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Laparoscopic hloecystectomy
Laparoscopic cholecystectomy is a minimally invasive surgical procedure
used to treat gallbladder disease by removing the gallbladder with the
aid of a laparoscope. The surgery is performed under general anesthesia.
Almost routinely the patient returns home on the day of surgery with
minimal associated discomfort. The procedure affords a return to normal
activities considerably earlier than the traditional “open” gallbladder
surgery.
Patients with gallbladder disease usually present with symptoms of
indigestion, bloating, intolerances to certain foods, and pain or
discomfort in the upper mid abdomen and right upper abdomen.
The decision to perform cholecystectomy is made after a sonogram or
ultrasound of the gallbladder confirms the presence of gallstones,
infection, or obstruction of the gallbladder.
The procedure begins by the surgeon making several very small incisions
on the abdomen. The laparoscope, which is both a fiber optic light
source and video camera, is actually a small tubular instrument which is
inserted into the abdomen through one of the incisions. The other
incisions are used for operating instruments. A small amount of carbon
dioxide is used to temporarily inflate the abdomen for improved
visualization with the laparoscope. The artery supplying blood and the
duct or tube emptying the gallbladder are secured, and the gallbladder
then removed. When indicated, the surgeon may elect to take an x-ray
during the procedure to clarify that your remaining bile duct system is
normal. Very complex problems may factor in and make the traditional or
“open” type of gallbladder surgery necessary.
Breast and Mastectomy Surgery
Most abnormalities of the breast are diagnosed by screening mammography
(mammogram: a specialized x ray or the breast) or ultrasound (a
procedure that uses sound waves to locate lumps in the breast which is
similar to the sonar that ships use to detect objects underwater).
Often, however, the patient or primary doctor feels a lump in the breast
on physical exam, this is called a palpable lesion and may or may not
show up on mammography or ultrasound.
Breast Biopsy
The first step in the diagnosis of a breast abnormality is to determine
the risk that the lesion may be a malignancy, a breast cancer. Features
of the abnormality (size, location, firmness, regularity) and the
patient (age, family history, number of pregnancies) help determine this
risk. If there is a chance the abnormality could be a cancer, a biopsy
of the lesion is recommended. Generally a small needle is guided into
the lesion with mammography or ultrasound to assure that the needle cuts
out a small (less than a millimeter) piece of tissue from the lesion.
The skin is anesthetized prior to the biopsy; however, breast tissue is
very sensitive and the procedure is somewhat uncomfortable and the area
of the biopsy is sore for several days. In some cases, an open biopsy is
indicated and a small surgical incision is made on the breast and the
entire lump is removed. This can be done with a wide area of the breast
anesthetized with local anesthetic, or the patient can be put to sleep
with a general anesthetic for the procedure. With either technique, the
biopsy is done in the operating room as an outpatient procedure.
Carcinoma In Situ, Precancerous Lesions
If the lesion is a precancerous lesion, the lesion and surrounding
normal breast tissue must be removed, this is called a segmental
mastectomy or lumpectomy. This procedure is similar to the open breast
biopsy. In the lesion is non-palpable, cannot be felt, a special wire
must be placed in the breast at the site of the lesion with mammography
or ultrasound guidance immediately prior to the surgery to allow the
surgeon to remove the proper tissue.
Breast Cancer
If the lesion is proven to be a breast cancer, the patient has many
options. The goal of treating a patient with breast cancer is to
maximize the chance of cure; however, many of the treatment pathways
arrive at the same point with very different effects and side effects on
the patient. It is important that the patient is involved in the
decision making process and tell the doctors what factors are most
important to her to help tailor the most appropriate therapy.
Neo-adjuvant Therapy
Most women will get surgery and chemotherapy. Generally, surgery is
first with chemotherapy afterward based on the findings at surgery.
Sometimes, chemotherapy and even radiation therapy is recommended prior
to surgery, this is termed neo-adjuvant therapy. A woman should be aware
of the risks, benefits and side effects of these two treatment pathways
and be involved in the decision process since the different pathways may
have very different challenges to her lifestyle.
Breast Conserving Therapy vs. Total Mastectomy
There are also two different types of surgery that offer similar cure
rates. One is to remove only the cancer and a small amount of
surrounding tissue (the margin) and then follow surgery with 4-6 weeks
of radiation treatments to the breast. This breast conserving therapy,
segmental mastectomy and radiation therapy, is equivalent to surgically
removing the entire breast, total mastectomy, as far as the chances for
curing the cancer. The choice of operations really depends on the
personal preferences of the woman and both operations are still
performed regularly. After removal of the whole breast there are many
options for immediate or delayed reconstruction of the breast in
conjunction with a plastic surgeon. This may involve breast implants or
using extra skin, fat and muscle from the abdomen to recreate a breast
using the woman’s own body tissues.
