Illustrated
Abdominal Surgery
Based on Embryology and
Anatomy of the Digestive
System
Hisashi Shinohara
123
Illustrated Abdominal Surgery
Hisashi Shinohara
Illustrated Abdominal
Surgery
Based on Embryology and Anatomy of the Digestive System
Hisashi Shinohara, M.D., Ph.D
Professor
Department of Surgery
Hyogo College of Medicine
Nishinomiya
Hyogo
Japan
ISBN 978-981-15-1795-2 ISBN 978-981-15-1796-9 (eBook) https://doi.org/10.1007/978-981-15-1796-9
© Springer Nature Singapore Pte Ltd. 2020
This English translation is based on the Japanese original Irastoreiteddo Gekashujyutsu Originally published in Japan in 2011 by Igaku-Shoin Ltd. This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed.
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Foreword
Although a large number of books are categorized as surgical atlases, which are essentially the surgeon’s lifeline, there are surprisingly few atlases available that truly meet the needs of the clinical surgeon. If surgical illustrations are simplified too much, they can become less realistic and not relatable to actual surgery; if the illustrations are too realistic, they can become more like plain intraoperative photographs that don’t clearly show what is important and what is not. In the past, illustrations were often considered supplementary to the explanatory text, but today where images are often more popular than text, it is expected that almost everything will be explained using illustrations. Achieving the right balance to do this is not as simple as it may first appear though.
We can understand this immediately if we really think about the process of writing a surgery book. There are few surgeons highly skilled at surgery who can also draw realistic pictures that are good enough to be used in textbooks, and illustrators are usually lay persons with no knowledge of surgery. This means thnat when the illustrator creates illustrations based on the author’s notes and instructions, the information the author intends to convey based on their extensive experience and skills can become lost along the way. Moreover, accomplished surgeons may no longer remember the various challenges they faced early in their surgical career. They have become so used to the steps that they may perform them reflexively, and this can often be problematic enough to confuse trainee or early career surgeons. For these reasons, even though senior surgeons are qualified to teach new techniques to highor intermediate- level surgeons, they may not be able to use illustrations clearly and comprehensively to explain key points to beginners who have just started learning the ropes.
So, if one of our colleagues, who may be struggling with questions and problems at a similar level, proposes an experiential solution in their own words, this will be great news and will represent an unprecedented attempt. The author of this book, Dr. Shinohara, is a surgeon perfectly suited for this role. He is a young, extremely talented surgeon who is also a professional- level illustrator.
Dr. Shinohara started working at our hospital as a resident in his second year after graduating from medical school. Initially, he was one of those highly motivated surgeons who had almost no experience in surgery, but he soon distinguished himself to the extent that he was able to complete almost all kinds of abdominal surgeries on his own, including liver lobectomy and
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pancreaticoduodenectomy, by the end of his 3 years working at our hospital. Of course, what made this possible was not only his gift and talent, but other factors too. For example, during his first gastric surgery, although he must have been nervous performing each step, he kept clear records of the questions he had during the operation and made detailed notes, which were in the form of illustrations not text. As his experience in surgery grew, he continued keeping such notes, and over time they became more detailed and sophisticated with added information and an appropriate mix of emphasis and omission. These illustrations are therefore notes about his practical experience, which he has also enriched with the knowledge and expertise that he has absorbed from senior colleagues along the way.
Considering the brilliance of the rough sketches and the fact that they helped his rapid progress in surgery, I suggested to him that he officially edit them as an educational tool for newcomers, or even publish them and ask for feedback from budding surgeons in the community. I was subsequently contacted by the medical publisher Igaku-Shoin, and the publication of these notes was made possible.
Open this atlas and you will see illustrations that are readily usable and give a sense of actually being at the surgery. You will also recognize that the book clearly shows, from the same standpoint, the efforts and trials of a young surgeon who was struggling to become an established surgeon. Although some local terms are used for certain surgical procedures and instruments, the underlying philosophies of the anatomy and physiology remain the same wherever we are, as are the basic principles of surgery. This book creatively conveys a message that is fresh and directly originates from actual scenes in surgery. I hope that this book will be carefully read by interested readers and practically applied to actual surgery.
