Repair 2 Split Skin Graft 3 Femoral Hernia Repair 4 Incision and Drainage of Abscess 5 Wedge Resection for Ingrown Toenail 6 Paraumbilical and Umbilical Hernia Repair 7 Appendicectomy 8 Establishing a Pneumoperitoneum 9 Laparotomy Vascular 10 Long Saphenous Vein Stripping 11 Short Saphenous Vein Ligation 12 Abdominal Aortic Aneurysm Repair 13 Below Knee Amputation 14 Carotid Endarterectomy 15 Temporal Artery Biopsy 16 Femorodistal Bypass 17 Brachiocephalic Fistula Urology 18 Scrotal Exploration 19 Vasectomy 20 Circumcision 21 Nephrectomy Orthopaedics 22 Dynamic Hip Screw 23 Hip Hemiarthroplasty 24 Carpal Tunnel Decompression Upper Gastrointestinal 25 Gastrectomy 26 Splenectomy 27 Gastrojejunostomy 28 Open Cholecystectomy 29 Thoracotomy Breast 30 Mastectomy, 31 Wide Local Excision 32 Axillary Node Clearance 33 Fibroadenoma Ear, Nose and Throat 34 Thyroidectomy 35 Tracheostomy Colorectal 36 Haemorrhoidectomy 37 Colostomy and Other Stomas 38 Small Bowel Resection and Anastomosis 39 Excision of Pilonidal Sinus 40 Right Hemicolectomy Appendices 41 Surgical Instruments 42 Sutures 43 Patient Safety and the WHO Surgical Checklist 44 Theatre Etiquette 45 How to Write the Operation Note 46 Consent Index

About the Author

Matthew Stephenson is Senior Surgical Registrar within the South East Thames Rotation


How to operate for MRCS candidates and other surgicaltrainees is an exciting addition to the market for the juniorsurgical trainee. Uniquely combining a DVD and handbook companion,it provides a step by step guide to more than 40 common operationslikely to be encountered during core surgical training. Thehandbook is aided by intra-operative images highlighting thesalient anatomy and surgical points. Whilst notionally aimed as ahelpful addition to those studying for the IntercollegiateMembership of the Royal College of Surgeons examination thiscompilation has much more scope than that. With the timeconstraints on training with the European Working Time Directive(EWTD) the opportunities to have seen, in vivo, a wide range ofprocedures has become more limited. Therefore, the desire to befully prepared when attending operating lists has heightened. Howto operate provides a solution to this conundrum. Its step by stepapproach allows the trainee to be, at least, familiar with thetechniques surrounding the operation prior to setting foot intotheatre. The DVD provides a comprehensively narrated guide to operativepractice. With 10 hours of footage and practical advice to thecommon pitfalls that may be encountered in the operating theatre.Unlike DVDs aimed at Higher Surgical Trainees, How tooperate does not profess to show operations without challenges.Rather, it tackles the realities of the situation that one islikely to encounter. This compendium is firmly based at the Core Surgical Trainee. Itcovers a breath of surgical procedures likely to be covered duringthe 2 year rotation. These are namely; general, vascular, urology,orthopaedics, upper gastrointestinal, breast, and colorecatal,along with appendices covering basic surgical skills and theatreetiquette. There are inevitably some admissions, for example the lack ofneurosurgical or cardiothoracic procedures. Furthermore, certainspecialties fare better than others with orthopaedics and ENTcovered somewhat more scantily than the general and urologysections of the DVD and book. It is surprising that a similar compilation is not already onthe market. Those battling with their surgical exams have utilisedAcland s Anatomy for many years, and whilst theirvalue cannot be negated they are a little dated. Furthermore, Howto operate has the added benefit of demonstrating the surgicalanatomy as it will be seen in the operating theatre. It will neverreplace comprehensive operative bibles in the mould ofFarquharson s Textbook of Operative General Surgerybut nor does it purport to be. Rather it provides the juniorsurgical trainee with a firm grounding. On this note, How tooperate will have limited benefit for the higher surgical traineeas they will be familiar with the procedures covered in theirparent specialty. However, it opens the possibility of furtheradditions to the series focussing on individual surgicalspecialties aimed at Registrar level trainees. (Captain NeilShastri-Hurst RAMC MRCS, Queen Elizabeth Hospital,Birmingham) This is a unique and useful addition to the bookshelves (andDVD players) of those progressing through basic surgical training.Detailed step-by-step videos of common operations are eachaccompanied by a chapter in the book detailing the proceduralsteps, coupled with operative pictures, radiographs and anatomicaldiagrams to illustrate the important learning points. The videos provide a clearly narrated guide to operativepractice, pitched for the junior trainee starting out in theoperating theatre. The narration tackles the realities ofoperations and their difficulties with useful tips and a commonsense, occasionally humorous approach not found in more senior andspecialist titles that often seem to present a more polishedversion of reality than one encounters in your own operatingtheatre. The procedures videoed cover the breadth of a typical core surgicaltraining rotation, including general, vascular, urological,orthopaedic, upper gastrointestinal, ENT, breast, and colorectalprocedures. For example, within upper gastrointestinal surgery thevideos feature gastrectomy, splenectomy, gastrojejunostomy, opencholecystectomy, and thoracotomy. It is perhaps surprising that no-one has already put such atraining package together. Many have used Acland s anatomyDVDs for MRCS revision, and although sub-specialist operativetraining DVDs do exist these are limited in scope and areprohibitively expensive. It must surely have been a labour of love to assemble and editthese training videos all together, and the author and productionteam are to be congratulated on bringing this to life as well asthey have. In the modern multimedia age this could well become asessential as Kirk s seminal text on basic surgical techniqueswas to previous generations climbing the slippery surgicalladder. Given the broad coverage of disparate specialties, fromorthopaedics to urology, the package will perhaps have limitedinterest to more senior trainees and one wonders whether dedicatededitions featuring each of the nine surgical specialties will beforthcoming in future. Certainly there would be demand for this.Similarly, the level of the accompanying book is no replacement foroperative surgery bibles such as Farquharson's or Kirk s, butneither does it set out to be. Overall, many surgical trainees at the core/senior houseoffice/resident level will find [this] greatly beneficial to theirtraining." (Ed Fitzgerald MRCS, Specialist Registrar,General Surgery, The Royal Marsden Hospital, London)

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