Thursday, April 30, 2009

Types of drains

  • * Jackson-Pratt drain - This consists of a tube connected to a see through collection bulb. The bulb has a drainage port which can be opened to remove fluid or air so that the bulb can be squeezed to create suction. The drain should always stay below the area of the wound.
  • * Penrose drain
  • * Negative pressure wound therapy - Involves the use of enclosed foam and a suction device attached; this is one of the newer types of wound healing/drain devices which promotes faster tissue granulation, often used for large surgical/trauma/non-healing wounds.
  • * Redivac drain
  • * Pigtail drain - has an exterior screw to release the internal "pigtail" before it can be removed
  • * Davol
  • * Chest tube
  • * Wound manager

Drain (surgery)

A surgical drain is a tube used to remove pus, blood or other fluids from a wound. Drains inserted after surgery do not result in faster wound healing or prevent infection but are sometimes necessary to drain body fluid which may accumulate and in itself become a focus of infection. The routine use of drains for surgical procedures is diminishing. Better radiological investigation and confidence in surgical technique have reduced their necessity. It is felt now that drains may hinder recovery by acting as an 'anchor' limiting mobility post surgery and the drain itself may allow infection into the wound. In certain situations their use is unavoidable.

Drains may be hooked to wall suction, a portable suction device, or they may be left to drain naturally. Accurate recording of the volume of drainage as well as the contents is vital to ensure proper healing and monitor for excessive bleeding. Depending on the amount of drainage, a patient may have the drain in place 1 day to weeks. Signs of new infection or copious amounts of drainage should be reported to the health care provider immediately. Drains will have protective dressings that will need to be changed daily/as needed.

Jet ventilation

Jet ventilation is a special type of mechanical ventilation for surgical operations in the airway. Jet ventilation (JV) is characterized by the insufflation of gas portions with high velocity into the airway. The latter has to be open to the atmosphere in order to allow an unhindered gas egress and therefore to avoid overdistention (barotrauma) of the lungs.

*  Indications
*  Procedure
*  Complications
*  References


While a definition for the term 'biomaterial' has been difficult to formulate, more widely accepted working definitions include: "A biomaterial is any material, natural or man-made, that comprises whole or part of a living structure or biomedical device which performs, augments, or replaces a natural function".

" A Biomaterial is a nonviable material used in medical device,so it's intended to interact with a biological systems (William 1987)"

A biomaterial is essentially a material that is used and adapted for a medical application. Biomaterials can have a benign function, such as being used for a heart valve, or may be bioactive . Used for a more interactive purpose such as hydroxy-apatite coated hip implants (the Furlong Hip, by Joint Replacement Instrumentation Ltd, Sheffield is one such example – such implants are lasting upwards of twenty years).

Biomaterials are also used every day in dental applications, surgery, and drug delivery (a construct with impregnated pharmaceutical products can be placed into the body, which permits the prolonged release of a drug over an extended period of time).

The definition of a biomaterial does not just include man-made materials which are constructed of metals or ceramics. A biomaterial may also be an autograft, allograft or xenograft used as a transplant material.

Cardiac surgery

Cardiac surgery is surgery on the heart and/or great vessels performed by a cardiac surgeon. Frequently, it is done to treat complications of ischemic heart disease (for example, coronary artery bypass grafting), correct congenital heart disease, or treat valvular heart disease created by various causes including endocarditis. It also includes heart transplantation.

Trauma surgery

Trauma surgeons are physicians (MBBS, MBChB, MB, MD) or (DO) who have completed residency training in general surgery and fellowship training in trauma or surgical critical care. The trauma surgeon is responsible for the initial resuscitation and stabilization of the patient, as well as ongoing evaluation. The attending trauma surgeon also leads the trauma team, which typically includes nurses, resident physicians, and support staff.

The majority of trauma surgeons practicing in larger centers complete a 1-2 year fellowship in surgical critical care. This allows them to sit for the American Board of Surgery (ABS) certifying examination in Surgical Critical Care. If this is passed, the examinee is then recognized as having a qualification in Surgical Critical Care. There is no separate board or examination for "trauma surgery".

