The Mallila/ qf Gyn('c%Ric SurRery is a comprehensive guide for opera tive decision-making and technique in female pelvic surgery. For a wide array of problems requiring surgical intervention, this volume examines the anatomy, preoperative evaluation, surgical strategy, details of tech nique, postoperative management, and anticipated results. The manage ment of operative complications and injuries to bowel, urinary system, and pelvic vessels is discussed. This volume is divided into three sections: ambulatory, vaginal, and abdominal surgery. The ambulatory section will be particularly useful to the family physician. The abdominal section explains complication man agement for the gynecologist whose surgical background may not include gastrointestinal or urinary tract surgery.. The section on ovarian surgery contains additional data for the general surgeon who may encounter unexpected ovarian lesions. Although the book should be most useful to gynecologic residents-in-training and practicing gynecologists, it will also be of use to general surgeons who perform gynecologic operations and to all physicians who perform ambulatory gynecologic procedures. The operative techniques depicted are currently used procedures based on the newer concepts of wound healing and suturing, utilizing mod ern surgical instrumentation. When several techniques are available, the author's personal preference is described. This book, which was produced by the project manager system, rep resents the efforts of 21 persons in three cities. Christine G. Williamson managed the project with drive, understanding, and skill. She was responsi ble also for coordinating information retrieval, organizing the chapters, and editing the text.

for a significant portion of the new information in this book. His ability to select the important developments from the literature of the last five years was essential to the completion of this second edition. Further, Dr. Stone's original research on wounds and sutures is included in this volume. Dr. Felix Rutledge and Dr. Laman Gray, Sr., in addition to all the named authors, made valuable comments. Their years of experience were especially helpful in updating the chapters on ovarian surgery and vaginal hysterectomy. My personal Administrative Assistant, Elizabeth Davies, successfully coor dinated my various clinical schedules, speaking engagements and department obligations, providing me the time necessary for writing this book. The advice and support of Jerry Stone, Senior Medical Editor, Springer Verlag, also were invaluable in the production of this edition. Lastly, one of our team became ill while we were preparing this book and subsequently died of a rare malignancy. Her outstanding work while with us and her continued interest and encouragement, even though quite of us. Mrs. Sue Koenig was a bright, competent ill, was an inspiration to all and effective co-worker whom is missed by all of us in the Department of Obstetrics and Gynecology at the University of Louisville.

This new edition brings surgeons fully up to date with the latest developments and technologies in laparoscopic and hysteroscopic gynaecological surgery. Beginning with the history, instruments and training of endoscopy, each chapter focuses on a different condition, presenting surgical procedures in a step by step process, as well as possible complications. The second edition includes new chapters on ovarian tumours, ectopic pregnancy and tubal surgery, as well as an up to date reference list. Written by an extensive author and editor team from Europe, the USA and Canada, this practical manual features nearly 750 full colour images and illustrations, and includes four interactive DVD ROMs demonstrating surgical procedures described in the book. Key points New edition presenting latest developments in laparoscopic and hysteroscopic gynaecological surgery Includes new chapters on ovarian tumours, ectopic pregnancy and tubal surgery Extensive author and editor team from Europe, USA and Canada Includes nearly 750 colour images and illustrations and four interactive DVD ROMs Previous edition published in 2006

