Dr. Andrew Kwa, MD

Hip replacement surgery is performed by an orthopedic surgeon to replace all or part of the hip joint with an artificial device known as a prosthesis. The prosthesis consists of three parts that include a cup that replaces the hip socket, a metal or ceramic ball that replaces the head of the femur, and a metal stem that is attached to the shaft of the bone to add stability.

Reasons for the surgery include severe pain and/or osteoarthritis, hip fractures or hip joint tumors.

Under general anesthesia, the surgeon will make an incision over the buttocks to expose the hip joint. The head of the femur is cut out and removed. The rest of the hip socket is cleaned out and removed of all bone and cartilage. The surgeon then places the new socket and ball in the area. The surgery usually takes two to three hours.

Most patients are discharged within ten days of having the surgery. Full recovery can take three to six months, depending on the type of surgery, the patient's overall health, and the type of rehabilitation.

As younger patients are having hip replacements, revision surgery is becoming more common as the wearing away of the joint surface becomes a problem after 15 to 20 years. The revision surgery can also be performed for fractures, partal dislocation, and infection.

Knee repair surgery (also known as ACL meniscal repair) is a surgical procedure performed to fix torn ligaments and torn meniscus cartilage in the knee. The anterior cruciate ligament (ACL) is a ligament that crosses from the underside of the lower thigh bone to the upper end of the shin bone, including the kneecap. Injuries to this area are quite common as the result of sports activity. This surgery is often used to repair the area, allowing for normal range of motion and stability in the knee.

ACL meniscal repairs are typically performed using arthroscopic surgery where the physician uses a camera or arthroscope inserted in small incisions in the joint. The physician is able to insert instruments through the incisions to make repairs.

An orthopedic surgeon usually performs this type of surgery. Almost all surgeries are performed on an outpatient basis. The surgery can be performed under local, regional (specific area), or general anesthesia.

The surgery is performed on the medial (the middle part) or lateral (the side part) area of the knee. The surgery can be performed on both areas at the same time. Some procedures included in this surgery are:

• Meniscetomy – The removal of lateral or medial (or both) meniscus cartilage in the knee.
• Shaving – The partial removal or shaving of torn areas of the meniscus which also prepares the area for placement of a new ligament.

Knee replacement surgery is the placement of an artificial knee joint. The most common cause of knee pain is arthritis. It can be osteoarthritis, which normally occurs after the age of 50, rheumatoid arthritis (where too much synovial fluid is produced, overflowing the joint space), or post-traumatic arthritis following a knee injury.

Each artificial joint contains the following:

• Tibial Component – This replaces the end of the tibia (shinbone).
• Femoral Component – This replaces the end of the femur (thighbone).
• Patellar Component –This replaces the surface on the bottom of the patella (kneecap).

The knee can be attached by either cemented prosthesis, which is where the cement proxy attaches to the bone, or uncemented prosthesis, which is where there is a mesh on the surface that allows bone to grow into prosthesis.

The surgery is performed by an orthopedic surgeon using general or local anesthesia in a hospital setting. The surgeon begins by making an incision on the front of the knee to allow access to the joint. A tool is placed on the femur to keep proper alignment while the diseased bone is cut away from the end of the femur. The surgeon then prepares the top of the tibia bone by using another cutting tool. The undersurface of the kneecap is removed and the surgeon places the femoral component, the tibia component, and then the patellar component.

This procedure requires a hospital stay of several days.

Laparoscopic gallbladder removal (also known as laparoscopic cholecystectomy) is a procedure in which the gallbladder is removed using instruments inserted through small incisions in the abdomen. The procedure is performed in an operating room with the patient under general anesthesia. Most patients are released from the hospital the following day; some may even go home the same day.

Using a narrow tube-like instrument called a cannula, the surgeon enters the abdomen through small incisions made near the area of the navel. Inserted through the cannula is a tiny camera, which allows the surgeon to view the internal organs. The gallbladder is removed through the cannula, as well. If the surgeon finds one or more stones, he or she may remove them with a special scope, may choose to have them removed later through a second invasive procedure, or convert to an open procedure for the surgery.

