Dr. John Carpenter, MD

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.

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).