SECTION 1 BASICS AND ANATOMICAL ASPECTS OF ENDOSCOPIC SURGERY Chapter 1. Historical Perspectives Chapter 2. Clinical Anatomy for Gynecological Laparoscopic Surgery Chapter 3. Instruments and Equipment for Laparoscopic Surgery: Apparatus and Optic Holders Chapter 4. Practical Approach to Instrumentation Chapter 5. Current Laparoscopic Training Models Chapter 6. Learning by Doing: How to Teach Laparoscopic Surgery? Chapter 7. Training in Minimally Invasive Gynecological Surgery Chapter 8. Current Training Models in Hysteroscopy Chapter 9. Risk Assessment and Counseling Prior to Laparoscopic Surgery Chapter 10. Peritoneal Access ""Chapter 11. Risk Management in Gynecological Endoscopy Chapter 12. Female Pelvis Innervation and Vascularization in Laparoscopy Chapter 13. Suturing and Ligature Techniques at Laparoscopy Chapter 14. General Surgery Conditions and Techniques for Gyne-endoscopic Surgeons Chapter 15. Pneumoperitoneum: Known and Lesser-known Perspectives-Scope and Considerations SECTION 2 SPECIFIC GYNECOLOGICAL LAPAROSCOPIC PROCEDURES Chapter 16. Benign Ovarian Tumors Chapter 17. Ectopic Pregnancy Chapter 18. Laparoscopic Surgery in Pregnancy Chapter 19. Extragenital Findings in Gynecological Laparoscopy Chapter 20. Tubal Surgery Chapter 21. Endoscopy Techniques for Tubal Sterilization Chapter 22. Tubal Torsion: The Diagnostic Dilemma Chapter 23. Endometriosis Chapter 24. Adenomyosis Treatment Chapter 25. Surgical Aspects and Therapeutic Modalities of Deep Infiltrating Diagnosis Chapter 26. Adenomyoma Resection in Infertility Chapter 27. Diagnosis of Bowel Endometriosis Chapter 28. Sentinel Lymph Node Detection Chapter 29. Laparoscopic Myomectomy Chapter 30. Specific Features of Myomectomy Chapter 31. Laparoscopic Myoma Therapy Chapter 32. Fertility-enhancing Endoscopic Surgeries Chapter 33. Technique of Routine Total Laparoscopic Hysterectomy with a Dissection of Uterine Vessels at Internal Iliac Level and Using a Uterine Manipulator Chapter 34. Total Laparoscopic Hysterectomy Chapter 35. Stepwise Approach to Total Laparoscopic Hysterectomy Chapter 36. Hysterectomies: Laparoscopic Subtotal Hysterectomy Chapter 37. Transvaginal Natural Orifice Transluminal Endoscopic Surgery Chapter 38. Overview of Endoscopic Pelvic Floor Defect Corrections Chapter 39. Critical Evaluation of Mesh-supported Vaginal and Chapter 40. Surgery for Pelvic Floor Defects Chapter 41. Laparoscopic Pectopexy Chapter 42. Esthetic Aspects of Pelvic Floor Repair Chapter 43. Oncologic Surgery on the Ovary Chapter 44. Oncologic Surgery on the Uterus Chapter 45. Robot-assisted Surgery in Gynecology SECTION 3 SPECIFIC HYSTEROSCOPIC PROCEDURES Chapter 46. Diagnostic and Office Hysteroscopy Chapter 47. Laparoscopy and Hysteroscopy as Complementary Procedures Chapter 48. Operative Hysteroscopy SECTION 4 COMPLICATIONS IN LAPAROSCOPIC AND HYSTEROSCOPIC SURGERY Chapter 49. Laparoscopic Complications and Management Chapter 50. Complications of Hysteroscopy Index

This third edition has been extensively updated to provide the gynecologic surgeon with a state-of-the-art and practical resource that can be used to review or learn about commonly performed surgical procedures in minimally invasive gynecology. To meet the needs of both novice and experienced surgeons, the text is engineered to cover the clinical decision-making, key instrumentation, and technical cascade for each surgical procedure. Wherever possible, discussion is focused on methods to optimize outcome and reduce risk. The content in this latest edition has been substantially bolstered by the addition of chapters covering vaginal hysterectomy, tissue retrieval in laparoscopic surgery, single port laparoscopy, robotic hysterectomy, robotic myomectomy, robotic sacralcolpopexy, radical robotic hysterectomy, and hemostatic agents for laparoscopic surgery.

It is appropriate that a surgical teacher. Robert E. Hermann. M.D . . with a large experience in a specialized field should author the beautifully il lustrated Manual of StlrRery of the Gallbladder. Bile Ducts. and Exocrine Pancreas. This manual. which takes its place in the distinguished series sponsored by RiChard H. Egdahl, M.D . . is designed for the working sur geon. resident or practitioner. who wishes to refresh his memory or to bring himself abreast of current thinking and technics. The carefully planned format and the elegant color illustrations of Mr. Robert Reed per mit this with the expenditure of a minimum of time and effort. and sur geons who must operate on the organs and structures it covers will wish to have it available for reference. Stanley O. Hoerr. M.D. former Chairman. Division of Surgery Cleveland Clinic Chairman. Department of Surgery Fairview General Hospital Cleveland. Ohio Preface Operations on the gallbladder and bile ducts are among the surgical proce dures most commonly performed by general surgeons. In most hospitals, cholecystectomy is the most frequently performed operation within the ab domen; approximately 6()(), OOO are performed each year in the United States. In addition, an estimated 120,000 bile duct operations are performed yearly. Pancreatic surgery is less frequent, but because of the close relation between the biliary system and the pancreas, knowledge of pancreatic problems is equally essential to the surgeon.

Initially we asked Springer-Verlag why they thought the world needed another book about aesthetic surgery. They pointed to the popularity of the Compre hensive Manual of Surgical Specialties Series, suggesting that completeness required our contribution. We recalled the current masters of aesthetic surgery: Rees, Sheen, among others. Each had produced his own monograph-all of them established classics. What could we add? Furthermore none of us was recognized exclusively for aesthetic surgery achievements. Nevertheless, each of us was committed to the challenge of teaching residents aesthetic surgery during their residency, not afterward as was done in the past. Furthermore, Dick Egdahl, Senior Editor and designer of CMSS, made clear to us the specific orientation of the manuals to residents-in-training. as did Springer-Verlag, well known for their commitment He won our support, to high-quality color illustrations. We appreciate being asked by Dr. Egdahl to contribute to CMSS. We were not even offended by his original plan to embrace all of plastic surgery in one volume. He should have known better! The Manual of Reconstructive Surgery will follow this volume in 2 years. Defining its scope remains an unmet challenge. Limiting the scope of Manual of Aesthetic Surgery has been an easier task. It is a sourcebook for beginning residents, not an encyclopedic reference.

