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What is Surgery?


Surgery is a branch of medicine that uses operative procedures to treat injuries, deformities, diseases and disorders. Many surgical procedures include mending broken bones, reattaching severed limbs, removing diseased and injured tissue and organs and stopping uncontrollable bleeding. The surgical field of medicine also includes the diagnoses, preoperative and postoperative care and treatment.

The first evidence of surgery was performed in the Neolithic Age about 8000BC. A procedure called Trepanning was performed which relieved pressure in the brain by drilling a hole in the skull. However, the earliest recorded medical writings is from the Egyptians who used various surgical procedures. Surgeons in India were able to remove urinary tract stones as far back as 2000 years ago.

Many surgical discoveries took place during the 16th, 17th and 18th centuries. A French Surgeon named Ambroise Paré made many significant discoveries. He pioneered the method of ligating, or tying off arteries to control profuse bleeding. He has been called the father of modern surgery. Another milestone in the surgery field was in 1846 when an American dentist, William Morton found a way to eliminate pain during surgery. William Morton is credited with discovering surgical anesthesia. This opened the door for many surgical procedures to be performed where it had been too uncomfortable in the past. Nonetheless, postoperative infections remained a problem until 1865 until a British Surgeon, Joseph Lister developed antiseptic techniques used in operating rooms. This helped minimize infection that developed during surgery. Now that the two biggest problems of surgery (pain and infection) had been addressed, Surgeons in the late 1800's began performing many new types of surgery.

Today, surgery has advanced at a rapid pace. Many diagnostic techniques have been developed. These advances include radiology, ultra sound and CAT scans (computerized axial tomography) all of which provide Surgeons images of the internal structures of the body. Surgeons also use endoscopes, which allow them to diagnose as well as operate on the inside of the body with minimal trauma to the patient.

Needless to say, technology has been a major factor in the growth of the surgical field. Inhalation devices, cardiac defibrillators, cardiac monitoring devices, lasers, anesthesia devices and heart/lung machines are some of the technological advancements. These devices have provided much needed support equipment to Surgeons. They have allowed them to monitor vital bodily functions accurately as well as help prolong the life of their patients.

Every day new technological advances are being made. New high-tech diagnostic equipment gets better every year, providing invaluable information to the Surgeon. Because of this, Surgeons must continually educate themselves to remain on the cutting edge of medicine.


How Surgeons Were Selected


Consumers' Research Council of America has compiled a list of top Surgeons throughout the United States by utilizing a point value system. This method uses a point value for criteria that we deemed valuable in determining top Surgeons. 

The criteria that was used and assessed a point value is as follows:

Experience: 

     

Each year the Surgeon has been in practice

Training:

Education and Continuing Education

Professional Associations:

Member of Professional Medical Associations

Board Certification:

Completing an approved residency program and passing a rigid examination on that specialty


Simply put, Surgeons that have accumulated a certain amount of points qualified for the list. This does not mean that Surgeons that did not accumulate enough points are not good Surgeons. They merely did not qualify for this list because of the points needed for qualification.

Similar studies have been done with other professions using a survey system. This type of study would ask fellow professionals on who they would recommend. We found this method to be more of a popularity contest, for instance; professionals who work in a large office have much more of a chance of being mentioned as opposed to a professional who has a small private practice. In addition many professionals have a financial arrangement for back-and-forth referrals. For these reasons, we developed the point value system.

Since this is a subjective call, there is no study that is 100% accurate. As with any profession, there will be some degree of variance in opinion. If you survey 100 patients from a particular physician on their satisfaction, you will undoubtedly hear that some are very satisfied, some moderately satisfied and some dissatisfied. This is really quite normal.

We feel that a point value system takes out the personal and emotional factor and deals with factual criteria. We have made certain assumptions. For example, we feel that the more years in practice is better than less years in practice; more education is better than less education, etc.

The top Surgeon list that we have compiled is current as of a certain date and other Surgeons may have qualified since that date. Nonetheless, we feel that the list of top Surgeons is a good starting point for you to find a qualified Surgeon.

No fees, donations, sponsorships or advertising are accepted from any individuals, professionals, corporations or associations. This policy is strictly adhered to insure an unbiased selection.


