This text on a global approach to operative surgery is an excellent sequel to the first addition and has clearly embedded new updated elements of the principles of surgical etiquette, including ethical situations and issues such as consent. The book is 435 pages in length, spanning 16 chapters, which includes a well structured text starting with pre-operative episodes, this chapter highlights the level of detail that the author has explore to ensure that a full basic understanding of surgery is reached by the reader. This includes pre-operative assessment for any surgical procedure, looking at relevant history, clinical examination, and the role of pre-medication; also, excellent pictures and photographs on surgical gowning and gloving in the operation theatre; occupational hazards are also discussed, such as bloodborne viral infections. Although the second chapter on informed consent is based mainly on Indian law, there is a fair amount of crossover between other legislations when dealing with surgical patients and this is a good summary chapter on how to obtain informed consent and some of the misconceptions frequently highlighted when this is assessed by peers.
It is extremely important that a surgeon is acutely aware of allied health professionals in an operating room, such as the anaesthetist, and a good summary on anaesthesia is given in this text including the main steps of a general anaesthetic, such as induction, maintenance and reversal, and the commonly used pharmacological agents used by anaesthetists and how they can interact with physiology, which can ultimately affect the patient intraoperatively. The author has clearly taken a general surgical approach at the start of this text and has highlighted extremely well various abdominal incisions that are used to carry out general surgical procedures. He then proceeds on to what is now, an evolutionary and expanding subspecialty of general surgery, i.e., minimal access or laparoscopic surgery, and this is summarised extremely well, in terms of the setup, the basic equipment that are required and techniques used to carry out an efficient and safe minimal access general surgical procedure.
There is a summary of the likely future of this subspecialty in the form of robotic surgery This leads nicely on to chapter 6, describing the most common surgical procedures which are encountered by not only general surgeons, but also by plastic surgeons, endocrine surgeons and breast surgeons; the pathological and clinical findings that lead up to these surgical procedures, such as an appendectomy or colostomy, and the operative techniques, followed by explanations on how these patients should be cared for. This highlights the holistic and global teaching by the author, in that surgical patients need to be cared for pre-, peri- and post-operatively, and each surgical procedure described highlights potential complications and how they can be managed. I find this an extremely useful summary and guide for medical students and junior doctors and there is a reference for senior colleagues who carry out the surgical procedure, either as an observation or as a first-time procedure, or even when done regularly. The author then moves on to summarise potential general post-operative complications and ward procedures which may be required, either pre- or post-operatively, such as urinary catheterisation.
It is very rare to see a summary chapter on radiological investigations in a comprehensive text such as the one under review with common radiological findings which are extremely well photographed and documented. Moving on from this, the author highlights the importance of sterilisations and caring of instruments, naming common surgical instruments that are used in modern operating rooms around the world. This provides an excellent atlas for medical students and junior surgeons and then moves on to the anatomy of the surgical blade and surgical needles and also the different types and classifications of suture material.
Another rare description is that of specimens, which is extremely well photographed in this text, to show the reader what macroscopic pathology looks like once treated surgically, allowing the reader to translate their theory-based pathological knowledge to visible macroscopic pathology. This will help the medical student or the junior surgeon to identify intraoperative findings when assisting or learning to carry out certain procedures. The final few chapters of this text move on from pathology to pharmacology which, for a surgeon, is extremely important when dealing with and working alongside physicians and anaesthetists. The chapters clearly explain the various drugs that may be used in an ITU setting or prophylactic use of antibiotics. There is a good description on endoscopy and an excellent atlas of endoscopic imaging for common pathologies that may be encountered.
The last chapter is aimed to answer the curiosity of students and junior surgeons who engage in higher order thinking. The chapter will help not only answer those curiosities, but also provide a point of discussion for those senior colleagues wishing to teach fundamental elements of surgery. Overall, this book is extremely useful for all those involved in surgical care, from the medical student, to senior practitioners of surgery. This is clearly an updated edition from the first by Dr. Yagnik and he should be applauded in his efforts to concisely summarise what would have been a 5 to 6 volume expanded series in to a small, easy to carry to text.
Prof Sandip Hindocha
MD, MPhil, MBChB, BTEC (laser), MRCS, PGCert (leadership), MFFLM, FRCS (plast)
Lead Consultant Plastic, Reconstructive, Cosmetic,
Laser & Hand Surgeon,
Clinical Director of Surgery,
Bedford Hospital NHS Trust, UK
Email: sandiphindocha@gmail.com