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4. Bilateral Tonsillectomy with Adenoidectomy
Tonsils and adenoids are part of the lymphatic system. Tonsils are at the back of the throat and the adenoids are higher up, behind the nose. They help protect from infection by trapping germs coming in through the mouth and nose. Sometimes the tonsils and adenoids become infected themselves. Tonsillitis makes the tonsils sore and swollen. Enlarged adenoids can be sore, make it hard to breathe and cause ear problems.
The two primary reasons for tonsil (tonsillectomy) and adenoid removal (adenoidectomy) are one, recurrent infection despite antibiotic therapy and two, difficulty breathing and swallowing due to enlarged tonsils and/or adenoids.
The 2 procedures are usually performed together and under general anesthesia. The doctor holds the mouth open to expose the tonsils. The tonsils are then cut or burned away. The doctor also removes the adenoids through the mouth. There will be no external incisions. The base of the adenoids will be cauterized with an electrical cauterizing unit. The whole procedure usually takes less than an hour.
After Procedure
A tonsillectomy and adenoidectomy is usually done on an outpatient basis. Complete recovery can take 2 weeks.
Expect some throat and ear pain in the first days following surgery. Ice packs can help relieve pain, and sucking on an ice cube or eating ice cream may provide some comfort. During recovery, it is recommended to eat soft, easy-to-swallow food and to drink a lot of cold fluids.
5. Functional Endoscopic Sinus Surgery (FESS)
The purpose of FESS is to open the passages of the sinuses allowing for proper drainage to the nose. A small flexible tube with a light and camera lens at the end, called an endoscope, is used in the nose to view the nasal cavity and sinuses. It has revolutionized the surgical treatment of chronic sinusitis. FESS generally eliminates the need for an external incision. The endoscope allows for better visualization and magnification of diseased or problem areas. Small incisions or cuts are made to allow the scope to pass. The cuts are usually made inside of the nose. The physician may create new passages or open existing ones by removing polyps, cysts, or thickened mucous membranes.
FESS usually takes between 1 to 3 hours and is done in the operating room under general anesthesia.
In traditional sinus surgery, an opening is made into the sinus. The opening may be made from inside the mouth or through the skin of the face. Traditional surgery is an effective method of treating chronic sinusitis or sinusitis that has caused complications.
FESS differs from traditional sinus surgery in that this endoscopic exam, along with CT scans, may reveal a problem that was not evident before. Also, FESS focuses on treating the underlying cause of the problem. The ethmoid sinuses are usually opened. This permits direct visualization of the maxillary, frontal, and sphenoid sinuses, and diseased or obstructive tissue can be removed if necessary. There is often less removal of normal tissue and surgery can frequently be performed on an outpatient basis. Generally, there are no external scars, little swelling, and only mild discomfort.
6. Nasal Endoscopy with Biopsy
Nasal endoscopy is a diagnostic procedure that doctors use to view the inside of the nasal cavity and the entrance to the sinuses. It is primarily used to detect abnormalities (e.g., structural defects, polyps, damage to the sinuses). The procedure can also be used to determine if certain surgeries are required or if medications are having their intended effect.
The procedure is done with a nasal endoscope, a thin, tube-like optical instrument designed to be inserted into the inner nose. It can be rigid and angled or flexible. It involves its insertion through the nostrils and up the nasal passageway. Miniature lights in the device illuminate the patient’s nasal passages, nasal cavities and entrance to the sinuses. The endoscope is equipped with fiber-optic cameras that record and display detailed images of the interior of the nose. Many endoscopes have attachments that allow the doctor to remove tissue samples or fluid for a biopsy.
LAPAROSCOPIC SURGERY (MINIMAL ACCESS SURGERY)
A hernia is an opening or weakness in the inside layers of the abdominal wall causing it to weaken then bulge or tear. The inner lining of the abdomen pushes through the weakened area to form a balloon-like sac. This, in turn, can cause a loop of intestine or abdominal tissue to slip into the sac, causing pain and other potentially serious health problems. The most common location for hernias is the groin (or inguinal) area
The laparoscopic approach allows complete broad exposure of the internal ring, the femoral ring, and other anatomic structures such that a large mesh can be applied over all of the possible areas of groin hernia formation and secured in place outside of the peritoneum. There are two techniques of performing laparoscopic herniorrhaphy; trans-abdominal and total extra-peritoneal.
In laparoscopic herniorrhaphy, the mesh is tacked or stapled to the defect on the inside. The natural stress on the repair during healing is from pressure inside the abdomen exerted outwards. Trans-abdominal laparoscopic herniorrhaphy involves repair of the hernia from inside the abdomen while viewing with the laparoscope. In contrast, total extra-peritoneal laparoscopic herniorrhaphy is done within the abdominal wall by creating a working space with a special balloon. Both procedures are equally effective at repairing all possible sources of abdominal wall herniation. The extra-peritoneal approach has the advantage of removing the risk of injury to intra-abdominal organs which is present, but very small, with the trans-abdominal approach.
The advantage of laparoscopic herniorrhaphy is in post-operative recovery. Following a standard open hernia tissue repair on one side, most patients experience some degree of discomfort and in many cases, this is quite significant. However, the degree of discomfort is significantly less on average when the repair is done with mesh. This is because a mesh repair does not place a lot of tension on the tissues while a tissue repair does.
The other situation in which laparoscopic herniorrhaphy is found to have a major advantage is in the patient who has had several previous hernia operations from the outside with repeated recurrences. In these cases the laparoscopic approach affords the ability to repair the hernia from the inside, in tissues which have not been previously operated upon. This makes the surgery in fact much easier and greatly diminishes the risk of injury to vital structures which may not be identifiable in the scar tissue from the previous surgery.
2. Laparoscopic Cholecystectomy
Laparoscopic cholecystectomy is a surgical procedure in which the doctor removes the gallbladder with the aid of a laparoscope (small camera that can be inserted into the abdomen) and other surgical tools through four small incisions. Laparoscopic cholecystectomy is the most common way to remove the gallbladder today.
This procedure is performed when there are stones or inflammation in the gallbladder that is causing pain. The gallbladder is shaped like a small balloon. It is attached to the liver and holds bile. Bile is produced in the liver and helps with digestion of fatty foods. Small particles of bile can form a sediment in the gallbladder that can turn into gallstones. These stones may remain loose in your gallbladder or they may block the gallbladder outlet causing pain when the gallbladder contracts. There are no alternatives to surgically removing the gallbladder when it is causing pain.
Procedure
A general anesthetic is given for this procedure. In order for the doctor to be able to see inside the abdomen, it is inflated with carbon dioxide gas. This lifts the abdominal wall and helps the doctor see the gallbladder. Three or four small incisions are made in your abdomen where special instruments can be inserted to remove the gallbladder.
After procedure
Most laparoscopic gallbladder removals are done as outpatient operations. Most patients have some incisional discomfort and nausea for 1-3 days after surgery, but most return to full, normal activities within 5 to 10 days. There are usually no restrictions on lifting or exercising.