Finding a Surgeon


Choosing a Surgeon is an important decision. The Surgeon you are looking for should be qualified at performing the procedure you need as well as understanding the particular circumstances of your case. The Surgeon should provide you with realistic information about the procedure and the outcome of your results. We strongly recommend finding a Surgeon that is board certified and who has received surgical instruction, training and experience in the procedure you need. Thus, our goal is to assist you in making that decision. First of all, when selecting a Surgeon, you may want to begin your search several different ways:

Ask a family physician. He or she is in constant contact with all kinds of healthcare professionals and will be able to point you in the right direction.
Ask family, friends, neighbors and/or co-workers.
Contact your local hospital and speak to surgical ICU nurses that do a lot of the procedures you are having done. These nurses take care of the end results of all Surgeons.
Contact your city, county or state medical agencies for names of qualified Surgeons. Contact and ask for referrals from medical associations. Many are listed in this book.

 


Surgical Specialties


Each surgical specialty has its own accrediting board for training and educating Surgeons for their specialty. Some of the boards have a sub-specialty which require additional training and examinations. Some examples of these sub-specialties are Hand Surgery, Pediatric Surgery and Vascular Surgery.     

A Surgeon first obtains a medical license. The Surgeon is required to take a program that is accepted by the Residency Review Committee for the specialty they are wanting to obtain. When the training is completed, the appropriate medical specialty board administers an examination for certification. The Surgeon is then required to make use of the facilities at a given hospital
, which has various committees that review all surgical cases. The hospital is reviewed by the Joint Commission on the Accreditation of Hospitals to make sure policies are being adhered to and that patient care is being handled at a high standard.


General Surgery

General Surgery is the largest of all the surgical fields. This area of expertise includes abdominal organs, the breast, thyroid, parathyroid, pancreas, digestive tract, blood vessels and injury management. There are two sub-specialties in general surgery that require additional training and examinations. These include pediatric surgery and hand surgery.


Colon & Rectal Surgery

Practitioners of this field are trained to diagnose and treat patients who have disorders of the colon, anal canal, rectum, and perianal area. These Surgeons have expertise in dealing with medical problems such as hemorrhoids, fissures, lower digestive tract issues, inflammatory diseases, polyps and cancer.


Thoracic Surgery

Thoracic Surgeons devote themselves to the operative conditions within the chest. Areas of specialization include the chest wall, the lungs, the heart, esophagus and major blood vessels in the chest area. Many Thoracic Surgeons specialize in cardiac procedures such as heart transplants, implantations of cardiac pacemakers, replacement of diseased and damages heart valves, bypass operations of the coronary arteries and surgical corrections and treatment of congenital heart defects. A Thoracic Surgeon has substantial knowledge and skills in cardiorespiratory physiology. The Surgeon is part of a large team of highly trained professionals that include cardiologists, heart-lung pump teams, catheterization teams, radiologists performing angiographies, echocardiography teams and nursing teams.


Vascular Surgery

This is an area of surgery that specializes in the disorders and treatment of blood vessels which affects all areas of the body with the exclusion of heart and intercranial vessels. A vascular Surgeon uses a variety of diagnostic techniques observing internal structures, including endoscopy and using specialized medical equipment.


Plastic Surgery

A Plastic Surgeon deals with the repair and restoration to the skin and underlying areas when injuries come about from accidents and major surgical operations. Reconstructive procedures include modifying tissues and scars to minimize or eliminate deformities due to prior operations, birth defects automobile accidents and other traumatic injuries. It is common for many plastic surgeons to devote their time to cosmetic surgery procedures. Typical cosmetic surgery procedures include Rhinoplasty (cosmetic surgery on the nose), Blepharoplasty (cosmetic surgery on the eyelids), Face Lift (cosmetic surgery to tighten facial tissue) and other cosmetic procedures that reducing and enlarging the breasts.


Neurological Surgery

A Neurological Surgeon deals with disorders of the brain, spinal cord, meninges, pituitary gland and nerves throughout the body. The advanced technology with CAT Scans assists the Neurological Surgeon in diagnoses and treatment of brain disorders and head injuries.


Orthopedic Surgery

The Orthopedic Surgeon is involved with problems related to joints, bones, and musculoskeletal oncology. Orthopedic Surgeons do surgical procedures for replacement of hips and knee joints that are replaced with special plastic and metals parts as well as the repairing of fractured bones with pins, plates and screws. They are also concerned with deformities, injuries and degenerative diseases of the elbows, hips, shoulders, hands, feet and spine.


Ophthalmic Surgery

Ophthalmic Surgery involves surgical procedures to the eye. It is common the Ophthalmic Surgeons use micro surgical techniques performed under a microscope and extensive use of the laser. This type of surgery includes the removal of cataracts, implantation of artificial lens, the reattachment of a detached retina, LASIK and many other vision related procedures.