The broad scope of their surgical critical care training enables the trauma surgeon to address most injuries to the neck, chest, abdomen, and extremities (other than fractures). Injuries to the central nervous system are generally treated by neurosurgeons. Musculoskeletal injuries are treated by orthopaedic surgeons. Facial injuries are often treated by maxillofacial surgeons. There is significant variation across hospitals in the degree to which other specialists, such as cardiothoracic surgeons, plastic surgeons, vascular surgeons, and interventional radiologists are involved in treating trauma patients.


Hypnosurgery is the term given to an operation where the patient is sedated using hypnotherapy rather than traditional anaesthetics. It is still in its experimental stages, and not often used. During hypnosurgery , the hypnotist helps the patient control their subconscious reflexes so that they do not feel pain in the traditional sense.[citation needed] Patients are aware of sensation as the operation progresses and often describe a tingling or tickling sensation when pain would normally be expected.[citation needed]

What is more frequently used is hypnosedation, a combination regimen of hypnosis, local injection of analgesics and mild sedation. . The patients -mostly aged or other persons that run an increased risk under general anesthesia - are mildly sedated and brought in a state of increased alertness by having them listen to a story in the operation theatre. Anesthesiologists at the University of Liège in Belgium have performed over 4800 surgical interventions, mainly in ENT and thyroid treatments, over the past 10 years


Modern pain control through anesthesia was discovered by two American dental surgeons, Horace Wells (1815-1848) and William Morton. Before the advent of anesthesia, surgery was a traumatically painful procedure and surgeons were encouraged to be as swift as possible to minimize patient suffering. This also meant that operations were largely restricted to amputations and external growth removals. Beginning in the 1840s, surgery began to change dramatically in character with the discovery of effective and practical anaesthetic chemicals such as ether and chloroform, later pioneered in Britain by John Snow. In addition to relieving patient suffering, anaesthesia allowed more intricate operations in the internal regions of the human body. In addition, the discovery of muscle relaxants such as curare allowed for safer applications.


The concept of infection was unknown until relatively modern times. The first progress in combating infection was made in 1847 by the Hungarian doctor Ignaz Semmelweis who noticed that medical students fresh from the dissecting room were causing excess maternal death compared to midwives. Semmelweis, despite ridicule and opposition, introduced compulsory handwashing for everyone entering the maternal wards and was rewarded with a plunge in maternal and fetal deaths, however the Royal Society in the UK still dismissed his advice. Significant progress came following the work of Pasteur, when the British surgeon Joseph Lister began experimenting with using phenol during surgery to prevent infections. Lister was able to quickly reduce infection rates, a reduction that was further helped by his subsequent introduction of techniques to sterilize equipment, have rigorous hand washing and a later implementation of rubber gloves. Lister published his work as a series of articles in The Lancet (March 1867) under the title Antiseptic Principle of the Practice of Surgery. The work was groundbreaking and laid the foundations for a rapid advance in infection control that saw modern aseptic operating theatres widely used within 50 years (Lister himself went on to make further strides in antisepsis and asepsis throughout his lifetime).


Before modern surgical developments, there was a very real threat that a patient would bleed to death before treatment, or during the operation. Cauterization (fusing a wound closed with extreme heat) was successful but limited - it was destructive, painful and in the long term had very poor outcomes. Ligatures, or material used to tie off severed blood vessels, are believed to have originated with Abu al-Qasim al-Zahrawi (Abulcasis)[7] in the 10th century and improved by Ambroise Paré in the 16th century. Though this method was a significant improvement over the method of cauterization, it was still dangerous until infection risk was brought under control - at the time of its discovery, the concept of infection was not fully understood. Finally, early 20th century research into blood groups allowed the first effective blood transfusions.

Modern surgery

Modern surgery developed rapidly with the scientific era. Ambroise Paré (sometimes spelled "Ambrose"[6]) pioneered the treatment of gunshot wounds, and the first modern surgeons were battlefield doctors in the Napoleonic Wars. Naval surgeons were often barber surgeons, who combined surgery with their main jobs as barbers. Three main developments permitted the transition to modern surgical approaches - control of bleeding, control of infection and control of pain (anaesthesia).

Types of surgery

Surgical procedures are commonly categorized by urgency, type of procedure, body system involved, degree of invasiveness, and special instrumentation.

