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Some 75 years ago, this ATLAS was created to document proven and safe operative techniques in common use by general surgeons. Many improvements and changes have occurred in the previous nine editions including use of stapled techniques for gastrointestinal anastomoses and minimally invasive surgery. These two techniques were joined in full flower in the ninth edition wherein what was once considered advanced laparoscopic techniques in the 1990s is now in common use and taught as essential elements in most surgical residency training programs.

In this new 10th edition several important improvements have been made. We have engaged Associate Editors as content experts who have helped identify new procedures that should be included and who have made significant improvements to existing content. Nineteen new surgical operations have been added. These include eight procedures that we think are essential to the practice of general surgery including axillary lymphadenectomy, insertion of a CAPD catheter, fasciotomy, escharotomy, insertion of an inferior vena caval filter, ventral hernia repair using the technique of open component parts separation, ureter repair, and basic thoracoscopy. In addition we have included four additional complex gastrointestinal procedures namely laparoscopic esophageal myotomy, sleeve gastrectomy for morbid obesity, transhiatal esophagectomy and transthoracic esophagectomy. The vascular surgery section now contains new variations on femoral thrombectomy, femorofemoral bypass, saphenous vein laser ablation, and thrombectomy of the superior mesenteric artery. Finally we added laparoscopic hand-assisted donor nephrectomy and kidney transplantation.

A major editorial reorganization has also occurred with the addition of 18 Associate Editors whose special expertise has been channeled into discrete body system–oriented chapters. This reorganization should make it easier to find operations whose titles no longer use roman numerals. The authors and the associate editors have critically reviewed and updated this entire 10th edition. The scientific content of all operative procedures from indications through postoperative care have been made current with significant improvements in about 50 chapters of text and art.

During the preparation of the 10th edition we received valuable input from Brian Belval at McGraw Hill and Donna Sampsill in the Department of Surgery at The Ohio State University. In the ninth edition, color processing and printing technology had advanced such that our medical illustrators, could add color to both old and new plates for improved anatomic clarity in more lifelike or realistic settings. For this 10th edition our medical illustrator, Marita Bitans, has prepared new artwork plates in high definition color with computer-generated graphics that now replace the original pen and ink sketches using white chalk scratch board.

We have also created an online Historical Supplement available at to provide open access to many now historical operations that over the last 70 years have been deleted from succeeding editions of the ATLAS. Many were replaced by newer procedures often involving modern technologies such as stapling, laparoscopy, or minimally invasive image-guided procedures. Others were rarely performed and a few were eliminated because of evolving indications. Additionally, in the past the authors and artists had page limitations imposed by the mechanical construction of the folio-sized ATLAS and the capacity of its binding. That is to say, heavily coated paper stock was needed for quality art reproduction and for the prevention of “strike through” of printed material on the backside of each page. The result was a restriction to about 500 pages—a size reached by the mid-1980s. At that point, the addition of any new or modern procedures such as stapling or laparoscopy required the pruning out of operations that (1) were rarely done—for example, portal/systemic shunts, or (2) were done by the increasing numbers of surgical specialists—for example, thoracic/pulmonary operations.

Furthermore, the authors and the publisher feel that many once popular operations should not be lost, but rather archived in this electronic Historical Supplement of the ATLAS where there are no page limitations. Many of these archived operations are still performed in specialized or complex situations because general surgeons by the nature of their practice, not infrequently encounter one of a kind events that are not in the text books. In these circumstances the surgeon must create an operative solution in real time. These solutions often rely upon general principles and experience, perhaps aided by one of these “old” operations. This may be particularly true in regions where expensive operative equipment such as staplers or disposable laparoscopic instruments are not available.

Today many medical libraries cannot afford to purchase and store all published texts, or even all the major printed medical journals. However, the internet is truly worldwide and accessible to almost all medical/surgical facilities and physicians. We trust this electronic Historical Supplement will help fill in some of the historical surgical technique reference gaps.

As Dr. Cutler graciously allowed his original coauthor to continue on after him, so my father did with me. Now it is my turn. Dr. E. Christopher Ellison has become the new lead principle author who will continue the ATLAS. Dr. Ellison is the other son of the Z-E syndrome. He is the Robert M. Zollinger Professor in the Department of Surgery at the Ohio State University Medical Center. He has accepted the primary responsibility for the ATLAS and its migration back to Columbus and the OSU Department of Surgery, where Dr. Zollinger Senior nurtured the ATLAS for over 40 years. Finally, of additional historic note, all of Dr. Zollinger’s papers plus the text and artwork from all earlier editions are now archived in the Medical Heritage Center within the OSU Prior Health Sciences Library where these materials are catalogued and available online.

E. Christopher Ellison, MD
Robert M. Zollinger, Jr., MD

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