Ep-PAINE-nym



Kocher Incision

 

Other Known Aliasesright subcostal incision

 

Definitionoblique incision in the right subcostal area starting 2-5cm below the xiphoid process, running parallel to the ribs, and extending to 2.5cm below the inferior costal margins

 

Image result for kocher incision

 

Clinical Significanceclassic incision used for open cholecystectomy

 

Kocher Maneuver

 

Other Known Aliasesretroperitoneal exposure

 

Definition – maneuver to expose the retroperitoneal structure (pancreas, duodenum, vena cava)

 

Clinical Significancethis maneuver is used for resection of pancreatic head tumors or in trauma with retroperitoneal hemorrhage.  The peritoneum is incised at the right edge of the duodenum and continued in a “C” shaped from superior to inferior.  The duodenum and head of the pancreas is then reflected medially to the left to expose the retroperitoneal structures.

Image result for kocher maneuver exposure

History – Named after Emil Theodor Kocher (1841-1917), a Swiss surgeon who obtained his medical doctorate from the University of Bern in 1865.  He was arguably the most accomplished surgeon of his time and true pioneer in the field of surgery by promoting and advocating the use of aseptic technique, meticulous dissection with attention to minimal blood loss, and implementation of the scientific method in surgery. His “Text-Book of Operative Surgery” was the definitive guide to surgery in the early 1900s.  He received the Nobel Prize in Physiology and Medicine in 1909…the first Swiss citizen and first surgeon to do so.  The practice of modern surgery would certainly not be where it is today without the work of Dr. Kocher and his other notable eponyms are:

 

  • Kocher forceps – hemostatic tooth and groove forceps
  • Kocher’s point – entry point for intrventricular catheter to drain CSF from the cerebral ventricles
  • Kocher-Debre-Semelaigne Syndrome – hypothyroidism in infancy
  • Kocher collar incision – used in thyroid surgery
  • Kocher’s sign – eyelid phenomenon in hyperthyroidism

 

Emil Theodor Kocher.jpg

 


References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
  5. Up To Date. www.uptodate.com
  6. Kocher T.  Text-Book of Operative Surgery. 1911. https://archive.org/details/textbookofoperat01kochuoft
  7. Gautschi OP, Hildebrandt G. Emil Theodor Kocher (25/8/1841-27/7/1917)–A Swiss (neuro-)surgeon and Nobel Prize winner. British journal of neurosurgery. 2009; 23(3):234-6. [pubmed]
  8. Biography of Theodor Kocher by Nobel Prize Society. https://www.nobelprize.org/nobel_prizes/medicine/laureates/1909/kocher-bio.html

Ep-PAINE-nym



Weitlaner (VIGHT-lahn-er) Retractor

 

Other Known Aliases – Wheatlander, Wheaty

 

DefinitionSelf-retaining retractor

Image result for weitlaner retractor

Clinical SignificanceOne of the more common self-retaining retractors used in surgery.  They have a ratchet locking system and may also be available with jointed hinges.  Primarily used for small to medium incision exposures.

History – Named after Franz Weitlaner (1872-1944), an Austrian physician who received his medical doctorate from Innsbruck Medical University in Austria at the age of 26 in 1898.  He enjoyed a prolific career as as ship surgeon and house physician practicing in St. Poelten and Ottenthal in his homeland.  In 1905, he published an article in the Vienna Clinical Review entitled “Ein Automatischer Wundspreizer” (An Automatic Wound-spreader), which would be the first description of his famous retractor.  They were originally manufactured by Windler Instrument Makers in Berlin in 1912, but Weitlaner never patented his design or received any monetary gains from his invention, only the right to have the instrument named after him.

 

 

 


References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
  5. Up To Date. www.uptodate.com
  6. Sharma A, Swan KG. Franz Weitlaner: the great spreader of surgery. The Journal of Trauma. 2009; 67(6):1431-4. [pubmed]
  7. Weitlaner F. Ein automatischer Wundspreizer. Wien klin Rundschau. 1905;xix:114.

Ep-PAINE-nym



Varess Needle

 

Other Known AliasesNone

Definition12-15cm long, 2 cannula instrument used for insuflating the abdominal cavity before laparoscopic port placement.  The outer cannula has a beveled needle for dissecting through the abdominal wall.  The spring-loaded inner stylet resides within the outer cannula and has a dull tip to prevent injury to abdominal viscera.  Due to this spring-loaded mechanism, the inner stylet retracts into the outer cannula while it moves through the abdominal planes and advances past the sharp, cutting tip of the outer cannula once through the peritoneum.

Image result for veress needleImage result for veress needle

Clinical Significance Using the Varess needle is the oldest and most traditional techniques for obtaining laparoscopic access

History – Named after János Vares (1903-1979), a Hungarian internist, who used iatrogenic pneumothoraces to treat tuberculosis patients.  He created this spring loaded needle in 1932 and published his results in 1936 (in a Hungarian journal), which was subsequently translated and published in German for wider audience in 1938.  Raoul Palmer (1904-1985), a French gynecologist, began using the Varess needle for laparoscopic surgery in 1947.


References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com/
  5. Vares J. Neues instrument zur ausfuhrung von brust-oder bauchpunktionen und pneumothoraxbehandlung. Deut Med Wochenschr. 1938;64:1480-1481.
  6. Palmer R. Instrumentation et technique de la coelioscopie gynécologique. Gynecologie et obstetrique. 1947; 46(4):420-31. [pubmed]

PAINE #PANCE Pearl – Surgery



Question

 

  1. What are the five classic causes of a post-operative fever?
  2. What are two other clever causes to think of (if I do say so myself)?

 



Answer

 

  1. The five classic causes of post-operative fever are:
    1. Wind = lungs (atelectasis, pneumonia, aspiration) = POD 1-2
    2. Water = UTI = POD 2-3
    3. Wound = surgical site infection = POD 3-5
    4. Walking = DVT = POD 3-5
    5. Wonder drugs = drug reactions = anytime
  2. Another two “W’s” to add to this list:
    1. Withdrawal = typically alcohol
    2. “Wonky” glands = thyrotoxicosis, adrenal crisis

 

Check out my article in JAAPA from 2016 on “Evaluating Postoperative Fever” for a more in-depth look

Ep-PAINE-nym



Glisson’s Capsule

 

Other Known AliasesNone

DefinitionOuter capsule of connective fibrous tissue, surrounding the liver, the intrahepatic branches of the portal vein, hepatic arteries, and bile duct

Clinical Significance The is a structure that must be dissected while operating on the liver.  In trauma, you can have subcapsular hematomas from hemorrhage that are contained by Glisson’s capsule.

History – Named after Francis Glisson (1597-1667), who was an English physician, anatomist, and pathologist.  His work on the liver in the late 1600s produced the foremost textbook on the digestive system, The Anatomia Hepatis, where he first described the covering of the liver in detail.

 

 


References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com/
  5. Haubrich WS. Glisson of Glisson’s capsule of the liver. Gastroenterology. 2001; 120(6):1362. [pubmed]