Dr. John Boswell, MD

Some common locations for aneurysms include:

• Abdominal aorta – the major artery from the heart that supplies blood to your abdomen, the pelvis, and legs.
• Thoracic aorta – the major artery from the heart that supplies blood through the chest.

• Open Aorta Surgical Repair – The open aorta surgical repair involves placing clamps above and below the aneurysm to stop the blood flow to that part of the artery. Whether or not the surgery will involve the use of a heart-lung machine (cardio-pulmonary bypass) depends on the location of the aneurysm. If the aortic arch is involved, the surgeon may use a specialized technique known as circulatory arrest — a period without blood circulation while the patient is on life support. The surgeon replaces the weakened wall with a fabric tube called a graft. The surgeon may also use a prosthesis device.
  
• Graft-Stent Repair – This less-evasive procedure is used to repair thoracic aneurysms and does not require a chest incision. The surgeon inserts a tube where special catheters are introduced through the arteries at the groin. The physician then deploys a stent-graft or prosthesis at the site of the aneurysm which allows the flow of blood without putting pressure on the weakened wall.
  
• Endovascular Stent-Graft Repair – This less-invasive procedure is used for abdominal aneurysms. This procedure involves using long, thin tubes called catheters inserted in the patient's groin and guided through the blood vessels using live x-ray pictures. The physician then deploys a stent-graft or prosthesis at the site of the aneurysm which allows the flow of blood without putting pressure on the weakened wall. If this repair is unsuccessful, the surgeon may elect to perform an open repair.

• Severe abdominal pain
• Fever
• Loss of appetite
• Nausea and vomiting

A ruptured appendix must be removed immediately, or it may leak into the abdominal space and cause peritonitis, a life-threatening condition. Both open and laparoscopic surgery are performed under general anesthesia, and require a hospital stay of 1-4 days. Recovery time is usually 1-3 weeks following surgery, but is shorter with laparoscopic surgery.

An orthopedic surgeon usually performs this surgery, which requires a hospital stay. Recovery time will vary, and depends upon the patient, the extent of the injury, and the judgment and expertise of the physician.

Back surgery involves removal of all or part of a vertebra or disk in order to relieve pressure and pain on the nerves in the spine. A vertebra is one of 33 small bones making up the spine. Disks are the cushioning between the vertebrae that prevent the bones from coming into contact with each other.

A herniated disk is one that has ruptured or bulged from a tear in the disk covering. If the herniated disk presses on a nerve, surgery may be required to relieve the pressure and the pain associated with it.
Surgery may include:

Back surgery is usually performed by an orthopedic surgeon, and is done under general anesthesia. It is an inpatient procedure, which means that it requires a hospital stay. The surgery will relieve pain and allow the back to heal. Recovery time is typically 1-3 months.

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.

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.

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).

• 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)

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.

Cornea transplant surgery is performed when the damaged or diseased disc-shaped area of the cornea is replaced with a healthy similar-sized area of donor cornea. Some conditions that can cause the deterioration of the eye are keratoconus, bullous keratopathy, Fuch's dystrophy, and herpetic eye disease. Sometimes transplantation is necessary due to trauma or perforation to the cornea. Cornea transplants are one of the most frequently performed transplantation with over a 90-percent success rate.

The surgery is performed by an ophthalmologist in an outpatient setting using a local anesthetic. The surgery can be performed in tandem with cataract removal or intraocular lens (IOL) implantation.

After the patient is anesthetized, the surgeon sews a ring to the ocular surface to support the eye. The surgeon removes the cornea and the donor cornea is sewn into place with ultra-fine sutures. Post-operatively, the patient can expect gradual improvement of vision within six to twelve months. The surgeon will remove some of the sutures within a few weeks or months as the cornea heals.

The procedure is performed by a cardiologist and a team of specialized trained individuals at a hospital catheterization laboratory. The patient remains awake for the procedure (no anesthesia) but pain medicine may be given as needed.

Coronary angioplasty is performed by inserting a hollow needle into the femoral artery (an artery located in the groin near the thigh) . With the help of x-ray images, a guide wire is pushed through the needle into the artery, where it is advanced to a point just past the narrowing of the artery to be treated. Once the guide wire is in place, a balloon-tipped catheter is threaded over the guide wire and pushed along the artery until it reaches the area to be treated. The balloon at the tip of the catheter is then inflated and deflated several times to widen the narrowed part of the artery. When the procedure is complete, the balloon is deflated and the catheter is withdrawn.

