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ICD-10 code:
Other codes:
A craniotomy is a surgical operation in which part of the skull, called a bone flap, is removed in
order to access the brain. Craniotomies are often a critical operation performed on patients
suffering from brain lesions or traumatic brain injury (TBI), and can also allow doctors to
surgically implant deep brain stimulators for the treatment of Parkinson's disease, epilepsy and
cerebellar tremor. The procedure is also widely used in neuroscience for extracellular recording,
brain imaging, and for neurological manipulations such as electrical stimulation and chemical
titration.
Human craniotomy is usually performed under general anesthesia but can be also done with the
patient awake using a local anaesthetic; the procedure generally does not involve significant
discomfort for the patient. In general, a craniotomy will be preceded by an MRI scan which
provides a picture of the brain that the surgeon uses to plan the precise location for bone removal
and the appropriate angle of access to the relevant brain areas. The amount of skull that needs to
be removed depends to a large extent on the type of surgery being performed. Most small holes
can heal with no difficulty. When larger parts of the skull must be removed, surgeons will usually
try to retain the bone flap and replace it immediately after surgery. It is held in place temporarily
with metal plates and rather quickly reintegrates with the intact part of the skull, at which point
the metal plates are removed.
Craniotomy is distinguished from craniectomy, in which the skull flap is not replaced, and from
trepanation, which is performed voluntarily without medical necessity.
Decompressive craniectomy
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Intervention:
Decompressive craniectomy
ICD-10 code:
Other codes:
The National Emphysema Treatment Trial has examined the results of LVRS. The results of this study
report that people not considered good candidates for this surgery include people who have:2
• Severely impaired lung function as measured by breathing tests or a uniform pattern of emphysema
throughout the lungs.
• Largely non-upper lung emphysema and who are able to exercise for a longer time than other people with
COPD.
• Certain other serious medical problems.
For other people LVRS, compared to medical treatment, may provide an increased ability to exercise and
may result in fewer symptoms. LVRS also can reduce the number of COPD exacerbations for some
people.3 But it does not improve the survival rate compared to medical treatment, except for people who
have emphysema mainly in the upper portion of the lungs and who are not able to exercise well even
after pulmonary rehabilitation.4
Although selecting candidates for LVRS is subjective, criteria identifying good candidates for LVRS
include people:5
• Who have severe emphysema that does not respond to medical therapy.
• Who are younger than 75 to 80 years old.
• Who have not smoked for at least 4 months.
• Who have reasonable expectations of surgery results.
• Who have areas of the lung that can be targeted.
• Who have severe difficulty breathing, as determined by breathing tests.
Decision to have the surgery
The decision to have this surgery is not an easy one. Not all patients who have emphysema or COPD will
benefit from this surgery. Detailed testing is needed to find out if a person is likely to be helped by LVRS.
Talk with your doctor about all of the treatment options available for COPD.
Lung transplant surgery has been found to help people with COPD for at least 3 to 4 years after surgery.
A transplant can improve breathing and quality of life. But the long-term benefit of lung transplant for
people with COPD is not yet known.
Criteria have not been firmly established for selecting people with COPD to have a lung transplant. Lung
transplant for people with COPD may be considered for those who:
Bullae sometimes can become so large that they interfere with breathing and may cause complications:
• They can burst, leading to a collapsed lung (pneumothorax). A collapsed lung will often need treatment
with a chest tube.
• They can become infected, leading to an abscess in the lung that can spread to the pleural cavity (the
space between the lung and the membrane that surrounds it). This condition (empyema) can be difficult
to resolve and often requires extensive treatment with antibiotics.
For some people, surgically removing the enlarged air sacs-known as a bullectomy-makes breathing
easier. However, few people are considered good candidates for a bullectomy. It may work best for
people with COPD who are young, have large bullae that are grouped in just one area of the lung, and do
not have severe blockage in their airways.1 A bullectomy may be considered if the bullae:
• Are larger than one-third of a lung.
• Prevent the lung from expanding so the person cannot move enough air into his or her lungs.
Bullectomy may make the lungs work better so more oxygen gets into the blood.
If there are many bullae spread throughout the lungs, surgery is not likely to be helpful. In this case, other
areas of the lung often become damaged after the surgery. The best surgical results are obtained when
there is only one bulla or only a few that are all clustered in one area.
Long-term follow-up studies have begun to show that within 3 to 5 years after surgery, lung function
deteriorates to the level it was before surgery.2
The decision about whether to perform the surgery is difficult and usually is based on the doctor's
experience and the person's overall condition.
Bullae can be removed using a laser, but this method has not been found to have an advantage over
traditional surgery.
Lumpectomy
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Lumpectomy is a common surgical procedure designed to remove a discrete lump, usually a
tumor, benign or otherwise, from an affected man or woman's breast. As the tissue removed is
generally quite limited and the procedure relatively non-invasive, compared to a mastectomy, a
lumpectomy is considered a viable means of "breast conservation" or "breast preservation"
surgery with all the attendant physical and emotional advantages of such an approach.
Mastectomy
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In medicine, mastectomy is the medical term for the surgical removal of one or both breasts,
partially or completely. Mastectomy is usually done to treat breast cancer; in some cases, women
and some men believed to be at high risk of breast cancer have the operation prophylactically,
that is, to prevent cancer rather than treat it. It is also the medical procedure carried out to
remove breast cancer tissue in males. Alternatively, certain patients can choose to have a wide
local excision, also known as a lumpectomy, an operation in which a small volume of breast
tissue containing the tumor and some surrounding healthy tissue is removed to conserve the
breast. Both mastectomy and lumpectomy are what are referred to as "local therapies" for breast
cancer, targeting the area of the tumor, as opposed to systemic therapies such as chemotherapy,
hormonal therapy, or immunotherapy.
Traditionally, in the case of breast cancer, the whole breast was removed. Currently the decision
to do the mastectomy is based on various factors including breast size, number of lesions,
biologic aggressiveness of a breast cancer, the availability of adjuvant radiation, and the
willingness of the patient to accept higher rates of tumor recurrences after lumpectomy and
radiation. Outcome studies comparing mastectomy to lumpectomy with radiation have suggested
that routine radical mastectomy surgeries will not always prevent later distant secondary tumors
arising from micro-metastases prior to discovery, diagnosis, and operation.
Contents
[hide]
• 1 Rates
• 2 Mastectomy
indications
• 3 Types of mastectomy
• 4 Gallery
• 5 See also
• 6 References
• 7 External links
[edit] Rates
Mastectomy patient
Mastectomy rates vary tremendously world-wide, as was documented by the 2004 'Intergroup
Exemestane Study',[1] an analysis of surgical techniques used in an international trial of adjuvant
treatment among 4,700 women with early breast cancer in 37 countries. The mastectomy rate
was highest in central and eastern Europe at 77%. The USA had the second highest rate of
mastectomy with 56%, western and northern Europe averaged 46%, southern Europe 42% and
Australia and New Zealand 34%.
Cardiac surgery is surgery on the heart and/or great vessels performed by a cardiac surgeon.
Frequently, it is done to treat complications of ischemic heart disease (for example, coronary
artery bypass grafting), correct congenital heart disease, or treat valvular heart disease created by
various causes including endocarditis. It also includes heart transplantation.
