Common procedure information


Anaesthesia

What is Anaesthesia?

You are given an anaesthetic when you have surgery so that you don’t feel pain during the operation. There are different types of anaesthesia and the type you receive will depend on the type of surgery you are having and how long it will take.

The anaesthetist may prescribe a pre-med, which is a medication taken prior to surgery, designed to help you relax.

Care During Surgery
During the operation the anaethetist's main roles are as follows:

  • to prevent pain - achieved by administration of appropriate pain relief agents
  • to monitor oxygenation - assessed by skin colour, heart rate and your level of consciousness
  • to monitor ventilation - assessed by the respiratory rate, volume of each breath and the inhaled and exhaled carbon dioxide concentrations
  • to monitor circulation - assessed by blood pressure, urine output and skin temperature.

Postoperative Care
When your operation is over, you will be taken to a special recovery area where your condition will be monitored as you wake up from the anaesthetic.

You are put into a state of unconsciousness either by the injection of an anaesthetic medication into a vein or by breathing in a mixture of gases. You will be unaware of what is happening around you and you feel no pain from the surgery. You will be constantly monitored and the anaesthetic adjusted as necessary throughout the operation.

A muscle relaxant may also be administered, which relaxes muscle and allows easier surgical access to the operation area.

Regional Block
This involves injection of a local anaesthetic which blocks nerve impulse transmission, thus numbing the part of the body to be operated on but not affecting the rest of the body. A regional block is often used for hand, arm or leg surgery.

Epidural Block
An epidural block involves injection of local anaesthetic and pain medication into the epidural space, blocking the transmission of nerve impulses in the spinal cord. It usually involves insertion of a small tube (that stays in place in the back) that can allow regular small does of pain medication to be administered, depending on the amount of pain you are feeling.
Sensation is decreased or lost (dependent on the amount administered) below the level of the block (usually around the mid stomach region). An epidural is commonly used for pain relief during labour and also for caesarian section.

Spinal Block
This involves an injection of a local anaesthetic and pain relief.  A spinal block is a one-off injection, unlike an epidural which is used for regular/continuous administration. The injection is given directly into the cerebrospinal fluid and takes effect very quickly. 

Local anaesthesia is typically used when minor procedures are performed on specific parts of the body. Following local anaesthesia, you are awake but the part of your body being operated on is numb.  Local anaesthesia is administered via an injection; it takes effect quickly and lasts a long time.  During the surgery you will be aware of touch and pressure, but not pain.  If this type of local is being used, it is common practice to be looked after only by the nursing staff and the surgeon, an anaesthetist does not need to be present.  The surgeon will generally administer the local anaesthesia.


Bariatric surgery

What is Bariatric surgery?

Bariatric or weight loss surgery is a term that covers all the different surgical procedures used to help extremely overweight or morbidly obese patients lose weight.

Morbidly obese patients are usually identified by their Body Mass Index (BMI) measurement, although other factors may also be taken into account. Morbid obesity is associated with an increased risk of developing illnesses such as: heart attack, hypertension, stroke, diabetes, sleep disorders and joint pain. Bariatric surgery can cure or greatly improve these illnesses as well as give the patient an improved quality of life.

In this procedure an adjustable band is used to create a small stomach pouch that means you will feel full after a smaller amount of food.

Small incisions or cuts are made in the abdominal wall through which surgical instruments and a tiny camera are introduced.  An inflatable silicon band is placed around the upper part of the stomach, creating a small upper pouch that reduces the amount of food that can be eaten at one time. The band can be made tighter or looser after the operation by adding or removing fluid via a tube connected to a small port placed just under the skin on the abdominal wall. 

This procedure helps weight loss by permanently reducing the size of your stomach.

Small incisions or cuts are made in the abdominal wall through which surgical instruments and a tiny camera are introduced. Approximately 80% of your stomach is removed, leaving behind a long, narrow tube or sleeve. Having a smaller stomach means you will feel full after eating a smaller amount of food.

This procedure helps weight loss by reducing the size of the stomach and by bypassing a section of the small intestine.

The stomach is divided into a small upper pouch and a larger lower pouch. The small pouch becomes your new stomach and because of its size you will feel full after eating smaller meals than before.

The small intestine is reattached to the small stomach pouch but further along the gastrointestinal tract. By bypassing the first part of the small intestine there is less effective absorption of the food that you eat.


Cardiothoracic surgery

What is Cardiothoracic surgery?

Cardiothoracic surgery provides surgical treatment for conditions affecting the organs inside the chest (thorax) – usually the heart or lungs.

When the arteries that supply the heart with blood (coronary arteries) become blocked with fatty substances, surgery may be required to restore blood flow to the heart muscle.

Coronary Artery Bypass Graft surgery uses pieces of arteries from the arm or chest or from veins in the leg to create a detour around the blocked coronary artery.

The procedure involves making a cut through the front of the chest and breastbone (sternotomy) to expose the heart. The heart is then stopped and its function taken over by a heart-lung machine. Once the new blood vessels are in place, the heart is restarted, the heart-lung machine disconnected and the breastbone closed with wires. The operation usually takes between three and five hours.

