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How to Operate: for MRCS candidates and other surgical trainees, includes 3 DVDs



How to Operate: for MRCS candidates and other surgical trainees, includes 3 DVDs

Matthew Stephenson

ISBN: 978-0-470-65744-7 September 2011 Wiley-Blackwell 288 Pages

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A unique blend of integrated video and book content, How to Operate provides a comprehensive, multimedia training resource for medical students, junior doctors, MRCS candidates and surgeons in training.

The three DVDs present over 40 of the most common general, urological, ENT and orthopaedic surgical procedures, complete with step-by-step commentary from experienced surgical consultants. At key points during each procedure, the frame freezes so that anatomical structures and pathology are ‘drawn’ onto the frame for clarity and to reinforce learning.

The 10 hours of video is supported by an accompanying book containing an introduction to each procedure, a thorough explanation of the operation mirroring the video with relevant video stills, and bullet point summaries which can be used as OSCE-style checklists.

With a foreword by John Black, President of the Royal College of Surgeons, How to Operate is a truly comprehensive learning resource for all budding surgeons. All you need to become a surgeon is here – scalpel not included!

List of Contributors

Foreword by John Black, President of the Royal College of Surgeons



1 Inguinal Hernia Repair

2 Split Skin Graft

3 Femoral Hernia Repair

4 Incision and Drainage of Abscess

5 Wedge Resection for Ingrown Toenail

6 Paraumbilical and Umbilical Hernia Repair

7 Appendicectomy

8 Establishing a Pneumoperitoneum

9 Laparotomy


10 Long Saphenous Vein Stripping

11 Short Saphenous Vein Ligation

12 Abdominal Aortic Aneurysm Repair

13 Below Knee Amputation

14 Carotid Endarterectomy

15 Temporal Artery Biopsy

16 Femorodistal Bypass

17 Brachiocephalic Fistula


18 Scrotal Exploration

19 Vasectomy

20 Circumcision

21 Nephrectomy


22 Dynamic Hip Screw

23 Hip Hemiarthroplasty

24 Carpal Tunnel Decompression

Upper Gastrointestinal

25 Gastrectomy

26 Splenectomy

27 Gastrojejunostomy

28 Open Cholecystectomy

29 Thoracotomy


30 Mastectomy,

31 Wide Local Excision

32 Axillary Node Clearance

33 Fibroadenoma

Ear, Nose and Throat

34 Thyroidectomy

35 Tracheostomy


36 Haemorrhoidectomy

37 Colostomy and Other Stomas

38 Small Bowel Resection and Anastomosis

39 Excision of Pilonidal Sinus

40 Right Hemicolectomy


41 Surgical Instruments

42 Sutures

43 Patient Safety and the WHO Surgical Checklist

44 Theatre Etiquette

45 How to Write the Operation Note

46 Consent


How to operate for MRCS candidates and other surgical trainees is an exciting addition to the market for the junior surgical trainee. Uniquely combining a DVD and handbook companion, it provides a step by step guide to more than 40 common operations likely to be encountered during core surgical training. The handbook is aided by intra-operative images highlighting the salient anatomy and surgical points. Whilst notionally aimed as a helpful addition to those studying for the Intercollegiate Membership of the Royal College of Surgeons examination this compilation has much more scope than that. With the time constraints on training with the European Working Time Directive (EWTD) the opportunities to have seen, in vivo, a wide range of procedures has become more limited. Therefore, the desire to be fully prepared when attending operating lists has heightened. How to operate provides a solution to this conundrum. Its step by step approach allows the trainee to be, at least, familiar with the techniques surrounding the operation prior to setting foot into theatre.

The DVD provides a comprehensively narrated guide to operative practice. With 10 hours of footage and practical advice to the common pitfalls that may be encountered in the operating theatre. Unlike DVDs aimed at Higher Surgical Trainees, How to operate does not profess to show operations without challenges. Rather, it tackles the realities of the situation that one is likely to encounter.

This compendium is firmly based at the Core Surgical Trainee. It covers a breath of surgical procedures likely to be covered during the 2 year rotation. These are namely; general, vascular, urology, orthopaedics, upper gastrointestinal, breast, and colorecatal, along with appendices covering basic surgical skills and theatre etiquette.

There are inevitably some admissions, for example the lack of neurosurgical or cardiothoracic procedures. Furthermore, certain specialties fare better than others with orthopaedics and ENT covered somewhat more scantily than the general and urology sections of the DVD and book.

It is surprising that a similar compilation is not already on the market. Those battling with their surgical exams have utilised Acland’s Anatomy for many years, and whilst their value cannot be negated they are a little dated. Furthermore, How to operate has the added benefit of demonstrating the surgical anatomy as it will be seen in the operating theatre. It will never replace comprehensive operative bibles in the mould of Farquharson’s Textbook of Operative General Surgery but nor does it purport to be. Rather it provides the junior surgical trainee with a firm grounding. On this note, How to operate will have limited benefit for the higher surgical trainee as they will be familiar with the procedures covered in their parent specialty. However, it opens the possibility of further additions to the series focussing on individual surgical specialties aimed at Registrar level trainees. (Captain Neil Shastri-Hurst RAMC MRCS, Queen Elizabeth Hospital, Birmingham)

“This is a unique and useful addition to the bookshelves (and DVD players) of those progressing through basic surgical training. Detailed step-by-step videos of common operations are each accompanied by a chapter in the book detailing the procedural steps, coupled with operative pictures, radiographs and anatomical diagrams to illustrate the important learning points.

The videos provide a clearly narrated guide to operative practice, pitched for the junior trainee starting out in the operating theatre. The narration tackles the realities of operations and their difficulties with useful tips and a common sense, occasionally humorous approach not found in more senior and specialist titles that often seem to present a more polished version of reality than one encounters in your own operating theatre.

The procedures videoed cover the breadth of a typical core surgical training rotation, including general, vascular, urological, orthopaedic, upper gastrointestinal, ENT, breast, and colorectal procedures. For example, within upper gastrointestinal surgery the videos feature gastrectomy, splenectomy, gastrojejunostomy, open cholecystectomy, and thoracotomy.

It is perhaps surprising that no-one has already put such a training package together. Many have used Acland’s anatomy DVDs for MRCS revision, and although sub-specialist operative training DVDs do exist these are limited in scope and are prohibitively expensive.

It must surely have been a labour of love to assemble and edit these training videos all together, and the author and production team are to be congratulated on bringing this to life as well as they have. In the modern multimedia age this could well become as essential as Kirk’s seminal text on basic surgical techniques was to previous generations climbing the slippery surgical ladder.

Given the broad coverage of disparate specialties, from orthopaedics to urology, the package will perhaps have limited interest to more senior trainees and one wonders whether dedicated editions featuring each of the nine surgical specialties will be forthcoming in future. Certainly there would be demand for this. Similarly, the level of the accompanying book is no replacement for operative surgery bibles such as Farquharson's or Kirk’s, but neither does it set out to be.

Overall, many surgical trainees at the core/senior house office/resident level will find [this] greatly beneficial to their training." (Ed Fitzgerald MRCS, Specialist Registrar, General Surgery, The Royal Marsden Hospital, London)

Sample video  - view a sample operation from How To Operate.