The patient is monitored for 12-14 hours after the procedure with frequent vital sign checks. Most patients are released from the hospital within a day or two of the procedure.

Alternative Names: Balloon angioplasty; Coronary angioplasty; Coronary artery angioplasty; Cardiac angioplasty; PTCA; Percutaneous transluminal coronary angioplasty; Heart artery dilatation

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.

• Developmental abnormalities of the fetus
• Abnormal fetal heart rate
• Abnormal position of the fetus
• Extreme maternal illness
• Active genital herpes infection
• Maternal HIV infection
• Previous uterine surgery, including previous C-section
• Prolonged or arrested labor
• Placenta attached in abnormal location

Both regional and general anesthesia may be used. Regional anesthesia is most frequently used for labor and delivery. Regional anesthesia is when narcotics may be given by continuous infusion into the epidural space in the spine. General anesthesia is not recommended for routine deliveries, but is often the method used for an emergency cesarean section. Most mothers and infants recover well.

This major surgery carries significant risks that need to be considered. For the mother, these risks are:

• Hemorrhage
• Pain
• Infection
• Placental implantation problems in future pregnancies

There are also risks to a child born by a C-section:

• Respiratory problems
• Accidental surgical cuts
• Breastfeeding difficulties
• Asthma

Both regional and general anesthesia may be used. Regional anesthesia is most frequently used for labor and delivery, and is administered by continuous infusion into the epidural space in the spine. General anesthesia is not recommended for routine deliveries, but is often the method used for an emergency cesarean section. The average hospital stay after a cesarean section is 2-4 days.

During colon resection surgery (bowel resection) the diseased part of the large intestine is removed and the two healthy ends are sewn back together (resected). This surgery is used to treat many conditions, such as bowel obstruction, diverticulitis, Crohn's Disease and colon cancer.

If the entire colon and rectum is removed, the procedure is called a proctocolectomy.

A bowel resection may be performed as a traditional open procedure or as a minimally invasive laparoscopic procedure. The surgery is performed in a hospital setting under general anesthesia and can involve a hospital stay of up to seven days.

•  Open Procedure – The surgeon makes one large incision in the abdomen.

•  Laparoscopic Surgery – The surgeon makes three or four small incisions in the abdomen and inserts tube-like instruments. The abdomen is filled with gas to help the surgeon view the abdominal cavity. A camera is inserted through one of the tubes allowing the surgeon to work inside your abdomen.

Some other procedures that can be performed with the colon resection are:

•  Colectomy – If it is necessary to allow the colon to heal before returning it to its normal digestive process, a temporary opening of the colon (large intestine) through the abdominal wall may be created. In this procedure, the end of the healthy bowel tissue is passed through the abdominal wall, and the edges are stitched to the skin of the abdominal wall. An adhesive drainage bag is placed around the opening. Depending on the situation, the colostomy is usually temporary and can be closed with another operation at a later date.

•  Ileostomy – The ileum is located at the lowest portion of the small intestine. Similar to the colectomy, the healthy end of the ileum is brought through the abdominal wall, and the edges are stitched to the skin of the abdominal wall and an adhesive drainage bag is placed around the opening. When a large portion of the bowel is removed and the colon is no longer functional, the colostomy is usually permanent.

•  Coloproctostomy – An artificial opening that is created between the colon and the rectum.

Cornea transplant surgery is performed when the damaged or diseased disc-shaped area of the cornea is replaced with a healthy similar-sized area of donor cornea. Some conditions that can cause the deterioration of the eye are keratoconus, bullous keratopathy, Fuch's dystrophy, and herpetic eye disease. Sometimes transplantation is necessary due to trauma or perforation to the cornea. Cornea transplants are one of the most frequently performed transplantation with over a 90-percent success rate.

The surgery is performed by an ophthalmologist in an outpatient setting using a local anesthetic. The surgery can be performed in tandem with cataract removal or intraocular lens (IOL) implantation.

After the patient is anesthetized, the surgeon sews a ring to the ocular surface to support the eye. The surgeon removes the cornea and the donor cornea is sewn into place with ultra-fine sutures. Post-operatively, the patient can expect gradual improvement of vision within six to twelve months. The surgeon will remove some of the sutures within a few weeks or months as the cornea heals.