There are four major heart valves that control blood flow through the heart. If the valves become narrow (stenosis) so that blood flow through them becomes difficult, or leaky so that some blood flows in the wrong direction, they may need to be repaired or replaced. Valves may be damaged by diseases such as rheumatic fever or bacterial infection, degenerate with age or may not be formed properly at birth.

Heart valve surgery involves making a cut through the front of the chest and breastbone (sternotomy) to expose the heart. The heart is then stopped and its function taken over by a heart-lung machine. Part of the heart is then opened and the valve repaired or possibly replaced using a human donor valve, a valve from a pig or cow or an artificial valve. The heart is then restarted, the heart-lung machine disconnected and the breastbone closed with wires. The operation usually takes between three and five hours.


Endoscopy

What is Endoscopy?

Endoscopy is the process of looking inside body cavities, using a very tiny camera attached to the end of a long, flexible tube (endoscope). Images from the camera are sent to a television monitor so that the doctor can direct the movement of the endoscope. It is also possible to pass different instruments through the endoscope to allow small samples or growths to be removed.

Endoscopy allows a doctor to make a diagnosis either by seeing directly what is causing the problem or by taking a small tissue sample for examination under a microscope (biopsy).

Endoscopy can also be used as a treatment e.g. for removal of swallowed objects in the oesophagus (food pipe), healing of lesions etc.

Colonoscopy With or Without Removal of Polyps (Polypectomy) or Biopsy

A long, narrow tube with a tiny camera attached (colonoscope) is inserted into your anus and then moved along the entire colon. This allows the surgeon a view of the lining of the colon.

Polyps (small growths of tissue projecting into the bowel) may be removed during a colonoscopy.

Sometimes a biopsy (small piece of tissue) will be taken during the procedure for later examination at a laboratory. Polyps (small growths of tissue projecting into the bowel) may be removed during a colonoscopy.

Gastroscopy With or Without Biopsy or Oesophageal Dilatation

A long, flexible tube with a tiny camera attached (gastroscope) is inserted through your mouth and moved down your digestive tract. This allows the surgeon a view of the upper part of your digestive tract i.e. oesophagus (food pipe), stomach and duodenum (top section of the small intestine).

Sometimes a biopsy (small tissue sample) will need to be taken during the procedure for later examination at a laboratory.

If there are any strictures (narrowings) found in the oesophagus during the gastroscopy these can be dilated or stretched to allow easier swallowing.

Gastroscopy and Colonoscopy With or Without Biopsy or Removal of Polyps (Polypectomy)

Gastroscopy: a long, flexible tube with a tiny camera attached (gastroscope) is inserted through your mouth and moved down your digestive tract. This allows the surgeon a view of the upper part of your digestive tract i.e. oesophagus (food pipe), stomach and duodenum (top section of the small intestine).

Sometimes a biopsy (small tissue sample) will need to be taken during the procedure for later examination at a laboratory.

Colonoscopy: a long, narrow tube with a tiny camera attached (colonoscope) is inserted into your anus and then moved along the entire colon. This allows the surgeon a view of the lining of the colon.

Sometimes a biopsy (small piece of tissue) will be taken during the procedure for later examination at a laboratory.

Polyps (small growths of tissue projecting into the bowel) may be removed during a colonoscopy.

Sigmoidoscopy With or Without Biopsy

A long, narrow tube with a tiny camera attached (sigmoidoscope) is inserted into your anus and moved through your lower large intestine (bowel). This allows the surgeon a view of the lining of the lower large intestine (sigmoid colon).

If necessary, a biopsy (small piece of tissue) may be taken for examination in the laboratory.


General Surgery

What is General surgery?

General surgery deals with a wide range of conditions within the abdomen, breast, neck, skin and vascular (blood vessel) system.

Cuts (incisions) are made across the lower stomach and around the tummy button and the muscles underneath are pulled together and stitched. Excess fat is removed. The skin flap is stretched down and the excess skin removed. A new hole is made and the tummy button replaced.

Laparoscopic: several small incisions (cuts) are made in the lower right abdomen (stomach) and a narrow tube with a tiny camera attached (laparoscope) is inserted. This allows the surgeon a view of the appendix and, by inserting small surgical instruments through the other cuts, the appendix can be removed.

Open: an incision is made in the lower right abdomen and the appendix removed.

Under local anaesthesia and using x-ray guidance, a very fine guide wire or hookwire is inserted into the breast to mark the specific area of breast tissue the surgeon needs to remove.

When a breast has been removed (mastectomy) because of cancer or other disease, it is possible in most cases to reconstruct a breast similar to a natural breast. A breast reconstruction can be performed as part of the breast removal operation or can be performed months or years later.

There are two methods of breast reconstruction: one involves using an implant; the other uses tissue taken from another part of your body. There may be medical reasons why one of these methods is more suitable for you or, in other cases, you may be given a choice.

Implants

A silicone sack filled with either silicone gel or saline (salt water) is inserted underneath the chest muscle and skin. Before being inserted, the skin will sometimes need to be stretched to the required breast size. This is done by placing an empty bag where the implant will finally go, and gradually filling it with saline over weeks or months. The bag is then replaced by the implant in an operation that will probably take 2-3 hours under general anaesthesia (you will sleep through it). You will probably stay in hospital for 2-5 days.