Otolaryngologic Surgery

This surgical specialty diagnoses and treats diseases of the ear, nose, throat and larynx. This Surgeon provides surgical therapy for the prevention of diseases, allergies, deformities and injuries to the nose, ear and throat, face and jaw. Areas of expertise include head and neck oncology, facial plastic and reconstructive surgery and the diagnosis and treatment of hearing and voice disorders. 


Hand Surgery

A Hand Surgeon is specially trained to diagnose and treat hand related problems. Common problems they treat include carpal tunnel syndrome, tennis elbow, reattach fingers and treat injured hands.


Pediatric Surgery

The Pediatric Surgeon understands and is trained to handle surgical procedures on children. Children and infants' organ systems are not fully developed and procedures, anesthetics, medications and treatments need to be adjusted accordingly. Many pediatric procedures include the correction of birth defects and the removal of potentially cancerous growths.


Common Surgical Procedures



Thyroid Surgery

Thyroid experts advise that people over the age of thirty five be thyroid tested. Experts have concluded that women are seven times more likely than men to develop a thyroid problem. Age is also another major factor; women at the age of sixty have a one-in-five chance of having a thyroid problem. The post-partum and menopausal periods are times when a woman is most vulnerable to thyroid disorders.

Many symptoms of a thyroid disorder are common symptoms of other health conditions. These symptoms do not mean that you have a thyroid disorder, but you should be aware of them so you can determine if you should be tested by your physician.

Some common symptoms include:

      A high or low pulse rate       Fatigue and exhaustion
Anxiety-Panic Attack Low sex drive
High or low blood pressure Insomnia
Heart palpitations Mood swings, irritability
Rapid weight gain or loss
despite exercise and diet
Irregular menstrual cycles


There are various reasons for thyroid surgery. Common reasons for thyroid surgery include:
When a woman is pregnant and her hyperthyroidism can not be controlled and regulated by any other means.
When breathing and swallowing is difficult due to enlarged thyroid nodules.
When cancerous cells have been discovered near or on the thyroid gland.

In most cases thyroid surgery is not complicated and the actual surgery takes less than two hours. It is now common for this type of surgery to be performed on an outpatient or overnight basis. There are three types of thyroid surgery performed. They are as follows:

Thyroid Lobectomy: The removal of approximately one quarter of the thyroid gland
Subtotal Thyroidectomy:    The removal of approximately one half of the thyroid gland
Total Thyroidectomy: The complete removal of the thyroid gland


Most thyroid patients resume work within seven to fourteen days following surgery. Generally, the only major restriction will be no swimming. You will be encouraged to move about as soon as possible. Eating and drinking can be a discomfort and a soft diet is usually prescribed until it has had time to heal.

Thyroid replacement drugs will almost always be prescribed for the remainder of the patient's life. It is common to be tested a month after starting hormone replacement drugs to make sure that you are not taking too much or too little. A patient following this surgery should carefully watch for signs of hypothyroidism which symptoms include fatigue, feeling run down, depressed, muscle cramps and weight gain. Good patient/doctor communication and patient follow-up is essential for a good and complete recovery.


Angioplasty

Angioplasty is a procedure performed during a heart catheterization. The atherosclerotic blockages in the coronary arteries are compressed against the vessel wall by expanding a balloon from within the artery.The angioplasty procedure is an invasive method of opening blocked arteries that are restricting and impeding blood flow. When the balloon is inflated, the plaque blocking the interior arterial wall is compressed and remains compressed, clearing space so the blood flow volume can increase.

The angioplasty method is a less invasive procedure as compared to a bypass surgery. Angioplasty has less risk and the recovery period is much quicker. Your cardiologist will tell you if you are a good candidate for this procedure. The cardiologist will take into consideration your age, severity of the blockage and your overall physical condition.

Angioplasty procedures have been performed for the past 25 years. Results show that patients are doing better today because of advanced drug therapies and new advanced techniques that are better able to detect the exact locations of the blockages.

 In the early 1990's Surgeons started using stents. Stents are tiny wire mesh tubes which are inserted permanently at the location of the blockage. The use of stents have been highly successful in reducing the possibility of arterial collapse and the renarrowing of the artery which is called restenosis. Seasoned doctors who perform this procedure are able to install stents in one or more arteries with a high degree of success.