Open heart surgery
This is a surgery in which the patient's chest is opened and surgery is performed on the heart. The
term "open" refers to the chest, not to the heart itself. The heart may or may not be opened
depending on the particular type of surgery. Surgeons realized the limitations of hypothermia -
complex intracardiac repairs take more time and the patient needs blood flow to the body (and
particularly the brain); the patient needs the function of the heart and lungs provided by an
artificial method, hence the term cardiopulmonary bypass. Dr. John Heysham Gibbon at
Jefferson Medical School in Philadelphia reported in 1953 the first successful use of
extracorporeal circulation by means of an oxygenator, but he abandoned the method,
disappointed by subsequent failures. In 1954 Dr. Lillehei realized a successful series of
operations with the controlled cross-circulation technique in which the patient's mother or father
was used as a 'heart-lung machine'. Dr. John W. Kirklin at the Mayo Clinic in Rochester,
Minnesota started using a Gibbon type pump-oxygenator in a series of successful operations, and
was soon followed by surgeons in various parts of the world.
Dr. Nazih Zudhi worked for four years under Drs. Clarence Dennis, Karl Karlson, and Charles
Fries, who built an early pump-oxygenator. Zudhi and Fries worked on several designs and re-
designs of Dennis' earlier model from 1952-1956 at the Brooklyn Center. Zuhdi then went to
work with Dr. C. Walton Lillehei at the University of Minnesota. Lillehei had designed his own
version of a cross-circulation machine, which came to become known as the DeWall-Lillehei
heart-lung machine. Zudhi worked on perfusion and blood flow trying to solve the problem of air
bubbles while bypassing the heart so the heart could be stopped for the operation. Zudhi moved
to Oklahoma City, OK, in 1957, and began working at the Oklahoma University College. Zudhi,
the heart surgeon, teamed up with Dr. Allen Greer, a lung surgeon and Dr. John Carey, forming a
three man open heart surgery team. With the advent of Dr. Zudhi's heart-lung machine which was
modified in size, being much smaller than the DeWall-Lillhei heart-lung machine, and with other
modifications, reduced the need for blood down to a minimal amount, and the cost of the
equipment down to $500.00 and also reduced the prep time from two hours to 20 minutes. Dr.
Zudhi performed the first Total Intentional Hemodilution open heart surgery on Terry Gene Nix,
age 7, on February 25, 1960, at Mercy Hospital, Oklahoma City, OK. The operation was a
success; however, Nix died three years later in 1963.[7] In March, 1961, Zudhi, Carey, and Greer,
performed open heart surgery on a child, age 3 1/2, using the Total Intentional Hemodilution
machine, with success. That patient is still alive.[8]
[edit] Modern beating-heart surgery
Since the 1990s, surgeons have begun to perform "off-pump bypass surgery" - coronary artery
bypass surgery without the aforementioned cardiopulmonary bypass. In these operations, the
heart is beating during surgery, but is stabilized to provide an almost still work area. Some
researchers believe this approach results in fewer post-operative complications (such as
postperfusion syndrome) and better overall results (study results are controversial as of 2007, the
surgeon's preference and hospital results still play a major role).
[edit] Minimally invasive surgery
A new form of heart surgery that has grown in popularity is robot-assisted heart surgery. This is
where a machine is used to perform surgery while being controlled by the heart surgeon. The
main advantage to this is the size of the incision made in the patient. Instead of an incision being
at least big enough for the surgeon to put his hands inside, it does not have to be bigger than 3
small holes for the robot's much smaller hands to get through. Also, a major advantage to the
robot is the recovery time of the patient, instead of months of recovery time, some patients have
recovered and resumed playing athletics in a matter of weeks.[citation needed]
[edit] Risks
The development of cardiac surgery and cardiopulmonary bypass techniques has reduced the
mortality rates of these surgeries to relatively low levels. For instance, repairs of congenital heart
defects are currently estimated to have 4-6% mortality rates.[9][10]
A major concern with cardiac surgery is the incidence of neurological damage. Stroke occurs in
2-3% of all people undergoing cardiac surgery, and is higher in patients at risk for stroke.[citation
needed]
A more subtle constellation of neurocognitive deficits attributed to cardiopulmonary bypass
is known as postperfusion syndrome (sometimes called 'pumphead'). The symptoms of
postperfusion syndrome were initially felt to be permanent,[11] but were shown to be transient
with no permanent neurological impairment.[12]
Cardiopulmonary bypass
Cardiopulmonary bypass (CPB) is a technique that temporarily takes over the function of the
heart and lungs during surgery, maintaining the circulation of blood and the oxygen content of
the body. The CPB pump itself is often referred to as a Heart-Lung Machine or the Pump.
Cardiopulmonary bypass pumps are operated by allied health professionals known as
perfusionists in association with surgeons who connect the pump to the patient's body. CPB is a
form of extracorporeal circulation.
Coronary artery bypass surgery, also coronary artery bypass graft surgery, and colloquially
heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce
the risk of death from coronary artery disease. Arteries or veins from elsewhere in the patient's
body are grafted to the coronary arteries to bypass atherosclerotic narrowings and improve the
blood supply to the coronary circulation supplying the myocardium (heart muscle). This surgery
is usually performed with the heart stopped, necessitating the usage of cardiopulmonary bypass;
techniques are available to perform CABG on a beating heart, so-called "off-pump" surgery.
Complications
People undergoing coronary artery bypass are at risk for the same complications as any surgery,
plus some risks more common with or unique to CABG.
[edit] CABG associated
• Postperfusion syndrome (pumphead), a transient neurocognitive impairment
associated with cardiopulmonary bypass. Some research shows the incidence
is initially decreased by off-pump coronary artery bypass, but with no
difference beyond three months after surgery. A neurocognitive decline over
time has been demonstrated in people with coronary artery disease
regardless of treatment (OPCAB, conventional CABG or medical
management).
• Nonunion of the sternum; internal thoracic artery harvesting devascularizes
the sternum increasing risk.
• Myocardial infarction due to embolism, hypoperfusion, or graft failure.
• Late graft stenosis, particularly of saphenous vein grafts due to
atherosclerosis causing recurrent angina or myocardial infarction.
• Acute renal failure due to embolism or hypoperfusion.
• Stroke, secondary to embolism or hypoperfusion.
[edit] General surgical
• Infection at incision sites or sepsis.
• Deep vein thrombosis (DVT)
• Anesthetic complications such as malignant hyperthermia.
• Keloid scarring
• Chronic pain at incision sites
• Chronic stress related illnesses
• Death
General
[edit] Risks
The development of cardiac surgery and cardiopulmonary bypass techniques has reduced the
mortality rates of these surgeries to relatively low levels. For instance, repairs of congenital heart
defects are currently estimated to have 4-6% mortality rates.[9][10]
A major concern with cardiac surgery is the incidence of neurological damage. Stroke occurs in
2-3% of all people undergoing cardiac surgery, and is higher in patients at risk for stroke.[citation
needed]
A more subtle constellation of neurocognitive deficits attributed to cardiopulmonary bypass
is known as postperfusion syndrome (sometimes called 'pumphead'). The symptoms of
postperfusion syndrome were initially felt to be permanent,[11] but were shown to be transient
with no permanent neurological impairment.[12]
Thoracic surgery
Thoracic surgery is the field of medicine involved in the surgical treatment of diseases affecting
organs inside the thorax (the chest). Generally treatment of conditions of the lungs, [[chest wall],
and diaphragm.
