Liver transplantation or hepatic transplantation is the second most carried out transplant procedure in the world. It is a potentially difficult surgery that is performed by a team of two to four surgeons along with the help of anesthesiologists and nurses. It takes around 10 to 12 hours to complete the procedure as there are many anastomoses, sutures, reconnections, and disconnections, which are to be performed under the liver bed which is necessary for the transplant to be a success.

Tests required before a transplant is planned

Computed tomography, or CT scan which employs X-rays and a computer to create pictures of the liver, showing its size and shape. CTs and chest X-rays are also recorded to evaluate your heart and lungs.
Laser Doppler flowmetry: to check if the blood vessels to and from the liver are normal.
Echocardiogram to check the status of heart function.
Pulmonary function test or lung capacity test to study and determine the lungs' ability to exchange oxygen and carbon dioxide.
Blood tests are performed to determine the patient's blood type, clotting ability, and biochemical status of blood, and to determine liver function.
The liver transplant procedure

After an admission at the hospital, an Intravenous line is started in the patient's arm or hand. Other tubes (catheters) are put in their neck and wrist, or their collarbone or the area between the belly and the thigh (the groin). These are used to check heart and blood pressure, and to get blood samples.
The patient is placed on the back, over the operating table.
If there is too much hair at the surgical site, it may be shaved.
A catheter is placed into the bladder to drain urine.
After the patient is sedated, the anesthesiologist will insert a tube into the lungs. This is done so that the breathing can be helped with a ventilator. The anesthesiologist will keep checking the heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
The skin at the surgical site will be cleaned with a sterile (antiseptic) solution.
The doctor will make a cut (incision) just under the ribs on both sides of the belly.
The doctor will carefully separate the diseased or the injured liver from the nearby organs and structures.
The attached arteries and veins are then clamped to stop the blood flow into the diseased liver.
The diseased liver will be cut off from the blood vessels and then removed.
The surgeon will check the donor liver before implanting it into the body.
The donor's liver is placed in the patient's body.
The incision will then be closed with sutures or surgical staples.
In case you have a concern or query you can always consult an expert & get answers to your questions!

Liver Transplant Surgery - Understanding The Procedure!

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.


Know All About Gynae Laparoscopy Surgery

Breasts are a part of female identity- which is why for most women, breast cancer still continues to be a big fear. Many feel that having cancerous cells in these parts rob them of their identity and puts a question on everything they stand for. More than a disease, many women treat it as an emotional trauma that one has to go through, rather than something that has to be dealt at a physical level. But breast cancer is not a taboo subject anymore and with the huge awareness created, women are now more knowledgeable in identifying their risk levels. What s more, breast cancer can be prevented to the maximum by making minor changes to our daily chores and life style. 

Let us have a look at ways to keep breast cancer in check.

Have regular checkups: Move over traditional mammography methods; new digital checks that are more accurate in identifying the symptoms have come into the picture. Make these checks mandatory as a part of the yearly check-ups and never postpone them.
Exercises: Regular exercises can be very helpful in keeping the body fit. Estrogen is the biggest factor that can stimulate breast cancer. Having regular activities alters the estrogen metabolism thus minimizing the cancer levels. Even a relaxed exercise of 15 - 20 minutes can do a world of good, both for the body and mind in keeping the condition under check.
Family history: About 5% to 10% of the breast cancers are hereditary. Hence always ensure that you know your family history and their tryst with cancer.
Minimize screening tests that use radiation: Go for X-ray screening and chest x-rays only when absolutely necessary. Always consult with the physician about the precautions to be taken when going for a screening test.
Reduce hormone intake: Hormone therapy is most commonly used to manage menopausal symptoms. However, there is a chance that they can indirectly aid in producing estrogen that can cause breast cancer. Always have a proper consultation with the gynecologist and as far as possible avoid hormone intake. Try to treat the symptoms through natural ways.
Breast Feeding: This is one of nature's ways of preventing the contagion that causes breast cancer. Breast feeding naturally reduces the estrogen levels thus drastically reducing the chances.
Diet and the right food: Tons of articles have been written about the good food to have and the proper diet to maintain. When it comes to breast cancer, increasing the carotenoid levels in the body can decrease the chances of breast cancer. Foods that are rich in carotenoid include fresh vegetables and fruits and greens. Also, increase the intake of fibers to have a natural defense mechanism against cancer.
Early detection: There is no better treatment plan for breast cancer than detecting it early. The symptoms do not appear initially and they appear only in the advanced stages. Hence make sure that regular checkups are done to diagnose it.
Alcohol abuse: Alcohol can be had in minimal quantities but do not abuse them. Excessive drinking can increase the chances of breast cancer.
Smoking: Researchers have found a direct link between smoking and breast cancer. This increases phenomenally during menopause stages. Quit smoking altogether for a better life and in preventing many other ailments.
Breast cancer can be an emotional phase for women and following the above methods can keep breast cancer in check and prevent them in the long run.

Breast Cancer - 10 Tips To Help You Avoid It In Future!

Ultra sound is commonly known as sonography. It is a process of reproducing ultrasound images of soft tissues of a particular body part and other organs on the computer screen with the help of the echoes of the sound waves produced by the transducer, a high-frequency generating instrument.
Ultra sound is commonly used during the different stages of pregnancy to denote the foetal health, the foetal sex, date of delivery, birth defects etc. However, in recent times, the ultra sound has also been associated with the diagnosis of other body parts such as the eyes, heart, gall bladder, liver, ovary, uterus, kidney, uterus, testicles, and ovaries. Ultra sound has also been useful in conducting biopsies for suspecting cancer patients, although not all of the cancers are detected by this imaging process. 3D & 4D ultrasound imaging are useful for looking at a particular body portion with much more precision and in slow motion respectively.