Coronary Artery Bypass Graft Surgery

Coronary bypass surgery is very successful in relieving angina. This surgical procedure is highly invasive which requires the opening of the chest, routing the blood through a heart lung machine, transplanting new vessels and stopping and restarting the heart. Bypass surgery requires taking large blood vessels from the patients legs, stomach or chest and grafting them to the front and back of the blocked arteries.

During a bypass procedure the heart-lung machine takes over the functions of the heart and lungs. This is done so the heart can be carefully stopped and the Surgeon can work in a blood-free environment. The heart-lung machine keeps oxygen-rich blood flowing through the body. It receives the blood and removes the carbon dioxide and other waste products, warms and/or cools the blood and adds oxygen as it pumps the blood through the patient's body. At the conclusion of the bypass surgery, the heart is restarted and the heart-lung machine is disconnected.

New advances in bypass surgery are continuing. A minimally invasive bypass surgery technique is being tested with promising results. This new procedure requires the Surgeon to work on the front of the heart through a four inch incision while it is beating slowly. Another type is that the heart is stopped and a Surgeon uses a fiberoptic scope that is passed through a 4 ½ inch incision and the Surgeon works on all sides of the heart by viewing a video image. This less invasive procedure would be less expensive and requires a much shorter hospital stay.


Rhinoplasty

Rhinoplasty is plastic surgery of the nose. This procedure is very common and you are a good candidate for this procedure if:

        Your nose is crooked or off-center
Nostrils are excessively wide or flared
A bump or high point on your nasal bridge
Your nose is too large for your face
The nasal tip is sagging or thickened/ enlarged

Many Surgeons prefer not to operate on teenagers until they have completely stopped growing. Each case is individual and needs to be discussed in detail with your Surgeon.

The actual procedure usually takes between one and two hours. Rhinoplasty can be performed under local or general anesthesia depending on what procedure you and your Surgeon have decided upon. The skin of the nose is separated from the bone and cartilage and then is sculpted to the desire shape. Many times the incisions are made on the inside of the nose, depending on the Surgeon and what exactly needs to be done.

Your face will experience discomfort for the first twenty-four to forty-eight hours. It is common for your face to feel swollen and for you to have a headache after this procedure. It is usually recommended to stay off of your feet for the first 24 hours and get proper rest. By applying cold compresses, swelling and aching will be reduced to a minimum. Slight bleeding will occur and blowing your nose is not advisable for the first
week following the procedure.


Arthroscopic Surgery

Until recently, treatment, diagnosis and examinations were difficult in orthopedic injuries. The arthroscope has made it possible for Surgeons to treat joint injuries quickly and effectively. The arthroscope is a small fiber optic medical device used for viewing. This high-tech instrument consists of a tiny lens and video with a light source.

The arthroscope is inserted through a very tiny 1/4" incision into the joint. The incision is called a portal. Other portals in the immediate area are used for the insertion of other medical instruments used in the surgical procedure. An arthroscopic Surgeon can correct and diagnose a variety of problems such as ligament tears, arthritis and other joint-related problems. The portals leave very little scars and many times are unnoticeable.


Gallbladder Surgery

Each year over 500,000 Americans have gallbladder surgery. One type of gallbladder surgery is called a laproscopic cholecystectomy. It is used in 95% of gallbladder removal surgeries. The Surgeon inserts a miniature video camera and surgical instruments through tiny incisions in the abdomen. The video camera transmits images to a video monitor, giving the Surgeons a close up and detailed view of the various organs and tissue. While using the camera as his eyes, the Surgeon separates the gallbladder from the liver, ducts and other tissue. The cystic duct is cut and the gallbladder is removed through one of the small incisions.

Laparoscopic surgery is preferred since abdominal muscles are not cut. This results in a much quicker recovery and sometimes requires only one night in the hospital. However, an open surgery is sometimes required due to complications. They call this an open surgery because it requires an incision that is 5 to 9 inches long in the abdomen. This is considered a major surgery with up to a one-week stay at a medical facility.


Vasectomy

A vasectomy is a simple surgical procedure that causes sterility. Over 500,000 men in America choose to have this procedure done as a permanent form of birth control. Vasectomy is nearly 100% effective.

A vasectomy makes men sterile by keeping the sperm out of the fluid that is discharged through the penis during sex. The sperm are the male's reproductive cells; when sperm meet with a woman’s egg, pregnancy results. The sperm passes through tubes called vas deferens to other glands and mixes with seminal fluids to make semen. A vasectomy blocks the vas deferens so the semen does not contain sperm. Without the sperm, a pregnancy can not occur.

