General Surgery

The structures the operations walk past, and the ones they must not injure. Real plates and photographs only; the 3D lab carries the BodyParts3D specimens.

Abdomen

Open appendectomy approach (RLQ)

The layer-by-layer descent through the right lower quadrant at McBurney's point, the classic muscle-splitting approach.

• Iliohypogastric nerve: Runs between the oblique layers; injury causes groin numbness and weakens the inguinal canal mechanism.
• Cecum: Immediately deep to the peritoneum; the reason the peritoneum is tented before opening.
• Appendiceal artery: An end artery in the mesoappendix, secure ligation is the operation's key vascular step.

Open appendectomy

Abdomen, biliary

Hepatocystic triangle (Calot)

The space bounded by the cystic duct, common hepatic duct, and inferior liver edge, the anatomy that decides a safe cholecystectomy.

• Common bile duct: Clipping it instead of the cystic duct is a life-altering injury; the Critical View exists to prevent exactly this.
• Right hepatic artery: Often loops close to the cystic artery; injury can devascularise the right liver.
• Duodenum: Sits just below the porta, thermal injury from diathermy can present days later as a leak.

Laparoscopic cholecystectomy

Abdomen, biliary

The biliary tree & its variants

From gallbladder to ampulla: the duct system whose normal pattern is only two-thirds of patients, which is exactly why cholecystectomy has a Critical View.

• Common bile duct: The structure every biliary operation is designed not to injure; misidentification is the field's defining catastrophe.
• Right hepatic artery: Crosses the triangle aberrantly in about one in seven patients, hugging the cystic duct.
• Duct of Luschka: A small subvesical duct in the liver bed; missed, it declares itself as a postoperative bile leak.

Laparoscopic cholecystectomy

• Laparoscopic cholecystectomy

  Common bile duct

  Inflammation shortens and tents the cystic duct until the common duct can masquerade as it; the classic injury is clipping and dividing the wrong duct with complete confidence.

  Protect it: The Critical View of Safety: the triangle cleared until exactly two structures enter the gallbladder and the lower gallbladder is off its liver bed, before anything is clipped.

• Open inguinal hernia repair

  Ilioinguinal nerve

  It lies on the very cord the operation dissects and beside the mesh the operation places; entrapment by a suture or the mesh is as damaging as division.

  Protect it: Find it at the moment the canal opens, protect or deliberately handle it, and keep fixation sutures away from where it runs.