Thoracic surgery is often grouped with cardiac surgery and called cardiothoracic surgery.
"According to a June, 2003 article in the Annals of Thoracic Surgery, the workforce currently
appears "right sized," although the workforce survey cited indicates significant retirement during
the next 10 to 15 years. The annual salary for thoracic surgeons ranges from $218,550 to
$533,000".
Abdominal surgery
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The term abdominal surgery broadly covers surgical procedures that involve opening the
abdomen. Surgery of each abdominal organ is dealt with separately in connection with the
description of that organ (see stomach, kidney, liver, etc.) Diseases affecting the abdominal
cavity are dealt with generally under their own names (e.g. appendicitis).
Contents
[hide]
• 1 Types
• 2 Complications
• 3 See also
• 4 References
[edit] Types
The three most common abdominal surgeries are described below.
• Exploratory Laparotomy -- This refers to the opening of the abdominal cavity
for direct examination of its contents, for example, to locate a source of
bleeding or trauma. It may or may not be followed by repair or removal of the
primary problem.
• Appendectomy -- Surgical opening of the abdominal cavity and removal of
the appendix. Typically performed as definitive treatment for appendicitis,
although sometimes the appendix is prophylactically removed incidental to
another abdominal procedure.
• Laparoscopy -- A minimally invasive approach to abdominal surgery where
rigid tubes are inserted through small incisions into the abdominal cavity. The
tubes allow introduction of a small camera, surgical instruments, and gases
into the cavity for direct or indirect visualization and treatment of the
abdomen. The abdomen is inflated with carbon dioxide gas to facilitate
visualization and, often, a small video camera is used to show the procedure
on a monitor in the operating room. The surgeon manipulates instruments
within the abdominal cavity to perform procedures such as cholecystectomy
(gallbladder removal), the most common laparoscopic procedure. The
laparoscopic method speeds recovery time and reduces blood loss and
infection as compared to the traditional "open" cholecystectomy.
[edit] Complications
Complications of abdominal surgery include
• bleeding,
• infection,
• post-surgical adhesions
• shock, and
• ileus, or more commonly Paralytic ileus (short-term paralysis of the bowel)
Sterile technique, aseptic post-operative care, antibiotics, and vigilant post-operative monitoring
greatly reduce the risk of these complications. Planned surgery performed under sterile
conditions is much less risky than that performed under emergency or unsterile conditions. The
contents of the bowel are unsterile, and thus leakage of bowel contents, as from trauma,
substantially increases the risk of infection
Laparotomy
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Intervention:
Laparotomy
Abdominal cavity
ICD-10 code:
Other codes:
A laparotomy is a surgical procedure involving an incision through the abdominal wall to gain
access into the abdominal cavity. It is also known as coeliotomy.
Contents
[hide]
• 1 Terminology
• 2 Spaces accessed
• 3 Types of incisions
○ 3.1 Midline
○ 3.2 Other
• 4 Related procedures
• 5 References
• 6 External links
[edit] Terminology
In diagnostic laparotomy (most often referred to as an exploratory laparotomy and abbreviated
Ex-Lap), the nature of the disease is unknown, and laparotomy is deemed the best way to identify
the cause.
In therapeutic laparotomy, a cause has been identified (e.g. peptic ulcer, colon cancer) and
laparotomy is required for its therapy.
Usually, only exploratory laparotomy is referred to as a surgical operation by itself; and when a
specific operation is already planned, laparotomy is considered merely the first step of the
procedure.
Appendicectomy
From Wikipedia, the free encyclopedia
(Redirected from Appendectomy)
An appendicectomy in progress
Contents
[hide]
• 1 Prophylactic
appendicectomy
• 2 Pregnancy
• 3 Recovery
• 4 References
• 5 External links
[edit] Pregnancy
If appendicitis develops in a pregnant woman, an appendicectomy is usually performed and
should not harm the fetus.[1] The risk of fetal death in the perioperative period after an
appendectomy for early acute appendicitis is 3% to 5%. The risk of fetal death is 20% in
perforated appendicitis. [2]
[edit] Recovery
This section does not cite any references or sources. Please help improve this
article by adding citations to reliable sources. Unverifiable material may be
challenged and removed. (February 2008)
Recovery time from the operation varies from person to person. Some will take up to three
weeks before being completely active; for others it can be a matter of days. In the case of a
laparoscopic operation, the patient will have three stapled scars of about an inch in length,
between the navel and pubic hair line. When a laparotomy has been performed the patient will
have a 2-3 inch scar, which will initially be heavily bruised.
Laparoscopic surgery
From Wikipedia, the free encyclopedia
(Redirected from Laparoscopy)
Laparoscopic surgery, also called minimally invasive surgery (MIS), bandaid surgery, keyhole
surgery is a modern surgical technique in which operations in the abdomen are performed
through small incisions (usually 0.5-1.5cm) as compared to larger incisions needed in traditional
surgical procedures. Laparoscopic surgery includes operations within the abdominal or pelvic
cavities, whereas keyhole surgery performed on the thoracic or chest cavity is called
thoracoscopic surgery. Laparoscopic and thoracoscopic surgery belong to the broader field of
endoscopy.
The key element in laparoscopic surgery is the use of a laparoscope. There are two types: 1)a
telescopic rod lens system, that is usually connected to a video camera (single chip or three chip)
or a digital laparoscope where the charge-coupled device is placed at the end of the laparoscope,
eliminating the rod lens system.[1] Also attached is a fiber optic cable system connected to a 'cold'
light source (halogen or xenon), to illuminate the operative field, inserted through a 5 mm or 10
mm cannula or trocar to view the operative field. The abdomen is usually insufflated with carbon
dioxide gas to create a working and viewing space. The abdomen is essentially blown up like a
balloon (insufflated), elevating the abdominal wall above the internal organs like a dome. The
gas used is CO2, which is common to the human body and can be absorbed by tissue and
removed by the respiratory system. It is also non-flammable, which is important because
electrosurgical devices are commonly used in laparoscopic procedures.
Contents
[hide]
• 1 History
• 2 Procedures
• 3 Advantages
• 4 Risks
• 5 Robotics and technology
• 6 Non-robotic hand guided assistance
systems
• 7 See also
• 8 References
• 9 External links
[edit] History
It is difficult to credit one individual with the pioneering of laparoscopic approach. In 1902
Georg Kelling, of Dresden, Saxony, performed the first laparoscopic procedure in dogs and in
1910 Hans Christian Jacobaeus of Sweden reported the first laparoscopic operation in humans. In
the ensuing several decades, numerous individuals refined and popularized the approach further
for laparoscopy. The introduction of computer chip television camera was a seminal event in the
field of laparoscopy. This innovation in technology provided the means to project a magnified
view of the operative field onto a monitor, and at the same time freed both the operating
surgeon's hands, thereby facilitating performance of complex laparoscopic procedures. Prior to
its conception, laparoscopy was a surgical approach with very limited application and used
mainly for purposes of diagnosis and performance of simple procedures in gynecologic
applications.
