GOLDEN NOTES IN SURGERY

( As per CBME curriculum of NMC )

Author : K Jayarama Shenoy

Professor & Former Head of Surgery
Kasturba Medical College, Mangalore

Highlights :

A compact notes made from author’s 40 years of teaching experience combining available literature in
public domain -including standard text books , manuals, specialty , treatises.

30 core competencies of CBME curriculum discussed in just 610 pages .

It Contains , 620 questions . 191 tables , over 125 handwritten illustrative diagrams and photos .

Focus on concepts of disease and surgery , (helps understanding )

A good adjunct to text books and manuals, Helps in preparation for NExT exams,

Handy for postgraduate residents in understanding basics.

Expected to inspire junior faculty in preparation of cloasses like SGTs, theory or clinics.

Forewords by :
Lt Gen Dr MD Venkatesh, VSM (Rtd)
Vice Chancellor , Manipal Academy of Higher Education
Manipal, Karnataka, India

Dr M Vijayakumar , MBBS DNB MCh FRCS FACS FICS

Vice Chancellor, Yenepoya (Deemed to be University)
Deralakatte, Mangaluru, Karnataka, India

Dr K Ramesh Reddy , MS MCh (Pediatric Surgery)

Director of Medical Education ,
Government of Telangana
Hyderabad, Telangana, India
 Preface
Golden Notes in Surgery is not a substitute for textbooks. It only guides the medical students in
learning the concepts of Surgery, as a boost to their preparation for National Exit Examination
(NEXT)/final examination in Surgery. It consists of the 30 broad competencies as mandated by
the NMC in the CBME syllabus. Briefly outlined are the topics under surgical specialties and
subjects like surgical ethics, audit, legal aspects of surgery and hospital waste management, the
book contains 191 tables for easy reference and about 125 figures which include my handwritten
descriptive diagrams, clinical and operative photographs, all from my personal collection. I have
also given 620 typical questions (long and short answer type) against respective topics for benefit
of students.
The book is also expected to help the Junior Residents in surgery (MS/DNB) to learn the
basic concepts, which they can apply in their academics and clinical practice of surgery.
The junior faculty of surgery in various colleges are expected to find this book useful in
preparing their lessons for any class—theory, clinical or short group teaching.
This book presents the lecture notes, I have compiled during my teaching career in surgery
since 1984, reasonably updated to contemporary levels, with the help of literature available in
public domain, including, but not limited to, the textbooks and manuals enlisted in the
bibliography, WHO monograms, various journals and online resources like the Medscape and
drjosephtm.blogspot.com.
I have avoided any plagiarism and violation of copyright to the best of my belief.
I hope the book serves its purpose of strengthening the knowledge-based professional
learning.

K Jayarama Shenoy
 Contents
Section 1: Basics in Surgery

1. Metabolic Response to Injury

Neuroendocrine Reflex Response: Modulates the Immune Response

Homeostatic Response to Injury
Diagnosis of SIRS

2. Shock..
Shock -types and pathophysiology
Septic Shock
Other Forms of Shock

3. Blood and Blood Components

Blood Transfusion

Indications for Blood Transfusion

Massive Blood Transfusion
Complications of Blood Transfusion
Blood Substitutes
Plasma Substitutes

4. Burns.................................................................................................................................................
Mechanism of Burns
Depth of Burns
Types of Burns
Classification of Burns Based on Body Surface Area (BSA)
Pathophysiology of Burns
Assessment of Burns Patient and Management
Surgery in Acute Burns
Nutrition in Burns
Inhalation Burns Injuries
Electrical Burns
Cold Injuries
Frostbite
Radiation Burns (Good to Know)
Medico-Legal Aspects in Burn Injuries
Legalities of the Award of Disability by Various Competent Authorities
Impairment and Disability
Legal Rights of Burns Survivors for Compensation

5. Wound Healing and Wound Care.

 Wounds
Chronic Wound Healing (Abnormal Healing)
Assessment and Treatment of Acute Wound
Burst Abdomen
Diabetic Ulcers
Negative Pressure Wound Closure Therapy (NPWT)
Pressure Sores
Hypertrophic Scar
Keloid
Contracture
Skin Grafts
Flaps

6. Surgical Infections and Hand Infections

Surgical Infections
The Decisive Period—The 4 Hours Interval
Surgical Site Infection
Microbiology of Surgical Infections
Antimicrobial Treatment of Surgical Infection
Short Notes Questions
Acute Cellulitis and Lymphangitis
Tetanus
Gas Gangrene

