Dr. Juan Gonzalez, MD

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.

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)