Thyroidectomy: Anatomical Basis of Surgical Technique Ernesto P Molmenti, Hebe Thioly Molmenti, Luis A Molmenti
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FM1THYROIDECTOMY Anatomical Basis of Surgical TechniqueFM2
FM3THYROIDECTOMY Anatomical Basis of Surgical Technique
Ernesto P Molmenti MD PhD MBA Professor of Surgery, Medicine, and Pediatrics Vice Chairman, Department of Surgery Director, Adult and Pediatric Kidney Transplantation Hofstra Northwell School of Medicine Long Island, New York, USA Hebe Thioly Molmenti Ex-Professor of Fine Arts Luis A Molmenti MD PhD FACS Ex-Vice Dean, University del Salvador School of Medicine, Argentina Ex-Profesor of Surgery, University del Salvador School of Medicine, Argentina Ex-Director, Post-Graduate School, University del Salvador School of Medicine, Argentina Ex-Chairman of Surgery, Fiorito Hospital, Argentina Ex-Chief Consultant Surgeon, Central Air Force Hospital, Argentina Ex-Chairman of Surgery, Don Bosco Hospital, Argentina Ex-Director, Don Bosco Hospital, Argentina Ex-Associate Professor of Surgery, University of La Plata School of Medicine, Argentina Ex-Assistant Professor of Surgery, University of Buenos Aires School of Medicine, Argentina With the assistance of: Hebe Molmenti, MD PhD; Luis A Molmenti, Jr, MD PhD; Octavio Molmenti; Christine LS Molmenti, MPH, PhD; and Alexia Molmenti
FM4
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Thyroidectomy: Anatomical Basis of Surgical Technique
First edition: 2017
9789352700035
FM5We become victims of what we underestimate, ignore, and disregard
Molmenti
FM6
FM7FOREWORD
“The search of Truth is both difficult and simple, since it cannot be entirely possessed or completely disregarded. But as we all make small contributions to the knowledge of nature, an unquestionable greatness arises.”
Adapted from Aristoteles
“Nobody has yet formulated a prologue theory. Its omission should not be a matter of concern since we all are aware of its contents. And in the presence of favorable celestial alignments, it does not represent a lesser form of celebration but rather an equivalent form of admiration and critical intelligence.”
Adapted from ‘Prologues, with a Prologue of Prologues’ by Jorge Luis Borges
The privilege and gratitude of presenting the ‘Thyroidectomy: Anatomical Basis of Surgical Technique’ by Professors Luis Augusto and Hebe Thioly Molmenti are both moving and honoring.
The title of the work highlights its anatomical and surgical goals. Centuries have gone by since man realized the similarities and differences of the living beings. Since the times of Aristoteles, the observation and study of the form and function of the human body were considered a fundamental principle of medical education.
Scientific and technological progress, ranging from the development of tele-robotic medicine to the discovery of penta quark particles (building blocks of the protons and neutrons that form our bodies), confirms that anatomy continues to be the first and ultimate reason of such advances.
Guy de Chauliac related that nothing can be done in surgery in the absence of anatomy. In his book ‘Histories’, Herodotus (acknowledged by Cicero as ‘The Father of History’) described Egypt as a land of physicians. There the thyroid had already been described, and its pathologies treated on magicalreligious and empiric-rational bases.
Molmenti's book guides us through a detailed and concrete visualization and understanding of the gland. We encounter its embryological continuity and contiguity with other organs, locoregional associations, undiscovered anatomical spaces, neurovascular fasciae and sheaths, and noble elements of the cervicomediastinal region. The graphic illustrations represent ‘mirror images’ of surgical fields, gestures, and anatomical-surgical resolutions.
Thorough and concise, with brilliant simplicity, it is the result of the strategic planning of all steps of the intervention, from positioning of the patient to skin closure.
The technique of the various steps, incision, approach, identification and protection of organs and vasculoneural elements, highlight and differentiate the surgical gestures, marked by grace, precision, and modest respect for the tissues. Coincident with the described anatomy and surgical technique is the precise, substantive, expressive, and didactic language of the drawings, figures, and illustrations.
This work fulfills the expectations of young surgeons. It also solidifies the knowledge and happiness of those who experienced the complex anatomical-surgical treatment of the thyroid gland.
We celebrate the success of this work, and once more express our gratitude.
Your disciples
FM8
Luis and Hebe Molmenti
FM9PREFACE
This book is a fundamentally practical book destined to those at the initial stages of their experience. It does not claim originality, but rather aspires to highlight the relevance of surgical anatomy—the fundamental basis of any intervention.
We chose to base the text on the analysis of images and illustrations derived from our own experience, as registered by means of surgeries, anatomical dissections, and schematic representations.
We believe that the best knowledge is the one acquired in the operating room, followed by that obtained from anatomical dissections, drawings, and images.
In order not to deter this work from its practical approach, we have not listed any references or statistics.
Ernesto P Molmenti
Hebe Thioly Molmenti
Luis A Molmenti
FM11ACKNOWLEDGMENTS
We would like to acknowledge the contribution of:
Professor Dr Julio Bassan
Professor Emeritus of Surgery
Universidad del Salvador School of Medicine
Buenos Aires, Argentina
Chief Consultant Surgeon
Central Army Hospital
Buenos Aires, Argentina
Docent
University of Buenos Aires School of Medicine
Buenos Aires, Argentina
Certification and Accreditation
National Academy of Medicine,
Argentine Association of Surgery, and
Argentine Medical Association
Professor Dr José Luis de Echave
Associate Professor of Surgery
Universidad del Salvador School of Medicine
Buenos Aires, Argentina
Professor
Management and Organization of Emergencies
Arturo Jauretche University
Director of Emergencies of the Province of Buenos Aires, Argentina (1991-2006)
Chairman of Clinical Simulation
El Cruce High Complexity Hospital
Buenos Aires, Argentina
Professor Dr Rodolfo Daniel Figari
General and Thoracic Surgery
Ex-Director
San Roque Hospital
Gonnet, Argentina
Ex-Director
Hospitals of the Department of Health of the Province of Buenos Aires
Buenos, Aires, Argentina
Professor Dr Nestor Garrido
General and Thoracic Surgery
Ex-Chairman of Thoracic Surgery
FM12‘Dr Oscar E Allende’ General Interzonal Hospital
Mar del Plata, Argentina
Ex-Clinical Practice Chief
Ex-Instructor of General Surgery Residents
Mar del Plata branch
University of La Plata School of Medicine
Buenos Aires, Argentina
Thoracic Surgeon, Belgrano Clinic
Mar del Plata, Buenos Aires, Argentina
Dr Luciano Alessi
Dr Mario Aued
Dr Alfredo Bertolotti
Dr Horacio Cacheda
Dr Fernando Carignano
Dr Jorge Carrillat
Dr Ricardo Casabellas
Dr Gustavo García
Dr Rafael Inzeo
Dr Horacio Martinez Couto
Dr Enrique Luis Monti
Dr Raúl Rauch
Dr Julio Rigamonti
Dr Miguel Rodriguez
Dr Miguel Salvadores
Dr Salvador Scafidi
Dr Juan Carlos Taliansky
Dr Omar Verdullas
Dr Pablo Cesar Bassan
Ms Sabina Figari
We would like to thank Mr Robert Hinton for his expert help with the images in this work.