The procedure is performed by a cardiologist and a team of specialized trained individuals at a hospital catheterization laboratory. The patient remains awake for the procedure (no anesthesia) but pain medicine may be given as needed.

Coronary angioplasty is performed by inserting a hollow needle into the femoral artery (an artery located in the groin near the thigh) . With the help of x-ray images, a guide wire is pushed through the needle into the artery, where it is advanced to a point just past the narrowing of the artery to be treated. Once the guide wire is in place, a balloon-tipped catheter is threaded over the guide wire and pushed along the artery until it reaches the area to be treated. The balloon at the tip of the catheter is then inflated and deflated several times to widen the narrowed part of the artery. When the procedure is complete, the balloon is deflated and the catheter is withdrawn.

The patient is monitored for 12-14 hours after the procedure with frequent vital sign checks. Most patients are released from the hospital within a day or two of the procedure.

Alternative Names: Balloon angioplasty; Coronary angioplasty; Coronary artery angioplasty; Cardiac angioplasty; PTCA; Percutaneous transluminal coronary angioplasty; Heart artery dilatation

Defibrillator implant surgery is performed to implant a device to help control a patient's heart rhythm. There are two types of devices, pacemakers and implantable cardioverter defibrillator (ICD). Both help treat arrhythmias–irregularities in your heart's natural heart rhythm. Almost everyone's heart skips a beat and most are considered harmless. Some patients, however, will need medication and/or a defibrillator implant.

• Pacemaker – This is a small battery-operated device (about the size of a matchbox). It usually has two parts: a pulse generator (which includes the battery and several electronic circuits), and leads, which are attached to the heart wall. You may have one or two leads, depending on the pacemaker.

• Implantable Cardioverter Defibrillator (ICD) – This implant is about the size of a pager (larger than a pacemaker). It too has two parts: the pulse generator (which includes the battery and several electronic circuits), and a lead wire, or wires, depending on the device implanted. The lead wire(s) are placed inside the heart or on its surface and attached to the ICD. ICD are typically used to control fast irregular heart rates.

Pacemaker surgery is performed under local anesthesia. It is implanted just near the collarbone. If the pacemaker has only one lead, the lead is placed inside the lower right chamber. If two leads are needed, the second lead is placed in the upper right chamber. The procedure takes about one to two hours.

ICD surgery is performed in a hospital under general anesthesia. The device is implanted beneath the skin near the collarbone. It can also be implanted at another location at or above the waistline. The surgeon will then test the device and this can take up to two hours. An overnight stay is recommended.

Dilatation and Curettage (D&C) is a procedure to scrape and collect tissue from inside the uterus. This procedure is used to help diagnose medical conditions using the tissue collected, to treat irregular or heavy menstrual bleeding, or to remove fetal or placental tissue following a miscarriage.

This procedure can be performed in a hospital or in a clinic setting using either local or general anesthesia.

The vaginal canal is held open by a speculum and the opening to the cervix is anesthetized. The cervix is then opened (dilated) using various rod sizes until the cervix is opened to the desired size. After the cervix is dilated, instruments can be inserted into the uterus and manipulated, depending on the nature of the procedure.

Ear tube placement, or tympanostomy, is a procedure to drain fluid that has built up behind a child's eardrums to restore the normal function of the ear. This surgery is performed by an otolaryngologist. The tubes ventilate the ears, which help prevent fluid from building up in the ear which can cause reoccurring ear infections, and help reduce hearing loss due to fluid trapped behind the eardrum.

The tubes are placed through the ear canal in an operating room under general anesthesia. A tiny hole is made in the eardrum, and fluid is suctioned. A tiny tube is then inserted into the hole, allowing air to enter the middle ear. The procedure is a short one, and the patient is allowed to go home after a brief recovery period.

The tubes usually will fall out of the ear within one to two years as the eardrum grows.