Bariatric surgery, or gastric bypass surgery, is surgery that can be used to achieve significant weight loss in individuals who are very obese (morbidly obese). A thumb-sized stomach pouch is created (using a stapling or banding technique) then the outlet of the pouch is connected directly to the intestine, essentially bypassing the lower stomach. After the surgery, the amount of calories your body can intake is reduced which leads to weight loss.

Different procedures used include:

• Vertical-banded Gastroplasty – The upper stomach near the esophagus is stapled to form a small pouch. The outlet from the pouch to the stomach is restricted by the use of a band made of special material. This band delays the emptying of food from the pouch, causing a fullness sensation.
• Short-limbed Roux-en-Y Gastroenterostomy – The surgeon will divide the stomach into a small upper section. The surgeon will staple off the small section from the larger section. Then, they will reconnect a section of the small intestine to this new pouch, bypassing the larger stomach area remaining and connecting the base to the remaining portion of the small intestine.
• Small Intestine Reconstruction – In this procedure, more of the small intestine is bypassed than with the short-limbed Roux-en-Y procedure.

All procedures are performed under general anesthesia. A hospital stay of two to four days is expected.

Bone marrow is a soft, fatty tissue inside the bones where blood cells (red blood cells, platelets, and white blood cells) are produced and developed. Bone marrow biopsies (collection of a small sample for examination) are used to evaluate blood disorders and diagnosis certain types of cancers. They can also be helpful in diagnosing fevers of unknown origins.

A bone marrow biopsy can be an aspiration, a needle biopsy, or both. A local anesthetic is applied to numb the skin and the tissue down to the surface of the bone. A special needle is then used to penetrate the outer shell of the bone. Once inside, the center part of needle is replaced by a syringe and the liquid is collected. For a biopsy, the center of the needle is not replaced and the needle cuts a core that is collected by the needle. The core is extracted and prepared for examination by a pathologist.

Since the area is very small, usually a bandage is applied and the patient is released.

Bone marrow is a soft, fatty tissue inside the bones where blood cells (red blood cells, platelets, and white blood cells) are produced and developed. A bone marrow transplant is a procedure to transplant healthy bone marrow into a patient whose bone marrow is not functioning properly (that is, diseased or damaged). Problems in bone marrow are often caused by chemotherapy or radiation treatment for cancer. Bone marrow transplant is also done to correct hereditary blood diseases.

The patient is given high doses of chemotherapy and/or radiation to destroy the diseased cells prior to the implantation or transplantation. The cells and/or marrow are then injected directly into the patient's vein. This procedure is done in the patient's hospital room and does not require an operating room.

The name of the procedure depends the source of the healthy bone marrow (or stem cells). The healthy bone marrow (or stem cells) may be taken from:

•  the patient prior to chemotherapy or radiation treatment (autograft or transplantation-autologous),

•  a donor who is not an identical twin (allograft or transplantion-allogenic), or

•  an identical twin (syngenetic or transplantation-syngenetic).

Brain surgery is sometimes necessary to repair an injury, remove a tumor or lesion, or to stop bleeding or infection. Before surgery, an incision is made in the skull, and bone is removed to provide access to the brain. After surgery, the bone is replaced. This inpatient surgery is performed under general anesthesia by a neurosurgeon and requires a hospital stay. Brain surgery is performed in order to:

• Repair a fracture
• Remove a tumor or lesion
• Remove a blood clot
• Treat an area of infection
• Stop bleeding
• Implant electrodes to monitor seizures
• Treat an aneurysm (weakness in a blood vessel wall)

The patient may achieve partial recovery from brain surgery in one to four weeks; full recovery may take up to eight weeks, depending on patient health, the extent of the disease or injury, and the surgical procedures used by the physician.

