Operative Dictations in General and Vascular Surgery

Operative Dictations in General and Vascular Surgery Jamal J. Hoballah Carol E.H. Scott-Conner Editors Operative Dictations in General and Vascular Surgery Second edition Editors Jamal J. Hoballah, MD, MBA, Carol E.H. Scott-Conner, MD, PhD, FACS MBA, FACS Professor and Chairman Professor of Surgery Department of Surgery Department of Surgery American University of Beirut University of Iowa Carver College Medical Center of Medicine Beirut, Lebanon Iowa City, IA, USA [email protected] Professor of Surgery Department of Surgery Vascular Surgery Division University of Iowa Carver College of Medicine Iowa City, IA, USA [email protected] ISBN 978-1-4614-0450-7 e-ISBN 978-1-4614-0451-4 DOI 10.1007/978-1-4614-0451-4 Springer New York Dordrecht Heidelberg London Library of Congress Control Number: 2011935376 © Springer Science+Business Media, LLC 2011 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) To Harry (CSC) To Leila, Jawad, Nader and Wafa (JJH) Preface A SPECIAL WORD TO SURGICAL RESIDENTS AND FELLOWS Surgeons love to operate, but nobody likes paperwork. The operative dictation, or “op note” as it is commonly called, is one of the most important pieces of paperwork that a surgeon creates. Accurately recording what happened in the operating room – what the indications were, what was found, what was done, who was there, what sutures and devices were used, what individual differences in anatomy were encountered – is a crucial skill that all surgeons must learn. Yet, surgical residents rarely receive detailed instruction in how to dictate concise, informative operative notes. Quite simply, this is a book we wish we had had when we were residents. It is a book we want our residents to have and to use. Personalize your copy. Use the space labeled “notes” to take note of particular technical variations favored by the various attending surgeons with whom you scrub. Note their preferences in suture materials, patient positioning, and other small details. Make it your practice to review this material before scrubbing on a case. Surgery is made up of thousands of small details. Note what works well, and what is less useful. Sooner than you might believe, you will be facing your board exams and working independently. When you do, this book will help you recall everything you have learned, and help you to determine your own technical preferences. We hope you will enjoy using this unique resource. We wel- come your comments or suggestions. Jamal J. Hoballah Carol E.H. Scott-Conner vii Introduction The second edition of this book, once again, seeks to put a world of technical information in your pocket, or OR locker. A total of 60 new operations have been added, expanding the content by more than 35%. A large number of endovascular procedures have been added in the second edition, reflecting the changes in the manage- ment of vascular pathology. The volume has two primary objectives. First, it is designed to serve as a source of model operative dictations that may be individualized and used as templates. Second, it is intended as an aide-memoir, giving the surgeon a short list of pertinent information about each procedure. Ample space is provided to allow each surgeon to add notes. By reviewing this introductory material before scrubbing on a procedure, the trainee surgeon will enter the operating room better prepared to participate actively and to learn as much as possible. At the end of training, this book, with the notes accumulated by the resident, will serve as an invaluable review resource analogous to the individualized notebooks many surgeons keep. The first edition was noted to be very valuable by graduating surgical trainees in preparation for the certifying exam of the American Board of Surgery. This book is also intended for practicing surgeons, who may modify each template to reflect their own individual practice. It also serves as a concise reminder of essential steps in those operations that may be only rarely performed. Here you will find concise summaries of 226 operations. This comprises the majority of procedures commonly performed by general and vascular surgeons. For each procedure, a list of common indications is given. This list is by no means exhaustive, but ix x INTRODUCTION is intended to cover 95% of the situations in which a particular procedure will be used. A list of essential steps follows. These can be used to mentally rehearse the procedure before it is performed. The next heading, Note these technical variations, introduces a list that is intended to prompt the surgeon for particular things to note and dictate within the template. These particular things must be individualized – they range from fundamental variations such as a stapled vs. sutured anastomosis, through such details as type of suture or whether an autotransfusion device was used. A list of possible complications that are typically associated with that particular surgical procedure follows. Complications (such as myocardial infarction, bleeding, infection) which can follow any operative intervention are not listed unless they are characteristically more common alter that operation. Finally, a template operative dictation is provided. We believe that paper is cheap and time is precious, and have assumed that the reader of this part of the chapter wants completeness and con- venience. We have minimized the need to refer to other chapters by including all the parts of the operative note regardless of dupli- cation across chapters. To this end, we have included common opening and terminating sequences (for example, how to enter and close the abdomen) in all laparotomy dictations. (Although fundamental to any operative notes, comments regarding blood loss, fluid replacement, and instrument counts were not included in these templates to avoid redundancy.) More complicated procedures are more prone to variation, and we have tried to strike a balance between conciseness and completeness. Thus, under operative findings, we have enumerated those most pertinent to the procedure in question and prompted for additional findings. These surgery operative dictations are intended to be used in conjunction with the following texts by the editors: Scott-Conner CEH (ed). Chassin’s Operative Strategy in General Surgery, 3rd edition, Springer-Verlag, New York, 2001. This detailed review of strategy in general surgery includes almost all of these procedures. The sections of the present book correspond directly to the sections of this text. Scott-Conner CEH (ed). Chassin’s Operative Strategy in Colon and Rectal Surgery. Springer-Verlag, New York, 2006. This provides additional information on laparoscopic colorectal procedures. Scott-Conner CEH (ed). The SAGES Manual: Fundamentals of Laparoscopy and GI Endoscopy. Springer-Verlag, New York, 2nd edition, 2006. Endoscopic and laparoscopic procedures are discussed in detail. INTRODUCTION xi Scott-Conner CEH, Cuschieri A, Carter AF. Minimal Access Surgical Anatomy. Lippincott Williams & Wilkins, Philadelphia, 2000. This text covers the anatomy of laparoscopic surgery in color plates and line drawings. Scott-Conner CEH, Dawson DL. Operative Anatomy, 3rd edition. Lippincott Williams & Wilkins, Philadelphia, 2009. The anatomy and technique of common procedures, including thoracic, vascular, and transplant, is covered. Lumley JSP, Hoballah JJ. Vascular Surgery. Springer Surgery Atlas Series. Springer, Heidelberg (forthcoming 2010). Hoballah, JJ. Vascular Reconstructions: Anatomy, Exposures, and Techniques. Springer-Verlag, New York, 2000. Step-by-step review of all common vascular reconstructions, along with basics of exposure and access, and technical tips. The vast majority of these chapters were written by surgical residents at the University of Iowa College of Medicine or the American University of Beirut. These residents are introduced to you on the pages which follow. The virtues of this book must accrue to them; any faults rest squarely with the section editor. The hard work and assistance of Ms. Katherine Carolan, the encour- agement of Laura Gillan who saw the first edition to fruition, and Richard Hruska and Elizabeth Orthmann who shepherded this second edition along, and the input of residents and colleagues is gratefully acknowledged. Contents Section I Esophagus 1 Esophagectomy: Right Thoracotomy and Laparotomy with Thoracic Anastomosis ..............................................

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