The advantages of ultra sound are:
1. The process of ultrasound imaging is a painless and a fast one. It does not require any insertion of needles or similar objects to denote the problems of the concerned body part.
2. The process is more convenient as compared to other similar imaging processes like MRI, mammogram and x-rays as they can capture images of the soft tissues, blood flow & cysts more clearly than the other processes.
3. The process is free of any harmful effects as there are no chances of exposure to radiation as compared to similar processes such as CT scans or X-rays.

Ultrasound - How it is Beneficial over Other Imaging Techniques?

Kidney cancer or renal cancer is when kidney cells grow uncontrollably and form a tumour. Kidney cancer often begins in the tubules (tiny tubes in the kidneys). The prognosis may depend on the stage of the kidney cancer.

Different Stages of Kidney Cancer
The TNM system helps to categorize each stage of the kidney cancer.
Tumour (T)   Describes the size and location of the tumour.
Node (N)   Describes the spread of cancer to lymph nodes.
Metastatis (M)   Describes the spread of cancer to other body parts.

These results combined with the five stages (0 and 1 to 4) can help to identify the right treatment option for every patient. Zero stage describes no cancer presence. For instance  
Stage 1   Here the tumour is confined to kidneys and its size is smaller than 7 centimetres. (T1 or T1, N0, M0)
Stage 2   Here the tumour is confined to kidneys and its size is more than 7 centimetres. (T2)
Stage 3   Here the tumour is in kidneys or blood vessels or fatty tissues but also a lymph node; cancer spreads to major veins but doesn t extend beyond renal or Gerota s fascia (connective tissues surrounding adrenal glands and kidneys). (T3)
Stage 4   Here the cancer is in the fatty tissues surrounding kidneys and adjacent lymph nodes; has spread to other nearby organs and beyond renal fascia. (T4)

Treatment and management of kidney cancer
Once your doctor has determined the staging of your kidney cancer, a treatment plan can be formulated for you.

Surgery
Simple nephrectomy removes the affected kidney.
Radical nephrectomy is a common surgery for kidney cancer. It removes all affected parts such as the kidneys, adrenal gland, lymph nodes and surrounding tissues.
Partial nephrectomy is for small tumours and removes the kidneys and the surrounding tissues.
Interventional radiology: This is a surgery aided by real-time images. An advanced surgery using a nano knife is minimally-invasive and is effective for inoperable kidney tumours.
Targeted therapy: Drugs target specific tumour cells and destroy them.
Immunotherapy: Used for kidney cancer that has spread to other organs, this therapy may use different types of drugs to either help immune cells find cancer growth or regulate the immune system activity to stop or slow cancer growth.
Arterial embolization: It is a procedure to stop blood supply to the kidney tumour, in order to shrink it in size prior to surgery.
Cryotherapy: This procedure involves using extreme cold to kill cancer cells.
Chemotherapy is not very effective for treating kidney cancer. Talk to your doctor about all possible treatment options for your cancer. You can lower your risk of kidney cancer by eating healthy, maintaining your ideal body weight and managing your blood pressure.

Stages Of Kidney Cancer - How They Can Be Managed?

All healthy individuals will always have some amount of urea in the blood. Yet, when the urea level in the blood becomes too high, that means there is a malfunction in some part of the body due to which the body is not being able to remove this excess urea successfully. This urea can be formed in the liver when there is a process in terms of the protein metabolism's chemical balance. This urea is then transported to various parts of the body until the kidney cleans it out as urine. But when this urea does not get cleaned out properly, the urea gets concentrated in the blood and signifies a problem with the kidneys and other internal organs as well as the blood flow to the kidneys. 

The cause may include burns, heart failure, renal artery embolism, vomiting and loose motions as well as more serious ailments like diabetes. This can lead to long term kidney damage and symptoms like thirst, fluid retention, headaches, fatigue, dizzy spells, accelerated pulse, restlessness in limbs, pain in the abdomen and more. Here are the best ways to reduce the blood urea levels in a natural manner.

Herbal medicines:

Ayurveda is an ancient science that can be used for the benefit of many patients suffering from chronic and painful ailments like diabetes, kidney failure, cardiovascular ailments and more. One of the mainstays of ayurveda includes the use of herbs to create medicines and concoctions that will help in giving relief with their 100% natural elements. Medicines like mutrakrichantak churna, punarnava mandur, varunadi vati and many others can be used to avoid dialysis and bring down the urea levels in the blood by aiding better functioning of the kidneys.

Punarnava: the name of this herb has been derived from two words - puna and nava. While puna means again, nava means new and together they help in renewed functioning of the organ that they treat. This herb helps in flushing out the excess fluid in the kidneys by reducing the swelling without any side effects. This herb is basically a kind of hogweed.
Varun: this is the common caper which can be used to break down the stones present in the renal region and even as a cure for urinary tract infection. This herb helps in removing any element that may be obstructing the urinary tract and finally removes the excess fluid build up and inflammation.
Gokshur: this is a diuretic that can be used as a herbal tonic to give strength to the weak kidney cells for regeneration.
Other aspects of ayurvedic treatment for this condition include proper protein intake and better hydration along with massages and yogic postures.

How to Reduce Urea Levels in Blood Naturally

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