The introduction in 1990 of a laparoscopic clip applier with twenty automatically advancing
clips (rather than a single load clip applier that would have to be taken out, reloaded and
reintroduced for each clip application) made surgeons more comfortable with making the leap to
laparoscopic cholecystectomies (gall bladder removal). On the other hand, some surgeons
continue to use the single clip appliers as they save as much as $200 per case for the patient,
detract nothing from the quality of the clip ligation, and add only seconds to case lengths.
[edit] Procedures
Laparoscopic cholecystectomy is the most common laparoscopic procedure performed. In this
procedure, 5-10mm diameter instruments (graspers, scissors, clip applier) can be introduced by
the surgeon into the abdomen through trocars (hollow tubes with a seal to keep the CO2 from
leaking). Rather than a minimum 20cm incision as in traditional cholecystectomy, four incisions
of 0.5-1.0cm will be sufficient to perform a laparoscopic removal of a gallbladder. Since the gall
bladder is similar to a small balloon that stores and releases bile, it can usually be removed from
the abdomen by suctioning out the bile and then removing the deflated gallbladder through the
1cm incision at the patient's navel. The length of postoperative stay in the hospital is minimal,
and same-day discharges are possible in cases of early morning procedures.
In certain advanced laparoscopic procedures where the size of the specimen being removed
would be too large to pull out through a trocar site, as would be done with a gallbladder, an
incision larger than 10mm must be made. The most common of these procedures are removal of
all or part of the colon (colectomy), or removal of the kidney (nephrectomy). Some surgeons
perform these procedures completely laparoscopically, making the larger incision toward the end
of the procedure for specimen removal, or, in the case of a colectomy, to also prepare the
remaining healthy bowel to be reconnected (create an anastomosis). Many other surgeons feel
that since they will have to make a larger incision for specimen removal anyway, they might as
well use this incision to have their hand in the operative field during the procedure to aid as a
retractor, dissector, and to be able to feel differing tissue densities (palpate), as they would in
open surgery. This technique is called hand-assist laparoscopy. Since they will still be working
with scopes and other laparoscopic instruments, CO2 will have to be maintained in the patient's
abdomen, so a device known as a hand access port (a sleeve with a seal that allows passage of
the hand) must be used. Surgeons that choose this hand-assist technique feel it reduces operative
time significantly vs. the straight laparoscopic approach, as well as providing them more options
in dealing with unexpected adverse events (i.e. uncontrolled bleeding) that may otherwise require
creating a much larger incision and converting to a fully open surgical procedure.
Conceptually, the laparoscopic approach is intended to minimise post-operative pain and speed
up recovery times, while maintaining an enhanced visual field for surgeons. Due to improved
patient outcomes, in the last two decades, laparoscopic surgery has been adopted by various
surgical sub-specialties including gastrointestinal surgery (including bariatric procedures for
morbid obesity), gynecologic surgery and urology. Based on numerous prospective randomized
controlled trials, the approach has proven to be beneficial in reducing post-operative morbidities
such as wound infections and incisional hernias (especially in morbidly obese patients), and is
now deemed safe when applied to surgery for cancers such as cancer of colon.
The restricted vision, the difficulty in handling of the instruments (new hand-eye coordination
skills are needed), the lack of tactile perception and the limited working area are factors which
add to the technical complexity of this surgical approach. For these reasons, minimally invasive
surgery has emerged as a highly competitive new sub-specialty within various fields of surgery.
Surgical residents who wish to focus on this area of surgery gain additional training during one
or two years of fellowship after completing their basic surgical residency.
The first transatlantic surgery (Lindbergh Operation) ever performed was a laparoscopic
gallbladder removal.
Laparoscopic techniques have also been developed in the field of veterinary medicine. Due to the
relative high cost of the equiment required, however, it has not become commonplace in most
traditional practices today but rather limited to specialty-type practices. Many of the same
surgeries performed in humans can be applied to animal cases - everything from an egg-bound
tortoise to a German Shepherd can benefit from MIS. A paper published in JAVMA (Journal of
the American Veterinary Medical Association) in 2005 showed that dogs spayed laparoscopically
experienced significantly less pain (65%)than those that were spayed with traditional 'open'
methods. Arthroscopy, thoracoscopy, cystoscopy are all performed in veterinary medicine today.
The University of Georgia School of Veterinary Medicine and Colorado State University's
School of Veterinary Medicine are two of the main centers where veterinary laparoscopy got
started and have excellent training programs for veterinarians interested in getting started in MIS.
[edit] Advantages
There are a number of advantages to the patient with laparoscopic surgery versus an open
procedure. These include:
• reduced haemorrhaging , which reduces the chance of needing a blood
transfusion.
• smaller incision, which reduces pain and shortens recovery time.
• less pain, leading to less pain medication needed.
• Although procedure times are usually slightly longer, hospital stay is less, and
often with a same day discharge which leads to a faster return to everyday
living.
• reduced exposure of internal organs to possible external contaminants
thereby reduced risk of acquiring infections.
• can be used in Gamete intrafallopian transfer (GIFT) surgery to put the eggs
back into the fallopian tubes
[edit] Risks
Some of the risks are briefly described below:
• The most significant risks are from trocar injuries to either blood vessels or
small or large bowel. The risk of such injuries is increased in patients who are
obese or have a history of prior abdominal surgery. The initial trocar is
typically inserted blindly. While these injuries are rare, significant
complications can occur. Vascular injuries can result in hemorrhage that may
be life threatening. Injuries to the bowel can cause a delayed peritonitis. It is
very important that these injuries be recognized as early as possible.[2]
• Some patients have sustained electrical burns unseen by surgeons who are
working with electrodes that leak current into surrounding tissue. The
resulting injuries can result in perforated organs and can also lead to
peritonitis.
• There may be an increased risk of hypothermia and peritoneal trauma due to
increased exposure to cold, dry gases during insufflation. The use of heated
and humidified CO2 may reduce this risk.[3]
• Many patients with existing pulmonary disorders may not tolerate
pneumoperitoneum (gas in the abdominal cavity), resulting in a need for
conversion to open surgery after the initial attempt at laparoscopic approach.
• Not all of the CO2 introduced into the abdominal cavity is removed through
the incisions during surgery. Gas tends to rise, and when a pocket of CO2 rises
in the abdomen, it pushes against the diaphragm (the muscle that separates
the abdominal from the thoracic cavities and facilitates breathing), and can
exert pressure on the phrenic nerve. This produces a sensation of pain that
may extend to the patient's shoulders. For an appendectomy, the right
shoulder can be particularly painful. In some cases this can also cause
considerable pain when breathing. In all cases, however, the pain is transient,
as the body tissues will absorb the CO2 and eliminate it through respiration. [4]
• Coagulation disorders and dense adhesions (scar tissue) from previous
abdominal surgery may pose added risk for laparoscopic surgery and are
considered relative contra-indications for this approach.
• Patients can often have trouble walking after surgery for a few days
[edit] Robotics and technology
The process of minimally invasive surgery has been augmented by specialized tools for decades.
However, in recent years, electronic tools have been developed to aid surgeons. Some of the
features include:
• Visual magnification - use of a large viewing screen improves visibility
• Stabilization - Electromechanical damping of vibrations, due to machinery or
shaky human hands
• Simulators - use of specialized virtual reality training tools to improve
physicians' proficiency in surgery
• Reduced number of incisions
Robotic surgery has been touted as a solution to underdeveloped nations, whereby a single
central hospital can operate several remote machines at distant locations. The potential for
robotic surgery has had strong military interest as well, with the intention of providing mobile
medical care while keeping trained doctors safe from battle.