Hand Infections
Paronychia
Felon (Terminal Pulp Space Abscess)
Webspace Abscess (Collar-Button Abscess)
Acute Suppurative Flexor Tenosynovitis
Midpalmar Abscess
Thenar Space

Section 2: Essential Topics in General Surgery

7. Surgical Audit and Research

Audit and Service Evaluation
Audit Cycle
Steps of Conducting Clinical Research (Must Know)
Details of Research Study Designs (Good to Know)

8. Ethics in Surgery
Informed Consent
Confidentiality
Medico-Legal Issues in Surgical Practice
“On Table Death” and Post-operative Death
9. Investigation of the Surgical Patient and Basis of Cancer Therapy...................
Biopsy
Imaging: In a Surgical Patient
rationale of modalities of cancer therapy

10. Pre, Intra and Post-operative Management

Perioperative Management

11. Anesthesia and Pain Relief, Day Care Surgery and Safe General Surgery
Anesthesia and Pain Relief
Management of Chronic Pain
Day Care Surgery
Safe General Surgery

12. Nutrition and Fluid Therapy..................................................................................................................

Physiology of Body Nutrition
Parenteral Nutrition
Types of Fluids Used

13. Transplantation....................................................................................................................................
Immunosuppressive Therapy
Transplantation and Immunosuppression
Mechanism of Graft Rejection
Donor Recipient Matching
The Tissue: Typing Laboratory
Organ Transplantation in Practice
Liver Transplantation (Orthotopic)
Graft Dysfunction
Legal, Social and Ethical Issues

14. Basic Surgical Skills......

Beginning of Antisepsis and Disinfection
Methods of Sterilization and Disinfection
Surgical Approaches
Abdominal Incisions
Drains
Suturing

15. Hospital Waste Disposal

Disposal of Hospital Waste

16. Minimally Invasive Surgery and Bariatric Surgery Minimally Invasive Surgery Conversion to Open
Surgery

Bariatric Surgery
Surgery for Obesity and Diabetes
Obesity Surgery \
Types of Bariatric Surgery
17. Trauma......

... Mass Casualties War Surgery: Mass Injuries due to War (Conflicts) Damage Control Surgery
Neurotrauma
Pathophysiology of Head Injury
Types of Hematomas in Head Trauma
Chronic Subdural Hematoma
Clinical Assessment of Head Injury
Principles of Treatment of Head Injury
Soft Tissue Injuries

Chest Trauma
Pathophysiology of Chest Injuries

Section 3: Skin, Face, Mouth, Oropharynx, Salivary Glands and Jaws

18. Infections and Tumors of Skin

Anatomy and Function of Skin and Adnexa
Infections of Skin
Lipoma
Neurofibroma
Hemangioma
Arteriovenous Fistula (AV Fistula)
Branham’s Bradycardiac Sign
Benign Lesions of Skin and Subcutaneous Tissue
Malignant Melanoma of Skin
Systemic Therapy
Basal Cell Carcinoma
Squamous Cell Carcinoma
Microscopy
Malignant Soft Tissue Tumors

19. Developmental Anomalies of Face, Tumors and Swellings of Gums and Jaws....
Craniofacial Anomalies: The “Omens”
Cleft Lip and Palate
Epulis (“Epulides” Pleural)
Swellings of Jaw
Dentigerous Cyst (Follicular Odontome)
Dental Cyst
Adamantinoma

20. Oropharyngeal Cancer...................................................................................................................

Premalignant Lesions of Oral Cavity
Oral and Oropharyngeal Cancers
Oral Cancers
Management of Secondaries in Neck Nodes

21. Salivary Glands

Surgical Anatomy of Salivary Glands

Disorders of Salivary Glands
Xerostomia
Cysts: Ranula
Submandibular Salivary Gland and Parotid Disorders
Salivary Calculi
Acute Sialadenitis and Parotid Abscess
Acute Bacterial (Suppurative) Parotitis and Parotid Abscess
Frey’s Syndrome (Auriculotemporal Syndrome)
Sialadenosis (Sialosis)
Classification of Salivary Gland Tumors
Primary Malignancies of Salivary Glands
Treatment of Salivary Malignancies (General)
Adenoid Cystic Carcinoma (Cylidromatous Carcinoma)
Acinic Cell Tumor
Malignancy in a Mixed Tumor
Minor Salivary Gland Tumors

