| Surgery |
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| Breast Biopsies |  |
| 1. Open Biopsy 2. Stereotactic Biopsy |
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| Laparoscopic Cholecystectomy (Removal of Gallbladder) | |
| Laparoscopic
cholecystectomy involves the removal of the gallbladder through
a laparoscopic approach. The gallbladder
normally stores bile produced in the liver until it is needed for digestion. Unfortunately,
the gallbladder often forms gallstones. These seem to be related to body weight, diet, gallbladder motility and inherited body chemistry. Many patients have stones which do not cause symptoms and require no surgery. If however these stones attempt to pass out of the gallbladder and block the gallbladder outlet, severe upper abdominal pain can develop. This is known as colic. It usually lasts for short periods of time and often occurs after fatty meals which stimulate the gallbladder to contract. Occasionally, these stones may become lodged within the neck of the gallbladder and results in prolonged episodes of pain associated with infection. This is known as acute
cholecystitis and generally requires
admission to hospital and cholecystectomy. Another complication
of gallstones may be obstructive jaundice. In this situation
the gallstones pass out of the gallbladder and into the bile
duct where they occlude the bile duct exit. This may result in
progressive jaundice and infection known as cholangitis. This
needs to be treated immediately as discussed in the further sections. In the operating room under general anesthesia, a small needle is inserted into the umbilicus to allow inflation of the abdomen with gas. A telescope is inserted through a small 10 mm. hole or "port" inserted in the umbilicus to allow visualization. A second hole (port) is placed just under the breast bone in the midline of the abdomen. Two small ports are placed in the right side of the abdomen to allow for retraction. The gallbladder is then freed of any scar tissue which may be present from previous episodes of acute cholecystitis. The cystic duct (the duct that joins the gallbladder to the bile duct) is identified. The small artery known as the cystic artery supplying blood to the gallbladder is also identified. A small incision is made either in the gallbladder itself or in the cystic duct to allow insertion of a small tube or catheter. Dye is injected through this catheter to allow visualization of the bile ducts and insure that no stones are present within the bile duct on an x-ray screen. If there are no stones present in the bile duct, the cystic duct is divided after sealing it with metallic clips. The cystic artery is clipped and divided and the gallbladder is removed from the bed of the liver with a cautery device or laser. The gallbladder is then removed through one of the small incision (usually the umbilicus) and the ports are closed. The patient is able to eat immediately after waking from surgery and is usually discharged home that day or the next. Most patients return to normal activities within one to two weeks of their procedure. If a stone is found in the common bile duct, most may also be
removed during the laparoscopy. These stones can be flushed through
the bile duct and into the bowel where they will pass without
further problems. If they are not flushed easily, access to the
bile duct can be gained through the cystic duct by dilating it
up to a size big enough to allow passage of a small scope known
as a choledocho scope. The choledocho scope allows doctors to
see within the bile duct and the stones can be grasped with small
baskets and removed. Rarely, if the stones are impacted a small
drain is left in place, and the stones are removed later at another
procedure called ERCP. |
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| Laparoscopic Hernia Repair (Ventral, Inguinal and Umbilical Hernia) | |
| In laparoscopic hernia surgery, a telescope attached to a camera is inserted through a small incision that is made under the patient's belly button. Two other small cuts are made (each no larger than the diameter of pencil eraser) in the lower abdomen. The hernia defect is reinforced with a 'mesh' (synthetic material made from the same material that stitches are made from) and secured in position with stitches/staples/titanium tacks or tissue glue, depending on the preference of your individual surgeon. | |
| Colon Surgery | |
| Surgeons use
a tiny camera inserted through a half-inch-long hole in the skin to see
harmful growths in the colon. The images from the camera are displayed
on a monitor in the operating room. Other tools, inserted through other
small holes in the skin, are used to remove diseased sections of the
colon and to sew together the remaining tissue. Sometimes the diseased sections are removed (resected) and the healthy sections reconnected outside the body. Sometimes only one of these steps (resection and reconnection) is done outside the body. |
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| Hemorrhoid Surgery | |
| PPH is a technique developed in the early 90’s that reduces the prolapse of the hemorrhoidal tissue by excising a band of the prolapsed anal mucosa membrane with the use of a circular stapling device. In PPH, the prolapsed tissue is pulled into a device that allows the excess tissue to be removed while the remaining hemorrhoidal tissue is stapled. This restores the hemmorrhoidal tissue back to its original anatomical position. | |
| Carotid Endarterectomy | |
| A carotid endarterectomy is a surgical procedure in which a doctor removes fatty deposits from one of the carotid arteries, two main arteries in the neck supplying blood to the brain. Carotid artery problems become more common as people age. The disease process that causes the buildup of fat and other material on the artery walls is called atherosclerosis, popularly known as "hardening of the arteries." The fatty deposit is called plaque; -- the narrowing of the artery is called stenosis. The degree of stenosis is usually expressed as a percentage of the normal diameter of the opening. | |
| Treatment of Varicose Veins | |
| Transilluminated
powered phlebectomy is a patented, clinically tested surgical technique
for varicose vein removal. “Tansilluminated” refers to the
passing of light under the skin and “phlebectomy” is the
medical term for vein removal. In this procedure, the surgeon removes
the vein using a small powered surgical device while viewing the vein
using a transilluminated light. Clinical studies suggest that this method
enables the surgeon to remove veins using a minimal number of small incisions
and short operative times, which may result in an easier recovery for
the patient with good cosmetic results.