Flap Reconstruction

A skin flap taken from another part of the body such as your back, stomach or buttocks, is used to reconstruct the breast. This is a more complicated operation than having an implant and may last up to 6 hours and require a 5- to 7-day stay in hospital.

The foreskin is pulled away from the body of the penis and cut off, exposing the underlying head of the penis (glans). Stitches may be required to keep the remaining edges of the foreskin in place.

Laparoscopic: several small incisions (cuts) are made in the abdomen and a narrow tube with a tiny camera attached (laparoscope) is inserted. This allows the surgeon a view of the colon (also called bowel or large intestine) and, by inserting small surgical instruments through the other cuts, part or all of the colon can be removed. The two healthy ends of the colon are stitched back together (resected).

Open: an abdominal incision is made and part or all of the colon is removed.

In this procedure the colostomy bag is removed normal waste removal by bowel movements is allowed to resume.

Under general anaesthesia an incision or cut is made around the colostomy bag, releasing the bowel from the skin. The freed end of the bowel is then reattached to the rest of the bowel and the opening where the bag was is sealed off.

Skin lesions such as cysts and tumours are removed by cutting around and under them with a scalpel.

Partial: the diseased part of the stomach is removed and the remaining section is reattached to the oesophagus (food pipe) or small intestine.

Total: all of the stomach is removed and the oesophagus is attached directly to the small intestine.

Haemorrhoidectomy: each haemorrhoid or pile is tied off and then cut away.

Stapled Haemorrhoidectomy: a circular stapling device is used to pull the haemorrhoid tissue back into its normal position.

Sigmoidoscopy: a long, narrow tube with a tiny camera attached (sigmoidoscope) is inserted into your anus and moved through your lower large intestine (bowel). This allows the surgeon a view of the lining of the lower large intestine (sigmoid colon).

Laparoscopic: several small incisions are made in the abdomen and a narrow tube with a tiny camera attached (laparoscope) is inserted. Small instruments are inserted through the other cuts, allowing the surgeon to push the hernia (part of the intestine that is bulging through the abdominal wall) back into its original position.

Open: an abdominal incision is made and the hernia is pushed back into position.

An inguinal hernia occurs when some of the abdominal contents protrude through a weak area in the lower abdominal muscles and appears as a bulge on one (unilateral hernia) or both (bilateral hernia) sides of the groin. Surgery to repair the hernia may be:

Open: an abdominal incision is made and the hernia (part of the intestine that is bulging through the abdominal wall) is pushed back into its original position. The weakness in the abdominal wall is repaired.

or 

Laparoscopic: several small incisions are made in the abdomen and a narrow tube with a tiny camera attached (laparoscope) is inserted. Small instruments are inserted through the other cuts, allowing the surgeon to push the hernia (part of the intestine that is bulging through the abdominal wall) back into its original position. The weakness in the abdominal wall is repaired.

An umbilical hernia is caused by a weakness in the muscles of the abdominal wall near the belly button or navel, which allows the contents of the abdomen to push through and form a bulge around the belly button.

An incision is made underneath the navel (tummy button) and the hernia (part of the intestine that is bulging through the abdominal wall) is pushed back into the abdominal cavity. The weakness in the abdominal wall is repaired with stitches and in some case a piece of mesh is also laid over the area to help strengthen it.

Umbilical hernia repair may be:

Major - when a larger part of the abdominal wall is involved

or

Minor - when only a small area of the abdominal wall is involved. 

Several small incisions (cuts) are made in the abdomen (stomach) and a narrow tube with a tiny camera attached (laparoscope) is inserted. Small instruments are inserted through the other cuts, allowing the surgeon to push the hernia (part of the stomach and lower oesophagus that is bulging into the chest) back into position in the abdominal cavity. The hiatus (opening) in the diaphragm (a sheet of muscle between the chest and stomach) is tightened and the stomach is stitched into place.

Several small incisions (cuts) are made in the abdomen (stomach) and a narrow tube with a tiny camera attached (laparoscope) is inserted. This allows the surgeon a view of the gallbladder and, by inserting small surgical instruments through the other cuts, the gallbladder can be removed.

Mastectomy, surgical removal of the breast, may be:

Unilateral (only one breast is involved) or bilateral (both breasts are involved).

Simple or Total: all breast tissue, skin and the nipple are surgically removed but the muscles lying under the breast and the lymph nodes are left in place.

Modified Radical: all breast tissue, skin and the nipple as well as some lymph tissue are surgically removed.

Partial: the breast lump and a portion of other breast tissue (up to one quarter of the breast) as well as lymph tissue are surgically removed.

Lumpectomy: the breast lump and surrounding tissue, as well as some lymph tissue, are surgically removed. When combined with radiation treatment, this is known as breast-conserving surgery.

Scrotal: a small incision (cut) is made in the front of the scrotum and the testicles removed. This greatly reduces the amount of testosterone produced in the body.

Inguinal: an incision is made in the groin to remove a testicle that: is undescended from childhood, has wasted away (atrophied), or has a tumour.

A small incision (cut) is made in the groin on the side of the undescended testicle and the testicle pulled down into the scrotum. Sometimes a small cut will need to be made in the scrotum as well.


Gynaecology

What is Gynaecology?