Risks for any surgery are:

• Bleeding
• Infection

Additional risks of brain surgery are:

• Injury to brain tissue
• Injury to blood vessels
• Nerve or muscle paralysis or weekness
• Loss of mental functions (memory, speech, understanding)

Breast reconstruction surgery is performed when a breast has been removed due to cancer or other disease. Virtually any patient who loses their breast can have it rebuilt (with artificial implants and native tissue) through econstructive surgery, but there are risks associated with any surgery.

There are several different procedures that are associated with breast reconstruction. The first stage of reconstruction, the creation of the breast mound, is almost always performed in a hospital setting under general anesthesia. Follow-up surgery, however, may be performed at a hospital or an outpatient facility.

The surgery can take place immediately following the mastectomy or can be delayed.

Procedures include:

• Breast Prosthesis – This procedure involves inserting a breast implant.

• Nipple/Areola Reconstruction – This procedure involves either rebuilding the nipple or the areola (the circular area of darker pigmentation around the nipple). The nipple can be rebuilt using a skin flap or graft. The areola can be rebuilt using a graft or tattooing process.

• Breast Expander – A breast expander is used to stretch the skin. A surgeon inserts a balloon expander beneath the skin and the chest muscle. Periodically, the surgeon will inject a salt-water solution over a period of several weeks or months to stretch the skin. Once stretched, the surgeon can insert a more permanent implant. Some expanders can be left in place as the final implant.

• Flap Reconstruction – Flap reconstruction is the process of creating a skin flap using tissue from other areas of the body. Latissimus Dorsi Flap uses the tissue on the upper back. Free Flaps transplant non-essential donor tissue from one part of the body. Transverse Rectus Abdominis Myocutaneous (TRAM) Flaps use tissue from the lower abdominal wall.

Breast reduction surgery is performed to reduce the size of a patient's breasts. Many patients choose this operation to reduce back, neck and shoulder pain. Some choose this operation to make it easier to participate in sporting activities, to eliminate sleeping problems or poor posture resulting from large breasts, or to avoid unwanted attention and comments about large breasts.

Often called Reduction Mammoplasty, this surgery involves the removal of excess skin and fat from the breasts, reshaping of the breasts to form smaller breasts, and repositioning of the nipples.

The surgery is performed in a hospital setting under a general anesthesia and involves an overnight stay, sometimes longer.

A bunion is an enlargement of the joint at the base and the side of the big toe and consists of a bony growth. Most commonly seen in women, it is thought that wearing narrow pointed-toed shoes is the main cause. However, bunions are also known to be hereditary and are even found in societies where no footwear is ever worn, leading to the conclusion of inherited foot problems.

Surgical removal of a bunion is usually done while the patient is under general anesthesia and rarely requires a hospital stay. A podiatrist will make an incision along the bones of the big toe into the foot. The deformed joint and bones are repaired, and the bones are stabilized with a pin and/or cast.

Different procedures include:

• Keller Procedure – Distal soft tissue release
• McBride Procedure – Removal of the base of the proximal phalanx
• Mayo Procedure – Removal of the metatarsal head
• Removal of Joint with Implant - Removal of the total joint with implant placement
• Joplin Procedure – Transplantation of tendons
• Osteotomy – Surgical cutting of the joint
• Lapidus Procedure – Distal soft tissue rearrangement

Carotid surgery is a surgical procedure to remove the lining and fatty obstruction of a carotid artery that has been narrowed by atherosclerosis. Atherosclerosis is the narrowing of arteries usually due to the buildup of fatty tissue. The largest and most common clinical problems associated with atherosclerosis of a carotid artery are stroke or transient ischemic attack (TIA).

A carotid surgery restores normal blood flow to the brain, reducing stroke or TIA risk. Before surgery, the site of narrowing is located by means of an x-ray procedure called angiography.

Carotid surgery is a delicate procedure that may take several hours to perform. The procedure is performed in a hospital setting with general anesthesia. The artery is exposed, clamps are applied, an incision is made, and the diseased lining is removed along with the atherosclerotic material and any thrombus (blood clot) that has formed. The incision is closed with stitches. Most patients are able to leave the hospital within a day or two.