Section 4: Endocrines and the Breast

22. Thyroid and Parathyroid

Embryology
Ectopic Thyroid and Thyroglossal Cyst
Congenital Thyroid Disorders
Thyroglossal Cyst
Goiter (Goitre) any Enlargement of Thyroid Gland
Diffuse Hyperplastic Goiter and Nodular Goiter
Investigations for Thyroid Disorders
Toxic Goitre (Toxic Goiter)
Toxic Multinodular Goiter (Plummer’s Disease)
Treatment of Thyrotoxicosis (Very Important Topic)
Treatment of Toxic (Multi) Nodular Goiter
Thyroiditis
Hashimoto’s Thyroiditis
Thyroidectomy: Definitions
Thyroid Malignancies
Differentiated Thyroid Carcinoma
Medullary Thyroid Carcinoma
Treatment of Thyroid Cancers
Management of Discrete (Solitary) Thyroid Nodules

Parathyroids
Hypoparathyroidism
Pseudohypoparathyroidism
Hyperparathyroidism
Primary Hyperparathyroidism
Secondary Hyperparathyroidism

23. The Adrenal Glands...............................................................................................................................

Applied Anatomy of Adrenal Glands
Disorders of Adrenal Glands
Incidentaloma
Investigations in any Adrenal Mass
Primary Hyperaldosteronism
Cushing’s Syndrome
Adrenogenital Syndrome
Tumors of Adrenal
Tumors of Adrenal Medulla
Neuroblastoma
Pheochromocytoma

24. The Pancreas - Exocrine and Endocrine

Anatomy of the Pancreas
Functions of the Pancreas
Serum Amylase
Lipase
Annular Pancreas
Mucoviscidosis (Cystic Fibrosis—CF)
Pancreatic Fistula
Pancreatitis
Acute Pancreatitis
Clinical Features of Acute Pancreatitis
Complications of Acute Pancreatitis
Management of Acute Pancreatitis
Local Complications and Management
Acute Peripancreatic Fluid Collection
Sterile and Infected Pancreatic Necrosis 242
Pseudocyst of Pancreas
Chronic Pancreatitis
Surgery in Chronic Pancreatitis
Pancreatic Tumors: Exocrine and Endocrine
Tumors of the Pancreas
Exocrine Pancreatic Tumors
Pathology
Staging of Pancreatic Cancer
Tumor Node Metastasis Stage
Treatment of Carcinoma of Pancreas
Palliative Surgery
Palliation in Pancreatic Cancer
Endocrine Tumors or Pancreas Neuroectodermal Tumors (PNET)
Diagnosis and Treatment of PNETS
Glucagonoma , Somatostatinoma

25. The Breast

Diseases of Breast Evaluation

of Breast Diseases , Mammography
Benign Breast Diseases ,
Acute Mastitis and Breast Abscess
Aberrations of Normal Differentiation and Involution
Mastalgia
Benign Tumors of the Breast
Treatment Algorithm for Breast Lumps
Galactocele
Carcinoma Breast
Management of Carcinoma Breast
Treatment of Carcinoma Breast
Surgical Operations
Surgery for Axillary Node Metastases
Hormone Therapy , Chemotherapy Biological Therapy
Treatment of Non-invasive Breast Cancer
Treatment of Invasive Carcinoma of Breast
Treatment of Locally Advanced Breast Cancer
Inflammatory Carcinoma of Breast
Treatment of Metastatic Carcinoma Breast
Recurrent Carcinoma of Breast
Palliation ,
Rehabilitation in Breast Cancer
Section 5: Cardiothoracic and Vascular System

26. Cardiothoracic Surgery...............................................................................................................

