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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.
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.
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Dear sir/madam Below is the my MRI report of L-SPINE. Please review my report and suggest the plan of treatment as I am feeling with acute pain from low back to ankle. Report is as follows -DIFFUSE BULGE OF L5-S1 DISC WITH THE CENTRAL PROTRUSION INTENDING THECAL SAC AND COMPROMISING NEURAL FORAMEN.
Breast cancer begins when the cells that are present in the breast start to go out of control. These cells generally form a tumor which can be seen on mammogram or one can feel it as a lump. The tumor is threatening if the cells can grow into the tissues that surround it or spread to other areas of the body. Breast cancer happens mostly in ladies. Here are a few methods with which you can prevent breast cancer-
- Keep your weight in check: Maintaining a healthy weight is important for everyone although, it is easy to tune it out since it is said so often. Being overweight can expand the danger of a wide range of cancers, including breast cancer, particularly after menopause.
- Be physically active: Women who are physically active for almost or at least 30 minutes a day have a lower danger of breast cancer. Normal activity is additionally one of the ideal approaches to keep weight under control.
- Eat Your Fruits and Vegetables and Avoid Too Much Alcohol: A balanced and healthy diet can bring down the danger of breast cancer. Attempt to eat a considerable measure of fruits and vegetables and keep liquor at moderate levels or lower. While moderate drinking can be useful for the heart in most grown-ups, even low levels of intake can build the danger of breast cancer. If you do not drink, don't feel you have to begin. In case you drink modestly, there is less risk.
- Try not to Smoke: Smokers and non-smokers alike know how undesirable smoking is. It brings down a person’s quality of life and expands the danger of heart and lung diseases, stroke, and no less than 15 types of cancer, including breast cancer. It additionally causes bad breath, awful teeth, and wrinkles.
- Breastfeed, If Possible: Breastfeeding for almost one year or more brings down the danger of breast cancer. It additionally has extraordinary medical advantages for the baby as well, especially in terms of immunity.
- Keep away from Birth Control Pills: Contraceptive pills have both dangers and advantages. In many cases, the more young a lady is, the lower the danger is. While ladies are taking birth control pills, they have more chances of falling prey to breast cancer as per various medical studies. This danger leaves rapidly in the wake of stopping the pill. The danger of stroke and heart attack is increased while on the pill, especially if the woman smokes. Long term use can likewise have essential advantages, such as bringing down the danger of ovarian cancer, colon tumor and uterine cancer and undesirable pregnancy. In case you are exceptionally worried about breast cancer, staying away from birth control pills is also an alternative to lower the risk. If you wish to discuss about any specific problem, you can consult an oncologist and ask a free question.
What should I be doing to releave the pain for two herniated disc's one above and one below a fusion surgery of the cervical spine.
I have diagnosed with infiltrating ductal carcinoma, NOS, in right breast (in biopsy report, triple negative (ER-negative, PR-NEGATIVE, HER 2-NEGATIVE). The tumor measures 4 cm* 3 cm mammographically. After giving 3 no. Of chemo My doctor suggest me for modified radical mastectomy. Please tell me if I go for complete breast removal & subsequent chemotherapy Radiotherapy is must or optional?
Breast cancer is a form of cancer which develops from the breast tissue. Breast cancer is indicated by signs such as a lump in the breast, changes in breast shape, fluid flowing from the nipple, dimpling of skin, or the development of red scaly patches. Breast cancer is a fatal form of cancer in women and immediate diagnosis is required on observing the symptoms.
Diagnosis of breast cancer
Other than the regular breast screening, the diagnosis of breast cancer involves the following steps and methods:
- Seeing your general practitioner (GP): It is very important to visit your GP soon after noticing the symptoms of breast cancer. Your GP will examine you properly and in case your symptoms need more assessment, he/she will refer you to a breast cancer clinic.
- Mammogram and breast ultrasound: You will be required to have a mammogram, as recommended by a specialist breast unit. This is an X-ray of the breasts. An ultrasound scan may also be required. Breast ultrasound should be undertaken only if you are less than 35 years of age. This is because, young women have denser breasts and a mammogram is not as effective as ultrasound in the diagnosis of breast cancer. In ultrasound, high frequency sound waves are used for obtaining an image of your breasts. It is observed to notice any abnormality or lumps. A breast ultrasound is also important for determining whether a lump is solid or contains liquid.
- Biopsy: In this diagnosis process, a sample of the tissue cells is taken from the breasts and tested under a microscope to find out if it is cancerous. A scan and needle test for the lymph nodes present in your armpit is also done to check whether they have also been affected. A biopsy is undertaken in several ways, depending upon the condition and severity. A needle aspiration biopsy is used for testing a sample of your breast cells without the removal of the tissues. This is the most common form of biopsy and it is also used for draining a small fluid-filled lump or benign cyst. During the process, you will be given a local anesthetic. Usually, a needle biopsy is carried out guided by an X-ray, ultrasound and an MRI scan as well. This helps in distinguishing it from non-invasive changes such as ductal carcinoma in situ.
