surgery

Pros and Cons of Robotic Surgery

 

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The Pros and Cons of Robotic Surgery
What you should know before going under the remote-controlled knife
Exerpt from article by STEWART PINKERTON

WALL STREET JOURNAL REPORT
Insights from The Experts

MORE IN UNLEASHING INNOVATION: HEALTH CARE

You’d be forgiven for some hesitation.

Every patient profile is different, and a robot is just another surgical instrument: It’s only as good as the surgeon using it.
Before making a decision on what kind of procedure to elect, here are some things to consider:

Why the spike in robotic usage?
Back in 2000, there were only 1,000 robotic surgeries world-wide. That number surged to 360,000 in 2011 and 450,000 in 2012. Boosters say the practice is on the rise because of its strong benefits. For the patient, there’s usually less blood loss, a shorter hospital stay and less reliance on postoperative pain medication. There’s also the cosmetic benefit of no big scars: As in laparoscopic surgery, the instruments enter the body through small incisions.

For surgeons, the procedures can be less tiring. They don’t have to bend over an operating table—they can sit in front of a screen with a magnified, full-color 3-D view of the surgical field. For maneuvering in very tight spaces, like the back of the throat, the enhanced screen image makes it “much easier to see what I’m doing,” says Eric Genden, chief of otolaryngology at New York’s Mount Sinai Hospital.

But some doctors say robotics is catching on not just because of its merits—there’s a “wow” factor at work. Martin Makary, a pancreatic surgeon at Johns Hopkins, believes the technique is safe and useful for certain procedures.
“As with any new technology, care should be taken that protocols are in place to ensure appropriate patient selection and the full explanation of risks and benefits for all surgical options.”

How should patients decide?

The wisest approach is to have your surgeon explain the alternative procedures, including typical postoperative scenarios and why the suggested approach is the best option in your particular case. No single approach is a one-size-fits-all answer for all conditions requiring surgery.

How much training is required to perform robotic surgery?
Dr. Makary, the Johns Hopkins surgeon, believes that overall, robotic surgery is safe. But, he says, problems can get magnified if a surgeon doesn’t have advanced laparoscopic surgical skills to begin with and doesn’t have full command of the device. That means it’s easier to cause inadvertent injury.

Obviously, ask your surgeon how experienced he or she is in the procedure and whether there have ever been any complications. Good question for the hospital, too.

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Plan for Pain Before Surgery

Plan for Pain Before SurgeryWhen your doctor says you need surgery many scary things come to mind. Is my condition very serious? Will this procedure cure what’s wrong? Then, there is the prospect of post-surgery pain. How badly is this going to hurt?

It’s inevitable that some pain will come with most types of surgery. The cutting of the skin stimulates nerve fibers to signal pain. As the body begins to heal, pain should decrease and eventually stop. The amount of time pain lasts after surgery can depend on several factors such as:

  • A person’s general health
  • The presence of coexisting medical problems
  • Cigarette smoking

The good news is that there are many highly effective medications to keep post-surgical pain under control. In addition to the benefit of greater comfort, experts say well-controlled pain can speed recovery and prevent long-term problems.

In order to make sure you’re getting the best possible treatment for your post-surgical pain, experts advise taking an active role and keeping the channels of communication open between you and your doctor — starting before your operation. Talk with your surgeon and anesthesiologist about how your pain will be managed after surgery during pre-surgery testing, not after the procedure has occurred.

Some important items to discuss with your doctor before making your way to the hospital:

  • Tell them about everything you’re taking
  • Ask how much pain to expect and how long will it last

On rare occasions, pain may remain, though the cause of pain cannot be identified. This condition can become long-term pain.

Pain after surgery can be a sign of surgical complications such as the following:

  • Infection
  • A break in the wound
  • A collection of blood or other body fluid below the skin (a hematoma)
  • Vomiting or a change in your bowel habits after abdominal surgery
  • Formation of fistulas (abnormal passages between body structures
  • Lung complications
  • Chest pain
  • Bleeding
  • Chronic conditions

Contact Dr. Johnson for any General Surgery needs. He and his experienced team will work with you to design a safe and effective pain management plan for you.

Read more online at: http://surgery.about.com/od/aftersurgery/qt/SurgeryPain.htm

Diverticulitis: Symptoms and Treatments

Diverticulitis: Symptoms and TreatmentsWhen pouches form in the wall of the colon and become inflamed or infected, it is called diverticulitis. Diverticulitis is a very painful condition that in serious cases can require surgery.

Doctors aren’t sure what causes diverticula in the colon (diverticulosis). Diverticulitis happens when feces get trapped in the pouches (diverticula), allowing bacteria to grow and can lead to inflammation or infection.

Signs and symptoms of diverticulitis include:

  • Pain, which may be constant and persist for several days. Pain is usually felt in the lower left side of the abdomen, but may occur on the right, especially in people of Asian descent.
  • Nausea and vomiting
  • Fever
  • Abdominal tenderness
  • Constipation or, less commonly, diarrhea

Several factors may increase the risk of developing diverticulitis:

  • Aging – The incidence of diverticulitis increases with age.
  • Obesity – Being seriously overweight increases the odds of developing diverticulitis. Morbid obesity may increase your risk of needing more-invasive treatments for diverticulitis.
  • Smoking – People who smoke cigarettes are more likely than nonsmokers to experience diverticulitis.
  • Lack of exercise – Vigorous exercise appears to lower the risk of diverticulitis. * High-fat, low-fiber diet – Although the role of low fiber alone isn’t clear.
  • Certain medications – Several drugs are associated with an increased risk of diverticulitis, including steroids, opiates, and nonsteroidal anti-inflammatory drugs, such as ibuprofen and naproxen.