Men consider a vasectomy for the following reasons:

     

Their mate's health could be in jeopardy if by a future pregnancy.

They want to enjoy the act of sex without causing a pregnancy.

They do not want a child in the future.

Other methods of birth control are unacceptable.

They do not want to pass on any hereditary illnesses.

It is easier, safer, faster and more cost effective than to
have their mate undergo a tubal sterilization.

This simple surgical procedure takes about twenty minutes to perform. Your family doctor or local hospital can assist you in finding a Surgeon to perform this procedure. Most men will recover with little or no time off of work. Many of these procedures are scheduled on a Friday and the patient can return to work by the next Monday morning.


Vasectomy (No scalpel)

The no scalpel vasectomy was developed in China over 25 years ago. Since that period over 10 million men have had no scalpel vasectomies. A small puncture is made in the skin with a specially designed clamp, then the vas deferens are clipped and divided. The hole is so small that sutures are not required. There is less bleeding, discomfort, swelling and chance of other complications. Using the no scalpel technique, the complication rate for a vasectomy procedure has gone down to 0.4% as compared to 3.1% with the standard incisional technique. The no scalpel surgery takes about 12 to 15 minutes under local anesthesia and is an office procedure.


LASIK Surgery

LASIK, or "LAser in SItu Keratomileusis" is the most common refractive surgery procedure used to correct poor vision. This procedure is great for people who are tired of wearing glasses or who have a difficult time wearing contact lenses. Many people who are susceptible to getting eye infections from contact lenses will opt for this surgery.

The actual procedure is fast and virtually painless. First, anesthetic eye drops are put in your eye. After a few moments the eye drops will start numbing the nerves of the eye. A suction ring is then placed over the center of the cornea. The suction creates pressure in the eye which is required for the microkeratome to function properly. The microkeratome is a highly sophisticated instrument that is of paramount importance in the LASIK procedure. The instrument has an extremely sharp blade that moves back and forth at a very high speed . It actually shaves a thin layer of the cornea and folds the cornea back. The part of the cornea that is uncut acts as a hinge.

At that point the suction ring and the microkeratome are removed. The next instrument used is the excimer laser. This laser uses a cool ultraviolet light beam to precisely remove very minute pieces of tissue from the cornea to actually reshape it. A properly shaped cornea will focus light into the eye and onto the retina, resulting in clear vision.

The last step is folding back the cornea into its original position. Your eyes heal very fast and your vision will improve immediately.

When opting for this procedure, finding a physician is very important. Even with the highly technical and sophisticated excimer laser and microkeratome, the physician is still the most important part of the procedure. Therefore, choosing a physician should take a lot of thought and consideration. Many consumers can be fooled by the clever advertisements they hear on the radio or see on TV. For instance, it is common for vision correction facilities to advertise that they have performed over 20,000 procedures. Although this may be true, it does not mean that the physician performing your surgeries has done all 20,000 procedures. Therefore, find out how many surgeries the actual doctor performing your surgery has done. We suggest that he or she has done a minimum of 300. We also suggest asking your family physician or friends for any recommendations when searching for the right Surgeon.

Also, feel free to ask your physician questions. Most eye-care professionals don’t mind if you ask them questions.

Here are a few questions you may consider asking:

How many procedures have you performed?

How long have you been performing the LASIK procedure?

What is your complication rate for LASIK treatment?

Who will perform my pre-treatment testing?

Who will perform my post-treatment follow up?

We also suggest asking your family physician or friends for any recommendations.


Gastric Bypass Surgery


Gastric bypass surgery is a type of procedure that can be used to cause significant weight loss. Gastric Bypass is the most common form of weight loss surgery in the United States because it results in reliable weight loss with acceptable risks. Gastric bypass operations combine the creation of a small stomach pouch to restrict food intake and construction of bypasses of the duodenum—the first part of the small intestines—and other segments of the small intestine to cause malabsorption—the decreased ability to absorb nutrients from food. The surgery reduces your body's intake of calories. Calorie reduction is accomplished in two ways: 1. After the surgery, your stomach is smaller. You feel full faster and learn to reduce the amount that you eat at any given time. Simply put, patients cannot eat as much as they did before the surgery. 2. Part of your stomach and small intestines are literally bypassed so that fewer calories are absorbed. Sometimes nutrients are lost as well. People who have bypass operations generally lose two-thirds of their excess weight within 2 years.