Carpal tunnel release is a surgery performed by an orthopedic and/or hand surgeon to relieve hand and wrist pain caused by the compression of the medial nerve at the wrist. The medial nerve and the tendons are located in one wall of the carpal tunnel. The other wall holds the bones of the wrist. Most conditions are caused by wrist fracture, rheumatoid arthritis, or overuse of the wrist.

The surgery is usually performed on an outpatient basis using either local or general anesthesia. The surgery can be performed two different ways:

• Using Endoscopy – The surgeon makes a small cut at the patient's wrist, reaches the carpal ligament using an endoscope, and makes repairs.

• Open Method – The surgeon makes a cut in the palm of the patient's hand and reaches the ligament by cutting through the underlying tissue and muscle.

The recovery time after the surgery depends on how damaged the nerve was before the surgery.

 

A cataract is the clouding of the eye's natural lens that lies between the iris and the pupil. Cataract surgery is performed to remove the clouded lens and replace the lens with a permanent implant. This implant is known as an intraocular lens implant (IOL). This surgery usually results in a return to normal vision. It is the most common surgery performed in the United States.

The surgery is usually performed on an outpatient basis by an ophthalmologist. The patient is given eye drops and sometimes medication to help the patient relax. A local anesthetic is applied to help make the operation painless.

The surgeon will make a small incision in the eye using an operating microscope. The lens is then removed or the surgeon will use a laser, ultrasound or other surgical solution to break up the lens for removal. The surgeon will then insert the lens implant (IOL) and close the incision. A patch is placed over the eye and after a short stay in the recovery area the patient is ready to go home.

Shoulder surgery involves the repair or reconstruction of bones, tendons or muscles that help the shoulder rotate smoothly and properly. Shoulder surgery is usually performed to restore movement, stability, function and comfort following an injury.

Depending on the extent of damage, repairing the shoulder could involve:

• Repairing a torn rotator cuff (the tendons and muscles that help the shoulder rotate properly)
• Repairing a broken collarbone (clavicle) with pins, plates, or wires
• Replacing the shoulder joint with an artificial implant
• Cutting of tendons to lengthen a muscle
• Repair of scapula using synthetic material
• Muscle transfer

An orthopedic surgeon usually performs this type of surgery as either open surgery (larger incision to expose the joint) or arthroscopic surgery (where the physician uses a camera or arthroscope inserted in small incisions in the joint). Shoulder surgery is done under general anesthesia. Recovery time can be from one to six months, depending on the procedure and severity of injury. For many patients of shoulder surgery, physical therapy may help them regain range of motion and strength.

Splenectomy is the surgical removal of a diseased or damaged spleen. A splenectomy can also be performed as a treatment for some blood disorders and some cancers. A complete splenectomy removes the entire spleen, while a partial splenectomy removes only a part of the spleen. A splenectomy can be performed in conjunction with another partial organ removal, such as the pancreas.

The spleen is in the uppermost area of the left side of the abdomen, just under the diaphragm. In healthy people, the spleen plays a role in immunity against bacterial infections and acts as a reservoir for blood.

During a splenectomy the artery to the spleen is tied to prevent blood loss, and surgeon detaches the ligaments and removes the spleen. A splenectomy can be performed as either open or laparoscopic surgery.

• In the open procedure, the surgeon makes an incision in the abdomen, under general anesthesia. This is performed in a hospital setting only and involves a hospital stay.

• The laparoscopic method is also performed in the hospital under general anesthesia but involves a shorter stay. The surgeon makes several small incisions in the abdomen, and using a tiny camera and instruments inserted through one of the openings, performs the removal of the spleen.

Thyroidectomy is the surgical removal of all or part of the thyroid gland. A thyroidectomy can be used to correct conditions such as hypothyroidism (low thyroid function), hyperthyroidism (overactive thyroid function), thyroid cancer, and nontoxic goiter.

