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UROLOGY

  1. Trans-urethral Resection of the Prostate (TURP)
  2. Extracorporeal Shock Wave Lithotripsy (ESWL) 
  3. Laparoscopic Cystoscopy RGP Double J Stent Ureterolithotomy

HEAD & NECK SURGERY

  1. Uvulopalatopharyngoplasty
  2. Tympanoplasty (ENT)
  3. Thyroid Surgery
  4. Bilateral Tonsillectomy with Adenoidectomy
  5. Functional Endoscopic Sinus Surgery  (FESS)
  6. Nasal Endoscopy with Biopsy

LAPAROSCOPIC SURGERY (MINIMAL ACCESS SURGERY)

  1. Laparoscopic Herniorrhaphy
  2. Laparoscopic Cholecystectomy

THORACOCARDIOVASCULAR SURGERY

  1. Percutaneous Transluminal Coronary Angioplasty (PTCA)

VASCULAR PROCEDURES

  1. Coronary Angiography
  2. Porta Cath Insertion

GENERAL SURGERY

  1. Excision Biopsy, with or without Frozen Section
  2. Exploratory Laparotomy
  3. Open Cholecystectomy with Intraoperative Cholangiogram

 

UROLOGY

1.  Trans-urethral Resection of the Prostate (TURP)

The prostate gland is an organ at the base of the bladder in men.  If the prostate is swollen, the tissues in the gland may need to be surgically removed or destroyed.
If it is not removed, the enlarged prostate can cause urinating problems and urinary tract infections. These symptoms can often be relieved by removing all or part of the prostate gland.

Procedure

Transurethral resection of the prostate (TURP) is the most common surgical procedure for benign prostatic hyperplasia (BPH). A spinal or general anesthesia. is normally used for this procedure.  A cystoscope, a tube-like instrument, is inserted into the penis through the urethra and up to the prostate gland.

A special cutting instrument is inserted through the cystoscope to remove the prostate gland piece by piece. An electric current is used to stop the bleeding during surgery. This is called cauterization.

After surgery, a Foley catheter is placed into the body to help remove urine. To keep the catheter from being clogged with blood or tissue and to flush it, a liquid solution may be attached to it. The bleeding will gradually decrease, and the catheter will be removed within 1 to 3 days. Hospital stay is around 1 to 3 days.

After Surgery

Patients recovering from surgery for an enlarged prostate may have burning with urination, blood in the urine, urinary frequency, and urgent urination.  Complete recovery from surgery can take 3 weeks. Drinking plenty of fluids to help flush fluids through the bladder is recommended.  A stool softener may be used to help prevent constipation, which can delay the healing process. Strenuous activity, constipation, and sexual activity should be avoided for about 6 weeks.

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2.  Extracorporeal Shock Wave Lithotripsy (ESWL) 

Extracorporeal shock wave lithotripsy (ESWL) uses shock waves to break a kidney stone into small pieces that can more easily travel through the urinary tract and pass from the body.  ESWL may be used on people with a kidney stone that is causing pain or blocking the urine flow.  ESWL works best for kidney stones in the kidney, not in the ureter.  It may be harder for ESWL to break up a stone that has moved into the ureter, although this is still possible.  The doctor may try to push the stone back into the kidney with a small instrument/ureteroscope) and then use ESWL.

Procedure

You lie on a water-filled cushion, and the surgeon uses X-rays or ultrasound tests to locate the stone. High-energy sound waves pass through your body without injuring it and break the stone into small pieces. These small pieces move through the urinary tract and out of the body more easily than a large stone. The whole process takes about an hour.  A local anesthesia may be used.  Your surgeon may use a stent when your stones are larger than 2.5 cm. A stent is a small, short tube of flexible plastic mesh that holds the ureter open. This helps the small stone pieces to pass without blocking the ureter.

After the Procedure

ESWL is usually an outpatient procedure. You go home after the treatment and do not have to spend a night in the hospital.
It may take a few days or weeks for all the stone fragments to pass from your body. There may be mild pain as the small fragments pass through the urinary tract.

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3.  Lap Cystoscopy Retrograde Pyelography (RGP) Double J Stent Ureterolithotomy

Retrograde pyelography is a radiographic examination of the renal pelvis and ureter by means of contrast medium injection via a retrogradely introduced ureteric catheter. The catheter is pushed retrogradely into the ureter or renal pelvis via a cystoscopic approach. The procedure is done to define the site of ureteric or renal pelvis tumor or stones.