Axillary Lymph Nodes
The next step in the management of breast cancer is to assess the lymph
nodes under the arm (axilla) on the same side as the breast cancer as
this is the first place the cancer generally spreads. If the lymph nodes
are obviously enlarged, the entire mass of lymph nodes will be removed
at the time the breast cancer is removed. An axillary lymph node
dissection is done in addition to the segmental mastectomy for breast
conserving surgery, or the lymph nodes are removed with the entire
breast and the procedure is called a modified radical mastectomy.
If the cancer is small and the axillary lymph nodes are not likely
obviously enlarged, a special procedure may be done to remove only 1-3
lymph nodes to make sure there is no cancer in them and spare the
patient the risks involved with removing all the lymph nodes. This
procedure is called sentinel lymph node biopsy and uses a blue dye and a
short acting radioactive tracer to identify the lymph nodes most likely
to have cancer in them so only they are removed and examined. If the
sentinel lymph nodes do have cancer in then, all the axillary lymph
nodes should be removed or receive radiation therapy to prevent
recurrence of cancer in the axilla (the underarm). The spread of cancer
to the lymph nodes also changes the prognosis (chance for cure) and
changes the types of chemotherapy that may be offered.
The treatment of breast disease and breast cancer has many different
options, many of which are equally effective. There is no “one size fits
all” treatment, and many of the treatments have very different effects
on the appearance and independence of the patient. At Coast Surgical
Group, we encourage women to become informed as to the risks, benefits,
procedures and side effects of the various treatment options and help us
make the most appropriate treatment plans to suit their individual
needs.
Colon Surgery
The colon or large intestine is the last portion of the intestinal tract
its primary role is to absorb water and temporarily store waste
material. The colon is divided into several segments based on the
divisions of the blood vessels feeding it. These segments are the right
colon, the transverse colon, the descending colon, the sigmoid colon and
the rectum.
The indications for surgery on the colon are tumors, colon cancer or
large precancerous polyps, infections such as diverticulitis and
perforations, and bleeding from tumors, diverticulosis or abnormal blood
vessels called arteriovenous malformations (AVM’s). Surgical removal of
the colon is called a colectomy. Surgeons generally remove the segment (hemicolectomy
or partial colectomy) that contains the tumor, infection or bleeding
site. Other diseases such as ulcerative colitis and familial polyposis
involve the entire colon and require a subtotal or total colectomy.
The colon is not essential and many people have their entire colon
removed and lead a normal life. On rare occasions, the remaining colon
or small intestine is attached to the skin on the anterior abdomen and
drains into a bag, a colostomy. This is generally a temporary condition
and a second operation can be performed to reattach the beginning part
of the colon to the final part of the colon, the rectum, to return
normal bowel function. If the distal rectum is the site of the disease,
then the colostomy may be permanent.
Prior to surgery, patients must take a “bowel prep” that consists of a
liquid diet, strong laxatives and antibiotic tablets over two days to
reduce the bacteria in the colon to make surgery safer. This is
generally done at home. Colon surgery requires a general anesthetic and
takes from 1 ½ to 3 ½ hours. Patients generally need to stay in the
hospital from 5 to 10 days after surgery and are fully recovered in 4 to
six weeks.
In some circumstances, colon surgery can be preformed laparoscopically.
In this case, a series of small incisions are made and a TV camera and
long thin instruments are inserted into the abdomen. The identical
surgery is then performed but without a large incision (opening) into
the abdominal cavity. With the smaller incisions, the hospital stay and
recovery period are shortened. This is a relatively new procedure and is
used only in specific situations, but may be used more generally in the
future as experience with the procedure around the world grows.
Laparoscopic Splenectomy
Laparoscopic splenectomy entails removing the spleen using minimally
invasive surgical techniques. The spleen, located in the left upper
quadrant of the abdomen, is an organ that helps fight infections and
filters out old red blood cells. Indications for spleen removal include
traumatic injury (such as a motor vehicle accident), disorders of
premature destruction of red blood cells, and certain cancers of blood
and lymphatic tissues (leukemias and lymphomas). Spleen removal usually
does not result in lasting negative effects in the vast majority of
patients. Prior to splenectomy (spleen removal), patients usually
receive a vaccine (pneumovax) to protect against certain infections.
Splenectomy requires a general anesthetic. During laparoscopic
splenectomy, the surgeon makes several small incisions ranging in size
from a ¼ inch to 2 inches. The incisions are used to insert “ports”
which allow mobilization of the spleen from its various attachments to
surrounding organs and structures such as the colon and diaphragm. The
detached spleen is then placed inside a “bag” that has been inserted
into the abdominal cavity. One of the incisions is then enlarged
slightly to allow the lip of the bag to be brought out to the surface.