Cholecystectomy
From Wikipedia, the free encyclopedia
Jump to: navigation, search
Contents
[hide]
• 1 Open surgery
• 2 Laparoscopic surgery
○ 2.1 Procedural Risks and Complications
○ 2.2 Biopsy
• 3 Long-Term Prognosis
• 4 References
A US Navy general surgeon and an operating room nurse discuss proper procedures
while performing a laparoscopic cholecystectomy surgery.
Laparoscopic cholecystectomy requires several small incisions in the abdomen to allow the
insertion of operating ports, small cylindrical tubes approximately 5-10 mm in diameter, through
which surgical instruments and a video camera are placed into the abdominal cavity. The camera
illuminates the surgical field and sends a magnified image from inside the body to a video
monitor, giving the surgeon a close-up view of the organs and tissues. The surgeon watches the
monitor and performs the operation by manipulating the surgical instruments through the
operating ports.
To begin the operation, the patient is anesthetized and placed in the supine position on the
operating table. A scalpel is used to make a small incision at the umbilicus. Using either a Veres
needle or Hassan technique the abdominal cavity is entered. The surgeon inflates the abdominal
cavity with carbon dioxide to create a working space. The camera is placed through the umbilical
port and the abdominal cavity is inspected. Additional ports are placed inferior to the ribs at the
epigastric, midclavicular, and anterior axillary positions. The gallbladder fundus is identified,
grasped, and retracted superiorly. With a second grasper, the gallbladder infundibulum is
retracted laterally to expose and open Calot's Triangle (the area bound by the liver, cystic duct,
and common hepatic duct). The triangle is gently dissected to clear the peritoneal covering and
obtain a view of the underlying structures. The cystic duct and the cystic artery are identified,
clipped with tiny titanium clips and cut. Then the gallbladder is dissected away from the liver
bed and removed through one of the ports. This type of surgery requires meticulous surgical
skill, but in straightforward cases can be done in about an hour.
Recently, this procedure is performed through a single incision in the patient's umbilicus. This
advanced technique is called Single Incision laparoscopic Surgery or "SILSTM".
[edit] Procedural Risks and Complications
Laparoscopic cholecystectomy does not require the abdominal muscles to be cut, resulting in less
pain, quicker healing, improved cosmetic results, and fewer complications such as infection and
adhesions. Most patients can be discharged on the same or following day as the surgery, and
most patients can return to any type of occupation in about a week.
An uncommon but potentially serious complication is injury to the common bile duct, which
connects the gallbladder and liver. An injured bile duct can leak bile and cause a painful and
potentially dangerous infection. Many cases of minor injury to the common bile duct can be
managed non-surgically. Major injury to the bile duct, however, is a very serious problem and
may require corrective surgery. This surgery should be performed by an experienced biliary
surgeon.[1]
Abdominal peritoneal adhesions, gangrenous gallbladders, and other problems that obscure
vision are discovered during about 5% of laparoscopic surgeries, forcing surgeons to switch to
the standard cholecystectomy for safe removal of the gallbladder. Adhesions and gangrene, of
course, can be quite serious, but converting to open surgery does not equate to a complication.
A Consensus Development Conference panel, convened by the National Institutes of Health in
September 1992, endorsed laparoscopic cholecystectomy as a safe and effective surgical
treatment for gallbladder removal, equal in efficacy to the traditional open surgery. The panel
noted, however, that laparoscopic cholecystectomy should be performed only by experienced
surgeons and only on patients who have symptoms of gallstones.
In addition, the panel noted that the outcome of laparoscopic cholecystectomy is greatly
influenced by the training, experience, skill, and judgment of the surgeon performing the
procedure. Therefore, the panel recommended that strict guidelines be developed for training and
granting credentials in laparoscopic surgery, determining competence, and monitoring quality.
According to the panel, efforts should continue toward developing a noninvasive approach to
gallstone treatment that will not only eliminate existing stones, but also prevent their formation
or recurrence.
One common complication of cholecystectomy is inadvertent injury to an anomalous bile duct
known as Ducts of Luschka, occurring in 33% of the population. It is non-problematic until the
gall bladder is removed, and the tiny supravesicular ducts may be incompletely cauterized or
remain unobserved, leading to biliary leak post operatively. The patient will develop biliary
peritonitis within 5 to 7 days following surgery, and will require a temporary biliary stent. It is
important that the clinician recognize the possibility of bile peritonitis early and confirm
diagnosis via HIDA scan to lower morbidity rate. Aggressive pain management and antibiotic
therapy should be initiated as soon as diagnosed.
[edit] Biopsy
After removal, the gall bladder should be sent for biopsy (pathological examination) to confirm
the diagnosis and look for an incidental cancer. If cancer is present, a reoperation to remove part
of liver and lymph nodes will be required in most cases. [2]
Orthopedic surgery
From Wikipedia, the free encyclopedia
(Redirected from Orthopaedic Surgery)
Jump to: navigation, search
This fracture of the lower cervical vertebrae, known as a 'teardrop fracture' is one of the
conditions treated by orthopedic surgeons.
This image, taken in September 2006, shows extensive repair work to the right acetabulum 6
years after it was carried out (2000). Further damage to the joint is visible due to the onset of
arthritis.
Orthopedic surgery or orthopedics (also spelled orthopaedics) is the branch of surgery
concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both
surgical and non-surgical means to treat musculoskeletal trauma, sports injuries, degenerative
diseases, infections, tumors, and congenital conditions.
Nicholas Andry coined the word "orthopaedics", derived from Greek words for orthos ("correct",
"straight") and paideia ("rearing" (usually of child)), in 1741, when at the age of 81 he published
Orthopaedia: or the Art of Correcting and Preventing Deformities in Children.
In the US the spelling orthopedics is standard[citation needed], although the majority of university and
residency programs[citation needed], and even the AAOS, still use Andry's spelling. Elsewhere, usage
is not uniform; in Canada, both spellings are common; orthopaedics usually prevails in the rest
of the Commonwealth, especially in Britain.
[edit] Training
In the United States and Canada, orthopedic surgeons have typically completed 4 years of
undergraduate education and 4 years of medical school. Subsequently, orthopedic surgeons
undergo residency training in orthopedic surgery. The five-year residency consists of one year of
general surgery training followed by four years of training in orthopedic surgery.
Selection for residency training in orthopedic surgery is extremely competitive--candidates for
orthopedic residencies generally graduate at the top of their medical school classes.
Approximately 650 physicians complete orthopedic residency training per year in the US. About
7 percent of current orthopaedic surgery residents are women; about 20 percent are members of
minority groups. There are approximately 20,400 actively practicing orthopaedic surgeons and
residents in the United States.[1] According to the latest Occupational Outlook Handbook (2006–
2007) published by the US Department of Labor, between 3–4% of all practicing physicians are
orthopedic surgeons.
