Netter’s Surgical Anatomy and Approaches Conor P. Delaney, MD, MCh, PhD, FRCSI, FACS, FASCRS Chief, Division of Colorectal Surgery Vice-Chair, Department of Surgery Surgical Director, Digestive Health Institute University Hospitals Case Medical Center Jeffrey L. Ponsky MD Professor of Surgical Education Case Western Reserve University School of Medicine Cleveland, Ohio Illustrations by Frank H. Netter, MD Contributing Illustrators Carlos A. G. Machado, MD Kristen Wienandt Marzejon, MS, MFA James A. Perkins, MS, MFA John A. Craig, MD 1600 John F. Kennedy Blvd. Ste. 1800 Philadelphia, PA 19103-2899 NETTER’S SURGICAL ANATOMY AND APROACHES ISBN: 978-1-4377-0833-2 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Permission for Netter Art figures may be sought directly from Elsevier’s Health Science Licensing Department in Philadelphia, PA: phone 1-800-523-1649, ext. 3276, or (215) 239-3276; or email [email protected] Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. ISBN: 978-1-4377-0833-2 Senior Content Strategist: Elyse O’Grady Senior Content Development Manager: Marybeth Thiel Publishing Services Manager: Patricia Tannian Senior Project Manager: John Casey Senior Design Manager: Steven Stave Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 In memory of my father, Peter Vincent Delaney, whose love of surgery and its ability to help others led me to this field About the Artists Frank H. Netter, MD Frank H. Netter was born in 1906, in New York City. He studied art at the Art Students’ League and the National Academy of Design before entering medical school at New York University, where he received his MD degree in 1931. During his student years, Dr. Netter’s notebook sketches attracted the attention of the medical faculty and other physicians, allowing him to augment his income by illustrating articles and textbooks. He continued illustrating as a sideline after establishing a surgical practice in 1933, but he ultimately opted to give up his practice in favor of a full-time commitment to art. After service in the United States Army during World War II, Dr. Netter began his long collaboration with the CIBA Pharmaceutical Company (now Novartis Pharmaceuticals). This 45-year partnership resulted in the production of the extraor- dinary collection of medical art so familiar to medical professionals worldwide. In 2005, Elsevier, Inc. purchased the Netter Collection and all publications from Icon Learn- ing Systems. Over 50 publications featuring the art of Dr. Netter available through Elsevier, Inc. (in the US: www.us.elsevierhealth.com/Netter and outside the US: www.elsevierhealth.com) Dr. Netter’s works are among the finest examples of the use of illustration in the teaching of medical concepts. The 13-book Netter Collection of Medical Illustrations, which includes the greater part of the more than 20,000 paintings created by Dr. Netter, became and remains one of the most famous medical works ever published. The Netter Atlas of Human Anatomy, first published in 1989, presents the anatomical paintings from the Netter Collection. Now trans- lated into 16 languages, it is the anatomy atlas of choice among medical and health professions students the world over. The Netter illustrations are appreciated not only for their aesthetic qualities, but, more important, for their intellectual content. As Dr. Netter wrote in 1949, “… clarification of a subject is the aim and goal of illustration. No matter how beautifully painted, how delicately and subtly rendered a subject may be, it is of little value as a medical illustration if it does not serve to make clear some medical point.” Dr. Netter’s planning, conception, point of view, and approach are what inform his paintings and make them so intellectually valuable. Frank H. Netter, MD, physician and artist, died in 1991. Learn more about the physician-artist whose work has inspired the Netter Reference col- lection: http://www.netterimages.com/artist/netter.htm Carlos Machado, MD Carlos Machado was chosen by Novartis to be Dr. Netter’s successor. He continues to be the main artist contributing to the Netter collection of medical illustrations. Self-taught in medical illustration, cardiologist Carlos Machado has meticulous updated some of Dr. Netter’s original plates and has created many original paintings of his own in the style of Netter as an extension of the Netter collection. Dr. Machado’s photorealistic expertise and keen insight into the physician-patient relationship informs his vivid and unforgettable visual style. His dedication to researching each topic and subject he paints places him among the premier medical illustrators at work today. Learn more about his background and see