The spleen is then removed out of the bag in a piecemeal fashion.
Patients undergoing laparoscopic splenectomy versus open splenectomy
usually have shorter hospital stays and faster recovery with less pain.
As a result, they can resume their normal activities sooner. Traumatic
injuries to the spleen or bleeding complications during the surgery may
require open splenectomy.
Bloodless Medicine & Surgery
Bloodless medicine and surgery is an advanced method of treating
patients who, for religious or personal reasons, choose to receive care
without the use of donated blood or blood products. Bloodless surgery
uses sophisticated techniques before, during and after surgery to ensure
patients have and maintain a safe and effective volume of their own
blood. With bloodless surgery, patients can avoid the risk of
communicable diseases and allergic reactions sometimes associated with
donated blood, and also help relieve the stress on the nation’s
overburdened donated blood supply system. Studies have shown that
bloodless surgery can help reduce the incidence of post-surgical
infection, speed healing, reduce hospital stays, and lower medical
costs.
Anal - Rectal Problems
Probably since the origin of our species man has been plagued with
hemorrhoidal and other anal-rectal problems. Modern man however, has
seen an increase in the incident of these conditions that rob him of his
well-being, workday, and peace of mind.
Not all painful and-rectal conditions are hemorrhoid related. Others,
such as fissures, abscesses, fistulas, and cancers can give rise to pain
and bleeding. Passage of blood with stools is probably the most common
complaint of our patients, although usually related to bleeding internal
hemorrhoids, may represent any of the other conditions mentioned above.
Our modern urban lifestyles with its unhealthy diets and lack of
physical activity are probably the greatest contributor to the increase
in problems of the ano-rectal area. Likewise, these problems can be
prevented by a change in lifestyles to incorporate a diet rich in fiber
and a regimented exercise program.
Surgery for these conditions should be reserved as a treatment of last
resort. Once a qualified physician establishes the diagnosis of a
condition, a treatment plan can be instituted.
Symptoms that should be brought to the attention of you physician are:
anal pain, bleeding, change in bowel habits (diarrhea and constipation),
and mass formation (lumps or bumps).
Thyroid Surgery
Thyroid surgery is sometimes used to treat conditions that affect the
thyroid gland. Physicians typically prefer to avoid treating thyroid
conditions with surgery whenever possible. However, surgery is usually
necessary in patients with thyroid cancer and for patients whose thyroid
condition fails to respond to other treatment methods.
The thyroid is a butterfly-shaped gland that sits just below the Adam’s
apple in the neck. It secretes hormones that regulate a person’s
metabolism, the physical and chemical processes necessary for the
maintenance of life. Various disorders may affect the thyroid and
prevent or cause excessive release of these hormones. This alters a
person’s metabolism and may lead to significant health problems.
Surgery may be used to treat various cancerous (malignant) and
noncancerous (benign) thyroid conditions. Most often, it is used to
treat growths of cells in the thyroid that form a lump (thyroid
nodules). Surgery is typically recommended if cancer is discovered and
is usually recommended if cancer is suspected. Additional options for
cancer after surgery is performed include thyroid hormone therapy,
radioactive iodine therapy, external-beam radiation therapy or
chemotherapy.
If analysis reveals that the nodule tissue is noncancerous (benign),
experts generally recommend alternative therapies such as antithyroid
medications or no treatment. However, surgery sometimes is performed if
the benign nodule continues to grow larger or if it causes pain,
swallowing problems or other significant symptoms.
Other thyroid conditions that may require surgery include:
Enlarged thyroid (goiter). This can be felt or even seen as a swelling
at the base of the neck. It often results from hyperthyroidism
(overactive thyroid gland) or hypothyroidism (underactive thyroid
gland). Surgery is usually used for this condition if the goiter becomes
so large that it impairs a patient’s ability to breathe, or if it
impinges upon the esophagus or blood vessels. Surgery may also be
recommended if other treatments, such as medications, fail to work.
Hyperthyroidism. Hyperthyroidism is a condition in which overactivity of
the thyroid gland causes too much thyroid hormone to build up in the
bloodstream. As a result, processes in the body speed up. Left
untreated, hyperthyroidism can have serious health consequences.
Thyroiditis. Inflammation of the thyroid
requires surgery only in unusual cases. For example, a rare condition
called Riedel’s thyroiditis can spread in the neck and impede
swallowing or breathing, necessitating surgery to remove all or part of
the inflamed thyroid.
Surgery may also be recommended if the patient’s thyroid disorder cannot
be controlled with medication because of pregnancy or other conditions.
Though thyroid surgery involves some risks, the prognosis usually is
excellent when skilled and experienced endocrine surgeons perform the
procedure. |
