Surgery

For many people, surgery is a daunting prospect. Our surgical specialists share a common goal: creating a patient experience dedicated to superior quality, safety, satisfaction and the best possible outcomes. We have some of the finest surgeons in the area and state-of-the-art diagnostic facilities. We hope to make your operative experience as pleasant as possible. Your care is our primary concern, and we’ve compiled the necessary guidelines to help prepare you for your surgery.

Blepharoplasty

Blepharoplasty (BLEF-uh-roe-plas-tee) is a type of surgery that repairs droopy eyelids and may involve removing excess skin, muscle and fat. As you age, your eyelids stretch, and the muscles supporting them weaken. As a result, excess fat may gather above and below your eyelids, causing sagging eyebrows, droopy upper lids and bags under your eyes.

If you have surgery on your upper and lower eyelids, the surgeon generally works on your upper lids first. He or she cuts along the fold of the eyelid, removes some excess skin, muscle and possibly fat, and closes the cut.

On the lower lid, the surgeon makes a cut just below the lashes in your eye's natural crease or inside the lower lid. He or she removes or redistributes excess fat, muscle and sagging skin, and closes the cut.

If your upper eyelid droops close to your pupil, your surgeon may do blepharoplasty with a procedure called ptosis (TOE-sis) that provides additional support to the eyebrow muscle.

Resource: https://www.mayoclinic.org/tests-procedures/blepharoplasty/about/pac-20385174

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Rhinoplasty requires local anesthesia with sedation or general anesthesia, depending on how complex your surgery is and what your surgeon prefers. Discuss with your doctor before surgery which type of anesthesia is most appropriate for you.

  • Local anesthesia with sedation.This type of anesthesia is usually used in an outpatient setting. It's limited to a specific area of your body. Your doctor injects a pain-numbing medication into your nasal tissues and sedates you with medication injected through an intravenous (IV) line. This makes you groggy but not fully asleep.
  • General anesthesia.You receive the drug (anesthetic) by inhaling it or through a small tube (IV line) placed in a vein in your hand, neck or chest. General anesthesia affects your entire body and causes you to be unconscious during surgery. General anesthesia requires a breathing tube.

Rhinoplasty may be done inside your nose or through a small external cut (incision) at the base of your nose, between your nostrils. Your surgeon will likely readjust the bone and cartilage underneath your skin.

Resource: https://www.mayoclinic.org/tests-procedures/rhinoplasty/about/pac-20384532

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In gastric sleeve surgery, a surgeon removes part of the stomach and makes a narrow tube or "sleeve" out of the rest. The new, banana-shaped stomach is much smaller than the original stomach. After the operation, a person will eat less, feel full sooner, and be less hungry.

Gastric sleeve surgery is a major operation. Doctors will give you anesthesia so you sleep through the surgery. After you're asleep, the surgeon will take out three-quarters of your stomach, leaving you with a smaller banana-shaped stomach called the gastric sleeve.  

After the operation, you'll probably stay in the hospital for a couple of nights so doctors and nurses can monitor your recovery. They will give you medicine for pain or nausea (feeling sick), help you to get up and move around, and make sure you can drink liquids without throwing up.

Resource: https://kidshealth.org/en/teens/gastric-sleeve.html

Gastric sleeve surgery is a major operation. Doctors will give you anesthesia so you sleep through the surgery. After you're asleep, the surgeon will take out three-quarters of your stomach, leaving you with a smaller banana-shaped stomach called the gastric sleeve.  

After the operation, you'll probably stay in the hospital for a couple of nights so doctors and nurses can monitor your recovery. They will give you medicine for pain or nausea (feeling sick), help you to get up and move around, and make sure you can drink liquids without throwing up.

Resource: https://kidshealth.org/en/teens/gastric-sleeve.html

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Gastric bypass surgery is an operation that creates a small pouch to restrict food intake and bypasses a segment of the small intestine. In the gastric bypass procedure, a surgeon makes a direct connection from the stomach pouch to a lower segment of the small intestine, bypassing the duodenum (the first part of the small intestine) and some of the jejunum (the second part of the small intestine), delaying the mixing of ingested food and the digestive enzymes.