In digestion, food passes through the stomach and enters the small intestine, where most of the nutrients and calories are absorbed. Food then passes into the large intestine, and the remaining waste is eventually excreted.

The most common gastric bypass surgery is a Roux-en-Y gastric bypass. In a Roux-en-Y gastric bypass, the stomach is made smaller by creating a small pouch at the top of the stomach using surgical staples or a plastic band. The smaller stomach is connected directly to the middle portion of the small intestine, bypassing the rest of the stomach and the upper portion of the small intestine (duodenum).

Extensive gastric bypass

In this more complicated gastric bypass operation, portions of the stomach are removed. The small pouch that remains is connected directly to the final segment of the small intestine, so it is completely bypassing both the duodenum and jejunum. While this procedure effectively promotes weight loss, it is not widely used because of the high risk for nutritional deficiencies.

Risks

People who undergo this procedure are at risk for the following:

1.      Nutritional deficiencies causing health problems.

2.      Leakage of stomach contents into the abdomen. This is dangerous
  because the acid can eat away at other organs.

3.      Your stomach may stretch out to the way it was before surgery

Limited absorption of vitamin B12 and iron can cause anemia. The lack of calcium absorption can cause osteoporosis and metabolic bone disease. People who undergo this procedure are instructed to take nutritional supplements that usually prevent these deficiencies. The more extensive the bypass operation, the greater is the risk for complications and nutritional deficiencies

Roux-en-Y gastric bypass operations may also cause dumping syndrome, an unpleasant reaction that can occur after a meal high in simple carbohydrates, which contain sugars that are rapidly absorbed by the body. Stomach contents move too quickly through the small intestine, causing symptoms such as nausea, bloating, abdominal pain, weakness, sweating, faintness, and sometimes diarrhea after eating.

Common Knee Surgeries


Anterior Cruciate Ligament

When you twist your knee or fall on it, you can tear a stabilizing ligament that connects your thighbone to the shinbone. The Anterior Cruciate Ligament (ACL) unravels like a braided rope when it’s torn and does not heal on its own. Fortunately, reconstruction surgery can help many people recover their full function after an ACL tear. Anterior cruciate ligament surgery is usually not performed until several weeks after the injury. Studies have shown better results when ACL reconstruction surgery is delayed several weeks from the time of injury. This time allows the inflamed and irritated knee to settle down—swelling decreases, inflammation reduces, and range of motion improves. Swelling and stiffness prior to ACL reconstruction surgery improves the post-operative function of the joint. The techniques for ACL reconstruction have changed a great deal in the past 10 years. As a result, ACL knee surgery is now improved and the rehabilitation is generally easier.

The cruciate ligaments in your knee joints crisscross to give you stability on your feet. People often tear the ACL by changing direction rapidly, slowing down from running or landing from a jump. People involved in sports are especially vulnerable to damaging their ACL.

Today, a part of a tendon, usually from somewhere else around your knee, is removed and put in the place of the torn ACL. The ACL is like a rope that is made from lots of little individual fibers, and it is impossible to get the fibers to grow back together so that the ligament is strong enough to function normally. However, in some rare cases, a torn ACL may heal on its own without being replaced. This happens very seldom, and only when the ACL is partially torn or has pulled cleanly away from the bone.

Why have your ACL fixed?

Many people are living very active lives for a much longer period of time then ever before. Most of us want to be able to enjoy the activities that we like doing today for many years to come. This may include sports that keep us fit, active, and healthy. 

Orthopedic Surgeons have fine-tuned both the operation and rehabilitation for ACL reconstruction surgery to the point where it can be great option for treatment. Around 90% of people who have had an ACL reconstruction are very happy and satisfied with how their knee functions after surgery. Although ACL surgery is not for some people, and it is certainly not a decision that you should to rush into, you should give good thought to the surgery’s abilities to keep you as active as possible, for as long as possible.

Medial Collateral Ligament

The Medial Collateral Ligament (MCL) is one of four ligaments that are important to the stability of the knee joint. This ligament is made of tough fibrous material and functions to control excessive motion by limiting joint mobility. The medial collateral ligament spans the distance from the end of the femur—known as the thigh bone—to the top of the tibia—known as the shin bone—and is on the inside of the knee joint.  The medial collateral ligament resists widening of the inside of the joint, and prevents opening-up of the knee.