Principles of Cardiopulmonary Bypass
Surgery for Coronary Artery Disease
Echocardiography
Surgery for Valvular Heart Disease
Role of Surgery for Congenital Heart Diseases
Cyanotic Heart Diseases
Acyanotic Heart Diseases
Pleural Effusion
Empyema Thoracis
Empyema Necessitans
Surgery for Medical Conditions
Lung Cysts
Mesothelioma of Pleura
Tumors of the Chest Wall
Lung Tumors
Lung Cancers
Small Cell Lung Cancer (SCLC) (Oat Cell Cancer)
Non-Small Cell Lung Cancer (NSCLC)
Metastatic Lung Cancers
Mediastinal Diseases and Principles of Management
Treatment of Mediastinal Mass Lesions
Thymoma

27. Arteries, Veins and Lymphatics.......

Arterial Diseases
Occlusive Arterial Disease of the Extremities
Gangrene
Signs Elicited on Examination of Ischemic Limb
Diagnosis and Management
Treatment of Acute Limb Ischemia (ALI)—Must be Started Immediately
Treatment of Chronic Limb Ischemia
Surgical Treatment
Vasospastic Conditions and Arteritis
Raynaud’s Disease and Syndrome

Veins
Applied Anatomy of Venous System of Lower Limbs
Venous Pathophysiology
Venous Hypertension and Chronic Venous Insufficiency
Chronic Venous Insufficiency
Deep Venous Thrombosis
 Lymphatic System Lymphedema
Classification of Lymphedema
Treatment of Lymphedema
Acute Lymphangitis

Lymphomas
Burkitt’s Lymphoma
Hodgkin’s Lymphoma
Clinical Features of Lymphomas
Investigations and Diagnosis
Treatment of Lymphoma
Tips for Examination of Lymphatic System

Section 6: Hernia, Peritoneum and the Digestive Tract

28. Abdominal Cavity, Hernia and Digestive Tract...............

28.1: Hernia, Peritoneum and Retroperitoneum
Herniology
Hernia
Etiology and Pathogenesis of Hernia
Principles of Treatment of Hernia
Groin Hernias (Herniae)
Surgical Anatomy of Femoral Hernia
Classification of Groin Hernias
Nyhus’ Classification of Groin Hernia
Fruchaud’s Myopectineal Orifice
Inguinal Hernia
Sliding Hernia
Tension Repairs
Surgery for Femoral Hernia
Ventral Hernias
Epigastric Hernia
Incisional Hernia
Rare Hernias
Parastomal Hernia

The Peritoneum
Peritoneal Cavity
Peritonitis - Acute Peritonitis
Factors Spreading/Deciding Severity

Peritonitis: Clinical Features, Treatment of Acute Peritonitis

Special Types of Peritonitis
Bile Peritonitis
Meconium Peritonitis
Abdominal Tuberculosis , Tuberculous Peritonitis
Complications of Acute Peritonitis and Intraperitoneal Abscess
Localised Intra-abdominal Abscess
Pelvic Abscess
Subphrenic Spaces and Abscess
Subdiaphragmatic Abscess
Mesenteric Cysts
Carcinomatosis Peritonei
Pseudomyxoma Peritonei

Retroperitoneum
Retroperitoneal Pathology
Retroperitoneal Tumors
Retroperitoneal Lipoma
Retroperitoneal Sarcoma

28.2: Esophagus and Stomach

Esophagus
Applied Anatomy of Esophagus
Lower Esophageal Sphincter
Evaluation of Dysphagia
Esophageal Perforations
Esophageal Diverticula
Classification of Esophageal Motility Disorders
Achalasia Cardia
Esophageal Atresia and Tracheoesophageal Fistula
Gastroesophageal Reflux Disease (GERD/GORD) 371
Esophageal Hiatus Hernia
Carcinoma of Esophagus
Staging Esophageal Carcinoma
Treatment of Esophageal Carcinoma
Surgery for Esophageal Carcinoma
Radiotherapy and Chemotherapy (Combination)
Palliation in Carcinoma Esophagus

Stomach
Applied Anatomy and Physiology of Stomach
Nerve Supply to the Stomach
Microscopy of Gastroduodenal Mucosa
Surgical Physiology of Stomach and Duodenum
Investigation of Stomach and Duodenum: Gastric Function Study
Gastrin
Hypergastrinemia
Helicobacter Pylori

Congenital Hypertrophic Pyloric Stenosis

Gastritis
Peptic Ulcer
Pathology of Peptic Ulcers
Complications of Peptic Ulcer
Hematemesis and Melena
Bleeding Peptic Ulcer: Massive Bleed

Pyloric Stenosis in Duodenal Ulcer

Gastric Volvulus
Acute Dilatation of Stomach
Gastric Cancer
Pathology of Gastric Cancer
Treatment of Carcinoma Stomach
Summary of Treatment of Gastric Carcinoma
Palliation in Gastric Cancer
Other Tumors of Stomach
Gastric Lymphoma
Zollinger-Ellison Syndrome