Roux-en-Y gastric bypass is the most common type of bariatric surgery. The surgeon begins by creating a small pouch by dividing the upper end of the stomach. This restricts the food intake. Next, a section of the small intestine is attached to the pouch to allow food to bypass the duodenum, as well as the first portion of the jejunum. The small intestine is re-connected 150 centimeters from the pouch to allow ingested food and digestive enzymes to mix.

Resource: https://my.clevelandclinic.org/departments/bariatric/treatments/gastric-bypass

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This procedure has been performed on many patients over the last several years and is accepted standard of care for patients with kidney stones that are large, very firm, or resistant to other forms of stone treatment. As such it has replaced open operations for kidney stones in the vast majority of patients.

Typically, the length of the surgery is three to four hours. The surgery is performed by making a small 1 cm incision in the patient’s flank area (Figure 1). A tube is placed through the incision into the kidney under x-ray guidance. A small telescope is then passed through the tube in order to visualize the stone, break it up and remove it from the body. If necessary a laser or other device called a lithotripter may be used to break up the stone before it can be removed. This procedure has resulted in significantly less post-operative pain, a shorter hospital stay, and earlier return to work and daily activities when compared to open stone surgery.

Resource: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/percutaneous-nephrolithonomy-pcnl

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Trans Ureteral Lithotripsy (TUL)

Ureteroscopy is a common procedure whereby a stone can be removed via a special telescope, or in certain instances, a laser can be used to break the stone up into very small bits that can be passed.  Ureteroscopy is done under anesthesia in the operating room.  It takes between 30 minutes and 2 hours depending on the stone and your anatomy, and can be very simple or quite complex.

The procedure first requires the doctor to look inside your bladder and to put in a special guide wire to allow the ureter to be entered.  X-rays may be done prior to the actual procedure to locate the stone, and the procedure is done with the aid of real-time x-ray (called fluoroscopy).  Depending on the location of the stone, either a shorter semi-rigid scope, or a longer flexible ureteroscope is then inserted into the ureter until the stone is located.

Occasionally the ureter must be dilated with a special balloon to allow the scope to be inserted. 

The ureteroscope is a special, very thin instrument used to look directly at and visualize the inside of the ureter. Some ureteroscopes are flexible like a small, very long straw. Others are more rigid and firm. Overall more than 400 ureteroscopic procedures are performed annually in our center.

Resource: http://www.iurtc.org.ir/en_us/Page/trans-ureteral-lithotripsy

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Transurethral Resection of the Prostate (TURP)

Transurethral resection of the prostate (TURP) is a surgery used to treat urinary problems due to an enlarged prostate.

A combined visual and surgical instrument (resectoscope) is inserted through the tip of your penis and into the tube that carries urine from your bladder (urethra). The prostate surrounds the urethra. Using the resectoscope, your doctor trims away excess prostate tissue that's blocking urine flow.

TURP is generally considered an option for men with moderate to severe urinary problems that haven't responded to medication. Traditionally, TURP has been considered the most effective treatment for an enlarged prostate.

TURP helps reduce urinary symptoms caused by benign prostatic hyperplasia (BPH), including:

  • Frequent, urgent need to urinate
  • Difficulty starting urination
  • Slow (prolonged) urination
  • Increased frequency of urination at night
  • Stopping and starting again while urinating
  • The feeling you can't completely empty your bladder
  • Urinary tract infections

Resource: https://www.mayoclinic.org/tests-procedures/turp/about/pac-20384880

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Before surgery, a complete blood count and liver function tests are usually obtained. Prophylactic treatment is given to prevent deep vein thrombosis. Use of prophylactic antibiotics is controversial; however, a dose may be given prior to surgery to prevent infection in certain people at high risk. Gas may be removed from the stomach with an OG or NG tube. A Foley catheter may be used to empty the patient's bladder.