Another form of biopsy used for the diagnosis of breast cancer is called vacuum assisted biopsy or mammotome biopsy. In this process, a needle gets attached to a suction tube, which helps in obtaining the sample and for clearing the bleeding. If you wish to discuss about any specific problem, you can consult a general-surgeon.
Are you prone to Slipped disc problem? + the ideal way to treat it.
A slipped disc, also known as a prolapsed disc or herniated disc, is the term given to the phenomenon that occurs when a cartilaginous disc found between the vertebrae in the spine becomes slightly displaced or protrudes, thereby pressing on the nerves in the adjacent areas and causing back pain.
This happens when the soft inner part of the disc, known as nucleus pulposus, bulges out through a weakness in the exterior part of the disc. A prolapsed disc usually occurs in the lower region of the spine and can be of varying sizes. There might even be the development of inflammation around the disc in some cases.
Who is likely to get affected?
Most cases of herniated disc occur in patients between the ages of 30 and 50. The number of men affected is twice as many as the number of women. Although the root cause of this problem is not yet known, there are a number of factors that may trigger it. These factors include working at a job that requires a lot of lifting, an occupation that involves remaining in a seated position for a long time, weight-bearing sports, obesity, smoking habits and increasing age.
Effective ways of treating the problem
The different methods that are commonly used to treat the problem are:
- Medications - There are many different kinds of medicines that are effective in providing relief. These include painkillers, muscles relaxants, anti-inflammatory pills, etc.
- Spinal (Epidural) injections - A number of spinal injections are used to treat slipped discs. The injection is done in operation theatre under X-Ray imaging to find exact level of disc bulge. The injection consists of drug mixture of local anaesthetic and steroid. The injection is done at the opening where the inflamed nerve roots are found and reduces pain, swelling and irritation in the area.
- Radiofrequency ablation - This procedure makes use of an electrical current produced by radio waves to reduced pain and sensitivity in the affected area.
- Ozone discectomy - As opposed to the surgical removal of the prolapsed disc, this new process makes use of an ozone-oxygen mixture that is injected into the spine to treat the problem. Many international studies have proved its superiority to traditional methods and surgeries.
Those affected by this problem are advised to keep exercising and continuing with their everyday activities as best as possible. After any of the above treatment methods a regular spine and core strengthening regime is to be followed. Immediate surgical intervention may be needed in acute cases of disc prolapse causing nerve compression with neurological deficits like leg weakness or loss of control over urine and stools. If you wish to discuss about any specific problem, you can consult a pain management specialist.
Treatment for breast cancer depends on the type of cancer, hormone sensitivity, size, grade and stage of cancer. A doctor considers the overall health of the patient and the patient’s individual preference before recommending a treatment plan. While there are many treatments options available for breast cancer, surgery is by far the most popular option for most patients. Along with surgery, some other treatments that a patient undergoes include radiation, chemotherapy and hormonal therapy.
- Lumpectomy: This is a procedure wherein the surgeon cuts the tumour and removes some of the surrounding healthy tissue in order to ensure that cancer does not spread to the healthy cells after the surgery. This procedure is applicable for small tumours.
- Mastectomy: This is a procedure in which all tissues of the breast are removed. This includes lobules, fatty tissue, ducts, areola, and nipple. In a skin-sparing mastectomy, all of the breast skin, except the nipple and the areola, is preserved, which makes the reconstruction process easier.
- Sentinel node biopsy: Since the sentinel lymph nodes are the first place that cancer is likely to spread, a doctor might suggest a sentinel node biopsy if cancer has spread to the lymph nodes. If no trace of a cancer cell is found in the nodes, it is unlikely that any more nodes need to be removed.
- Removal of breasts: Many women who have cancer in one breast often choose to remove both the breasts in order to avoid the risk of cancer spreading. While a family history of breast cancer can greatly increase the chance of breast cancer in a woman, statistics show that most women who have cancer in one breast do not develop cancer in the other one.
- Radiation: This is a process where a high-powered beam of energy is directed at the cancer cells to kill them. This method is often used after a lumpectomy. Radiations are of two types—external beam and brachytherapy. Some side effects of this treatment include fatigue, hair fall, loss of appetite and rashes.
- Chemotherapy: Chemotherapy is the treatment of cancer by cytotoxic and other drugs. This is often recommended by doctors when there is a good chance of the cancer cells spreading to other locations of the body. This form of treatment is often recommended before the surgery to shrink a tumour or restrict the growth of cells.
- Hormone therapy: Hormonal therapy is used to treat cancers that have hormonal sensitivity. They can be used before or after the surgery in order to ensure that cancer does not reoccur. Some of the treatment methods in this section include medication that restricts hormones from getting attached to the cancer cells, medications that restrict the body to produce oestrogen post-menopause and a medication that destroys cancer receptors.
In case you have a concern or query you can always consult an expert & get answers to your questions!