28.3: Spleen, Liver, and Biliary Tract

Spleen
Spleen
Splenunculi
Splenic Rupture
Splenic Trauma

Liver
Anatomy of Liver
Alfa-fetoprotein
Acute Liver Failure
Liver Injuries
Infectious Conditions of the Liver
Amebic Liver Abscess
Pyogenic Abscess
Portal Pyemia
Hydatid Cyst of Liver
Tumors of the Liver
Palliative Therapy for HCC
Metastatic Tumors
Portal Hypertension (PHT)
Etiopathogenesis , Child’s pugh Staging and treatment

Biliary Tract
Applied Anatomy of Biliary System
Percutaneous Transhepatic Cholangiography
Intraoperative Imaging Techniques
Extrahepatic Biliary Atresia
Choledochal Cyst
Gallstones (Cholelithiasis)
Gallstones
Pathogenesis of Gallstone Formation
Pathology and Complications of Gallstones
Chronic Cholecystitis
Acute Cholecystitis
Emergency Cholecystectomy
Choledocholithiasis (Stone in the Bile Duct)
T-tube Cholangiography
Biliary Strictures
Cholangiocarcinoma of Bile Ducts
Carcinoma of Gallbladder
Obstructive Jaundice
Extrahepatic Biliary Obstruction (Surgical Jaundice)
Courvoisier’s Law
Surgery in Obstructive Jaundice
Management Algorithm for Surgical Jaundice

28.4: The Intestines

Anatomy of Small Intestine
Anatomy of the Large Intestine, Lymphatic Drainage of the Colon
Intestinal Diverticulae
Meckel’s Diverticulum
Crohn’s Disease - Imaging in Crohn’s Disease
Tuberculosis of the Intestines
Surgical Complications of Typhoid
Surgical Complications of Roundworm (Ascaris Lumbricoides)
Pneumatosis Cystoides Intestinalis (PCI)
Ileal Strictures
Blind Loop Syndrome
Enterocutaneous Fistula

Small Intestinal Tumors

Peutz–Jeghers Syndrome
Malignant Tumors of Small Bowel
Short Gut Syndrome (SGS)
Intestinal Obstruction - Pathophysiology of Intestinal Obstruction (Dynamic)
Strangulated Obstruction
Paralytic Ileus
Clinical Features of Acute Intestinal Obstruction
Simple v/s Strangulated Obstruction
Chronology of Symptoms Related to Level of Obstruction
Paralytic Ileus
Pseudo-obstruction , Colonic Pseudo-obstruction
Volvulus of Intestines
Ileosigmoid Knotting (Compound Volvulus)
Cecal Volvulus
Intussusception - Acute Intussusception
Intestinal Obstruction due to Internal Hernias
Neonatal Intestinal Obstruction
Duodenal Atresia ,Midgut Malrotation
Associated Anomalies 20–25%
Meconium Ileus
Chronic Large Bowel Obstruction
Mesenteric Vascular Insufficiency (with/without Occlusion)
Chronic Mesenteric Ischemia (Mesenteric Angina)

28.5: The Vermiform Appendix

Diseases of the Vermiform Appendix
Acute Appendicitis
Clinical Signs in Acute Appendicitis
Differential Diagnosis of Acute Appendicitis
Appendix Mass (Appendicular Phlegmon)
Appendix Abscess
Mucocele of Appendix
Pseudomyxoma Peritonei (PMP)
Carcinoid of the Appendix—Syn: Argentaffinoma
Mass in the Right Iliac Fossa

The Large Intestine Chronic

Large Bowel Obstruction Hirchsprung’s Disease (Congenital Megacolon)
Diverticulosis Coli
Ulcerative Colitis (UC)
Surgical Manifestations of Intestinal Amebiasis
Ischemic Colitis
Chronic Constipation
Treatment of Chronic Constipation and Coloparesis
Colostomy
Lower Gastrointestinal Bleeding

Surgery in Acute GI Bleed: General Principles

Anorectal Surgery
Surgical Anatomy of Rectum
Emryology of Rectum and Anal Canal
Lymphatic Drainage of Rectum and Anal Canal
Puborectalis Sling of Levator Ani is the Key to Continence - Invertogram