Procedures used can include:

• Esophagectomy – An esophagectomy is the partial or complete removal of the esophagus (the tube from the mouth to the stomach) and the top part of the stomach. An esophagectomy is performed using one of two methods. Transhiatal Esophagectomy is performed with surgical incisions at the upper abdomen and the neck area. The second method, Transthoracic Esophagectomy is also known as the Ivor Lewis procedure and is performed with an upper abdominal incision and an incision into the chest area.
• Esophagoenterostomy – In this procedure, a connection is made between the esophagus and the small intestine following a gastrectomy.
• Roux-en-Y Reconstruction – In this procedure a small pouch is formed and connected to the intestine.
• Gastroduodenostomy – In this procedure, a connection is made between the stomach and duodenum (the first portion of the small intestine).
• Gastrojejunostomy – In this procedure, a connection is made between the stomach and the jejunum (the portion of the small intestine that extends from the duodenum to the ileum).
• Vagotomy – In this procedure the vagus nerve is cut to reduce acid secretion in the stomach. The vagus nerve has branches that go to different parts of the stomach.
• Pancreatectomy – This procedure involves the total or partial surgical removal of the pancreas.
• Whipple Procedure – Also known as a pancreaticoduodenectomy , this procedure is the removal of the duodenum with all or part of the pancreas.

A kidney transplant involves placing a healthy donor kidney into the body where it can perform all the functions that a failing kidney cannot. Kidney transplants are one of the most common transplant operations in the United States. People with chronic kidney disease can receive lifesaving dialysis until a donated kidney becomes available. A donated kidney may come from a living related donor, a living unrelated donor, or a deceased donor.

The donor kidney must match as closely as possible to your tissue type to reduce the chance that your body will reject the new kidney. A healthy donated kidney can be transported in cool salt water to preserve the organ for up to 48 hours. This allows time for tests to match the donor’s and recipient’s blood type before the operation.

For the surgery, a patient is put under general anesthesia. An incision is made in the lower abdomen area. The donor kidney is placed in the lower abdomen where it is surgically connected to nearby blood vessels and the bladder.

The donor kidney should begin to function immediately and patients typically remain in the hospital for about a week. The recovery period is usually three to six weeks and requires regular check-ups with blood tests during the first year. All transplant recipients need lifelong treatment with immunosuppressant medications to prevent rejection of the transplanted kidney.

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.

A liver biopsy is a medical procedure to remove a small amount of tissue from the liver for examination. The biopsy helps diagnose a number of liver diseases or assess the stage (early, advanced) of liver disease. This is especially important in hepatitis C infection. The biopsy also helps detect infections, cancer, unexplained enlarged liver, or abnormal liver enzymes detected by blood tests.

The biopsy is performed in a hospital setting under local anesthesia. The physician will use a needle to remove a small piece of liver tissue, which is sent to the laboratory for evaluation. The patient usually will remain lying down for one or two additional hours, to ensure that there have been no complications. The patient is then released and sent home.

The surgeon can also explore the bile ducts during the liver biopsy for congenital abnormalities such as atresia, in which the bile may back up into the liver.

Lumpectomy is the surgical procedure in which a cancerous lump or tumor in the breast is removed. The procedure is recommended only for those patients with less than 25 percent of the breast involved.

Lumpectomies can include excisional biopsy procedures. Biopsies are obtained either by needle or tissue sampling using either a scalpel or vacuum-assisted devices while under the guidance of ultrasound, MRI or other stereotactic diagnostic imaging.

To perform the lumpectomy, the surgeon will make a small incision over or near the breast tumor and cut free the lump and at least one-half inch of healthy tissue surrounding the tumor. The surgeon will submit the tissue to the pathologist for evaluation, often while the patient is still on the operating table, and if the extra tissue does not contain any cancerous cells, the excision will be sufficient. If cells are present, the surgeon may perform another sampling or perform a partial mastectomy.

A lung biopsy is a medical procedure in which a small amount of lung tissue is removed and examined by a pathologist for any abnormalities. The procedure is used to diagnose certain lung conditions, such as pulmonary fibrosis (scarring of the lungs with fibrotic tissue), sarcoidosis (clumps of cells formed in various organs), and cancer.

There are four types of lung biopsies:

• Bronchoscope Biopsy – For this method, a lighted instrument called a bronchoscope is inserted through the mouth or nose and into the airway to remove a lung tissue sample. This method is used if an infectious disease is suspected, if the abnormal tissue is located next to the breathing tubes (bronchi), or before trying more invasive methods.

  This is an outpatient procedure done by a pulmonologist with a local anesthetic sprayed into the mouth.