Many orthopedic surgeons elect to do further subspecialty training, or 'fellowships', after
completing their residency training. Fellowship training in an orthopedic subspeciality is
typically one year in duration (sometimes two) and sometimes has a research component
involved with the clinical and operative training. Examples of orthopedic subspecialty training in
the US are:
• Hand surgery
• Shoulder and elbow surgery
• Total joint reconstruction (arthroplasty)
• Pediatric orthopedics
• Foot and ankle surgery
• Spine surgery
• Musculoskeletal oncology
• Surgical sports medicine
• Orthopedic trauma
These specialty areas of medicine are not exclusive to Orthopaedic Surgery. For example, Hand
surgery is practiced by some plastic surgeons and spine surgery is practiced by most
neurosurgeons. Additionally, foot and ankle surgery is practiced by board certified Doctors of
Podiatric Medicine (D.P.M.) in the United States. Some family practice physicians practice
sports medicine, however their scope of practice is non-operative..
After completion of specialty residency/registrar training, an orthopedic surgeon is then eligible
for board certification. Certification by the American Board of Orthopaedic Surgery means that
the orthopaedic surgeon has met the specified educational, evaluation, and examination
requirements of the Board[2]. The process requires successful completion of a standardized
written exam followed by an oral exam focused on the surgeon's clinical and surgical
performance over a 6 month period. In Canada, the certifying organization is the Royal College
of Physicians and Surgeons of Canada; in Australia and New Zealand it is the Royal Australasian
College of Surgeons.
In the US, specialists in hand surgery and sports medicine may obtain a Certificate of Added
Qualifications (CAQ) in addition to their board certification by successfully completing a
separate standardized examination. There is no additional certification process for the other
subspecialties.
[edit] Practice
According to applications for board certification from 1999 to 2003, the top 25 most common
procedures (in order) performed by orthopedic surgeons are as follows[3]:
• Knee arthroscopy and meniscectomy
• Shoulder arthroscopy and decompression
• Carpal tunnel release
• Knee arthroscopy and chondroplasty
• Removal of support implant
• Knee arthroscopy and anterior cruciate ligament reconstruction
• Knee replacement
• Repair of femoral neck fracture
• Repair of trochanteric fracture
• Debridement of skin/muscle/bone/fracture
• Knee arthroscopy repair of both menisci
• Hip replacement
• Shoulder arthroscopy/distal clavicle excision
• Repair of rotator cuff tendon
• Repair fracture of radius (bone)/ulna
• Laminectomy
• Repair of ankle fracture (bimalleolar type)
• Shoulder arthroscopy and débridement
• Lumbar spinal fusion
• Repair fracture of the distal part of radius
• Low back intervertebral disc surgery
• Incise finger tendon sheath
• Repair of ankle fracture (fibula)
• Repair of femoral shaft fracture
• Repair of trochanteric fracture
A typical schedule for a practicing orthopedic surgeon involves 50–55 hours of work per week
divided among clinic, surgery, various administrative duties and possibly teaching and/or
research if in an academic setting. In 2007, the median salary for an orthopedic surgeon in the
United States is $388,784.[4]
[edit] History
Orthopedic implants to repair fractures to the radius and ulna. Note the visible
break in the ulna. (right forearm)
Jean-Andre Venel established the first orthopedic institute in 1780, which was the first hospital
dedicated to the treatment of children's skeletal deformities. He is considered by some to be the
father of orthopedics or the first true orthopedist in consideration of the establishment of his
hospital and for his published methods.
Antonius Mathysen, a Dutch military surgeon, invented the plaster of Paris cast in 1851.
Many developments in orthopedic surgery resulted from experiences during wartime. On the
battlefields of the Middle Ages the injured were treated with bandages soaked in horses' blood
which dried to form a stiff, but unsanitary, splint. Traction and splinting developed during World
War I. The use of intramedullary rods to treat fractures of the femur and tibia was pioneered by
Gerhard Küntscher of Germany. This made a noticeable difference to the speed of recovery of
injured German soldiers during World War II and led to more widespread adoption of
intramedullary fixation of fractures in the rest of the world. However, traction was the standard
method of treating thigh bone fractures until the late 1970s when the Harborview Medical Center
in Seattle group popularized intramedullary fixation without opening up the fracture. External
fixation of fractures was refined by American surgeons during the Vietnam War but a major
contribution was made by Gavril Abramovich Ilizarov in the USSR. He was sent, without much
orthopedic training, to look after injured Russian soldiers in Siberia in the 1950s. With no
equipment he was confronted with crippling conditions of unhealed, infected, and malaligned
fractures. With the help of the local bicycle shop he devised ring external fixators tensioned like
the spokes of a bicycle. With this equipment he achieved healing, realignment and lengthening to
a degree unheard of elsewhere. His Ilizarov apparatus is still used today as one of the distraction
osteogenesis methods.
David L. MacIntosh pioneered the first successful surgery for the management of the torn
anterior cruciate ligament of the knee. This common and serious injury in skiers, field athletes,
and dancers invariably brought an end to their athletics due to permanent joint instability.
Working with injured football players, Dr. MacIntosh devised a way to re-route viable ligament
from adjacent structures to preserve the strong and complex mechanics of the knee joint and
restore stability. The subsequent development of ACL reconstruction surgery has allowed
numerous athletes to return to the demands of sports at all levels.
Modern orthopaedic surgery and musculoskeletal research has sought to make surgery less
invasive and to make implanted components better and more durable.
Additionally, there is currently under development highly promising research involving the
regrowth of Anterior Cruciate Ligament Tissue by the use of scaffolding around the Ligament,
thereby providing an environment in which the tissue can clot and heal like other areas of the
body which are not surrounded by the clot-preventing liquids which surround the major
ligaments. This research among others conducted at the Sports Medicine Research Laboratory is
still in the Research and Development stage.
[edit] Arthroscopy
The use of arthroscopic tools has been particularly important for injured patients. Arthroscopy
was pioneered in the early 1950's by Dr. Masaki Watanabe of Japan to perform minimally
invasive cartilage surgery and re-constructions of torn ligaments. Arthroscopy helped patients
recover from the surgery in a matter of days, rather than the weeks to months required by
conventional, 'open' surgery. Knee arthroscopy is one of the most common operations performed
by orthopedic surgeons today and is often combined with meniscectomy or chondroplasty.
Bone grafting
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Bone grafting is a surgical procedure that replaces missing bone with material from the patient's
own body, an artificial, synthetic, or natural substitute. Bone grafting is used to repair bone
fractures that are extremely complex, pose a significant health risk to the patient, or fail to heal
properly.
Contents
[hide]
• 1 Types and Tissue Sources
○ 1.1 Autologous bone grafting
○ 1.2 Allograft bone grafting
○ 1.3 Demineralized Bone Matrix
○ 1.4 Synthetic variants
○ 1.5 Xenografts
○ 1.6 Alloplastic Grafts
○ 1.7 Growth Factors
• 2 Uses
• 3 Procedure
• 4 Risks
○ 4.1 Risks for grafts from the iliac crest
• 5 Recovery and Aftercare
• 6 Costs
• 7 References
• 8 See also
[edit] Uses
The most common use of bone grafting is in the application of dental implants, in order to restore
the edentulous area of a missing tooth. Dental implants require bones underneath them for
support and to have the implant integrate properly into the mouth. People who have been
edentulous (without teeth) for a prolonged period may not have enough bone left in the necessary
locations. In this case, bone can be taken from the chin or from the pilot holes for the implants or
even from the iliac crest of the pelvis and inserted into the mouth underneath the new implant.
In general, bone grafts are either used en block (such as from the chin or the ascending ramus
area of the lower jaw) or particulated, in order to be able to adapt it better to a defect.