more of his art at: http://www.netterimages.com/ artist/machado.htm vi Preface The Atlas of Human Anatomy by Frank H. Netter, MD, has been the pinnacle of demonstrating the anatomy of the human body for generations of students. To those who would wish to perform or understand surgical procedures, however, there has been no direct link between the beautiful images created by Dr. Netter and the surgical procedures being performed. In Netter’s Surgical Anatomy and Approaches, we try to address a request by many Netter users to tie these anatomical diagrams to the procedures they perform. This book presents the curriculum of basic and common general surgical procedures in chapters that portray the relevant anatomy for each procedure. In his very first edition, Dr. Netter stated that “anatomy of course does not change, but our understanding of anatomy and its clinical significance does.” Consequently, in some cases we have been able to pair the anatomy demonstrated in his illustrations with a modern intraoperative photograph or radio- graphic image. For some chapters, a new Netter-style illustration has been created to demon- strate a key anatomical point for an operative procedure or to show a key sur gical perspective or orientation that is not captured in the original Netter images. The result is a volume that covers the most important and commonest areas in surgery, addressing common procedures in the head and neck, endocrine surgery, upper and lower gastrointestinal surgery, hepatobili- ary surgery, surgery for hernias, vascular surgery, access and emergency procedures, breast and oncology surgery, and urology and gynecology. A book like this would not be possible without the help of many people. Being fortunate to work at institutions such as University Hospitals Case Medical Center and Case Western Reserve University, I elected to enlist the support of my faculty colleagues in many different surgical specialties. It is only with the guidance and assistance of the editorial team of Jerry Goldstone, Jeffrey Hardacre, Julian Kim, Pierre Lavertu, Mark Malangoni, Jeffrey Marks, Christopher McHenry, Lee Ponsky, Michael Rosen, Christopher Siegel, and Sharon Stein, and the direction and guidance of the ever-patient Marybeth Thiel at Elsevier that this project has been completed. On behalf of my co-editors and I, we hope you enjoy Netter’s Surgical Anatomy and Approaches. Conor P. Delaney, MD, MCh, PhD vii Video Contents 1. Neck Dissection (Chapter 1) 2. Tracheotomy (Chapter 2) 3. Thyroidectomy and Parathyroidectomy (Chapter 3) 4. Gastric Bypass (Chapter 11) 5. Laparoscopic Cholecystectomy (Chapter 12) 6. Appendectomy (Chapter 19) 7. Right Colectomy (Chapter 21) 8. Left Colectomy (Chapter 22) 9. Low Anterior Resection with Total Mesorectal Excision and Anastomosis (Chapter 24) 10. Carotid Endarterectomy (Chapter 32) 11. Abdominal Aortic Aneurysm (Chapter 33) 12. Oblique Femoral Artery Exposure for EVAR (Chapter 36) 13. Posterior Popliteal Artery Exposure (Chapter 38) 14. Retroperitoneal Sarcoma (Chapter 50) 15. Radical Prostatectomy (Chapter 54) ix Contributors EDITOR Mark A. Malangoni, MD, FACS Associate Executive Director Conor P. Delaney, MD, MCh, PhD, FRCSI, FACS, American Board of Surgery FASCRS Adjunct Professor of Surgery Chief, Division of Colorectal Surgery University of Pennsylvania Vice-Chair, Department of Surgery Philadelphia, Pennsylvania University Hospitals Case Medical Center Professor of Surgery Jeffrey M. Marks, MD, FACS Case Western Reserve University School of Medicine Director of Surgical Endoscopy Cleveland, Ohio University Hospitals Case Medical Center Associate Professor, Department of Surgery SECTION EDITORS Case Western Reserve University School of Medicine Cleveland, Ohio Jerry Goldstone, MD, FACS, FRCSEd Division Chief Emeritus Division of Vascular Surgery and Endovascular Therapy Christopher R. McHenry, MD University Hospitals Case Medical Center Vice Chairman, Department of Surgery Professor of Surgery MetroHealth Medical Center Case Western Reserve University School of Medicine Cleveland, Ohio Cleveland, Ohio Lee E. Ponsky, MD, FACS Jeffrey M. Hardacre, MD, FACS Leo and Charlotte Goldberg Chair in Advanced Surgical Section Head, Pancreatic Surgery Therapies University Hospitals Case Medical Center Director, Urologic Oncology and Minimally Invasive Associate Professor of Surgery Therapies Center Case Western Reserve University School of Medicine Urology Institute Cleveland, Ohio University Hospitals Case Medical Center Associate Professor, Urology Case Western Reserve University School of Medicine Julian A. Kim, MD Cleveland, Ohio Chief, Division of Surgical Oncology University Hospitals Case Medical Center