Gynaecology is the area of medicine that deals with health issues and conditions that are specific to women. This generally includes the female reproductive organs and genitalia. The reproductive organs consist of the ovaries that release an egg every month, the fallopian tubes that lead from the ovaries, the uterus (womb), which is where a baby will grow if the egg is fertilised during sexual intercourse, the cervix (opening of the uterus) and the vagina.

Laparoscopy

Many gynaeacological investigations are performed by laparoscopy. This is a procedure to view the inside of the abdomen (stomach) through a specially lit type of mini telescope (laparoscope) that is inserted through a small cut in the abdomen. The laparoscope also contains a small camera that sends pictures to a screen that the doctor can watch. Sometimes surgical procedures (keyhole surgery) can be performed at the same time. A laparoscopy is performed under a general anaesthetic (you are asleep).

Anterior: an incision (cut) is made in your navel (tummy button) and several small cuts in the abdomen (stomach). A thin telescopic instrument (laparoscope) and several small instruments are inserted into the cuts and used to tighten up the front wall of the vagina to repair a cystocele (bulging of the bladder into the vaginal wall).
 
Posterior:  an incision is made in your navel and several small cuts in the abdomen. A laparoscope and several small instruments are inserted into the cuts and used to tighten up the back wall of the vagina to repair a rectocele (bulging of the rectum into the vaginal wall).
A speculum is inserted into your vagina, as for a pap smear, and the light from a small microscope (colposcope) is focused on to the cervix. Special staining solutions are painted onto the cervix which show up abnormal cells. A biopsy (small tissue sample) may be taken to examine in the laboratory.
 

Metal dilators are inserted through your vagina and used to widen the opening to the uterus. A curette (an instrument with a flat metal loop at one end) is then used to scrape the lining of the uterus.

Endometrial ablation is the surgical removal or destruction of the lining of your uterus (endometrium). There are different methods of destroying the endometrium including electricity, laser therapy or freezing. The operation is done through the vagina, so there is no need for cuts to be made in the abdomen.

Endometriosis is a condition where tissue similar to the endometrium, or uterus lining, grows in other parts of the body such as the ovaries, bowel or a lining of the stomach called the peritoneum. Surgical removal may be:

Laparascopic:  an incision (cut) is made near your navel (tummy button) and a thin tube with a tiny camera attached (laparoscope) is inserted, allowing the surgeon a view of the internal organs. Small instruments are introduced through several small cuts in the lower abdomen and endometrial tissue is destroyed using an electric current or laser beam.

Abdominal (laparotomy):  if endometriosis is very widespread, an incision is made in the abdomen, opening up the abdominal cavity so that the endometrial tissue can be removed.

A hysterectomy is an operation to remove your uterus (womb). A hysterectomy is a treatment for many different diseases and conditions and it can be a:

Total Hysterectomy: the body of the uterus and the cervix are removed

or

Subtotal Hysterectomy: the body of the uterus is removed but the cervix is left in place.

 

Hysterectomies can be performed in different ways:

Abdominal Hysterectomy: an incision (cut) is made in the lower part of your abdomen (stomach) and the uterus removed.

Vaginal Hysterectomy: an incision (cut) is made in the wall of your vaginal canal and the uterus is removed through this incision.

Vaginal Hysterectomy with Pelvic Repair: an incision (cut) is made in the wall of your vaginal canal and the uterus is removed through this incision. At the same time the weakened pelvic floor tissues are repaired and the vaginal wall tightened so that the bulge of tissues and organs into the vagina (prolapse) is reduced.

Laparoscopic Assisted Vaginal Hysterectomy: several small incisions are made in your abdomen and a thin tube with a tiny camera attached (laparoscope) inserted along with instruments that cut the connections of the uterus, allowing it to be removed through the vagina.

Total Laparoscopic Hysterectomy: several small incisions are made in your abdomen and a thin tube with a tiny camera attached (laparoscope) inserted along with other instruments. These will be used to cut your uterus into smaller pieces and remove them through the incisions.

 

A speculum is inserted into your vagina, as for a pap smear, and a long, thin tube with a tiny camera attached (hysteroscope) is placed into the vagina and moved through into the uterus. This allows the surgeon to see inside the uterus and may, in some cases, show the reason for conditions such as infertility or pelvic pain. A hysteroscope may also be used to remove fibroids or polyps or to take a biopsy (small sample of tissue) for examination in the laboratory.

Several small incisions (cuts) are made in your abdomen (stomach) and a thin tube with a tiny camera attached (laparoscope) inserted, allowing the surgeon a view of your ovaries. Small instruments are inserted through the cuts and into the ovaries, where they remove the cysts.
An incision (cut) is made in your navel (tummy button) and several small cuts in the abdomen (stomach). A thin telescopic instrument (laparoscope) is inserted through your navel, allowing the surgeon a view of the pelvic floor. Small instruments are inserted into the cuts that can lift the prolapsed or sagging organs back into position and reattach them.

Sling procedures are common surgical operations to stop stress incontinence, a condition where urine leaks out when pressure is put on the bladder. Stress incontinence occurs when the muscles supporting the urethra (tube that carries the urine out of the body) become weak and the urethra no longer works well as a valve to keep the urine in the bladder.