Another common bone graft, which is more substantial than those used for dental implants, is of
the fibular shaft. After the segment of the fibular shaft has been removed normal activities such
as running and jumping are permitted on the leg with the bone deficit. The grafted, vascularized
fibulas have been used to restore skeletal integrity to long bones of limbs in which congenital
bone defects exist and to replace segments of bone after trauma or malignant tumor invasion.
The periosteum and nutrient artery are generally removed with the piece of bone so that the graft
will remain alive and grow when transplanted into the new host site. Once the transplanted bone
is secured into its new location it generally restores blood supply to the bone in which it has been
attached.
Besides the main use of bone grafting--dental implants--this procedure is used to fuse joints to
prevent movement, repair broken bones that have bone loss, and repair broken bone that has not
yet healed.[3]
Bone grafts are used in hopes that the defective bone will be healed or will regrow with little to
no graft rejection.[3]
[edit] Procedure
Depending on where the bone graft is needed, a different doctor may be requested to do the
surgery. Doctors that do bone graft procedures are commonly orthopedic surgeons,
otolaryngology head and neck surgeons, neurosurgeons, craniofacial surgeons, oral and
maxillofacial surgeons, and periodontists.[4]
[edit] Risks
As with any procedure, there are risks involved; among these include reactions to medicine and
problems breathing, bleeding, and infection.[3]Infection is reported to occur in less than 1% of
cases and is curable with antibiotics. Overall, patients with a preexisting illness are at a higher
risk of getting an infection as opposed to those who are overall healthy.[5]
[edit] Risks for grafts from the iliac crest
Some of the potential risks and complications of bone grafts employing the iliac crest as a donor
site include[5][6][7]:
• acquired bowel herniation (this becomes a risk for larger donor sites
(>4 cm))[5]. About 20 cases have been reported in the literature from 1945 till
1989[8] and only a few hundred cases have been reported worldwide[9]
• meralgia paresthetica (injury to the lateral femoral cutaneous nerve also
called Bernhardt-Roth's syndrome)
• pelvic instability
• fracture (extremely rare and usually with other factors[10][11])
• injury to the clunial nerves (this will cause posterior pelvic pain which is
worsened by sitting)
• injury to the ilioinguinal nerve
• infection
• minor hematoma (a common occurrence)
• deep hematoma requiring surgical intervention
• seroma
• ureteral injury
• pseudoaneurysm of iliac artery (rare)[12]
• tumor transplantation
• cosmetic defects (chiefly caused by not preserving the superior pelvic brim)
• chronic pain
Bone grafts harvested from the posterior iliac crest in general have less morbidity, but depending
on the type of surgery, may require a flip while the patient is under general anesthesia.[13][14]
[edit] Recovery and Aftercare
The amount of time it takes for an individual to recovery depends on the severity of the injury
being treated and lasts anywhere from 2 weeks to 2 months with a possibility of vigorous
exercise being barred for up to 6 months.[3]
[edit] Costs
This section may require cleanup to meet Wikipedia's quality standards.
Please improve this section if you can. (January 2009)
Bone graft procedures consist of more than just the surgery. The average cost of bone graft
procedures ranges from approximately $33,860 to $37,227.[15] Besides the cost of the bone graft
itself (ranging from $250 to $900) other expenses for the procedure include: surgeon's fees (these
vary), anesthesiologist fees (approximately $350 to $400 per hour), hospital charges (these vary;
averaging about $1,500 to $1,800 a day), medication charges ($200 to $400), and additional fees
for services such as medical supplies, diagnostic procedures, equipment use fees, etc.[16]
Hand surgery
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article by adding citations to reliable sources. Unverifiable material may be
challenged and removed. (June 2007)
The field of hand surgery deals with both surgical and non-surgical treatment of conditions and
problems that may take place in the hand or upper extremity (commonly from the tip of the hand
to the shoulder). Hand surgery may be practiced by graduates of general surgery, orthopedic
surgery and plastic surgery. Plastic surgeons and orthopedic surgeons receive significant training
in hand surgery during their residency training, with some graduates continuing on to do an
additional one year hand fellowship. These fellowships are sometimes also pursued by general
surgeons. Plastic surgeons are particularly well suited to handle traumatic hand and digit
amputations that require a "replant" operation. Orthopedic surgeons are trained to reconstruct all
aspects to salvage the appendage: tendons, muscle, bone. Orthopedic surgeons are particularly
well suited to handle complex fractures of the hand and injuries to the carpal bones that alter the
mechanics of the wrist. Hand surgeons perform a wide variety of operations such as fracture
repairs, releases, transfer and repairs of tendons and reconstruction of injuries, rheumatoid
deformities and congenital defects.
[edit] Indications
The following conditions can be indications for hand surgery:
• Hand injuries
• Carpal tunnel syndrome
• Carpometacarpal bossing
• Rheumatoid arthritis
• Dupuytren's contracture
• Congenital defects
Contents
[hide]
• 1 Background
• 2 Indications and
Contraindications
• 3 History and physical
examination
• 4 Surgical information
• 5 Benefits
• 6 Risks
• 7 Long-term results
• 8 External links
• 9 References
[edit] Background
In the early 1950s, Duncan C. McKeever theorized that osteoarthritis could be isolated to only
one compartment of the knee joint,[1] and that replacement of the entire knee might not be
necessary if only one knee compartment was affected.[1] The UKA concept was designed to cause
less trauma or damage than traditional total knee replacement by removing less bone and trying
to maintain most of the patient’s bone and anatomy.[1] Also, the concept was designed to use
smaller implants and thereby keep most of the patient’s bone; this can help patients return to
normal function faster.[1]
Initially, UKAs were not always successful, because the implants were poorly designed, patients
weren't thoroughly screened for suitability, and optimal surgical techniques were not
developed.[3][4][5][6][7] Recent advancements have been made to improve the design of the
implants.[7] Also, choosing the best-suited patients was emphasized to ensure that surgeons
followed the indications and contraindications for partial replacement. Proper patient selection[8],
following the indications/contraindications, and performing the surgery well are key factors for
the success of UKA.[1]
The uni-compartmental replacement is a minimally invasive option for patients whose arthritis is
isolated to either the medial or the lateral compartment. The procedure offers several benefits for
patients with a moderately active lifestyle, who have arthritis in just one knee compartment, and
who are within normal weight ranges. The surgeon uses an incision of just 3-4 inches; a total
knee replacement typically requires an incision of 8-12 inches. According to Dr. Howard J.
Luks,[13] Associate Professor of Orthopedic Surgery at New York Medical College, the partial
replacement does not disrupt the knee cap, which makes for a shorter rehabilitation period. A
partial replacement also causes minimal blood loss during the procedure, and results in
considerably less post-operative pain. The hospitalization time compared with a total knee
replacement is also greatly reduced.
