Others
1. Percutaneous Transluminal Coronary Angioplasty (PTCA)
Percutaneous transluminal coronary angioplasty (PTCA) is a non-surgical procedure that is performed to relieve and open narrowed and blocked coronary arteries caused by coronary artery disease (CAD) and to restore arterial blood flow to the heart tissue without open-heart surgery. A special catheter (long hollow tube) is inserted into the coronary artery to be treated, either in the groin or in the arm.
This catheter has a tiny balloon at its tip. The balloon is inflated once the catheter has been placed into the narrowed area of the coronary artery. The inflation of the balloon compresses the fatty tissue in the artery and makes a larger opening inside the artery for improved blood flow.
The use of fluoroscopy (a special type of x-ray) assists the physician in the location of blockages in the coronary arteries as the contrast dye moves through the arteries.
When successful, PTCA can relieve chest pain of angina, improve the prognosis of patients with unstable angina, and minimize or stop a heart attack without having the patient undergo open heart coronary artery bypass graft (CABG) surgery.
Procedure
A local anesthetic will be injected into the skin at the insertion site. Once it has taken effect, a sheath, or introducer, will be inserted into the blood vessel. This is a plastic tube through which the catheter will be inserted into the blood vessel and advanced into the heart.
If the arm is used, a small incision may be made to expose the blood vessel for insertion of the sheath. The angioplasty catheter will be inserted through the sheath into the blood vessel.
The physician will advance the catheter through the aorta into the heart. Fluoroscopy will be used to assist in advancing the catheter to the heart. The catheter will be advanced into the coronary arteries. Once the catheter is in place, contrast dye will be injected through the catheter into your coronary arteries in order to see the narrowed area(s). After the contrast dye is injected, a series of rapid, sequential x-ray images of the heart and coronary arteries will be made. When the physician locates the narrowed artery, the catheter will be advanced to that location and the balloon will be inflated to open the artery.
The physician may inflate and deflate the balloon several times. The decision may be made at this point to insert a stent in order to maintain the artery's opening. The inflation of the balloon will open the artery and fully expand the stent. Once it has been determined that the artery is opened sufficiently, the angioplasty catheter will be removed.
The insertion site will be closed. Once the bleeding has stopped, a very tight bandage will be placed on the site. A small sandbag or other type of weight may be placed on top of the bandage for additional pressure on the site, especially if the site is in the groin.
After Procedure
Your physician may decide not to remove the sheath, or introducer from the insertion site for approximately 4 to 6 hours, in order to allow the effects of blood-thinning medication given during the procedure to wear off.
If the insertion site was in the arm, your arm will be kept elevated on pillows and kept straight by placing your arm in an arm guard (a plastic arm board designed to immobilize the elbow joint).
Coronary angiography or coronary arteriography is an X-ray examination of the blood vessels or chambers of the heart. A catheter or a very small tube is inserted into a blood vessel in the groin or arm. The tip of the tube is positioned either in the heart or at the beginning of the arteries supplying the heart, and a contrast dye is injected. This fluid is visible by X-ray, and the pictures that are obtained are called angiograms.
Often an angiogram is necessary before deciding whether coronary disease needs more treatment.
The porta-cath is a catheter inserted by a doctor when intravenous access is required for a long time. It is placed under the skin and into the large vein that leads to the heart. At the end of the catheter is a hollow disk that remains under the skin for accessing the port with a needle. Ultrasound or x-ray imaging is used to make sure that it is placed accurately. Before passing the catheter into the vein, a portion of the catheter is passed through a small track under the skin. This decreases the chance of the catheter becoming dislodged and/or infected. The catheter can be used as soon as proper placement is confirmed. The procedure is usually done under local anesthesia with IV sedation or with general anesthesia and the patient asleep.
1. Excision biopsy, with or without Frozen Section
An excision biopsy is a procedure for complete removal of a lump or abnormal area from the skin or other part of the body. The tissue is then sent to a lab for tests. This is done to look for cancer, infection, and inflammation. It is often used to confirm a diagnosis. In some cases it may also be done to treat a problem, such as removal of a small skin cancer.
Frozen section is a specific type of biopsy procedure wherein small samples of tissue taken from a mass or tumor are frozen using a cryostat machine, cut, then stained with various dyes before being examined under a microscope to make a rapid diagnosis of a mass during surgery. This procedure only takes a few minutes as compared to the permanent (non frozen) section which takes one day to produce results.
Procedure
A local anesthetic is used to numb the skin and tissues that will be removed. The doctor will cut into or through the skin and remove the abnormal tissue. The doctor will then close the cut with stitches. The tissue is sent to the lab for tests.
Exploratory laparotomy (a large incision) is a method of abdominal exploration that allows doctors to examine the abdominal organs. The procedure may be recommended for a patient who has abdominal pain of unknown origin or who has sustained an injury to the abdomen. Because of the nature of the abdominal organs, there is a high risk of infection if organs rupture or are perforated. Exploratory laparotomy is used to determine the source of pain or the extent of injury and perform repairs if needed. It also plays an important role in the staging of certain cancers.
Procedure
The patient is usually placed under general anesthesia for the duration of surgery. An incision is made into the patient's abdomen . Skin and connective tissue called fascia is divided. The surgeon may then explore the abdominal cavity for disease or trauma. The abdominal organs in question will be examined for any signs of infection, inflammation, perforation, abnormal growths, or other conditions. Any fluid such as blood, bile, or other fluids surrounding the abdominal organs will be inspected. In some cases, an abnormal smell encountered upon entering the abdominal cavity may be evidence of infection or a perforated gastrointestinal organ.
If an abnormality is found, the surgeon has the option of treating the patient before closing the wound or initiating treatment after exploratory surgery. Alternatively, samples of various tissues (biopsy) and/or fluids may be removed for further analysis.Upon completion of any exploration or procedures, the organs and related structures are returned to their normal anatomical position. The incision may then be closed with sutures or staples.
After procedure
The patient may stay 1 or 2 days after the procedure, but may be later if additional procedures were performed. The patient will be instructed to watch for symptoms that may indicate infection, such as fever, redness or swelling around the incision, drainage, and worsening pain.
3. Open Cholecystectomy with Intraoperative Cholangiogram
Open cholecystectomy is a surgery in which the abdomen is opened to remove the gallbladder.
This operation is a safe and effective method for treating symptomatic gallstones, ones that are causing significant symptoms. Direct visualization and palpation of the gallbladder, bile duct, cystic duct, and blood vessels allow safe and accurate dissection and removal of the gallbladder.
Intra-operative cholangiography has been variably used as an addition to this operation wherein the doctor places a small tube called a catheter into the cystic duct, which drains bile from the gallbladder into the common bile duct. A dye is injected into the common bile duct and then X-rays are taken.
Intraoperative cholangiogram is done to look for gallstones that may be in the common bile duct. It also allows the doctor to see the anatomy of the bile duct system from the liver to the small intestine. Viewing the bile ducts before removal of the gallbladder may help ensure that the doctor does not accidentally cut or damage the common bile duct.