Small incisions (cuts) are made in your lower abdomen (stomach) and in the front wall of the vagina. Synthetic tissue is inserted to form a supportive sling under the urethra at the bladder neck to prevent urine leakage when there is pressure on the bladder.


Ophthalmology (Eye surgery)

What is Ophthalmology?

Ophthalmology is the branch of specialist medicine that is focused on the health of eyes and their surrounding tissues, including muscles, bones, eyelids, and tear production/drainage systems. Your eye is the organ of vision and consists of the cornea (the outer clear layer), the sclera (the white of the eye), the iris (the coloured part), the lens (lies behind the iris) and the retina (the light-sensitive lining at the back of the eye). Your eyes ‘see’ by focusing light that enters the eye onto the retina which sends the image to the brain by the optic nerve.

Once a cataract affects vision too much, a cataract removal operation is generally advised. The operation is almost always done under local anaesthetic. A tiny incision is made in your eye and the cataract is broken up into small pieces using ultrasound vibrations. Once the cataract has been removed an artificial intraocular lens is put in to replace it.

The surgery is relatively short in duration and an overnight stay in hospital is not required. Post-operative care consists of eye drops and a check at 1-2 days then after 2-4 weeks.


Oral & Maxillofacial (Dental)

What is Oral & Maxillofacial surgery?

Oral and maxillofacial surgery is the surgical specialty which involves the diagnosis and treatment of diseases, injuries and defects affecting the mouth, jaws, face and neck.

Oral and maxillofacial surgeons treat patients with problems such as impacted teeth, misaligned jaws, oral cancer, tumours and cysts of the jaws and facial trauma following accidents. They may also perform facial cosmetic surgery.

Tooth extraction involves the removal of damaged, decayed or infected teeth. Healthy teeth may be removed that the mouth does not have space for, or in preparation for orthodontic treatment, or to remove teeth that are impacted or partially impacted and at risk of causing infection.

To remove a tooth, an incision (cut) is made in your gum and access to the tooth cleared by pushing aside gum tissue and, if necessary, removing some bone. The tooth is removed whole or in pieces and the gum stitched together over the hole.

Over the following 1-2 months the socket will gradually fill in with gum tissue. 

Arthroscopic: several small incisions (cuts) are made over the joint in front of the ear. A small telescopic instrument with a tiny camera attached (arthroscope) is inserted, allowing the surgeon a view of the joint. Small instruments can be inserted into the other cuts to free up the joint by e.g. removing adhesions and scarring, or repositioning a disc.

Arthroplasty (Open Surgery): an incision is made in front of the ear, giving the surgeon access to reconstruct the joint by e.g. smoothing joint surfaces, repairing discs or removing diseased tissue. If a joint replacement is necessary, a second incision under the angle of the jaw may be required.


Orthopaedic surgery

 

What is Orthopaedic surgery?

This is an area that deals with conditions of the musculoskeletal system (bones and joints of the limbs and spine). The speciality covers a range of different types of conditions starting with congenital (conditions which children are born with) through to degenerative (conditions relating to the wearing out of joints). The field of orthopaedics includes trauma, where bones are broken or injuries are sustained to limbs.

Other conditions that are covered by orthopaedics are metabolic conditions, neurological and inflammatory conditions.

The anterior cruciate ligament (ACL) is a strong, stabilising ligament running through the centre of the knee
between the femur (thigh bone) and tibia (shin bone).

When the ACL is torn, arthroscopic surgery is performed to replace the damaged ligament with tissue grafted from elsewhere, usually the patellar or hamstring tendon. The ends of the grafted tendon are attached to the femur at one end and the tibia at the other using screws or staples.

 

Two or three small incisions (cuts) are made in the ankle and a small telescopic instrument with a tiny camera attached (arthroscope) is inserted. This allows the surgeon to look inside the joint, identify problems and, in some cases, operate. Tiny instruments can be passed through the arthroscope to remove bony spurs, damaged cartilage or inflamed tissue.
An incision (cut) is made in the front of, and several smaller cuts on the outside of, the ankle. The damaged ankle joint is replaced with a metal and plastic implant.

Surgery to relieve carpal tunnel syndrome involves making an incision (cut) from the middle of the palm of your hand to your wrist. Tissue that is pressing on the nerve is then cut to release the pressure.

This surgery can be performed on one (unilateral) or both (bilateral) wrists .

Small incisions (cuts) are made in the hip area and a small telescopic instrument with a tiny camera attached (arthroscope) is inserted. This allows the surgeon to look inside the joint, identify problems and, in some cases, operate. Tiny instruments can be passed through the arthroscope to remove loose, damaged or inflamed tissue.

An incision (cut) is made on the side of the thigh to allow the surgeon access to the hip joint. The diseased and damaged parts of the hip joint are removed and replaced with smooth, artificial metal ‘ball’ and plastic ‘socket’ parts.

Sometimes hip replacements fail due to factors such as loosening, wear or infection and will require revision surgery.

Hip revision surgery is a complex procedure that involves removal of the original implant, any old cement and any abnormal bone or scar tissue. Bone reconstruction may be required if there is bone loss. New hip joint components are then put in place and the layers of tissue closed.

Several small incisions (cuts) are made on the knee through which is inserted a small telescopic instrument with a tiny camera attached (arthroscope). This allows the surgeon to look inside the joint, identify problems and, in some cases, make repairs to damaged tissue.