Program Director, Case Surgery Michael J. Rosen, MD, FACS Charles Hubay Professor of Surgery Professor of Surgery Case Western Reserve University School of Medicine Chief, Division of GI and General Surgery Cleveland, Ohio Director, Case Comprehensive Hernia Center University Hospitals Case Medical Center Associate Professor of Surgery Pierre Lavertu, MD Case Western Reserve University School of Medicine Director of Head and Neck Surgery Cleveland Ohio Department of Otolaryngology—Head and Neck Surgery University Hospitals Case Medical Center Professor Case Western Reserve University School of Medicine Cleveland, Ohio xi xii Contributors Christopher T. Siegel, MD, PhD Bradley J. Champagne, MD Associate Professor of Surgery Associate Professor Division of Transplant and Hepatobiliary Surgery Case Western Reserve University School of Medicine University Hospitals Case Medical Center Cleveland, Ohio Cleveland, Ohio Edward Cherullo, MD Sharon L. Stein, MD, FACS Vice Chairman, Clinical Operations Associate Program Director, General Surgery Program Director, Urology Institute Surgical Director, Inflammatory Bowel Disease Center, University Hospitals Case Medical Center Digestive Health Institute Associate Professor of Urology University Hospitals Case Medical Center Case Western Reserve University School of Medicine Assistant Professor of Surgery Cleveland, Ohio Division of Colorectal Surgery Case Western Reserve University School of Medicine Jeffrey A. Claridge, MD, MS Cleveland, Ohio Associate Professor of Surgery Division of Trauma, Critical Care, and Burns CONTRIBUTORS MetroHealth Medical Center Cleveland, Ohio Mujjahid Abbas, MD Staff Surgeon John J. Como, MD, MPH Louis Stokes Cleveland Veterans Administration Medical Associate Professor of Surgery Center Division of Trauma, Critical Care, and Burns Cleveland, Ohio MetroHealth Medical Center Cleveland, Ohio Robert Abouassaly, MD, MSc Assistant Professor Robert L. DeBernardo, MD Urology Institute Assistant Professor University Hospitals Case Medical Center Division of Gynecologic Oncology Cleveland, Ohio Seidman Cancer Center Case Western Reserve University School of Medicine Matthew T. Allemang, MD Cleveland, Ohio Department of Surgery University Hospitals Case Medical Center Samuel J. DeJoy, DMD, MD Cleveland, Ohio Assistant Professor of Anesthesiology Case Western Reserve University School of Medicine Henry R. Baele, MD MetroHealth Medical Center Assistant Professor of Surgery Cleveland, Ohio Department of Surgery, Division of Vascular Surgery University Hospitals Case Medical Center Thomas J. Edwards, BSc, MBBS, MSc, FRCS Cleveland, Ohio Consultant, Colorectal Surgeon Taunton Hospitals NHS Trust Jeffrey A. Blatnik, MD Somerset, England General Surgery Resident Allen Research Scholar Heidi L. Elliott, MD University Hospitals Case Medical Center Department of Surgery Cleveland, Ohio University Hospitals Case Medical Center Cleveland, Ohio Joshua I. S. Bleier, MD Assistant Professor of Surgery Bruce L. Gewertz, MD Division of Colon and Rectal Surgery Surgeon-in-Chief, H. & S. Nichols Endowed Chair in Hospital of the University of Pennsylvania Surgery Philadelphia, Pennsylvania Chairman, Department of Surgery Vice President for Interventional Services Walter S. Cha, MD, FACS Cedars-Sinai Medical Center Cleveland Clinic General Surgery Los Angeles, California Digestive Disease Institute Cleveland, Ohio Contributors xiii Jason F. Hall, MD, MPH Jeremy M. Lipman, MD Surgeon, Department of Colon and Rectal Surgery Assistant Professor of Surgery Lahey Clinic Case Western Reserve University School of Medicine Burlington, Massachusetts; MetroHealth Medical Center Assistant Professor of Surgery Department of Surgery Tufts University School of Medicine Cleveland, Ohio Boston, Massachusetts Yi-Chun Carol Liu, MD Michael D. Holzman, MD, MPH Resident Physician Associate Professor, Department of Surgery Ear, Nose, and Throat Institute Vanderbilt University Medical Center University Hospitals Case Medical Center Nashville, Tennessee Cleveland, Ohio Harry A. Hoyen, MD Mark L. Manwaring, MD Associate Professor Colorectal Surgery Department of Orthopaedic Surgery Department of Surgery Case Western Reserve University East Carolina University Cleveland, Ohio Greenville, North Carolina Natalie E. Joseph, MD, FACS Eric L. Marderstein, MD, MPH Assistant Professor of Surgery Director of Colorectal Surgery Services Case Western Reserve University School of Medicine Louis Stokes Cleveland VA Medical Center Division of Surgical Oncology Assistant Professor of Surgery MetroHealth Medical Center Division of Colorectal Surgery Cleveland, Ohio University Hospitals Case Medical Center Cleveland, Ohio Arielle Kanters, MD