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Q1. What exactly is Laparoscopy?
Laparoscopy is an alternative to 'Open' surgery wherein the abdomen is opened by tiny 'key hole' incisions and surgery is done. 'Scopy' means the use of an endoscope or telescope to see inside the abdomen. This is attached to a camera and a light source and the inside of the abdomen is projected on to a monitor. The surgeon performs surgery looking at this screen. The surgeon makes a total of 2-4 small cuts on the abdomen ranging from half to 1 cm through which the telescope and other thin surgical instruments are passed into the abdomen. When the uterus is removed , known as hysterectomy, there is also a cut at the top of the vagina where the uterus is attached.
Q2. What kind of gynaecological surgeries can be performed by Laparoscopy?
Most surgeries done in gynaecology can now be performed by Laparoscopy and do not require the large incision as for open surgery. Laparoscopy can be done sometimes only for diagnosis and is called Diagnostic Laparoscopy, as in checking whether the tubes are open or not and to look for any causes of infertility or pain outside the uterus. In women who are unable to conceive, Diagnostic Laparoscopy is often combined with Hysteroscopy (endoscope inside the uterus, inserted from below, via the vagina). When laparoscopy is done to perform some surgical procedure inside the abdomen it is called Operative Laparoscopy. This may be for simple procedures like sterilization, minor adhesions, drilling ovaries; or for intermediate or major reasons like fibroids, endometriosis, removal of ovaries or tubes or both or removal of uterus, for staging of cancers or radical surgeries for cancer. However, about 5% of all surgeries including those for cancer or very large tumours may benefit from open surgery.
Q3. Why does an expert surgeon recommend Laparoscopy over Open Surgery?
Laparoscopic surgery has many advantages above open surgery: the incisions are much smaller (open surgery incisions are 8-10 cms long), therefore pain is much less; requirement for pain killers (which can have side-effects like sleepiness, impaired judgement) is lesser; hospital stay is shorter; complications fewer; requirement for blood transfusions infrequent; recovery in terms of physical, emotional and mental state is much better and quicker; return to work is faster with consequent lesser loss of working and earning days. Surgery with laparoscope is more precise because it is magnified view. Further vision is much better because it's like having your eye behind the structure because you can see with the telescope at places where the surgeon's eye cannot reach.
Q4. If the cuts on the abdomen are so small in Laparoscopic surgery, how do you remove the uterus or a large tumour from inside the abdomen?
Quite often if the tumour is not malignant and contains fluid, it is punctured to collapse it into a smaller size. If it is solid, it can be cut into smaller pieces inside the abdomen using a special instrument. The collapsed or cut structures can be removed gently through the 1 cm cut on the abdomen which may be increased a bit if required. After hysterectomy, the uterus can be removed easily from below, through the vagina.
Q5. Will there be much pain or discomfort after Laparoscopic Surgery?
There may be some pain and discomfort in lower abdomen for one day to few days after Laparoscopic surgery but this is much less as compared to open surgery because the incisions on the abdomen are much smaller and there is much less tissue handling inside the abdomen by fine instruments instead of rough, big, gloved hands which can cause tissue injury in open surgery. There may be some pain in the shoulder following laparoscopy. This is not serious and is due to the gas used in the surgery to make space for instruments.
Q6. When can I be discharged from hospital?
Following Diagnostic Laparoscopy or with simple Operative Laparoscopy you can expect to be discharged from hospital latest by the morning after surgery. In most other cases of intermediate or even major surgery, discharge is generally 1-2 days following the surgery unless there is some health issues prior to the surgery or any complication during the surgery. The complication rates for Laparoscopic surgery are not more than for open surgery and depend upon patient factors like anaemia, diabetes, obesity and skill of the surgeon.
Q7. When can I perform routine household activities or return to work after Laparoscopic Surgery?