The MCL is usually injured when the outside of the knee joint is struck. Injury to the MCL causes the outside of the knee to buckle, and the inside to widen. When the medial collateral ligament is stretched too far, it is susceptible to tearing and injury. An injury to the medial collateral ligament may occur as an isolated injury, or it may be part of a complex injury to the knee. Other ligaments, most commonly the anterior cruciate ligament, or the meniscus, may be torn along with a medial collateral ligament injury.

Treatment of an injured medial collateral ligament

Repair of a medial collateral ligament injury rarely requires surgical intervention. Grade I, which are the least serious sprains of the MCL, usually resolve within a few weeks. Resting from activity, icing the injury, and some anti-inflammatory medications will usually be all the treatment that is needed.

When a more serious grade II MCL sprain occurs, use of a hinged knee brace is common in early treatment. Athletes with a grade II injury can return to activity once they are not experiencing pain from the MCL. When a grade III injury occurs, patients usually wear a hinged knee brace and should not attempt to lift any heavy weight. They should have a gradual return to normal activities. Patients with more severe injuries usually require physical therapy and will not return to their full level of activity for 3 to 4 months.

However, if other structures in the knee are injured, surgery may be required. Repair of a recently torn medial collateral ligament usually requires the surgeon to make an incision through the skin over the area where the tear in the ligament has occurred. If the ligament has been pulled from its attachment on the bone, the ligament is reattached to the bone either with large sutures, which are strong stitches, or a special metal bone staple.

Chronic swelling or instability caused by a medial collateral ligament injury may require surgical reconstruction. Reconstruction differs from repair of the ligaments; a reconstruction operation usually works by either tightening up the loose ligaments or replacing them with a tendon graft. If a tendon graft is needed to replace the loose ligaments, it is usually taken from somewhere else in the same knee.

Meniscus Tear/Torn Cartilage

The meniscus is a shock-absorbing cartilage in the middle of your knee. There are two menisci—one on the inside (medial) and another on the outside of the knee (lateral).

The two most common causes of a meniscus tear are due to injury, which are often seen in athletes, and degenerative processes, which are seen in older patients who have more brittle cartilage. The most common type of traumatic meniscus tear occurs when the knee joint is bent and the knee is then twisted. It is not uncommon for the meniscus tear to occur along with injuries to the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL).

Symptoms of a Meniscus Tear

Individuals who experience a meniscus tear usually experience pain and swelling as their major symptoms. Another common complaint is joint locking, or the inability to completely straighten the joint.

The most common symptoms of a meniscus tear are:

  • Knee pain
  • Swelling of the knee
  • Tenderness when pressing on the meniscus
  • Popping or clicking within the knee
  • Limited motion of the knee joint

Surgery

Meniscus tear surgery is usually performed arthroscopically. Arthroscopic surgery is performed on an outpatient basis.  Most surgery for meniscus tears involves trimming the torn portion of your meniscus. The surgeon inspects the whole knee joint to see if there are any other problems—for example, arthritic areas, ligament tears or tears of the other meniscus—and then evaluates the meniscal. Since a torn meniscus is not working properly, it is only creating more damage by inflaming the knee and irritating the cartilage near it. However, if the meniscus is torn near its outer edge, then a meniscus repair may be possible. Typically, the surgeon can only determine this at the time of your arthroscopy.  If possible, it is definitely in the patient's best interest to try to repair the meniscus. Unfortunately, it is rare that a tear can actually be repaired.

Arthroscopy involves inserting a fiber-optic telescope that is about the size of a pen into the joint through an incision that is about 1/8" long. Using miniature instruments, which may be as small as 1/10", the structures are examined and the surgery is performed.

Recovery from removal of a meniscal tear is quick and requires the use of crutches for longer walks only until the patient can walk without limping, which is typically 5-7 days. With proper rehabilitation, the patient can usually expect to return to sports activities within 4-6 weeks after the meniscectomy.

Minimally Invasive Heart Surgery


Recent advances in surgical techniques and equipment allow surgeons to perform Coronary Artery Bypass Surgery in a less traumatic way. Minimally Invasive Coronary Artery Surgery is also called Limited Access Coronary Artery Surgery. It is as an alternative to the standard methods of Coronary Artery Bypass Graft Surgery. Unlike conventional surgery, which utilizes a 10-12" incision and requires the patient to be placed on the heart-lung machine, new minimally invasive surgery may avoid placing the patient on the machine, and can be performed through a 3-5" incision placed between the ribs, or may be done with several small incisions. Like conventional surgery, the surgery is done to reroute, or bypass, blood around coronary arteries clogged by fatty buildups of plaque and improve the supply of blood and oxygen to the heart.