• Needle Biopsy – For this method, a long needle is inserted through the chest wall to remove a sample of lung tissue. A CT scan, ultrasound or a fluoroscope is used to guide the needle to the desired area. This is the best method if the abnormality is located close to the chest wall.

  This outpatient procedure is done by a pulmonologist or a radiologist with a local anesthetic applied to the area where the needle will be inserted.

• Open Biopsy – For this method, a surgical incision is made between the ribs and a sample of lung tissue is taken. This surgical procedure is done when all other methods have not been successful or when a larger piece of tissue is needed.

  This surgical procedure is performed by a thoracic surgeon or a general surgeon under general anesthesia while the patient is in the hospital.

• Video-Assisted Thorascopic Surgery – For this method, a thorascope is passed through a small incision in the chest to remove a sample of lung tissue.

  This surgical procedure is performed by a thoracic surgeon or a general surgeon under general anesthesia while the patient is in the hospital.

• Simple or Total Mastectomy – Removal of the breast, its skin, the nipple, but no lymph nodes.
• Subcutaneous Mastectomy – Removal of entire breast but leaves nipple and areola (dark pigmented area around the nipple) in place.
• Radical Mastectomy – Removal of the entire breast, nipple/areolar region, the major and minor chest muscles, and the lymph nodes.
• Modified Radical Mastectomy – Removal of the entire breast, nipple/areolar region, and the axillary lymph nodes.

Mastectomies are performed by a surgeon while the patient is under general anesthesia. The surgeon makes an incision near the site of the tumor and removes the breast tissue, and makes another incision to remove the lymph nodes, if scheduled. Drains are inserted either in the breast or under the arm to collect any fluid during the healing process. The surgery time averages two to three hours, but can increase due to reconstruction of the breast. Most patients can leave the hospital in two to three days.

• Use forceps or a vacuum extractor. Forceps have rounded edges that fit around the fetus' head. A vacuum extractor consists of a small cup made of a rubberlike material that is connected to a vacuum. It is inserted into the vagina and uses suction to attach to the fetus's head.
• Perform an episiotomy. An episiotomy is an incision between the vaginal opening and the anus.

After delivery, the placenta will usually detach from the uterus and the woman can push out the placenta on her own. If the placenta is not delivered within 30 minutes the physician may insert a hand into the uterus, detach the placenta from the uterus and remove it.

Both regional and general anesthesia may be used. Regional anesthesia is the most frequently used for labor and delivery, and the narcotics are administered by continuous infusion into the epidural space. A physician may also use a Pudendal block, which involves injecting a local anesthetic through the vaginal wall. General anesthesia is not recommended for routine deliveries, but is often the method used for an emergency cesarean section.

The normal hospital stay for a vaginal delivery is 24-48 hours.

Open bladder surgery is performed to repair the bladder, to place incisions or insertions for drainage, to remove cysts, diverticulum, or tumors, or to remove the bladder completely.

Open bladder surgeries cover many different procedures.

• Ureteroncystostomy – This procedure involves the surgical fusion of a single or duplicated ureter to the bladder. This procedure may also include a bladder flap or extensive tailoring to help prevent reflex.
• Cystotomy – This is a surgical incision into the bladder which can be used to insert radioactive material, a stent or ureteral catheter, or a drain, remove a bladder stone, or to perform cryosurgery (freezing tissue in order to destroy it).
• Excision and Cystotomy – These procedures involve removing bladder cysts, lesions, diverticulum and tumors.
• Partial Cystectomy – This procedure involves the partially removing the bladder and can include reimplanting the ureters into the bladder.
• Complete Cystectomy – This procedure involves completely removing the bladder and can include fusion to the small and/or large intestines to create a "neobladder."
• Cystoplasty or Cystouterthroplasty – This procedure involves plastic or reconstructive surgery on the urinary bladder or ureter(s).
• Cystorrhaphy – This procedure is the suturing of the bladder to repair a wound.
• Closure – These procedures are repairs done on the bladder, vagina, or vaginal fistulas.

Most procedures are done in a hospital setting under general anesthesia.

Ovary removal surgery (also known as oophorectomy or ovariectomy), is the surgical removal of one or both ovaries. The surgery is performed to remove ovaries affected by cancer, to remove the source of estrogen that may stimulate some cancers, to remove large ovarian cysts, or to treat endometriosis.