Of all the developing fields of surgery, few have had the impact of vascular surgery in affecting so large a section of the population by offering the potential relief of disability and the prolongation of life. As would be anticipated, the interest of surgeons in this evolving specialty has largely been focused upon the selection of the most appropriate operations and the development of modifi cations or new procedures that overcome the limitations of previous ones. The literature contains numerous conflicting claims about the relative merits of various procedures, and those aPlJoaching this field for the first time may understandably be confused. Yet, if one were to approach any single vascular surgeon at any given time, he would upon request be given a firm and precise listing of preferred procedures. The procedures described in this two-volume publication are those that we currently favor. Their selection is the result of continuing analyses of our own experience during the past 30 years. All patients have been available for prolonged follow-up evaluation. Late failures often helped us to identify techniques that lessened the durability of an initially satisfactory operation, and they became a stimulus for the development of modifications or trials with alternative operations. Particular attention is directed to the manner in which knowledge of the natural history of disease influences the choice of operations.

Introduction Anthony J. Edis, Richard H. Egdahl, Tracy K. Mcintosh, Contents Lester F. Williams xi 1 Surgery of the Parathyroids General Introduction 1 SURGICAL ANATOMY Primary Hyperparathyroidism 7 PATHOLOGY 7 DIAGNOSIS 11 PREOPERATIVE LOCALIZATION STUDIES 22 TREATMENT 27 Secondary Hyperparathyroidism 35 SIGNS, SYMPTOMS, COMPLICATIONS 35 CLINICAL MANAGEMENT 36 Tertiary Hyperparathyroidism 37 Operative Technique 38 CERVICAL EXPLORATION WITH REMOVAL OF A PARATHYROID ADENOMA 46 SUBTOTAL PARATHYROIDECTOMY FOR HYPERPLASIA 59 PARATHYROIDECTOMY FOR CARCINOMA 60 MEDIASTINAL EXPLORATION FOR PARATHYROID TUMOR 61 References 66 2 Surgery of the Thyroid 71 General Introduction 71 SURGICAL ANATOMY 72 Nodular Goiter and Thyroid Carcinoma 79 PATHOLOGY 79 DIAGNOSIS 82 TREATMENT OF THYROID NODULES 94 TREATMENT OF THYROID CANCER RELATED TO PATHOLOGIC TYPE 97 Hyperthyroidism 110 Graves' Disease 111 PATHOLOGY 111 DIAGNOSIS 112 TREATMENT 115 Plummer's Disease 120 PATHOLOGY 120 DIAGNOSIS 120 TREATMENT 122 Complications of Thyroid Surgery 123 PREVENTION AND MANAGEMENT 123 viii CONTENTS 127 Operative Techniques TOTAL THYROID LOBECTOMY 127 REMOVAL OF A SUBSTERNAL GOITER 134 SUBTOTAL THYROID LOBECTOMY 136 MODIFIED NECK DISSECTION FOR PAPILLARY THYROID CARCINOMA 141 References 144 3 Surgery of the Adrenals 151 151 General Introduction SURGICAL ANATOMY 152 Pheochromocytoma 155 PATHOLOGY 155 156 DIAGNOSIS PREOPERATIVE 162 TREATMENT 166 172 Primary Aldosteronism PATHOLOGY 172 DIAGNOSIS 174 178 PREOPERATIVE LOCALIZATION STUDIES TREATMENT 180 Cushing's Syndrome 181 CLASSIFICATION 182 DIAGNOSIS 187 PREOPERATIVE LOCALIZATION STUDIES 192 TREATMENT 194 Adrenal Gland and Metastatic Breast Carcinoma 198 Adrenocortical Carcinoma 200 DIAGNOSIS 201 PREOPERATIVE LOCALIZATION STUDIES AND STAGING 201 TREATMENT 202 PROGNOSIS 203 Nonfunctioning Adrenal Tumors 203

This manual is intended as a comprehensive guide to the diagno sis and management of the burn patient. The author:s feel that this volume can serve as a practical reference for the wide range of physi cian and allied health personnel involved in the care of these critically ill patients. The Manual of Burns was planned and written by the authors when they were on staff together at the United States Army Institute of Surgical Research, Brooke Army Medical Center, Fort Sam Houston, Texas. The authors support the concept that appropriate therapy of the burn patient requires a multidisciplinary approach. The talents of physi cians from many medical specialties, supported by nurses, therapists, and other allied health science personnel, must be coordinated if such a patient is to receive optimum care. Although the main thrust of this manual is directed at current techniques of diagnosis and treatment and therefore of primary inter est to the physician, the authors also hope that the photographic and illustrative material will make this book useful to any member perform ing service in a burn treatment unit.