03 / Procedures

Operations, step by step

45 interactive timelines: what is happening, why, and what can go wrong. Conceptual teaching, not operative instructions.

45 operations

SAGES
General Surgery · laparoscopic
Laparoscopic cholecystectomy
Removal of the gallbladder through ports, built around one idea: never divide a structure until the Critical View of Safety proves what it is.
6 stages →
Pediatric Surgery Operative
General Surgery · open
Open appendectomy
The classic muscle-splitting RLQ operation, and the traditional first case a student scrubs into.
6 stages →
JoVE, Journal of Visualized Experiments
General Surgery · open
Small bowel resection & anastomosis
Segmental removal of non-viable or diseased small bowel with restoration of continuity.
4 stages →
Hernia Society of India
General Surgery · open
Open inguinal hernia repair (Lichtenstein)
Tension-free mesh repair of the commonest surgical lesion, built on knowing the canal better than the hernia does.
5 stages →
Conceptual Orthopedics (Dr Jignesh Gandhi)
General Surgery · open
Emergency laparotomy
The midline answer to peritonitis, obstruction and bleeding: find the problem, control it, and decide how much surgery this patient can afford today.
4 stages →
JOMI, Journal of Medical Insight
Trauma & Acute Care Surgery · open
Trauma laparotomy & splenectomy
The bleeding abdomen, answered in a fixed sequence: pack everything, find the bleeder, and for the shattered spleen, take it out and vaccinate the patient later.
4 stages →
UCSD Trauma and Burn
Trauma & Acute Care Surgery · open
Resuscitative thoracotomy
The last operation in the book: opening the chest of a patient in extremis to relieve tamponade, control the hilum, or clamp the aorta.
4 stages →
School of Surgery
Colorectal Surgery · laparoscopic
Right hemicolectomy
Resection of the right colon for cancer: take the vessels at their origin, take the nodes with them, and join ileum to transverse colon.
4 stages →
TVASurg, Toronto Video Atlas of Surgery
Colorectal Surgery · laparoscopic
Low anterior resection with TME
Rectal cancer surgery is a dissection of one embryological package: the mesorectum comes out intact or the operation has failed, whatever the margins say.
4 stages →
Karen Zaghiyan MD FACS FASCRS
Colorectal Surgery · open
EUA and drainage of perianal sepsis
The abscess around the anus: examine properly under anaesthesia, drain completely, and hunt the fistula gently or not at all.
4 stages →
Johns Hopkins Medicine
Hepatobiliary Surgery · open
Pancreaticoduodenectomy (Whipple)
The biggest scheduled operation in general surgery: resection of the pancreatic head and everything plumbed into it, then three anastomoses to put the plumbing back.
4 stages →
Digestive Disease Center, Medical University of South Carolina
Hepatobiliary Surgery · endoscopic
ERCP with sphincterotomy
Endoscopic drainage of the obstructed bile duct: cannulate the papilla, cut the sphincter, clear the stones, and in cholangitis, drainage beats everything else on the list.
4 stages →
CTSNet
Cardiac Surgery · open
Coronary artery bypass grafting
New plumbing around blocked coronaries: conduit from the chest wall and leg, grafted onto the arteries beyond their disease, classically on a heart stopped and lent to a machine.
4 stages →
Cleveland Clinic
Cardiac Surgery · open
Aortic valve replacement
Cutting out a stone-stiff valve and sewing in a new one, with the coronary openings watching from millimetres away.
4 stages →
Shanda Blackmon for the Society of Thoracic Surgeons
Thoracic Surgery · laparoscopic
VATS lobectomy
An anatomical lobe of lung removed through ports: artery, vein and bronchus each isolated and divided, nodes cleared, cancer out inside a bag.
4 stages →
Singapore General Hospital
Thoracic Surgery · laparoscopic
VATS bullectomy and pleurodesis
For the lung that keeps collapsing: staple off the blebs that leak and make the pleura stick so there is nowhere left to collapse into.
4 stages →
Neurosurgical Atlas, Aaron Cohen-Gadol MD
Vascular Surgery · open
Carotid endarterectomy
Coring the stroke-throwing plaque out of the carotid bifurcation, done soon after the warning event, with three cranial nerves watching the field.
4 stages →
Vascular Surgery · open
Femoral embolectomy
The six-hour operation: open the femoral artery, trawl the clot out with a balloon catheter, and give the leg its blood back before the muscle gives up.
4 stages →
Johns Hopkins Medicine
Neurosurgery · open
Burr-hole drainage of chronic subdural
Two small holes in the skull to let out the old blood that has been slowly squeezing an older brain; among neurosurgery's simplest operations and most grateful recoveries.
4 stages →
Congress of Neurological Surgeons
Neurosurgery · open
Craniotomy for extradural haematoma
The lucid-interval emergency: a window of bone over the clot, the middle meningeal bleeding point chased and killed, the dura hitched so it cannot happen again.
4 stages →
JBJS
Orthopedic Surgery · open
Debridement and fixation of an open tibial fracture
The bone is the second problem: the operation is the radical cleaning of a contaminated wound, and only then stabilisation with metal outside or inside.
4 stages →
Orthopedic Surgery · endoscopic
Arthroscopic washout of septic arthritis
Pus in a joint is an emergency for cartilage: the scope washes the knee with litres while the cultures are still growing.
4 stages →
Northwestern Medicine
Orthopedic Surgery · open
Total hip arthroplasty
The operation of the century by results: the worn joint is replaced by a cup, a stem and a bearing, and a life's mobility often comes back with it.
4 stages →
Children's Hospital Colorado
Plastic & Reconstructive Surgery · open
Split-thickness skin graft