[edit] Benefits
The potential benefits of UKA include a smaller incision because the UKA implants are smaller
than the total knee replacements, and the surgeon may make a smaller incision.[1] This may lead
to a smaller scar.[1] Another potential benefit is less post-operative pain because less bone is
removed. Also, a quicker operation and shorter recovery period may be a result of less bone
being removed during the operation and the soft tissue may sustain less trauma.[14] Also, the
rehabilitation process may be more progressive.[15] More specific benefits of UKA are it may
improve range of motion, reduce blood loss during surgery, reduce the patient’s time spent in the
hospital, and decrease costs.[10]
[edit] Risks
Blood clots (also known as deep vein thrombosis) are a common complication after surgery.[16][17]
However, a doctor may prescribe certain medications to help prevent blood clots.[16][17] Infection
may occur after surgery.[18] However, antibiotics may be prescribed by a doctor to help prevent
infections.[17] Individual patient factors (i.e., anatomy, weight, prior medical history, prior joint
surgeries) should be addressed with the patient’s doctor. There is some evidence that the rate of
complications may be higher than with total knee arthroplasty.[19] The causes of long-term failure
of UKAs include polyethylene wear, loosening of the implant, and degeneration of the adjacent
knee compartment.[1]
Epiphysiodesis
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links to this page from other articles related to it. (February 2009)
This article may require cleanup to meet Wikipedia's quality standards. Please
improve this article if you can. (August 2008)
Epiphysiodesis is a Pediatric surgical procedure in which the epiphyseal (growth) plate of a
bone is removed.
This procedure is used to:
• Lengthen an abnormally short leg
• Shorten an abnormally long leg
• Limit growth of a normal leg to allow a short leg to grow to a matching
length[1] This can incorporate a bone graft to produce fusion of the epiphysis
or premature cessation of the epiphyseal plate's growth.
The epiphysis can be removed in one of the bone's end to slow down the growth, or in both ends
to stop growth of that bone completely.
[edit] Limitations
The surgery must also be carefully planned with regard to timing, as it is non-reversible, so that
the limbs are at near-equal length at end of growth.
Back
Laminectomy/Laminotomy
Discectomy
With access to the nerve and disc areas gained through the
laminotomy or laminectomy, further corrections can be made. The surgeon uses small
instruments to remove the damaged disc material that is pressing on a nerve root.
Fusion
For patients with instability, a spinal fusion may be recommended. A spinal fusion involves
placing bone grafts between vertebrae. Frequently only two lumbar vertebrae are fused.
However, multiple vertebrae may be included. Bone grafts may be taken from the pelvic bone
and placed in a hollow, porous implant that is placed between two vertebrae or the bone is placed
along side the vertebrae on the transverse processes. As the body heals, the bone graft and the
vertebrae grow into one unit or become fused. This stabilizes the vertebrae reducing pain caused
by too much movement between vertebrae.
Before Surgery
Before performing surgery, your physician will study your back by means of X-ray or other tests
such as magnetic resonance imaging (MRI), myelography or a CT scan. Testing will help the
physician determine what procedure will be best for you. Your doctor will discuss whether your
procedure will be performed on an outpatient basis or if a hospital stay will be required; fully
explain the procedure; and explain the risks and benefits of surgery.
To prepare yourself for surgery, you may be asked to do a number of things. You may be asked to
lose weight if you are overweight. If you smoke, it is important for you to stop several weeks
prior to surgery. If you are taking aspirin or certain anti-inflammatory medications, inform your
surgeon; you may need to stop taking these two weeks before surgery.
Recuperation will depend on the type of procedure performed and varies with each patient. Ask
your doctor when it is safe to resume regular activities, including house work, returning to work,
and athletic activities.
Ngxshf
Doctors will almost always try non-surgical back pain treatments before
recommending surgery. People with chronic (recurring) back pain are often good
candidates for back surgery, as are people who have lower back pain without leg
pain. Some of the diagnoses that may need surgery include herniated discs,
spinal stenosis, spondylolisthesis, vertebral fractures, and discogenic low back
pain.
Back Surgery: An Introduction
Depending on the diagnosis, back surgery is sometimes used when other non-
surgical treatments have failed. People who may be candidates for back surgery
have:
• Constant pain
• Pain that recurs frequently and interferes with their ability to sleep
• Pain that prevents them from functioning at their job
• Pain that makes it difficult to perform daily activities.
In general, there are two groups of people who may require back surgery to treat
their spinal problems. People in the first group may have:
• Herniated discs
• Spinal stenosis
• Spondylolisthesis
• Vertebral fractures
• Discogenic low back pain.
• Laminectomy/discectomy
• Microdiscectomy
• Laser surgery.
Laminectomy/Discectomy
In this type of back surgery, part of the lamina (a portion of the bone on the back
of the vertebrae) is removed, as well as a portion of a ligament. The herniated disc
is then removed through the incision, which may extend two or more inches.
Microdiscectomy
As with traditional discectomy, this back surgery involves removing a herniated disc
or damaged portion of a disc through an incision in the back. The difference is that
the incision is much smaller and the doctor will use a magnifying microscope or lens
to locate the disc through the incision. The smaller incision may reduce pain and
the disruption of tissues, and it will reduce the size of the surgical scar. It appears
to take about the same time to recuperate from a microdiscectomy as from a
traditional discectomy.
Laser Surgery
Technological advances in recent decades have led to the use of lasers for operating
on people with herniated discs accompanied by lower back and leg pain. During this
back surgery, the surgeon will insert a needle into the disc, which will deliver a few
bursts of laser energy to vaporize the tissue in the disc. This will reduce its size and
relieve pressure on the nerves. Although many people return to daily activities
within three to five days after laser surgery, pain relief may not be apparent until
several weeks, or even months, after the surgery. The usefulness of laser
discectomy is still being debated.
• Pain
• Numbness in the legs
• Loss of bladder and/or bowel control.
People may have difficulty walking any distances and may also have severe pain in
their legs, as well as numbness and tingling.
The only back surgery option for spinal stenosis is a laminectomy. In this
procedure, the doctor will make a large incision down the affected area of the spine
and remove the lamina and any bone spurs (overgrowths of bone) that may have
formed in the spinal canal as the result of osteoarthritis. A laminectomy is a major
back surgery that requires a short hospital stay and physical therapy afterwards to
help regain strength and mobility.
The back surgery option for spondylolisthesis is spinal fusion. When a slipped
vertebra leads to the enlargement of adjacent facet joints, surgical treatment
generally involves both laminectomy and spinal fusion. In spinal fusion, two or more
vertebrae are joined together using bone grafts, screws, and rods to stop slippage
of the affected vertebrae. Bone that is used for grafting comes from another area of
the body, usually the hip or pelvis. In some cases, donor bone is used.
Although the back surgery is generally successful, either type of graft has its
drawbacks. Using your own bone means surgery at a second site on your body, and
with donor bone, there is a slight risk of disease transmission or rejection. In recent
years, a new development -- bone morphogenic proteins -- has eliminated these
risks for some people undergoing spinal fusion. Bone morphogenic proteins
are used to stimulate bone generation, thereby eliminating the need for grafts. The
proteins are placed in the affected area of the spine, often in collagen putty or
sponges. Regardless of how spinal fusion is performed, the fused area of the spine
becomes immobilized.
Vertebroplasty
Kyphoplasty
Much like vertebroplasty, kyphoplasty is used to relieve pain and stabilize the spine
following fractures due to osteoporosis. Kyphoplasty is a two-step process. In the
first step, the doctor will insert a balloon device to help restore the height and
shape of the spine. In the second step, the doctor will inject polymethyacrylate to
repair the fractured vertebra. This back surgery is done under anesthesia, and in
some cases it is performed on an outpatient basis.