Mastery of SurgeryMastery of Surgery

The beauty of Mastery of Surgery since its first edition in 1984 has been its unique format. The text was designed to help both the practicing surgeon and surgical resident improve their surgical outcomes by stressing “refinements in techniques.” The text has been formulated, developed, and refined by a group of internationally recognized masters in surgery.

The scope of the text has always been consistent with the broad training of a general surgeon, providing extensive coverage of vascular surgery as well as of common thoracic, head and neck, urological, and gynecological procedures. Anatomy chapters were scattered through the text, and every chapter ended with an insightful “Editor's Comment.” Drs Nyhus and Baker intended these comments to “emphasize important points” and “to add a contrapuntal review” but not to criticize or refute an individual author's approach.

This format has only been strengthened by the fifth-edition editor, Dr Josef E. Fischer, and his associate Dr Kirby I. Bland. Their decision to bring on section editors for hepatobiliary, laparoscopy, and vascular/endovascular sections adds expertise to the book's coverage of these evolving fields. Outstanding authors have been chosen without regard for national borders. More than 60 of the text's 450 contributing authors reside outside the United States. Evidence-based surgery is emphasized by the authors and editors. The vascular section has been completely revised. The entire section on surgery of the colon and half of the remaining sections have new authorship. A “Morbid Obesity Surgery” section has also been added.

One of the more striking improvements has been the new color format. The colored section tabs and the chapter title at the top of each page make it simple to navigate this 2-volume set. The chapters themselves are vastly easier to scan, with major headings in green and minor headings in blue and black. All tables and the editor's comments are also set in a colored background and easily distinguished from the narrative text. These changes make this edition a more pleasurable read than the previous black-and-white editions.

Like most current texts, the entire volume can be accessed online using the code that comes with the book. There is an online feature that allows the reader to enlarge the illustrations. This is ideal for projection purposes during conferences or resident lectures. The 17 Web-only chapters are a new addition necessitated by the length of the book (2286 pages). A short description of each Web-only chapter is included after the preface in the textbook. Clicking “Web Only Chapters” calls up only the description rather than the text of the chapter. The Web-only chapters must be accessed through volume 1 or volume 2. Many of the Web-only chapters deal with older, less commonly used procedures. These procedures include tissue repairs for inguinal hernias, vagotomy and antrectomy, vagotomy and pyloroplasty, and abdominoperineal resection. The “Thoracic Incisions” chapter and its editor's comment, however, reflect current surgical thought and practice (a must-read for surgical residents).

In the textbook itself, the esophageal section reveals how nicely laparoscopic and open techniques have been woven together. Multiple laparoscopic approaches to antireflux surgery are discussed by Dr Soper, among others, while open thoracic and abdominal approaches are given equal time by Dr Demeester, one of the contributing authors. Formal open, laparoscopic, and transhiatal esophagectomy techniques are each given their own chapter.

There are 8 chapters devoted to trauma. The “Common Facial Injuries” chapter is as practical as its title, offering several valuable pearls for the non–plastic surgeon called on to deal with these injuries. The text has always kept in mind the general surgeon practicing outside a major medical center and includes chapters on cesarean delivery, hysterectomy, and the surgical management of ovarian cancer. The thought-provoking chapter by Drs Starzl and Lakkis, “The Unfinished Legacy of Liver Transplantation,” only adds to the unique nature of Mastery of Surgery.

With regard to surgical oncology, Drs Bland and Fischer again provide us with outstanding authors and editorial comments. The “Total Gastrectomy” and “Subtotal Gastrectomy” chapters provide an excellent discussion and description of the D1, D2, and D3 nodal dissections for gastric cancer. The chapter “Pulmonary Resection” is among the most cogent in the book, presenting a discussion of staging, nodal anatomy, preoperative evaluation, pneumonectomy, and both open and video-assisted thorascopic lobectomies in 20 pages (another great quick reference for surgical residents).

The vascular section has been completely revised from the fourth edition. These 42 chapters in more than 300 pages offer comprehensive coverage of emerging vascular and endovascular techniques that cannot be found elsewhere. The vascular editors' laconic and insightful chapter ending adds a practical perspective to this rapidly changing field.

Part of the originality of Mastery of Surgery has been the “Editors Comment” at the end of each chapter. These comments have evolved from short, pithy statements to the fifth edition's more evidence-based discourses. All of the editors should be commended on their clarity of thought and command of the literature. The editors neatly tuck in references at the end of sentences, eg, J VASC SURG 2004;39:788. This abbreviated referencing is unobtrusive and useful to the reader. The editorials themselves have a personality of their own. In the case of Dr Fischer, his persona is certainly more Mike Wallace than Morley Safer. Acerbic and opinionated, he packs each editorial with pragmatic information and numerous references. He is particularly adept at exposing unanswered questions for us to consider. Leaving no stone unturned, each of Dr Fischer's editorials is a must-read on its own merit.