Borrowing the top layers of skin from a healthy site to resurface a wound that cannot close itself; the graft survives on the bed it lands on, which is the whole art.
4 stages →
Hand, Plastic, Reconstructive and Nerve Surgery
Plastic & Reconstructive Surgery · open
Flexor tendon repair
Rejoining a cut flexor tendon inside its tight fibrous tunnel, then the paradox: a repair that must be strong enough to move on day one, because stillness is what ruins it.
4 stages →
IR Education
Urology · percutaneous
Percutaneous nephrostomy
A tube through the flank into a blocked, infected kidney: the urological equivalent of draining an abscess, and the operation that turns sepsis around overnight.
4 stages →
European Association of Urology
Urology · endoscopic
Transurethral resection of bladder tumour
The bladder tumour is shaved away from inside in strips, deep enough to stage it, gently enough not to perforate the organ being saved.
4 stages →
Medscape
Otolaryngology, Head & Neck · open
Surgical tracheostomy
A controlled front door into the trachea below an obstruction the mouth cannot bypass, or for the ventilated patient whose tube has outstayed the larynx's welcome.
4 stages →
Columbia University Department of Surgery
Otolaryngology, Head & Neck · open
Total thyroidectomy
Removing the thyroid while sparing the four glands and two nerves hiding against it: an operation defined by the structures it must not touch.
4 stages →
StayCurrentMD
Pediatric Surgery · laparoscopic
Ramstedt pyloromyotomy
Splitting the overgrown pyloric muscle down to (never through) the mucosa, for the hungry vomiting baby; the emergency beforehand is the chemistry, not the surgery.
4 stages →
SAGES
Pediatric Surgery · open
Ladd's procedure for malrotation
The bilious-vomiting emergency: untwist the volvulus the wrong-rotated gut allowed, divide the bands, and widen the mesenteric stalk so it cannot twist again.
4 stages →
Cybersight (Orbis)
Ophthalmic Surgery · open
Phacoemulsification with IOL
The most performed operation on earth: the clouded lens is emulsified through a two-millimetre tunnel and a folded acrylic lens unrolls into its place.
4 stages →
Mayo Clinic
Ophthalmic Surgery · open
Primary repair of an open globe
The ruptured eye is closed watertight as the first, not the final, operation: anatomy tonight, vision's verdict later.
4 stages →
EM:RAP Medical Education
Trauma & Acute Care Surgery · open
Intercostal chest drain insertion
A tube into the pleural space through the safe triangle, the treatment of pneumothorax, haemothorax and effusion, and the trauma bay's most performed operation.
4 stages →
School of Surgery
Colorectal Surgery · open
Hartmann's procedure
Resection of the diseased sigmoid with an end colostomy and a closed rectal stump: the operation for the perforated, obstructed or unstable left colon where an anastomosis would be a gamble.
4 stages →
Emory Healthcare
Hepatobiliary Surgery · open
Liver resection (segmentectomy)
Removal of anatomical liver segments along Couinaud's planes: cancer surgery built on the fact that the liver is eight independent territories, each with its own inflow, outflow and duct.
4 stages →
Cleveland Clinic
Cardiac Surgery · open
Mitral valve repair
Reconstruction of a leaking mitral valve on bypass, resecting or re-suspending the prolapsing segment and reinforcing the annulus with a ring, repair beats replacement when the valve allows it.
4 stages →
CTSNet
Thoracic Surgery · open
Esophagectomy (Ivor Lewis)
Removal of the esophagus for cancer through abdomen then right chest, with the stomach refashioned into a tube and brought up to replace it, one of surgery's biggest physiological insults, staged as two operations in one.
4 stages →
NEJM Group
Vascular Surgery · percutaneous
EVAR (endovascular aneurysm repair)
Relining an abdominal aortic aneurysm from inside: a fabric-covered stent graft delivered up the femoral arteries and deployed across the sac, excluding it from pressure without opening the abdomen.
4 stages →
Cleveland Clinic
Neurosurgery · percutaneous
External ventricular drain insertion
A catheter into the lateral ventricle through a frontal burr hole at Kocher's point: the emergency treatment of hydrocephalus and raised intracranial pressure, and the ICU's window on the pressure itself.
4 stages →
Australian and New Zealand Hip Fracture Registry
Orthopedic Surgery · open
Hip fracture fixation (dynamic hip screw)
Fixation of an intertrochanteric hip fracture with a sliding screw-and-plate that lets the fracture compress as the patient walks on it, the fracture-clinic operation most on-call students will see first.
4 stages →
Hand, Plastic, Reconstructive and Nerve Surgery
Plastic & Reconstructive Surgery · open
Local flap reconstruction
Closing a defect by moving neighbouring skin on its own blood supply, rotation, transposition or advancement, the middle rung of the reconstructive ladder between graft and free tissue.
4 stages →
Professor Mohamed H Khadra, urological surgeon
Urology · endoscopic
TURP (transurethral resection of the prostate)
Coring out the obstructing inner prostate through the urethra with a resecting loop, the classic operation for prostatic outflow obstruction and the origin of half of urology's teaching points.
4 stages →
The ENT Resident
Otolaryngology, Head & Neck · open
Tonsillectomy
Removal of the palatine tonsils from their fossae, high-volume, deceptively routine, and owner of one of surgery's most feared small complications: the post-tonsillectomy bleed.
4 stages →
Pediatric Surgery Operative
Pediatric Surgery · open
Paediatric inguinal herniotomy
Ligation of a patent processus vaginalis through a groin crease incision, the commonest paediatric operation, and the purest lesson that children's hernias are a different disease from adults'.
4 stages →