In sclerotherapy, a tiny needle is used to inject the vein with a medication that irritates the lining of the vein. In response, the vein collapses. The surface veins are no longer visible, and most patients experience symptom relief. Sclerotherapy is usually used to treat smaller varicose veins and spider veins. Several sclerotherapy sessions may be required for any vein region. |
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| Treatment of Artery Occlusion in the Legs | |
| Surgery can be used to eliminate arterial blockages and restore circulation to the leg. The most common technique is the femoral-popliteal bypass. A vein from the inner thigh is used to link femoral and popliteal arteries, by-passing the occlusion and restoring circulation to the lower leg and feet. | |
| Surgery to Repair Abdominal Aneurysm | |
| The treatment
of this condition depends on your overall health, the size and location
of the aneurysm, and whether you are having symptoms. The risks and benefits
of surgery for abdominal aortic aneurysms are different than those for
thoracic aortic aneurysms. Abdominal aortic aneurysms are unlikely to rupture if they develop slowly, are less than 5.0 cm (about 2 inches) in diameter, and are causing no symptoms. Any abdominal aortic aneurysm larger than about 2 inches (5.0 cm) in size requires surgery to repair it. Aneurysms that are enlarging rapidly, causing symptoms, or showing signs of probably rupture (such as leaking) require immediate surgery. Delaying this surgery puts you at even greater risk of a rupture. |
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| Placement of AV Grafts and Fistulas for Dialysis | |
| The best way
to establish long-term hemodialysis access is to construct an arteriovenous
(AV) fistula. An AV fistula is a surgically placed "shunt" whereby
an artery is directly sutured to a vein. An artery is a high-pressure
tube that carries blood away from the heart and delivers nutrients and
oxygen to the tissues. A vein is a low-pressure system that returns blood
back to the heart to begin the process all over again. When an artery and a vein are sewn together, the high-pressure blood does not reach the tissues but is diverted instead into the vein and back to the heart. Over time the vein will dilate, which is often called maturation. At maturation, nurses can easily access the vein with needles for dialysis therapy. A surgeon usually performs the procedure in the operating room. The patient receives a local anesthetic (numbing medicine) at the proposed site along with sedation. Surgeons can create an AV fistula in the wrist, forearm, inner elbow or upper arm. Discomfort is minimal and the patient may even fall asleep during the procedure, which can take from one to two hours. The surgical incision is usually only two to four inches long. Generally patients are able to return home later that same day. The fistula usually requires from eight to 12 weeks for the veins to dilate prior to initial use. When properly constructed, and with satisfactory maturation, an AV fistula can function for many years. |
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| Placement of Portacaths for Chemotherapy | |
| A Portacath is
a small chamber or reservoir that sits under your skin at the end of
your central line. You can feel it, but unless you are very thin you
cannot usually see it. When you need treatment, your nurse puts a needle
into the chamber and gives you injections or attaches a drip. This stays
in place for as long as you need treatment. Then your nurse will remove
it until your next treatment.
The main advantage of a Portacath is that you can't see it on the
outside of your body. You don't have to have a tube coming out of your
chest as you do with a Hickman line. But others prefer a Hickman line
because they don't like having a needle put in each time they need
treatment. If you prefer, you can have the area over the portacath
numbed with a local anaesthetic cream before the needle goes in. |
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| Gastric Bypass Surgery for Obesity | |
| Severe obesity
is a chronic condition that is difficult to treat through diet and exercise
alone. Gastrointestinal surgery is the best option for people who are
severely obese and cannot lose weight by traditional means or who suffer
from serious obesity-related health problems. The surgery promotes weight
loss by restricting food intake and, in some operations, interrupting
the digestive process. As in other treatments for obesity, the best results
are achieved with healthy eating behaviors and regular physical activity. People who may consider gastrointestinal surgery include those with a body mass index (BMI) above 40—about 100 pounds of overweight for men and 80 pounds for women (see table 1 for a BMI conversion chart). People with a BMI between 35 and 40 who suffer from type 2 diabetes or life-threatening cardiopulmonary problems such as severe sleep apnea or obesity-related heart disease may also be candidates for surgery. The concept of gastrointestinal surgery to control obesity grew out of results of operations for cancer or severe ulcers that removed large portions of the stomach or small intestine. Because patients undergoing these procedures tended to lose weight after surgery, some physicians began to use such operations to treat severe obesity. The first operation that was widely used for severe obesity was the intestinal bypass. This operation, first used 40 years ago, produced weight loss by causing malabsorption. The idea was that patients could eat large amounts of food, which would be poorly digested or passed along too fast for the body to absorb many calories. The problem with this surgery was that it caused a loss of essential nutrients and its side effects were unpredictable and sometimes fatal. The original form of the intestinal bypass operation is no longer used. |
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