Dr. Phillip Kintner, MD

• 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.

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.

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.

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.

Hemorrhoid surgery (also called hemorrhoidectomy) is the surgical removal of hemorrhoids. Hemorrhoids are swollen or enlarged veins located inside (internal) or outside (external) the anus. They are usually caused by straining when constipated or during pregnancy. The surgery can remove large internal hemorrhoids that do not respond to nonsurgical treatment and large external hemorrhoids.

The surgery is performed in a surgery center under general or spinal anesthesia. The surgeon will make an incision in the tissue surrounding the hemorrhoid. The surgeon then ties off the swollen vein in the hemorrhoid to prevent bleeding and removes the hemorrhoid. The surgeon can remove the hemorrhoid with a knife (scalpel), a laser, or a cautery pencil. The area of the surgery is then either sewn closed or can be left open with gauze covering the wound.

Most patients can be released after the anesthetic wears off and the patient is able to urinate, although an overnight stay is not uncommon.

Hernia repair (or Herniorrhaphy) involves surgery to correct an abnormal protrusion of an organ through the wall of the area that normally holds the organ. This can happen when the outer layers of the abdominal wall weaken, bulge or rip. There are four types of hernias:

• Inguinal Hernia – The most common type of hernia; it occurs in the groin area.
• Umbilical Hernia – This is a hernia that develops through the navel.
• Incisional Hernia – This is a hernia that protrudes through a past surgical or operation site.
• Hiatal Hernia – This is a hernia that forms when the upper portion of the stomach slides into the chest cavity through the normal opening created by the esophagus.

If the protrusion can be pushed back into place, the hernia is referred to as reducible. If it cannot be, the hernia is referred to as irreducible, incarcerated or imprisoned. A strangulated hernia occurs when the blood supply to the tissue is cut off, causing worsening pain.

Most hernia repairs can be done on an outpatient basis. There are two methods used:

• Conventional Method – An incision is made over the site of the hernia. The surgeon returns the tissue to the abdominal cavity and removes the sac that has formed. The surgeon then sews strong surrounding muscle over the area.
• Laparoscopic Method – The surgeon inserts a scope through a small incision in the abdomen that the surgeon will use to view the contents of the abdomen with the use of a camera. The surgeon then makes repairs using instruments inserted into another small incision in the abdomen.

Both surgeries are performed using general anesthesia.

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 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.

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.

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.

For the surgery, a patient is put under general anesthesia and the patient’s blood is circulated through a heart-lung bypass machine to keep the blood oxygen-rich and circulating through the body. An incision is made through the breast bone. The diseased heart is removed and the donor heart is attached in its place. The heart-lung machine is disconnected so that blood can flow through the transplanted heart. The incision is closed.

Heart transplantation usually requires 7 to 21 days in the hospital, with the first 24 to 48 hours in an intensive care unit. The recovery period is about six months and often requires regular check-ups with blood tests and x-rays. All transplant recipients need lifelong treatment with immunosuppressant medications to prevent rejection of the transplanted heart.

Heart valve repair surgery is performed to repair malfunctioning heart valves. Examples of these can be valves that are blocked, narrowed or leaking. There are four valves in your heart. The mitral and aortic valves are the most commonly repaired, followed by the tricuspid valve.

Some procedures performed are:

• Valvuloplasty – This is plastic surgery repair of the valves and can be performed with cardiopulmonary bypass, occlusion (where the blood flow is temporarily interrupted by clamps) and dilation (stretching of the ventricle while on bypass).

• Valvotomy – This is a surgical incision into the stenosed cardiac valve to relieve obstruction. This can be performed with the patient being on occlusion (blood flow temporarily interrupted by clamps) and on a bypass. It can involve the placement of a prosthetic device that can replace the diseased area.
• Valvectomy – This is a surgical procedure in which a catheter is inserted to open a blocked or restricted valve and is performed while the patient is on bypass.

• Commissurotomy – This is a procedure where a surgical incision is made at the place where two cardiac valves form a connection.

All procedures are performed in a hospital setting by a cardiac surgeon under general anesthesia.

• Narrowing of the heart valve (stenosis)
• Leaking of the heart valve (regurgitation)
• Prolape (when the mitral valve flaps do not close properly).

Heart valve surgery is performed under general anesthesia by a cardiac surgeon. During the surgery your blood is routed to a heart-lung bypass machine that keeps the blood circulating during heart surgery. Replacement heart valves can be either natural (human or animal donors), or artificial (metal). After surgery the patient is usually placed in an intensive care unit for 2-3 days. The average hospital stay is 1-2 weeks and recovery time can take several weeks to several months.

Hemorrhoid surgery (also called hemorrhoidectomy) is the surgical removal of hemorrhoids. Hemorrhoids are swollen or enlarged veins located inside (internal) or outside (external) the anus. They are usually caused by straining when constipated or during pregnancy. The surgery can remove large internal hemorrhoids that do not respond to nonsurgical treatment and large external hemorrhoids.

The surgery is performed in a surgery center under general or spinal anesthesia. The surgeon will make an incision in the tissue surrounding the hemorrhoid. The surgeon then ties off the swollen vein in the hemorrhoid to prevent bleeding and removes the hemorrhoid. The surgeon can remove the hemorrhoid with a knife (scalpel), a laser, or a cautery pencil. The area of the surgery is then either sewn closed or can be left open with gauze covering the wound.

Most patients can be released after the anesthetic wears off and the patient is able to urinate, although an overnight stay is not uncommon.

Hernia repair (or Herniorrhaphy) involves surgery to correct an abnormal protrusion of an organ through the wall of the area that normally holds the organ. This can happen when the outer layers of the abdominal wall weaken, bulge or rip. There are four types of hernias:

• Inguinal Hernia – The most common type of hernia; it occurs in the groin area.
• Umbilical Hernia – This is a hernia that develops through the navel.
• Incisional Hernia – This is a hernia that protrudes through a past surgical or operation site.
• Hiatal Hernia – This is a hernia that forms when the upper portion of the stomach slides into the chest cavity through the normal opening created by the esophagus.

If the protrusion can be pushed back into place, the hernia is referred to as reducible. If it cannot be, the hernia is referred to as irreducible, incarcerated or imprisoned. A strangulated hernia occurs when the blood supply to the tissue is cut off, causing worsening pain.

Most hernia repairs can be done on an outpatient basis. There are two methods used:

• Conventional Method – An incision is made over the site of the hernia. The surgeon returns the tissue to the abdominal cavity and removes the sac that has formed. The surgeon then sews strong surrounding muscle over the area.
• Laparoscopic Method – The surgeon inserts a scope through a small incision in the abdomen that the surgeon will use to view the contents of the abdomen with the use of a camera. The surgeon then makes repairs using instruments inserted into another small incision in the abdomen.

Both surgeries are performed using general anesthesia.

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.

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.

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.

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.

• 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.