Diverticulitis is usually diagnosed during an acute attack. Treatment depends on the severity of signs and symptoms.

If symptoms are mild, your doctor is likely to recommend:

  • Antibiotics
  • A liquid diet for a few days while you heal
  • An over-the-counter pain reliever, such as acetaminophen

If you have a severe attack or have other health problems, treatment generally involves:

  • Intravenous antibiotics
  • Insertion of a tube to drain an abscess, if one has formed

You may need surgery to treat diverticulitis if:

  • You have a complication, such as perforation, abscess, fistula, or bowel obstruction
  • You have had multiple episodes of uncomplicated diverticulitis
  • You are immune compromised

If you are experiencing symptoms of diverticulitis or have already been diagnosed with it, contact Dr. Johnson for an appointment. He can advise you of treatment options for your case. Read more online at: http://www.mayoclinic.org/diseases-conditions/diverticulitis/basics/definition/con-20033495

Bilirubin: What it is and What it does

Bilirubin: What it is and What it doesBilirubin is a yellowish pigment found in bile, a fluid made by the liver. A small amount of older red blood cells are replaced by new blood cells every day. Bilirubin is left after these older blood cells are removed. The liver helps break down bilirubin so that it can be removed from the body in the stool. Bilirubin can be found in two forms in the body – direct bilirubin, which is soluble and indirect bilirubin, which is insoluble. All people have bilirubin in the body, but if the levels of this substance go very high from things like liver failure, Gilbert syndrome, gallbladder infections, and certain medications, it could lead to several health problems, some of which could include jaundice and brain injury.

Since jaundice is very common in children and newborn babies, most doctors monitor their levels of bilirubin. In case of suspected jaundice in adults, doctors may conduct tests and refer to the normal range of this substance in the adult bilirubin chart.

If an adult shows the symptoms of high bilirubin levels such as yellowing of the whites of the eyes or yellowish tinged skin, a doctor may recommend a bilirubin test. Once the results are available, the reading is compared to the bilirubin chart for adults showing whether levels are normal or not. In order to analyze the bilirubin levels in adults, a doctor looks at the values of three things – direct bilirubin, indirect bilirubin, and total bilirubin.

In cases of high bilirubin it is important to begin treatment immediately.

Treatment can include:

  • Medications
  • Liver transplant

If you have been diagnosed with high bilirubin levels or are noticing the symptoms, schedule a consultation with Dr. Johnson to find the best treatment options for you.

Read more online at: http://www.nlm.nih.gov/medlineplus/ency/article/003479.htm

Critical Questions to Ask your Surgeon

Critical Questions to Ask your SurgeonMillions of Americans have surgery each year, and well-informed patients tend to be more satisfied with the outcome of procedures. It is important to ask questions prior to any medical procedure. Ask your doctor to explain the answers clearly and ask for further clarification if you are having trouble understanding an explanation. Consider asking the following:

  • Why is the procedure needed? Ask your doctor to explain why this procedure is being recommended.
  • What are my alternatives? Are medications or nonsurgical treatments options for me?
  • What are the benefits of the surgery, and how long will they last? It is important to know the specific benefits for you. Also ask how long the benefits typically last.
  • What are the risks and possible complications? Surgery always carries some risks, so it is important to weigh the benefits against the risks.
  • What happens if you do not have the operation? If you decide not to have the operation, what will happen?
  • What is the doctor’s experience in doing this procedure? Choose a doctor who is thoroughly trained and experienced in doing the procedure. Ask about his or her experience with the procedure, including the number of times they’ve done it, and their record of successes, as well as complications.
  • Should I get a second opinion? Getting a second opinion can be an important step in ensuring that this option is right for you. (Of course, in the case of emergency surgeries, treatment should happen as quickly as possible. The necessity of getting a second opinion should always be weighed against the severity and urgency of the medical condition.)
  • What can I expect during recovery? You need to know how long you will be hospitalized and what limitations will be placed on you. Knowing ahead of time what to expect will help you to cope and recover more quickly following the surgery.

If you need an experienced General Surgeon, contact Dr. Johnson for a consultation.

Read more online at: http://www.medicinenet.com/surgery_questions/article.htm

Choosing a Surgeon: What’s Best for You?

DrJohnsonChoosing a surgeon is very important considering that in many cases, he or she will literally have your life in their hands. Making sure that you have good communication, trust in the doctor’s ability, and accessibility/availability is key to finding the right surgeon for you.

Communication

No matter how well qualified your doctor may be, you will not have a good experience if you cannot effectively communicate your concerns and get an adequate response. Most patients need a doctor willing and able to spend time discussing their concerns. Do you feel like your doctor answers all your questions? Does he/she provide information in a way that you understand? Do you feel comfortable asking all of the questions you have?

Competency

Ask your doctor how often he/she performs the surgery you are having done. Most often you will not need to find someone who just performs your procedure, but you also don’t want a surgeon who has never performed the procedure you are having. Look for a doctor who regularly performs your surgery. It is okay to ask these questions:

o Do you feel comfortable performing this procedure?

o What is the average complication rate?

o What is your complication rate?

o Can I get a second opinion? o Are you board certified?

Accessibility/Availability

Is your doctor located in a place you can easily get to? Not only will it be more convenient for you, but it can also improve your rehabilitation. Your doctor will be close by to guide you and help if you encounter any problems.

If you call your doctor’s office, do they respond in a timely manner? How are on-call duties shared among your doctor’s practice partners? Will he/she be available or will someone else? Make sure that the surgeon you choose will be available to you in case you have a complication or if the surgery needs to be revised. A busy surgeon is usually a good surgeon, but a surgeon that is too busy to see patients is not an ideal choice. Read more online at: http://www.surgery.com/article/choosing-surgeon