The surgery is performed under general anesthesia and can be either open or laparoscopic surgery.

• Open Surgery – The surgeon makes a horizontal or vertical abdominal incision and the abdominal muscles are pulled apart, allowing the surgeon a better view of the abdominal cavity and the ovaries. The surgeon then removes the ovaries and often, the fallopian tubes. If cancer is not present, the patient may be started on hormone therapy ease the symptoms of menopause. The patient is usually discharged from the hospital in two to five days.
• Laparoscopic Surgery – A tube containing a tiny lens is inserted through a small incision made in the navel. Other instruments are inserted through another small incision made in the pubic area. The ovary is disected into smaller pieces and removed through the small incision at the top of the vagina. If cancer is not present, the patient may be started on hormone therapy to ease the symptoms of menopause. The recovery time is normally shorter than that for the open procedure.

If a patient has a heartbeat that is too fast, too slow, or frequently irregular, blood is not pumped efficiently around the body and the body's cells do not get enough oxygen and nourishment. In this situation, a physician may recommend that an artificial pacemaker be implanted in the body to ensure that the heart beats more regularly.

A pacemaker is a small, battery-operated device implanted just under the skin near the collarbone to help the heart beat regularly at an appropriate rate. Pacemakers are about the size of a matchbox and are used to treat heart arrhythmias — irregularities in your heart's natural heart rhythm. Almost everyone's heart skips a beat sometimes, and that is generally considered harmless. Some people, however, will need medication and/or a pacemaker.

A pacemaker usually has two parts: a pulse generator (which includes the battery and several electronic circuits); and a lead(s), (which is attached to the heart wall).

Pacemaker surgery is performed under local anesthesia. It is implanted just near the collarbone. If the pacemaker has only one lead, the lead is placed inside the lower right chamber. If two leads are needed, the second lead is placed in the upper right chamber. The procedure takes about one to two hours. An overnight stay is usually recommended.

Prostate removal surgery (also known as Prostatectomy) is the removal of all or part of the prostate. The prostate gland is an organ at the base of the bladder in men, surrounding the urethra. When the gland becomes enlarged, the prostate can compress the urethra, causing problems with urination.

The removal of the prostate gland can be done in different ways, depending on the size of the prostate and the cause of the enlargement. The most common prostate removal surgical procedures are:

• Transurethral Resection of the Prostate (TURP)- is the most common treatment for benign hyperplasia (prostate gland overgrowth). The procedure is performed using either a general or a spinal anesthesia. A tubelike instrument called a cystoscope is inserted into the penis through the urethra. A cutting instrument is then inserted through the cystoscope to remove the prostate gland piece by piece. Any blood vessels are cauterized during the surgery to stop the bleeding. A catheter will be placed following surgery to help the bladder drain and is usually removed within one to three days. The hospitalization time is approximately one to five days.

• Open Prostatectomy – Using general or spinal anesthesia, an incision is made in the lower abdomen between the navel and the penis. The gland is then removed through this incision. Catheters inserted following surgery will remain in place from five days to a few weeks until the bladder has healed. The hospitalization time is longer than five days. This surgical procedure is also known as suprapubic or retropublic prostactomy.

• Transurethral Incision of the Prostate (TUIP) – is a procedure that is recommended for men with only slightly enlarged prostates. In this procedure, under general or spinal anesthesia, the surgeon will use an instrument inserted into the penis through the urethra that generates an electric current or laser beam to make incisions in the prostate where the prostate meets the bladder. This relaxes the opening to the bladder, allowing for greater flow out of the bladder. A catheter is inserted in the bladder following surgery and is left in for one to three days. This procedure can be done in a hospital setting with a short stay of one to three days, or in an outpatient setting.

• Reduce or increase the size of the nose
• Change the shape
• Narrow the opening of the nostrils
• Correct a birth defect
• Relieve breathing problems
• Correct an injury.

Rhinoplasty may be performed under local or general anesthesia, depending on the extent of the procedure. Surgery is usually performed by a plastic surgeon in an office-based facility, an outpatient surgery center, or hospital. Patients are up and about within two days, and can usually return to work after a week. Complete recovery may take several weeks.

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.