The surgery is performed while the patient is under general anesthesia. An incision is made through the skin in the low collar area of the neck. Incisions can also be made near the sternum (breastbone). The muscles in the area are spread aside to reveal the thyroid gland. All or part of the gland will be cut free from the surrounding tissues and removed. The surgeon will then use stitches to bring the neck muscles back together and the outer incision will be closed. A suction catheter is inserted near the incision to help drain any accumulating fluid. The catheter is removed within 24 hours, and most patients leave the hospital in one or two days after the surgery.

Tonsillectomy is the surgical removal of the tonsils. Tonsils are glands located on both sides of the opening to the throat) that serve as protection against infections. When the tonsils become enlarged or inflamed, they can cause infections in the throat and the ear and can obstruct breathing. Enlarged adenoids (lymphatic tissue located in the back of the throat) can also obstruct breathing and can be removed at this time. This is called an adenoidectomy.

An ear, nose and throat surgeon (ENT) performs the operation, usually in an outpatient setting. While the patient is under general anesthesia, the surgeon uses a device to hold the mouth open to expose the tonsils and/or the adenoids. The tonsils are either cut away with an instrument or burned away using cautery. Some surgeons will chose to cauterize the adenoids instead of removing them, because cautery heals naturally without stitches and has a minimum of blood loss. The recovery can take up to two weeks. The patient may have some throat and ear pain the first few days. The use of ice packs, sucking on ice chips and eating ice cream can help provide comfort.

A hysterectomy is a surgical procedure in which the uterus is removed through an incision in the abdomen. As part of the hysterectomy, the fallopian tubes and cervix may also be removed.

Hysterectomies are performed for uterine fibroids (benign tumors in the uterus), abnormal uterine bleeding, endometriosis (the formation of cells outside of the uterus), and uterine prolapse (loosening of support muscles and tissue in the pelvic area). A hysterectomy can also be performed to treat cancer of the uterus.

Types of hysterectomies include:

• Total Abdominal Hysterectomy – The surgeon removes the uterus and the cervix through an incision in the abdomen, similar to an incision used for a Cesarian section.
• Partial Hysterectomy – The surgeon removes only the uterus and the fallopian tubes. The cervix is left intact to help support the vagina.
• Radical Hysterectomy – This involves the removal of the uterus, the cervix, tissue surrounding the cervix, and some removal of the upper vagina. This procedure is usually performed for early cervical cancer.

All hysterectomies are performed in a hospital setting and involve a stay of a few days.

Transurethral bladder surgery is performed to repair the bladder, to place incisions or insertions for drainage, and to remove cysts and tumors. For this surgery, a cystoscope (a tube with a tiny camera used to perform tests and surgeries) is inserted through the urethra into the bladder. This procedure is performed under regional or general anesthesia. No abdominal incision is necessary. After surgery, the patient is usually released the same day or after an overnight stay.

During this procedure, it is possible to irrigate and evaluate clots, perform biopsies, inject directly to tissue, remove tissue, use cryosurgery or laser procedures to remove tumors, or insert stents. The surgeon may also perform a meatotomy, which is an incision to enlarge the opening.

Tubal ligation is a surgery where a woman's fallopian tubes are cut and sealed. It is commonly known as “tying one's tubes.” Tubal ligation permanently sterilizes a woman by preventing an egg from traveling from the ovary down to the uterus, so that the male sperm cannot make contact with the egg. If the sperm and the egg cannot make contact, fertilization cannot take place and pregnancy cannot occur.

Tubal ligations can be performed in a hospital or an outpatient setting under general anesthesia. It can be performed at any time when the patient is not pregnant. Often, tubal ligations are performed following childbirth in a hospital setting.

During this procedure, the physician makes one or two small incisions in the abdomen (usually below the navel) and a laparoscope (a tiny camera) is inserted. Using surgical instruments, the fallopian tubes are sealed shut with either cautery (burned), or a small clip placed on the tube. (Cautery heals naturally without stitches and has a minimum of blood loss.) The skin incision(s) is then stitched closed. The patient can return home a few hours after the procedure. Most patients recover fully within a week.

