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For more than 80 years, this Atlas has defined the scope of general surgery. In the 1930s, the original authors—Cutler and Zollinger—personally did the 64 procedures described in the first edition, but specialty boards were birthing in all areas of medicine and surgery. A generation later when Robert M. Zollinger, Jr., trained at the Brigham & Women’s Hospital in the 1960s, an academic general surgeon was exposed to, and assisted at, all the surgical specialty operations so as to have broad familiarity with the state of what we called “modern” surgical care. It was a time when 85% of surgical residencies were in community hospitals, where general surgeons cared for the majority of patients.

However, by the time of the next residency generation in the 1980s, when E. Christopher Ellison completed his training, specialty surgical boards were in evolution, and by the 1990s on into the twenty-first century, these specialty boards certified the training of large numbers of qualified surgeons. The Atlas then expanded to more than 100 surgical operations covering even the most complex operations done by general surgeons, 85% of surgical residencies were now associated with academic university programs, and superspecialist fellowships involving “advanced” surgical techniques and equipment permitting minimally invasive procedures were proliferating.

Concurrently, board recertification every 10 years was instituted, and the collected practice data revealed that most general surgeons were not generalists. Many tended to limit their practice to about 10 to 15 common procedures, including endoscopy or colonoscopy, or they had become superspecialists in a subset of cases and skills. However, just as the curriculum in medical schools exposes students to all areas of medicine, so must general surgery residency training provide exposure to diverse illnesses and their operative treatments—hence the broad scope of this Atlas. Not only is it important that we focus not just on the surgical illness and its operative solution but also that we can evaluate the patient as a whole with multiple organ systems, several of which may be compromised at the same time.

Of additional note, there has also been a shift in the practice configuration of surgeons in the United States. They have become mostly corporate employees with defined areas of clinical expertise and hours of service. One example of this is the morphing of the trauma surgeon in the emergency room of 1990 into the acute care surgeon as presented in the new Chapter 5.

Evolving surgical instrumentation and operations—think endoscopes to staplers to laparoscopes to robotic devices—to endovascular procedures and evolving delivery systems of learning—think operating room movies to the internet with videos and artificial intelligence—have changed during the life of this Atlas, and it will continue to challenge how we authors provide current state-of-the-art education to surgeons. As a result of the advances in surgical technology and procedures, this edition of the Atlas includes more than 160 surgical operations. Furthermore, we expanded the surgical expertise of the primary authors to include two additional professors at The Ohio State University: Dr. Timothy M. Pawlik, current chair of the Department Surgery, and Dr. Patrick S. Vaccaro, former chief of the Division of Vascular Diseases and Surgery. Beyond this, we invited a panel of associate editors who provided the necessary knowledge and experience in highly technical areas. We and our associates trust that this eleventh edition of the Atlas, in print and in electronic form, will aid in your continuing quest for mastering the art and science of surgery to the benefit of your patients.

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

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