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.

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)

• 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.

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.

• 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

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.