February 1994\ |
Yoshihiko Makino |
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Hyogo Prefectural Amagasaki Hospital |
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Hyogo, Japan |
Preface
Anatomy is without question the basis of surgery, but the surgeon’s mindset often tends more toward an understanding of “clinical” or “topographic” anatomy. This is because surgeons can’t perform surgeries simply by memorizing the contents of Sobotta’s Atlas of Human Anatomy or Netter’s Atlas of Human Anatomy although both are undoubtedly excellent books. Just as maps of the world with south-up orientation can look completely different from those with north-up orientation, the human anatomy encountered during surgery is not static and is highly variable—it changes constantly depending on the approach to the operative field and as the surgery progress, and what we see in open surgery is very different from that in endoscopic surgery. Surgeons constantly modify our atlas based on our intraoperative experiences and interpretations, and our interpretations certainly affect the quality of the surgery performed. For this reason, I set out to create a high-quality, detailed atlas of surgical procedures by providing with hand-drawn illustrations of the interpreted and reconstructed anatomy I have seen.
This is the English translation of the third edition of my textbook written in Japanese, Illustrated Surgery: Points of Surgical Techniques from the Anatomical Perspective of Membranes (Igaku-Shoin Publishing, Tokyo). The original edition was published in 1994, in my 5th year of residency. It was a unique textbook in which I sought to record operations learned from my first mentor Dr. Yoshihiko Makino as faithfully as possible using illustrations of step-by-step surgical procedures. It was reprinted more than expected, and the second edition was published with minor revisions in 1998. After a 12-year interval, in 2010 I published the 3rd edition with major revisions to reflect my accumulating experiences as a surgeon and to include more detailed topographic anatomical knowledge gained during endoscopic surgery and newly acquired embryologic knowledge that explains the continuity of membranes and dissection layers. In order to do that, simply updating the existing illustrations in the former edition would have been insufficient, so I created anew a total of 687 illustrations for 532 surgical steps. It took three and a half years to finish them all even though I set myself the task of completing one illustration every day. It was quite a job to sit after work (and on weekends) in front of a blank piece of paper with a pencil ready, but it was worth the effort: I’m pleased that the 3rd edition has been well received by
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young surgeons as well as by readers of the previous editions. More than 38,000 copies of the Japanese versions have been sold at this time of writing, a figure that is roughly 1.9 times the number of members of the Japanese Society of Gastroenterological Surgery. The Chinese translation was published in 2013 and the Korean translation in 2014. I am thrilled that Springer Japan recognizes the value of this book and has published this English version to reach more surgeons worldwide.
This textbook does not have a conventional structure. For example, illustrations dominate with the text limited to concise accompanying figure legends. Plain language is used as much as possible to help communicate as clearly as possible the dynamic and realistic situations encountered by surgeons. The illustrations included are close to what surgeons actually see during surgery (e.g., with surgical devices and the operators’ hands also depicted) so that readers can move through the procedures as smoothly as if actually doing them. Also, there are no ambiguous lines in any of the illustrations, which I believe is the most important point. All lines have start and end points because lines drawn with intention will help readers understand the anatomy more clearly. I purposely used monochrome illustrations to enhance the information communicated by such lines.
Today, with the popularity of endoscopic surgery, we can learn the excellent surgical maneuvers of experienced surgeons easily using clear video images. Yet, no matter how beautiful surgical videos are, they still offer only a small sample of what we surgeons will actually see, and not all of the operating surgeons’ intentions will be communicated. Also, even though the operating surgeons will clearly recognize the dissectible loose connective tissue layers and the small vessels in them, viewers are likely to miss them in the recorded procedures. The most effective way to convey such information is, undoubtedly, through illustrations. Indeed, surgical fields in any dissection plane can be shown freely this way. So, this book presents illustrations of open surgery to better explain the clinical anatomy and also takes an innovative approach by showing many illustrations of cross-sectional views to support the main illustrations. In this way, it is the ideal textbook to help readers understand the focus points and topographic anatomy of the surrounding structures. My sincere hope is that the three-dimensional illustrations in this book inspire young surgeons who are keen to improve their surgical skills and help them simulate surgeries.
Finally, I would like to thank Dr. Andrianos Tsekrekos (Karolinska University, Sweden) for encouraging me to publish this English version; Ms. Caryn Jones and Ms. Yuki Hidaka for editing the English text patiently and tirelessly; Ms. Kazuko Morozumi for helping with the labeling of illustrations; and Ms. Yoko Arai and other staff of Springer Japan. This book is dedicated to two very important people: Dr. Yoshihiko Makino—my lifelong
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mentor—and Prof. Yoshiharu Sasaki (Kyoto University), who have always cared about me and my work and provided continuous encouragement and support.
January 2020 |
HisashiShinohara |