Recovery after surgery depends upon many factors: presence of health problems before surgery; why the surgery is required; what surgery is being done; problems or complications of surgery, anaesthesia or blood transfusions. If all is well, one can perform routine household activities by 1 week, provided one doesn't feel tired. Although there may not be any harm, it may be unwise to be normally active within 48 hours of procedure. Following Diagnostic Laparoscopy or Operative Laparoscopy for simple procedures, one can return to work in 1 week. For other procedures, a 2-3 week off from work is reasonable. It depends on the type of work you are returning to. Avoid too rapid return to work if it is manually hard or requires standing for long durations of time. Sometimes a surgical procedure brings on a well needed rest and break from a lifetime of work. Mostly, when you return to work depends upon your own body and its signals of tiredness. You need to listen to those signals.
I have got pain in my leg from two years. The MRI shows this diffuse posture lateral iv disc at L4-L5 level causing anterior epidural space and lateral recess narrowing with mild thecal sac indentation and abutting transversing nerve fibres and existing neural foramen stenosis.(2) subtle L3 -L4 diffuse posture lateral iv disc bulge causing anterior epidural space and lateral recess effacement. What is the treatment of it .is surgery necessary for it.
Breast cancer is an abnormal growth of cells in the tissues of the breast. Mainly it occurs in females but less than 1% of all the breast cancer cases develop in males. The majority of breast cancers start in the milk ducts. A small number start in the milk sacs or lobules. It can spread to the lymph nodes and to the other parts of the body such as bones, liver, lungs and to the brain.
With more reliable early detection methods as well as the trend towards less invasive surgery, there is hope that even more women with breast cancer will be treated successfully and will go on to resume their normal lives.
Signs & Symptoms
It is painless, especially, during the early stage. Watch out for the following changes in the breast:
- A persistent lump or thickening in the breast or in the axilla.
- A change in the size or shape of the breast.
- A change in the colour or appearance of the skin of the breast such as redness, puckering or dimpling.
- Bloody discharge from the nipple.
- A change in the nipple or areola such as scaliness, persistent rash or nipple retraction (nipple pulled into the breast).
Consult a doctor immediately if you notice any of these changes.
Being a woman puts you at risk of getting breast cancer. There are certain factors that increase the risk of breast cancer. Some of them have been listed below:
- The risk increases with age; most cases of breast cancer develop after the age of 50
- Genetic alterations in certain genes such as BRCA1 and BRCA2
- Family history of breast cancer
- Being overweight
- Early menarche (onset of menstruation before the age of 12)
- Late menopause (after the age of 55)
- Never had children
- Late childbearing
- No breast feeding
- Excessive consumption of alcohol
- Use of hormonal replacement therapy (HRT) for a long period of time
However, most women who have breast cancer have none of the above risk factors. Likewise, not having any of these risk factors does not mean that you will not get breast cancer.
Early Detection and Screening
More treatment options are available when breast cancer is diagnosed at an early stage and hence the chances of recovery is also higher. So regular breast screening is important for early detection even if there are no symptoms. Following are the ways of screening:
- Breast Self-Examination (BSE): Perform BSE once a month about a week after your menses are over. If you no longer menstruate, choose a date each month which is easy to remember e.g. your date of birth or anniversary.
- Clinical Breast Examination: Get a breast specialist to examine your breast once a year if you are 40 years and above.
- Mammogram: Go for a screening mammogram once a year if you are 40 to 49 years old and once every two years if you are 50 years and above even if you do not have any symptom. It is not recommended for younger women (less than 40 years of age) as they have dense breasts, making it difficult for small changes to be detected on a mammogram. So ultrasonography of the breasts is advisable to them.
Types of Breast cancer
- Non-Invasive Breast cancer: These are confined to the ducts within the breasts. They are known as Ductal carcinoma in-situ (DCIS).
- Invasive Breast cancer: It occurs when cancer cells spread beyond the ducts or lobules. Cancer cells first spread to the surrounding breast tissue and subsequently to the lymph nodes in the armpit (Axillary lymph nodes). These cells can also travel to the other parts of the body such as bones, liver, lungs or brain and hence known as metastatic breast cancer.
Making A Diagnosis
If you notice any unusual changes in your breasts, you should see a doctor immediately. He will examine you clinically and may ask you to undergo some tests so that a definitive diagnosis can be made. Further, the staging work up is done to find out the stage of the disease and management accordingly.