Urinary incontinence is the accidental leakage of urine. The condition can range from occasional leakage to an inability to hold any urine. The two main types of urinary incontinence are:

• Stress Incontinence – Occurs with an activity that can put stress on the bladder, such as coughing, sneezing, exercise, or laughing.
• Urge Incontinence – Involves a strong sudden urge to urinate followed immediately by bladder contraction and involuntary loss of bladder control.

Urinary incontinence is most common among the elderly. Additionally, women are more likely to experience urinary incontinence due to the stress placed on the urinary tract by childbirth. Men can experience urinary incontinence due to prostate problems. Nerve problems and diseases such as diabetes and stroke can affect urinary incontinence in both sexes.

There are several surgical options for both men and women.

• Sling – For the male, the surgeon creates support for the urethra by wrapping a strip of material around the urethra and attaching the ends of the material to the pelvic bone. For female patients, the surgeon fashions a piece of material or muscle into a sling that lifts the urethra back into a normal position.
• Artificial Sphincter – This implanted device for men has three parts: a cuff that fits around the urethra, a small balloon reservoir placed in the abdomen, and a pump placed in the scrotum. The patient squeezes the pump when he wants to urinate, which deflates the cuff and allows the urine to flow. When the bladder is empty, the cuff automatically refills to keep the urethra tightly closed.
• Retropubic Suspension – This surgery for women lifts the sagging bladder neck and urethra by attaching their supporting tissues to the pubic bone.

All surgeries are performed using general anesthesia in a hospital setting. Stays in the hospital can average one to two days but could be more depending on the type of surgery and whether or not an abdominal incision is involved.

A vaginal hysterectomy is a surgical procedure in which the uterus is removed through the vagina. As part of the hysterectomy, the fallopian tubes and cervix may also be removed.

Hysterectomies are performed for uterine fibroids (benign tumors in the womb), abnormal uterine bleeding, endometriosis (the formation of cells outside of the uterus) and uterine prolapse, which involves the loosening of support muscles and tissue in the pelvic area. A hysterectomy can also be performed to treat cancer of the uterus.

In a vaginal hysterectomy, the uterus is removed through the vagina. A laparoscopic-assisted vaginal hysterectomy is performed with the help of a tiny lens that allows the surgeon to inspect the abdomen while performing surgery through small incisions.

Types of vaginal hysterectomies include:

• Partial Hysterectomy – The surgeon removes only the uterus and the fallopian tubes. The cervix is left intact to help support the vagina.
• Radical Hysterectomy – This involves the removal of the uterus and the cervix and tissue surrounding the cervix and some removal of the upper vagina. This procedure is usually performed for early cervical cancer.

All hysterectomies are performed in a hospital setting and involve a stay of a few days.

A vasectomy is a surgical procedure to tie the vas deferens of a man to cause sterility by preventing the sperm from leaving the testes. The vas deferens is located in the testicle as a small tube that carries the sperm to the semen. The procedure is recommended for adult men who are certain that they wish to prevent future pregnancies (permanent sterilization). There will still be a fluid ejaculate, but no sperm will be in the fluid, so the man cannot impregnate his partner.

Vasectomies are performed by an urologist in the office using a local anesthetic. There are two types of vasectomies:

• Conventional or Traditional – The surgeon uses a scalpel to make one or two incisions in the skin of the scrotum to expose the vas deferens in each testicle. The vas deferens is then lifted, cut and tied and returned to the scrotal sac and the incisions are closed with a few sutures.
• No Scalpel Vasectomy – The surgeon will locate the vas deferens in the scrotum manually, and will hold the tube in place with the use of a small clamp. A tiny puncture is made in the skin to form an opening for the vas deferens to be lifted, cut and tied, and put back into place. A suture can be used but most incisions are so small that none are needed.

Soreness is common, along with swelling and discomfort in the first few days. Most can return to normal activities within a week.