Minimally Invasive Coronary Artery Bypass—also called MIDCAB—is used to avoid the heart-lung machine. It's done while your heart is still beating and is intended for use when only one or two arteries will be bypassed. MIDCAB uses a combination of small holes, or ports, in your chest and a small incision made directly over the coronary artery to be bypassed. The heart surgeon usually detaches an artery from inside the chest wall and re-attaches it to the clogged coronary artery farthest from the occlusion. The surgeon views and performs the attachment directly, so the artery to be bypassed must be right under the incision.

Benefits of Minimally Invasive Bypass Surgery

Minimally Invasive Bypass Surgery has the same beneficial results as conventional bypass surgery. It restores adequate blood flow and normal delivery of oxygen and nutrients to the heart. This type of surgery has additional advantages, including the ability of the surgeon to work on a beating heart or through smaller incisions.

  1. The procedure is performed in only two to three hours, compared to three to six hours for a traditional bypass.
  2. The recovery time is dramatically reduced from months to days or a week. Complications associated with the heart-lung machine are avoided.
  3. Due to less time under anesthesia, patients are moved out of intensive care more quickly.
  4. Patients tend to experience less pain and discomfort.
  5. There is a 25-40% savings of the cost of conventional surgery.
  6. Lower infection rate: A smaller incision means less exposure and handling of tissue, which may reduce the chances of infection.
  7. This surgery is available to more patients. Many patients are poor candidates for traditional bypass surgery because their illness is too widespread or their heart is too weak. Some patients are able to receive this life-saving surgery through minimally invasive techniques.

Risks  

Performing surgery on a beating heart is more difficult than working on a heart that has been stopped with the help of the heart-lung machine. In addition, the stress on the heart during the procedure may lead to more heart muscle damage, lower blood pressure, irregular heartbeat and potential brain injury if blood flow to the brain is reduced for too long during surgery. In some cases—usually less than 10 percent—it is necessary to convert to conventional methods on an emergency basis.

 


Newest Surgical Procedures


Robotic Surgery

Robotic surgery is a new and very promising type of surgery. These mechanical marvels lend a helping hand to Surgeons performing delicate and intricate surgeries. Robotic Surgeons require a human Surgeon to operate them and input instructions via voice activation and various computer interfaces.

Robotic technology is being introduced in the medical field because they allow for unprecedented control and accuracy performing surgical procedures. Robotics decrease the fatigue that many Surgeons experience during long and tedious operations. When Surgeons get tired it is common for them to experience hand tremors, twitching and shaking. Robotics eliminate this by the mechanical arm keeping steady.

The Food and Drug Administration approved the first robotic system that is allowed to be used in American operating rooms. It is presumed that robotic technology could be used in over three million surgical procedures per year. As this technology advances we believe that this will be a common instrument in operating rooms throughout the country.

Laser Surgery

Lasers were developed in the mid 1960's for industrial applications. These lasers emitted a continuous beam of light and were nonspecific in their effects on tissue. For the first twenty years the use of lasers in the medical fields were limited, to say the least. In the early 1980's, lasers were developed that emitted pulses of light. This development made the use of lasers in medical applications popular due to the precise and effective results of this new technology.

Today, many surgical procedures are performed by lasers. Lasers are used to cut, coagulate, vaporize and remove tissue. Lasers are used are for open and laparoscopic procedures as well as breast surgery, gallbladder removal, hernia repair, bowel resection, hemorrhoidectomy, solid organ surgery and pilonidal cyst.

Dermatologists use lasers for many medical applications. These applications include:

Benign Skin Growths

Stretch Marks

Unwanted Hair

Enlarged blood vessels

Birthmark removal

Tattoo removal

Scar removal

Ophthalmologists use lasers frequently. The excimer laser is used to reshape the cornea and help the eye focus properly. Laser vision correction is used to correct nearsightedness, farsightedness and even astigmatism. Retina specialists are using lasers to help treat Macular Degeneration. Glaucoma and other diseases that cause pressure on the eye is now treated with lasers

Urologists are utilizing lasers in the treatment of diseases that affect the urinary and genital systems. Common diseases that are treated are urinary tract disorders, urinary stones, urothelial tumors, obstructions, tumors and warts. Podiatrists use lasers to treat fungal nails; ingrown nails; deformed nails; Plantar warts; skin fissures; certain types of cysts, and many other conditions.

With the continuing advancements of laser technology and the advantages minimal invasive surgery we expect see many new advances in this field.

 


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