Rectal Injuries

28.6: Tumors of Colon, Rectum and Anal Canal

Tumors of Large Intestine
Tumors of Large Intestine
Hereditary Polyposis Syndromes
Colorectal Cancers
Etiological Factors for Colorectal Carcinoma
Spread of Colorectal Carcinoma
Surgery for Colonic Carcinoma
Carcinoma Rectum
Rectal Lymphatics
Anal Carcinoma

Anal Canal
Etiology and Pathogenesis of Anorectal Abscesses
Etiology of Anorectal Abscesses , Pathogenesis: Anorectal Abscess
Anorectal Fistula - Goodsall’s Rule
Pelvirectal (Supralevator) Fistula (Extrasphincteric)
Pilonidal Sinus - Sacrococcygeal Pilonidal Sinus
Hemorrhoids - Anal Cushions “ Corpus Cavernosum Recti” of Stelzner
Principles of Stapled Hemorrhoidopexy (Syn: MIPH)
Thrombosed External Piles (Short Notes)
Fissure in Ano
Prolapse of the Rectum
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Section 7: Urogenital Surgery

29. Kidney, Ureters and the Bladder.........................................................................................................

Hematuria, Congenital Disorders, Infections and Obstructive Pathology
Hematuria
Embryology of Urogenital System
Congenital Abnormalities
Ectopic Kidney/Crossed Renal Ectopia
Horseshoe Kidney
Cystic Diseases of the Kidney
Autosomal Dominant Polycystic Kidney Disease
Urinary Tract Infections
Acute Pyelonephritis
Chronic Pyelonephritis
Emphysematous Pyelonephritis
Genitourinary Tuberculosis
Thimble Bladder
Vesico-ureteric Reflux
Lower Urinary Tract Infection and Cystitis
Schistosomiasis (Bilharziasis) of the Bladder
Hydronephrosis

Renal Calculi and Renal Tumors

Urolithiasis
Pain, Hematuria and Fever
Extracorporeal Shockwave Lithotripsy
Percutaneous Nephrolithotomy (PCNL)
Staghorn Calculus
Lower Urinary Tract Stones
Upper Tract Transitional Cell Carcinoma
Wilms’ Tumor (Nephroblastoma)
Additional Reading - Good to Know
Investigations in Surgery of Urinary Tract
CT Scan—Renal Cysts
Renal Trauma

Lower Urinary Tract: Bladder, Prostate and Urethra 5

Surgical Anatomy of the Bladder
Congenital Defects of the Bladder
Rupture of Bladder: Trauma
Bladder Diverticula
Neoplasms of the Bladder
Carcinoma of the Bladder
Disorders of Prostate

Benign Prostatic Hyperplasia

Acute Prostatitis
Chronic Prostatitis
Prostatic Abscess
Carcinoma Prostate
Anatomy of Urethra
Posterior Urethral Valves
Hypospadias
Injuries to the Male Urethra
Urethral Stricture

30. Scrotum, Testis and the Penis......................................................................................

Balanoposthitis
Carcinoma of Penis
Premalignant Conditions
Pathology of Carcinoma of Penis
Staging
Undescended Testis
Vanishing Testis
Acute Epididymo-orchitis
Chronic Epididymitis
Torsion of the Testis
Epididymal Cysts
Pyocele
Staging of Testicular Tumors
Treatment of Testicular Tumor
Tumors of Scrotum

Bibliography
1. AJCC Cancer Staging Manual, Version 8.
2. Anderson MD. Surgical Oncology Handbook, 6th edition.
3. Bailey and Love’s, Short Practice Surgery, 27th and 28th edition.
4. Campbell, Walsh Urology.
5. Das K. Clinical Methods in Surgery.
6. Ellis’ Clinical Anatomy for Medical Students.
7. Farquharson’s Textbook of Operative Surgery.
8. Fisher et al. Mastery of Surgery, 6th edition.
9. Govt. of India Gazzette.
10. Illustrative Handbook of General Surgery, 2nd edition, Springer.
11. Lee McGregor’s Surgical Anatomy.
12. Manipal Manual of Surgery, 4th and 5th editions.
13. Schwartz ‘s Principles of Surgery, 11th edition.
14. Smith & Tanagho’s General Urology, 19th edition.
15. SRB Manual of Surgery, 6th and 7th editions.
16. Townsend et al. Sabiston Textbook of Surgery, 20th edition.
17. Washington Manual of Surgery, 8th edition