Ovary removal surgery (also known as oophorectomy or ovariectomy), is the surgical removal of one or both ovaries. The surgery is performed to remove ovaries affected by cancer, to remove the source of estrogen that may stimulate some cancers, to remove large ovarian cysts, or to treat endometriosis.

The surgery is performed under general anesthesia and can be either open or laparoscopic surgery.

• Open Surgery – The surgeon makes a horizontal or vertical abdominal incision and the abdominal muscles are pulled apart, allowing the surgeon a better view of the abdominal cavity and the ovaries. The surgeon then removes the ovaries and often, the fallopian tubes. If cancer is not present, the patient may be started on hormone therapy ease the symptoms of menopause. The patient is usually discharged from the hospital in two to five days.
• Laparoscopic Surgery – A tube containing a tiny lens is inserted through a small incision made in the navel. Other instruments are inserted through another small incision made in the pubic area. The ovary is disected into smaller pieces and removed through the small incision at the top of the vagina. If cancer is not present, the patient may be started on hormone therapy to ease the symptoms of menopause. The recovery time is normally shorter than that for the open procedure.

If a patient has a heartbeat that is too fast, too slow, or frequently irregular, blood is not pumped efficiently around the body and the body's cells do not get enough oxygen and nourishment. In this situation, a physician may recommend that an artificial pacemaker be implanted in the body to ensure that the heart beats more regularly.

A pacemaker is a small, battery-operated device implanted just under the skin near the collarbone to help the heart beat regularly at an appropriate rate. Pacemakers are about the size of a matchbox and are used to treat heart arrhythmias — irregularities in your heart's natural heart rhythm. Almost everyone's heart skips a beat sometimes, and that is generally considered harmless. Some people, however, will need medication and/or a pacemaker.

A pacemaker usually has two parts: a pulse generator (which includes the battery and several electronic circuits); and a lead(s), (which is attached to the heart wall).

Pacemaker surgery is performed under local anesthesia. It is implanted just near the collarbone. If the pacemaker has only one lead, the lead is placed inside the lower right chamber. If two leads are needed, the second lead is placed in the upper right chamber. The procedure takes about one to two hours. An overnight stay is usually recommended.

Prostate removal surgery (also known as Prostatectomy) is the removal of all or part of the prostate. The prostate gland is an organ at the base of the bladder in men, surrounding the urethra. When the gland becomes enlarged, the prostate can compress the urethra, causing problems with urination.

The removal of the prostate gland can be done in different ways, depending on the size of the prostate and the cause of the enlargement. The most common prostate removal surgical procedures are:

• Transurethral Resection of the Prostate (TURP)- is the most common treatment for benign hyperplasia (prostate gland overgrowth). The procedure is performed using either a general or a spinal anesthesia. A tubelike instrument called a cystoscope is inserted into the penis through the urethra. A cutting instrument is then inserted through the cystoscope to remove the prostate gland piece by piece. Any blood vessels are cauterized during the surgery to stop the bleeding. A catheter will be placed following surgery to help the bladder drain and is usually removed within one to three days. The hospitalization time is approximately one to five days.

• Open Prostatectomy – Using general or spinal anesthesia, an incision is made in the lower abdomen between the navel and the penis. The gland is then removed through this incision. Catheters inserted following surgery will remain in place from five days to a few weeks until the bladder has healed. The hospitalization time is longer than five days. This surgical procedure is also known as suprapubic or retropublic prostactomy.

• Transurethral Incision of the Prostate (TUIP) – is a procedure that is recommended for men with only slightly enlarged prostates. In this procedure, under general or spinal anesthesia, the surgeon will use an instrument inserted into the penis through the urethra that generates an electric current or laser beam to make incisions in the prostate where the prostate meets the bladder. This relaxes the opening to the bladder, allowing for greater flow out of the bladder. A catheter is inserted in the bladder following surgery and is left in for one to three days. This procedure can be done in a hospital setting with a short stay of one to three days, or in an outpatient setting.

• Reduce or increase the size of the nose
• Change the shape
• Narrow the opening of the nostrils
• Correct a birth defect
• Relieve breathing problems
• Correct an injury.

Rhinoplasty may be performed under local or general anesthesia, depending on the extent of the procedure. Surgery is usually performed by a plastic surgeon in an office-based facility, an outpatient surgery center, or hospital. Patients are up and about within two days, and can usually return to work after a week. Complete recovery may take several weeks.

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.