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Some 70 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 eight editions, but two revolutionary ones were the refinement and popularization of stapling devices about 30 years ago and the creation of laparoscopic minimally invasive procedures around 1990. The first offered a quick, uniform solution to hand-sewn anastomoses of varying quality, whereas the latter, fueled by successful laparoscopic cholecystectomy, resulted in significantly faster and less painful recovery by patients. These two techniques are now joined in full flower in this edition wherein what was considered advanced laparoscopic technique just a decade ago is now in common use and taught in most surgical residency training programs.

Accordingly, the authors have now added these procedures to the Atlas. They include the following laparoscopic operations: right and left colectomy, distal pancreatectomy with splenic preservation, right and left adrenalectomy, bariatric Roux-en-Y gastric bypass, and adjustable gastric banding, plus transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) inguinal hernia repair, along with a new laparoscopic anatomy plate for the inguinal region. Additionally, three frequently performed minor but key operations are documented in the chapters on arteriovenous fistula for dialysis access, subclavian and internal jugular venous access with port placement, and percutaneous dilational tracheostomy. Numerous updates to all text and plates have been done, while the chapters on minor rectal procedures, hand infections, tendon repair, and skin grafting have undergone major revisions.

Our publisher, McGraw-Hill, has also experienced significant advances in printing and in electronic communication of medical information. Improved printing and binding now allow the Atlas to contain over 500 pages, thus overcoming a historic barrier that forced us to delete older operations in order to make room for new ones in each succeeding edition. Additionally, color processing and printing technology have advanced such that our medical illustrators, Marita Bitans and Jennifer Smith, have added color to both old and new plates for improved anatomic clarity in more lifelike or realistic settings. For the previous edition, only the text was computerized. However, for this ninth edition, the Internet has also been used extensively with computer processing of the art work, FTP transfers of megabyte art files, and nearly 1,000 e-mails and video conferencing among the authors and artists. McGraw-Hill also has ventured into new forms of electronic media. The Atlas is available now via the online site AccessSurgery and it may even be downloaded as individual chapters on your hand-held Internet device.

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 coauthor who will continue the Atlas. Dr. Ellison is the other son of the Z-E syndrome. He is the Robert M. Zollinger Professor and Chair of the Department of Surgery at the Ohio State University Medical Center. He has accepted 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. 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. These materials are catalogued and available online.

Finally, every edition of the Atlas has been enabled and facilitated by the support of the faculties of the Colleges of Medicine and staff of the authors' departments of surgery. The Peter Bent Brigham Hospital at Harvard was followed by the Ohio State University and then Case Western Reserve with its University Hospitals of Cleveland. Now the Ohio State University once again has assumed this key supporting role. The authors would like to acknowledge the many surgeons and physicians whose contributions, advice, critical evaluations, comments, and proofing were truly invaluable. In particular, the authors wish to recognize Mark W. Arnold, P. Mark Bloomston, Jeffrey H. Boehmler IV, Ginny L. Bumgardner, Charles H. Cook, Elizabeth A. Davies, William B. Farrar, Jeffrey M. Fowler (OB-GYN), Gayle M. Gordillo, Gregory E. Guy (Radiology), Alan E. Harzman, Jeffrey W. Hazey, Mitchell L. Henry, Eric H. Kraut (Internal Medicine/Hematology and Oncology), W. Scott Melvin, Dean J. Mikami, Susan Moffat-Bruce, Peter Muscarella, Bradley J. Needleman, William L. Smead, Jordana L. Soule, Steven M. Steinberg, Patrick S. Vaccaro, Cecilia S. Wang, and David A. Zvara (Anesthesia). In addition, the authors would not have been able to prepare this edition without the secretarial assistance of M. Renee Troyer and Internet support provided by Jerome A. Johnson. Finally, the staff at McGraw-Hill has provided invaluable overall guidance and support and the authors would like to acknowledge in particular their medical editors Marsha S. Gelber and Robert Pancotti.

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

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