Arthroscopy: several small incisions (cuts) are made on the knee through which is inserted a small telescopic instrument with a tiny camera attached (arthroscope).

Meniscectomy: the menisci are strips of cartilage that form a cushioning layer between the ends of the femur (thigh bone) and tibia (shin bone) in the knee joint. The menisci can become torn through injury or damaged from age-related wear and tear.

Partial meniscectomy  involves removal of the torn portion of the meniscus so that the cartilage surface is smooth again.

Meniscal repair involves suturing together the torn edges of the meniscus.

Sometimes only one of the knee's compartments is worn out - this is often the medial or inner compartment. Replacement of just one compartment means a smaller incision (cut) is required and there is less damage to surrounding tendons and ligaments.

An incision (cut) is made on the front of the knee to allow the surgeon access to the knee joint. Cartilage is removed from the damaged compartment of the knee and metal coverings are cemented on to the ends of the thigh bone (femur) and lower leg bone (tibia). A plastic component is inserted between the two metal caps.

An incision (cut) is made on the front of the knee to allow the surgeon access to the knee joint. The damaged and painful areas of the thigh bone (femur) and lower leg bone (tibia), including the knee joint, are removed and replaced with metal and plastic parts.

Total knee replacement is a major procedure which requires you to be in hospital for several days and will
be followed by a significant period of rehabilitation.  

Sometimes knee replacements fail due to factors such as loosening, wear or infection and will require revision surgery.

Knee revision surgery is a complex procedure that involves removal of the original implant, any old cement and any abnormal bone or scar tissue. Bone reconstruction may be required if there is bone loss. New knee joint components are then put in place and the layers of tissue closed.

This surgery is performed to remove part or all of a herniated intervertebral disc.

Open discectomy – involves making an incision (cut) over the vertebra and stripping back the muscles to expose the herniated disc. The entire disc, or parts of it are removed, thus relieving pressure on the spinal nerves.

Microdiscectomy – this is a ‘minimally invasive’ surgical technique, meaning it requires smaller incisions and no muscle stripping is required. Tiny, specialised instruments are used to remove the disc or disc fragments.

This surgery involves making several small incisions (cuts) on the shoulder through which is inserted a small telescopic instrument with a tiny camera attached (arthroscope). This allows the surgeon to look inside the shoulder, identify problems and, in some cases, make repairs to damaged tissue.

Tendons that have been damaged by injury can be repaired. An incision (cut) is made over the damaged tendon, the damaged ends of the tendon sewn together and, if necessary, reattached to surrounding tissue.


Otolaryngology (ENT)

What is Otolaryngology (ENT)?

Ear, Nose and Throat Surgery (ENT) is also known as Otorhinolaryngology, Head and Neck Surgery. This area of medicine is concerned with disorders of the ear, nose, throat, the head and the neck.

ENT Surgeons (or otorhinolaryngologists) are specialist doctors who deal with medical and surgical treatment of
conditions of the ears, nose, throat and structures of the head and neck.

Adenoidectomy With or Without Cautery of Turbinates
 
Adenoids are small lumps of lymphoid tissue located at the back of the nasal passages. Enlarged adenoids may cause obstruction of the airways and/or be associated with infection and require surgical removal.
 
This operation is performed through the mouth and will take approximately 10 - 15 minutes.
 
Turbinates are bony shelf-like structures that protrude into the nasal airway. Swollen turbinates may block the nasal passageways and require surgical reduction. Cauterisation of the turbinates with an electrical current causes them to scar and subsequently reduce in size. Access to the turbinates is via the nostrils.
Adenotonsillectomy With or Without Grommet Insertion
 
Adenotonsillectomy is the surgical removal of the tonsils and adenoids in the same operation. This operation is performed through the mouth and will take approximately 40 minutes.
 
Adenoids are small lumps of lymphoid tissue located at the back of the nasal passages. Enlarged adenoids may cause obstruction of the airways and/or be associated with infection and require surgical removal.
 
Tonsils are two small lumps of lymphoid tissue that sit on either side of the back of the throat. Surgical removal of the tonsils may be recommended if they become infected (tonsillitis) frequently.
 
Grommet Insertion may be performed at the same time as adenotonsillectomy. A small hole is made in the eardrum, allowing fluid and/or pus to drain from the middle ear thus relieving pressure in the ear. A small hollow tube (grommet) is placed in the eardrum hole which allows air into the middle ear.
An incision (cut) is made behind your ear and the skin pulled back exposing the mastoid bone. A hole is drilled through this bone to expose the cochlear. The electrodes of the cochlear implant are inserted into the cochlear while the receiver part of the implant is embedded into the skull just underneath the skin. The skin is then replaced back over the implant.

The surgery usually takes 2-3 hours and is performed under general anaesthesia (you sleep through it). You may be able to go home the same day or have to spend one night in hospital.

Balloon Sinuplasty is an endoscopic procedure in which a sinus guide catheter is inserted into the nostril to the opening of the blocked or narrow sinus. A guide wire is then advanced into the target sinus and used to introduce the ballon catheter into the sinus. Once in place, the balloon catheter is gently inflated thus enlarging the sinus passageway to allow normal sinus drainage. The balloon catheter is then deflated and removed. 