Ureterolithotomy refers to the open surgical removal of a stone from the ureter. Open ureterolithotomy has become very rare within the last decade due to the advent of less invasive procedures such as extracorporeal shock wave  lithotripsy [ESWL] treatment and ureteroscopic stone removal or fragmentation.  However, open ureterolithotomy still has a role where other sophisticated modalities are lacking, when other therapies have failed, and in cases involving significant ureteral strictures requiring open surgical repair.

Stones that result in complete obstruction of the ureter, causing severe pain, fever, and urosepsis, require treatment that includes prompt, appropriate drainage with the use of the double J stent and subsequent definitive stone removal. Open ureterolithotomy has finite indications and is employed most commonly when minimally invasive therapies have failed.

The double J stent is placed down the ureter from above cystoscopically over a previously placed guide wire. The stent curls up in the kidney at the proximal end and curls in the bladder distally. Double J stents have multiple perforations to allow the urine to drain from the kidney down the ureter to the bladder. They may be placed to bypass a stone, relieve obstruction, or to keep the ureter from swelling shut after a cystoscopic-ureteroscopic procedure. If a stent is left, it can easily be removed with a brief flexible cystoscopic office procedure in males and a small rigid cystoscopic procedure in females.

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HEAD & NECK SURGERY

1.   Uvulopalatopharyngoplasty

Uvulopalatopharyngoplasty (UPPP) is a procedure that removes the tonsils, uvula and part of the soft palate to make the airway wider. This sometimes can allow air to move through the throat more easily when breathing, reducing the severity of obstructive sleep apnea (OSA).  People with obstructive sleep apnea stop breathing while they sleep, sometimes hundreds of times per night and sometimes for a minute or longer each time. The soft tissue at the back of the throat closes obstructing the person's airway.

After Procedure

Continuous positive airway pressure (CPAP) therapy may be needed after surgery. CPAP therapy uses a breathing device that is worn at night that helps with breathing and prevents the airway from closing during sleep.

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2.   Tympanoplasty (ENT)

Tympanoplasty or eardrum repair is a procedure to correct a tear in the eardrum (tympanic membrane) or the small bones in the middle ear.

Using anesthesia, the doctor makes a small incision behind the ear to obtain tissue from the temporalis muscle fascia. This tissue is attached to the eardrum to cover the hole. If the bones of the middle ear need to be repaired, this is done as well.  A small pack may be left in position in the ear canal, and removed a few days after surgery. Stitches will be left behind the ear for a week, and then removed.

This is an outpatient procedure and takes 1 to 2 hours.  It is important to avoid water in the ear. The use of a hair cap is recommended when showering for a few weeks after the procedure.

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3.   Thyroid Surgery

The thyroid gland is a butterfly-shaped gland located at the front of the neck.  It is usually partially or totally removed when cancer is suspected.  There are two types of thyroid surgery to treat thyroid cancer. The decision about which type of surgery to have is based on the age, the type of thyroid cancer, how much the cancer has spread, and the patient’s general health.

Thyroid Unilateral Lobectomy with or without Frozen Section  

This removes only one part (lobe) of the thyroid gland. This surgery is an option if the cancer is small and is only in one lobe of your thyroid gland. Lobectomy is less complicated than a thyroidectomy and less likely to lead to hypothyroidism. However, people who have this type of surgery have a greater chance of their cancer coming back than people who have a thyroidectomy. During surgery, lymph nodes in the neck may also be removed and tested for cancer cells. If thyroid cancer has spread to the lymph nodes, radioactive iodine will be used to destroy the remaining cancer cells.

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.

Total Thyroidectomy

A total thyroidectomy is an operation in which the entire thyroid gland and the surrounding lymph nodes are removed. It is usually performed when a definitive diagnosis of thyroid cancer has been made. The goal of this operation is to remove as much thyroid tissue as possible without damaging or injuring any of the important structures in the neck. Even with the most meticulous surgery, small amounts of thyroid tissue are often left behind to help preserve the integrity of critical structures that lie beneath the lobes of the thyroid. This is the operation of choice when it is necessary to remove a thyroid gland that has become dangerously overactive, or has grown large enough to compress other structures in the neck.

Procedure

During surgery, an incision is made in the skin. The muscle and other tissues are pulled aside to expose the thyroid gland. Radioactive iodine is injected after surgery for thyroid cancer to make sure that all the thyroid tissue and cancer cells are gone.

Hypothyroidism develops after a thyroidectomy so one must take man-made (synthetic) thyroid hormone for the rest of his life.

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