Treatment of breast cancer may include various methods such as surgery with or without breast reconstruction, chemotherapy, radiation therapy, hormonal therapy and targeted therapy. Treatment options offered, depend upon the number of factors such as the stage of cancer and likelihood of cure, your general health and your preference. If you wish to discuss about any specific problem, you can consult an oncologist.
1. You felt a lump in your breast and it always means you have breast cancer.
It's a small percentage of breast lumps only that will turn out to be cancer. If you discover a persistent lump in your breast or notice any changes in breast tissue, never ignore it. You must see a physician for a clinical breast examination. He or she may possibly order breast imaging studies to determine if this lump is of concern or not.
Take charge of your health by performing routine breast self-exams, establishing ongoing communication and counseling with your doctor, getting an annual clinical breast exam, and scheduling your routine screening mammograms.
2. Only women get breast cancer, men do not.
Quite the contrary, each year it is estimated that approximately 2,190 men will be diagnosed with breast cancer and 410 will die. While this percentage is still small, men should also check themselves periodically by doing a breast self-exam while in the shower and reporting any changes to their physicians.
Breast cancer in men is usually detected as a hard lump underneath the nipple and areola. Men carry a higher mortality than women do, primarily because awareness among men is less and they are less likely to assume a lump is breast cancer, which can cause a delay in seeking treatment.
I am 39 years my weight is 95 kg, my height is 5.4, I have ligament tear in my right knee, I have slip disc in l4, l5, high bp. Etc, please suggest how to loose weight. Rapidly fast if any medicine that can help to reduce the weight.
STROKE- Popularly known as "Brain Attack". It occurs due to sudden impairment of blood supply to a part of brain leading to acute neurological insult.
Stroke is an emergency. Know the signs of a stroke and Remember FAST.
F- Face Drooping - Ask the person to smile. See for any deviation/asymmetry of mouth. If YES..
A - Arm Weakness Ask the person to raise both arms. Does one arm drift downward? If YES..
S- Speech Difficulty Ask the person to speak, look for any slurring of speech. If YES..
T- Time is money , Call Ambulance/Rush to the hospital.
Other signs/ symptoms -
Sudden onset of numbness or weakness of the leg / arm.
Sudden confusion/ trouble seeing in one or both eyes, trouble walking, Chakker, loss of balance, severe headache / Loss of speech.
Be Aware, This can be STROKE.
Act FAST, Save LIFE and disability. Up to 80% of strokes are preventable
Dear sir. My mother is suffering from pain in waist and legs unable to stand for sometime and unable to walk due to L5 L6 displaced and make pressure on nerve. I don't want to operate for this . Is any other solution.
What is ECMO?
Like dialysis for unfunctional kidney, Ecmo for unfunctional lung.
Ecmo stands for extracorporeal membrane oxygenation. It is a method of giving oxygen for the body when icu pateint lungs and/or heart are not able to supply oxygen on their own.
Why ICU pateint put on ECMO?
Doctors place ICU patients on ECMO when patients are not able to supply oxygen to the body.
ICU patients’ lungs fail for a number of reasons including pneumonia, lung cancer, pulmonary edema, pulmonary embolism and COPD.
When a patient’s lungs fail, he/she first is intubated (breathing tube) and hooked up to a ventilator (breathing machine).
However, sometimes lungs are so damaged that providing oxygen through intubation is not enough.
This is when doctors turn to v-v ecmo.
A heart can fail for many reasons including heart attack, pulmonary embolism, bad valve disease, or worsening heart failure. When a heart fails, doctors try to fix the underlying problem. They may also start medications (called ionotropes) to help improve the pump function of the heart. If medications are not enough, doctors will turn to v-a ecmo.
How long can someone stay on ecmo?
That is a complicated question. Due to the risks of ecmo discussed above, doctors try to keep patients on ecmo for as short a time as possible. Often patient will be on ecmo for several days up to 1-2 weeks. Every day, several blood and imaging tests are done to determine if a patient is ready to come off ecmo. As the technology of ecmo improves, hopefully side effects will decrease and patients can remain on ecmo for longer periods of time.
What is the difference between ecmo and a ventilator (breathing machine)?