Balloon sinuplasty can be performed on one (unilateral) or both (bilateral) sides of the nose.

A tiny camera attached to a tube (endoscope) is inserted into your nose. Very small instruments can be passed through the endoscope and used to remove small pieces of bone and soft tissue. This opens up the ventilation and drainage pathways in the outer wall of your nose.

Endoscopic sinus surgery can be performed on one (unilateral) or both (bilateral) sides of the nose.

Septoplasty: this operation repositions the nasal septum and is performed entirely within your nose so that there are no external cuts made on your face.

This operation is performed through the ear canal. A small hole is made in the eardrum, allowing fluid and/or pus to drain from the middle ear thus relieving pressure in the ear. A small hollow tube (grommet) is placed in the eardrum hole which allows air into the middle ear.
 
Grommets may be inserted into one (unilateral) or both (bilateral) eardrums.

Once the middle ear is healthy with no more fluid behind the ear drum, the grommets are no longer necessary. If they do not fall out on their own, a small operation can be performed to remove them.

Under general anaesthetic, the grommet is pulled out of the ear drum. The small hole left in the ear drum will soon heal on its own.

Nasal Septoplasty
If the nasal septum, the wall inside the nose that separates the nostrils, is bent or deformed and blocks the nasal airway it may require surgery to straighten it. This involves making an incision (cut) in the nasal septum and the removal or realignment of any bone or cartilage that is causing a blockage. The operation is performed entirely within the nose so that there are no external cuts made on the face.
 
Nasal septoplasty may be combined with turbinate surgery; turbinates are bony shelf-like structures that protrude into the nasal airway. Swollen turbinates (usually the inferior or lower turbinates) may block the nasal passageways and require surgical reduction (turbinoplasty) by:
 
  • Cautery of Turbinates - cauterisation of the turbinates with an electrical current causes them to scar and subsequently reduce in size. This procedure is performed through the nostrils.
  • Outfracture of Turbinates - the bone that supports the turbinates is fractured outwards to create more space in the nasal cavity. This procedure is performed through the nostrils.
  • Trimming of Turbinates - the swollen lower edge of the turbinates is trimmed to create more space in the nasal cavity. This procedure is performed through the nostrils.
 
Septorhinoplasty
Nasal septoplasty may also be combined with rhinoplasty (surgery to improve the appearance of the nose or to restore its appearance after injury). This operation will improve/restore the appearance of the nose and at the same time improve nasal breathing. 
  • External (open) Rhinoplasty - a small cut (incision) is made at the base of the nose between the nostrils. Excess bone and/or cartilage are removed and the nose reshaped and/or resized.
  • Internal (closed) Rhinoplasty -  small cuts (incisions) are made on the inside of the nose. Excess bone and/or cartilage are removed and the nose reshaped and/or resized.

An incision (cut) is made in the front of and at the base of the neck and part (sub-total thyroidectomy) or all (total thyroidectomy) of the thyroid gland is removed.

This operation is performed under general anaesthesia (you are asleep).

Tonsillectomy With or Without Coblation
 
Tonsils are two small lumps of lymphoid tissue that sit on either side of the back of the throat.
 
Tonsillectomy (surgical removal of the tonsils) may be recommended if the tonsils become infected (tonsillitis) frequently. The tonsils are removed in a 20 - 30 minute operation performed through the mouth.
 
Tonsillectomy with coblation is a technique in which radiofrequency energy is applied to a saline (salt) solution, producing highly charged ionised particles which can break apart and dissolve the tonsils. This process occurs at a relatively low temperature, resulting in minimal damage to tissue surrounding the tonsils. Surgery is performed under general anaesthetic.

Plastic & reconstructive surgery

What is Plastic surgery?

Plastic surgery covers a wide range of different surgical procedures that repair, reconstruct or replace structures in many different parts of the body including the skin, face and head, hands, breast and stomach. Plastic surgery does not involve the use of plastic materials.

Plastic surgery can generally be divided into two main types:

Reconstructive surgery: is performed on parts of the body that are abnormal or have been affected by a birth defect, accident or disease. This includes cleft lip and palate repair, scar revision or reconstruction (including skin grafts) following burns. Surgery is usually performed to improve function, but may also be performed to bring the appearance of a part of the body as close as possible to normal.

Aesthetic or cosmetic surgery: improves appearance or body image by reshaping features of the face or body e.g. breast enlargement, face lift, liposuction.

This procedure involves removing excess skin and fat from the stomach and tightening the muscles of the stomach wall.
Cuts (incisions) are made across the lower stomach and around the tummy button and the muscles underneath are pulled together and stitched. The skin flap is stretched down and the excess skin removed. A new hole is made and the tummy button replaced. The surgery is performed under general anaesthesia (you will sleep through it) and will take 3-4 hours.

Surgery to increase breast size involves inserting silicone sacks (implants) filled with silicone gel or salt water (saline) under the chest muscle and skin. The procedure involves making a cut (incision) in the armpit, under the breast or around the areola (the dark area around the nipple) from where the implant is inserted.
Surgery to reduce breast size involves making a cut (incision) around the areola (the dark area around the nipple) straight downwards and along the crease beneath the breast. Glandular tissue, fat and skin are removed and the breast reshaped.