In open cholecystectomy, a surgical incision of around 8 to 12 cm is made below the edge of the right rib cage and the gallbladder is removed through this large opening, typically using electrocautery. Open cholecystectomy is often done if difficulties arise during a laparascopic cholecystecomy, for example, the patient has unusual anatomy, the surgeon cannot see well enough through the camera, or the patient is found to have cancer. It can also be done if the patient has severe cholecystitis, emphysematous gallbladder, fistulization of gallbladder and gallstone ileuscholangitiscirrhosis or portal hypertension, and blood dyscrasias.

Resource: https://en.wikipedia.org/wiki/Cholecystectomy

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A laparoscopic cholecystectomy is a surgery during which the doctor removes your gallbladder. This procedure uses several small cuts instead of one large one.

A laparoscope, a narrow tube with a camera, is inserted through one incision. This allows your doctor to see your gallbladder on a screen. Your gallbladder is then removed through another small incision.

The procedure is used when you have stones in your gallbladder.

The gallbladder stores bile, a fluid made by your liver. Bile helps digest fats in the foods you eat. Gallstones can block the flow of bile in your digestive system. This blockage can cause bloating, nausea, vomiting, and pain in your abdomen, shoulder, back, or chest. Gallstones can also block the ducts that channel the bile from the liver or gallbladder to the intestine. Gallstones can cause the gallbladder to become infected. A blockage in the common bile duct can cause jaundice (yellowing of your skin or eyes) or irritate the pancreas.

Resource: https://my.clevelandclinic.org/health/treatments/7017-laparoscopic-cholecystectomy-gallbladder-removal

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Thyroidectomy is the removal of all or part of your thyroid gland. Your thyroid is a butterfly-shaped gland located at the base of your neck. It produces hormones that regulate every aspect of your metabolism, from your heart rate to how quickly you burn calories.

A thyroidectomy may be recommended for conditions such as:

  • Thyroid cancer.Cancer is the most common reason for thyroidectomy. If you have thyroid cancer, removing most, if not all, of your thyroid will likely be a treatment option.
  • Noncancerous enlargement of the thyroid (goiter).Removing all or part of your thyroid gland is an option if you have a large goiter that is uncomfortable or causes difficulty breathing or swallowing or, in some cases, if the goiter is causing hyperthyroidism.
  • Overactive thyroid (hyperthyroidism).Hyperthyroidism is a condition in which your thyroid gland produces too much of the hormone thyroxine. If you have problems with anti-thyroid drugs and don't want radioactive iodine therapy, thyroidectomy may be an option.
  • Indeterminate or suspicious thyroid nodules.Some thyroid nodules can't be identified as cancerous or noncancerous after testing a sample from a needle biopsy. Doctors may recommend that people with these nodules have thyroidectomy if the nodules have an increased risk of being cancerous.

Resource: https://www.mayoclinic.org/tests-procedures/thyroidectomy/about/pac-20385195

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Phaco

Before the phacoemulsification can be performed, one or more incisions are made in the eye to allow the introduction of surgical instruments. The surgeon then removes the anterior face of the capsule that contains the lens inside the eye. Phacoemulsification surgery involves the use of a machine with microprocessor-controlled fluid dynamics. These can be based on peristaltic or a venturi type of pump.

The phaco probe is an ultrasonic handpiece with a titanium or steel needle. The tip of the needle vibrates at ultrasonic frequency to sculpt and emulsify the cataract while the pump aspirates particles through the tip. In some techniques, a second fine steel instrument called a "chopper" is used from a side port to help with chopping the nucleus into smaller pieces. The cataract is usually broken into two or four pieces and each piece is emulsified and aspirated out with suction. The nucleus emulsification makes it easier to aspirate the particles. After removing all hard central lens nucleus with phacoemulsification, the softer outer lens cortex is removed with suction only.

Resource: https://en.wikipedia.org/wiki/Phacoemulsification

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