Both ecmo and a ventilator aim to provide oxygen to the body when the patient’s own lungs and breathing are failing. The ventilator assists the patient’s own lungs by pushing oxygen with pressure into the lungs. Ecmo instead provides oxygen directly via a catheter placed in a patient’s vein or artery. We almost always try oxygenating a patient with a ventilator first. However, when a patient’s lungs are too sick for this, we turn to ecmo to assist in providing oxygen to the body. V-v ecmo provides oxygen through a vein. This blood then has to travel to the heart and be pumped around the rest of the body through arteries. Therefore, with v-v ecmo or with a ventilator, a patient must have a well-functioning heart to get the oxygen pumped throughout the body. V-a ecmo has the additional advantage of pumping blood directly to arteries. This “by-passes” the heart and is therefore the method of ecmo we use when a patient’s heart is failing.
Dear sir, I am 33 year old. I have back ache since 2010 mri also have been done it shown herniated slip disk and doctor has advised me surgery. But I am not willing to get surgery please advise me what should I do.
Please advice some treatment for bulging of disc I tried everything possible. Visited all type of doctor, did physical exercise and massage as well but still pain persists.
MRI IMPRESSION 29 August 2016 -Posterior diffuse disc herniation at L4 -5 level with bilateral ligamentum flavum hypertrophy causing narrowing of bilateral neural recesses with compression of bilateral traversing nerve roots at same level. -Posterior diffuse disc bulge at L5-S1 level indenting ventral thecal space at same level -Changes of lumbar spondylosis I was having pain at my right hip joint on 15/8/16. It went unbearable extending to RT leg. On 3rd September night as usual on bed all the 24 hours trying to sleep on 4th at 5 am all my pain went. Till then no pain but having burning sensation on right foot, tingling, falling rt foot asleep when I sit on chair. Please advise:- 1. Surgical intervention required? Or 2.Pregabalin,Tolperisone, methylcobalamin,Calcium and D3 with rest will cure me fully? Or 3. Somekind of spinal exercises also required? ERODHA.
I am 51 yrs. I am suffering from neck pain and headache last two years. My mri report says that c5-6 disc shows diffuse asymmetric bulge[more towards left side], causing effacement of anterior subarachnoid space and indentation of bilateral c6 nerve roots[left>>right]. Along with posterior osteophytes, it constitutes hard disc. What should I do? please help me.
The most powerful and amazing organ in our body is the brain. It differs from many other organs of our body not only by its shape, but also by its special type of cell called neurons. When these cells gets affected or dead it can never be reverted or regenerated which is the most exclusive nature found only in brain cells. The cells in other parts of our body has the capacity to regenerate (can be replaced or new one can be grown or produced), but brain cells are exception. Hence any damage to the brain, injury or trauma is really a crucial thing to be considered with utmost care.
Brain surgeries really need skill, proper training, confidence and intelligence to perform this highly complicated and risky surgery.
Brain surgeries are performed to:
- Remove the brain tissues that are grown abnormally
- Aneurysm is clipped to prevent flow of blood cliff off an aneurysm
- Biopsy purpose or to remove the tumour
- Make a nerve free
- Drain the abnormal blood or clot collection or to drain any excessive fluid collection caused by infection.
- To implant artificial electronic device as a treatment for conditions like Parkinson’s disease
- Biopsy: A part of brain tissue is removed for the brain or whole tumour is removed.
- Craniotomy: The skull bone is opened to remove tumour, an aneurysm and drain fluid or blood from infection.
- Minimally invasive endonasal endoscopic surgery: Endoscopic devices are inserted through the nose to remove the lesions or tumour.
- Minimally invasive neuroendoscopy: Similar to endonasal surgery but small incision is made.
- Anaesthesia risks like breathing difficulty, allergic reaction to medications, excessive bleeding or clots and infection.
- Risk related to the brain surgeries are seizures, coma, swelling of brain, infection to brain or meanings, surgical wound infection that intrudes to the brain structures, abnormal clot formation and bleeding.
- General risks include muscle weakness, disturbances in memory, speech, vision, coordination, balance and other functions that are controlled by the brain. If you wish to discuss about any specific problem, you can consult a neurosurgeon.