This procedure removes unwanted pockets of fat from under your skin in specific parts of the body such as the chin, neck, upper arms, stomach, hips and thighs. Liposuction should not be regarded as a means of general weight loss, but instead as a way to improve the shape of particular areas of your body.

A small cut (incision) is made, through which a narrow, hollow tube (cannula) is inserted. The tube is moved around to loosen the fat cells, which are then sucked out with a vacuum device. During the procedure you will lose a lot of fluid, so you will be given intravenous (injected straight into the vein) fluid to stop you becoming dehydrated. The procedure usually takes 1-3 hours and is carried out under local anaesthetic (the area being treated is numb but you are awake). You will probably be able to go home the same day but will need someone to drive you. However, if the procedure is more extensive and numerous areas are being treated at the same time, it may require general anaesthesia (you will sleep through it) and you may have to remain overnight in hospital.

The area treated will be swollen and bruised after the surgery and you may need to take pain relief medication for several days. You will be given an elastic dressing or support garment that you may have to wear continuously for 2-3 weeks. You will probably be able to return to work after 1-2 weeks.


Urology

What is Urology?

Urology is the branch of medicine that looks at diseases of the urinary system in females and the genitourinary system (urinary system plus genital organs) in males.

The urinary system is made up of the:

  • kidneys (where urine is formed from material filtered out of the blood)
  • ureters (tubes that carry urine from the kidneys to the bladder)
  • bladder (a balloon-like organ that stores urine)
  • sphincter muscles (muscles around the opening of the bladder into the urethra)
  • urethra (the tube that carries urine to the outside of your body).

The male genital organs include the penis, scrotum and prostate gland. The prostate is a walnut-sized gland located between the bladder and the penis and in front of the rectum. The urethra passes through the center of the prostate.

A doctor who specialises in disorders of the urinary system and also the male reproductive system is known as an urologist. A doctor who specialises in kidneys and their function is called a nephrologist.

A long, thin tube with a tiny camera attached (cystoscope) is inserted into the urinary opening and through the urethra (the tube that carries urine from your bladder to the outside of your body) to your bladder. This allows the urologist to view any abnormalities in your lower urinary tract and, if necessary, take a small tissue sample to look at under the microscope (biopsy).

A small cut is made in the scrotum and the fluid is drained from the hydrocoele sac (a fluid-filled mass that forms in the scrotum). The sac may either be removed or is folded back behind the testicle.

Herniotomy: an incision is made in a skin fold in the groin and the hernia sac is cut out.

Four to five small keyhole incisions (cuts) are made in either the lower abdomen (stomach) or between the scrotum and the anus to allow removal of the enlarged parts of, or the entire, prostate gland.

The urethra (the tube that carries urine from the bladder and through the penis as well as carrying semen through the penis during ejaculation) must be cut to allow removal of the prostate. After the prostate is taken out, the urethra is reconnected to the bladder and a catheter, a flexible tube, is temporarily inserted into the penis through the urethra and into the bladder to drain urine.

An incision (cut) is made in the lower abdomen through which the prostate gland is removed.

The urethra (the tube that carries urine from the bladder and through the penis as well as carrying semen through the penis during ejaculation) must be cut to allow removal of the prostate. After the prostate is taken out, the urethra is reconnected to the bladder and a catheter, a flexible tube, is temporarily inserted into the penis through the urethra and into the bladder to drain urine.

A long, thin tube with a tiny camera attached (resectoscope) is inserted into the urinary opening, through the urethra and into the bladder. Instruments are passed through the resectoscope and the tumour removed.
A long, thin tube with a tiny camera attached (resectoscope) is inserted into the urinary opening of the penis and through the urethra (the tube that carries urine from your bladder to the outside of your body) to your bladder. The urologist is then able to view the prostate gland and, by passing an instrument through the resectoscope, is able to remove the part of the gland that has become enlarged.
A long, thin tube with a tiny camera attached (ureteroscope) is inserted into the urinary opening, through the urethra (the tube that carries urine from your bladder to the outside of your body) and bladder to the ureters (the two tubes that drain urine from the kidneys to the bladder). This allows the urologist to view and, in some cases, treat any problems in the ureters.
A tiny incision (cut) is made in the scrotum and a short length of the vas deferens (the tube carrying sperm away from the testicles where it is produced) is removed.

Vascular surgery

What is Vascular surgery?

Vascular surgery is the branch of surgery that involves the diagnosis and treatment of disorders of the vessels that carry blood away from (arteries) and back to (veins) your heart.

Vascular disorders include blockages and narrowings of the vessels, abnormal swellings of the vessels (aneurysm) or vessel malfunctions.

The disease processes involved in vascular disorders often involve other body systems and your treatment may therefore require the combined efforts of other medical specialists such as radiologists and general physicians.

Varicose vein surgery may be unilateral (only one leg is affected) or bilateral (both legs are affected).

Vein stripping: the varicose veins are cut out and the veins that branch off them are tied off. The cuts (incisions) made in the skin are closed with sutures.

Phlebectomy: small cuts (incisions) are made in the leg and the varicose veins are pulled out with a tiny hook-like instrument. The cuts are closed with tape rather than sutures and, once healed, are almost invisible.