Division of Pediatric Surgery Evan R. McBeath, MD University Hospitals Case Medical Center Resident Physician Cleveland, Ohio Ear, Nose, and Throat Institute University Hospitals Case Medical Center Vikram S. Kashyap, MD, FACS MetroHealth Medical Center Chief, Division of Vascular Surgery and Endovascular Louis Stokes Cleveland VA Medical Center Therapy Cleveland, Ohio Co-Director, Harrington Heart and Vascular Institute University Hospitals Case Medical Center Amy McDonald, MD, FACS Professor of Surgery Assistant Professor of Surgery Case Western Reserve University School of Medicine Case Western Reserve University School of Medicine Cleveland, Ohio Director, Trauma Intensive Care Unit MetroHealth Medical Center Jonathan E. Kiechle, MD Cleveland, Ohio Resident Physician Urology Institute Husein Moloo, MD, FRCS University Hospitals Case Medical Center Assistant Professor and Interim Chair Cleveland, Ohio Division of General Surgery University of Ottawa David M. Krpata, MD Interim Chief, Division of General Surgery Department of Surgery Director, Minimally Invasive Surgery Program University Hospitals Case Medical Center The Ottawa Hospital Cleveland, Ohio Ottawa, Ontario, Canada Matthew J. Kruse, MD Yuri W. Novitsky, MD Department of Surgery Co-Director, Case Comprehensive Hernia Center Cedars-Sinai Medical Center Director, Surgical Research Los Angeles, California Department of Surgery University Hospitals Case Medical Center Associate Professor of Surgery Case Western Reserve University School of Medicine Cleveland, Ohio xiv Contributors Raymond Onders, MD Juan Sanabria, MD, MSc, FRCSC, FACS Professor of Surgery Director, Pancreas Transplant Program Director of Minimally Invasive Surgery University Hospitals Case Medical Center Margaret and Walter Remen Chair of Surgical Assistant Professor of Surgery and Nutrition Innovation Case Western Reserve University School of Medicine University Hospitals Case Medical Center Cleveland, Ohio Cleveland, Ohio Edmund Q. Sanchez, MD Melissa S. Phillips, MD Surgical Director, Liver and Pancreas Transplant Assistant Professor Programs Department of Surgery Division of Transplant and Hepatobiliary Surgery University of Tennessee Graduate School of Medicine Department of Surgery Knoxville, Tennessee University Hospitals Case Medical Center Cleveland, Ohio Gilles Pinault, MD, FACS Department of Vascular Surgery Victor M. Sandoval, MD Case Western Reserve University School of Medicine Resident Physician Louis Stokes Cleveland VA Medical Center Department of Surgery Cleveland, Ohio University Hospitals Case Medical Center Cleveland, Ohio Todd Ponsky, MD Associate Professor of Surgery and Pediatrics James Schulak, MD Division of Pediatric Surgery Director, Transplant Institute Akron Children’s Hospital Chief, Division of Transplant and Hepatobiliary Surgery Akron, Ohio Department of Surgery University Hospitals Case Medical Center Benjamin K. Poulose, MD, MPH Cleveland, Ohio Assistant Professor, Department of Surgery Vanderbilt University Medical Center Charles E. Smith, MD, FRCPC Nashville, Tennessee Professor, Case Western Reserve University School of Medicine Kimberly Resnick, MD Director, Cardiothoracic and Trauma Anesthesia Assistant Professor, Division of Gynecologic Oncology MetroHealth Medical Center Department of Obstetrics and Gynecology Cleveland, Ohio University Hospitals Case Medical Center Cleveland, Ohio Christopher J. Smith, MD Assistant Professor of Surgery Harry L. Reynolds, Jr., MD, FACS, FASCRS Division of Vascular Surgery Director, Section of Colon and Rectal Cancer Surgery Case Western Reserve University School of Medicine Division of Colon and Rectal Surgery MetroHealth Medical Center University Hospitals Case Medical Center Cleveland, Ohio Associate Professor of Surgery Case Western Reserve University School of Medicine Lee L Swanstrom, MD, FACS Cleveland, Ohio Division Chief, GI and Minimally Invasive Surgery The Oregon Clinic Rod Rezaee, MD, FACS Clinical Professor of Surgery Assistant Professor Oregon Health and Sciences University Director, Microvascular Head and Neck Reconstructive Portland, Oregon Surgery Department of Otolaryngology—Head and Neck Surgery William Tabayoyong, MD, PhD University Hospitals Case Medical Center Urology Institute Cleveland, Ohio University Hospitals Case Medical Center Cleveland, Ohio Alan A. Saber, MD, MS, FACS, FASMBS Chief of Minimally Invasive Surgery Anthony Visioni, MD Medical Director of Bariatric and Metabolic Surgery General Surgery Resident The Brooklyn Hospital Center University Hospitals Case Medical Center The Weill Medical College of Cornell University Cleveland, Ohio The New York Presbyterian Healthcare System New York, New York