operative technique in general surgery

[...]... divided In the abdominoinguinal incision, the inguinal ligament is divided near the pubic tubercle and the inferior epigastric vessels are approached from the medial side as they are ligated at their origin and divided The indications for the abdominoinguinal incision are: 1 Large tumors in the iliac fossa extending anteriorly to involve the inner layers of the abdominal wall or inferiorly behind or... the external inguinal ring and the spermatic cord extricated by incising the inguinal floor to the internal inguinal ring (Figs 5 and 6) Because the cord lies lateral to the inferior epigastric vessels at the level of the internal ring, complete freedom of the former cannot occur before ligation and division of the latter After the inguinal ligament is divided at the pubic tubercle, the inguinal ligament... abdominoinguinal incision is the origin of the inferior epigastric vessels as it is true for the radical groin (ilioinguinal) dissection when the latter is performed with in continuity removal of the inguinal and deep nodes In the radical groin dissection, the anterolateral abdominal wall muscles and the inguinal ligament are divided lateral to the external iliac-femoral artery axis and the inferior epigastric... through the inguinal ligament into the groin 2 Tumors involving the iliac vessels requiring the in continuity exposure of the femoral vessels for their removal 3 Tumors fixed to the wall of the lesser pelvis requiring removal of the obturator internus 4 Large tumors of the pubic bone extending into the pelvis or adductor group of muscles; or pelvic tumors extending through the obturator foramen into the... A limited incision provides limited exposure, and over-retraction may result in complex local rib fractures and muscle tears The skin incision may be minimized, but the internal intercostal incision should be relatively wide from front to back to allow the ribs to separate by “hinging” like bucket handles Optimal pain management begins before thoracotomy, and a variety of ancillary indwelling catheters... Dividing the internal spermatic vessels deep to the internal inguinal ring, if necessary, allows the testicle to remain viable if the latter has not been mobilized off its scrotal sac that provides some blood supply to the testicle Alter- Abdominoinguinal incision Figure 1 A right abdominoinguinal incision for a tumor fixed to the right side of the pelvis (Reprinted with permission from Bland KI, Karakousis... spine procedures Am J Surg 194:98-102, 2007 Rob C: Extraperitoneal approach to the abdominal aorta Surgery 53:87-89, 1963 Williams GM, Ricotta J, Zinner M: The extended retroperitoneal approach for treatment of extensive atherosclerosis of the aorta and renal vessels Surgery 88:846-855, 1980 The Abdominoinguinal Incision Constantine P Karakousis, MD, PhD T he pivotal anatomical point in the abdominoinguinal... result in transient impairment of the ipsilateral cricothyroid muscle, making projection of one’s voice or singing a high note quite difficult Although these injuries tend to be transient and improve in the months after surgery, permanent injuries do occur Hypocalcemia in the postoperative period is not uncommon and results from removal, injury or devascularization of the parathyroid glands resulting in. .. tissues involved The closure of the incision is simple: The lateral third of the inguinal ligament is sutured to the iliac fascia (when the latter is removed, to the iliofemoral ligament of the hip joint), and the medial half of the inguinal ligament to Cooper’s ligament The anterior sheath and rectus abdominis are sutured to the pubic crest and the midline abdominal incision is closed in routine fashion... patient’s problems dictate the access options chosen Although minimally invasive options for elective operations within the chest are evolving, small chest incisions offer less flexible access than laparoscopic surgery because of fixed intercostal positions, postoperative pain from involvement of multiple intercostal nerves, and immature instrumentation to address the variety of pathologies encountered . skin incision is placed in a skin crease approximately 1 cm below the cricoid cartilage. The orientation of the incision should be along the lines of Langer, since crossing the normal skin lines. collar incision. Positioning of the collar incision during thyroidectomy is of critical importance, as an inappropriately placed incision may lead to needless scarring or unusual prominence. Inci- sions. thyroidec- tomy and its minimally invasive counterpart. 3 After deter - mining the minimum incision length in over 200 consecutive operations, this group proposed the term “minimally inva- sive” should