Elective surgery is done to correct a non-life-threatening condition, and is carried out at the patient's request, subject to the surgeon's and the surgical facility's availability. Emergency surgery is surgery which must be done quickly to save life, limb, or functional capacity. Exploratory surgery is performed to aid or confirm a diagnosis. Therapeutic surgery treats a previously diagnosed condition.

Amputation involves cutting off a body part, usually a limb or digit. Replantation involves reattaching a severed body part. Reconstructive surgery involves reconstruction of an injured, mutilated, or deformed part of the body. Cosmetic surgery is done to improve the appearance of an otherwise normal structure. Excision is the cutting out of an organ, tissue, or other body part from the patient. Transplant surgery is the replacement of an organ or body part by insertion of another from different human (or animal) into the patient. Removing an organ or body part from a live human or animal for use in transplant is also a type of surgery.

When surgery is performed on one organ system or structure, it may be classed by the organ, organ system or tissue involved. Examples include cardiac surgery (performed on the heart), gastrointestinal surgery (performed within the digestive tract and its accessory organs), and orthopedic surgery (performed on bones and/or muscles).

Minimally invasive surgery involves smaller outer incision(s) to insert miniaturized instruments within a body cavity or structure, as in laparoscopic surgery or angioplasty. By contrast, an open surgical procedure requires a large incision to access the area of interest. Laser surgery involves use of a laser for cutting tissue instead of a scalpel or similar surgical instruments. Microsurgery involves the use of an operating microscope for the surgeon to see small structures. Robotic surgery makes use of a surgical robot, such as the Da Vinci or the Zeus surgical systems, to control the instrumentation under the direction of the surgeon.

Thursday, April 9, 2009

Radiotherapy for breast cancer

When radiotherapy is used

Radiotherapy is often used after surgery for breast cancer. It may occasionally be used before, or instead of, surgery.

If part of the breast has been removed (lumpectomy or segmental excision), radiotherapy is usually given to the remaining breast tissue to reduce the risk of the cancer coming back in that area.

After a mastectomy, radiotherapy to the chest wall may be given if your doctor thinks there is a risk that any cancer cells have been left behind.

If a few lymph glands have been removed and these contained cancer cells, or if no lymph glands have been removed, radiotherapy may be given to the armpit to treat the remaining lymph glands. If all the lymph glands have been removed from under the arm, radiotherapy to the armpit is not usually needed.

External radiotherapy

The treatment is normally given in the hospital radiotherapy department as a series of short daily sessions. The treatments are usually given from Monday to Friday, with a rest at the weekend. Each treatment takes 10–15 minutes. Your doctor will discuss the treatment and possible side effects with you.

A course of radiotherapy for breast cancer may last from 3–6 weeks. It is usually given as an outpatient.

External radiotherapy does not make you radioactive and it's perfectly safe for you to be with other people, including children, after your treatment.

Planning radiotherapy

To ensure that you receive maximum benefit from your radiotherapy, it has to be carefully planned. This is done using a CT scanner, which takes x-rays of the area to be treated. Treatment planning is a very important part of radiotherapy and it may take a few visits before the clinical oncologist (the doctor who plans and supervises your treatment) is satisfied with the result.

Marks are usually drawn on your skin to help the radiographer (who gives you your treatment) to position you accurately and to show where the rays will be directed. These marks must stay throughout your treatment, and permanent marks (like tattoos) may be used. These are tiny, and will only be done with your permission. You may feel a little discomfort while it is being done.

The radiotherapy is normally given to the whole breast area, and may also include the underarm (axilla), and the area around the collar bone and at the top of the chest by the breast bone (sternum), where there are lymph nodes. Some women may have an extra dose given to the area of the breast where the cancer was. This is known as a booster dose.

Treatment sessions

At the beginning of each session of radiotherapy, the radiographer will position you carefully on the couch, and make sure you are comfortable. During your treatment you will be left alone in the room but you will be able to talk to the radiographer who will be watching you from the next room. Radiotherapy is not painful, but you do have to lie still for a few minutes while the treatment is being given.


If you are going to have radiotherapy, you will need to be able to get your arm into position so that the radiotherapy machine can give the treatment effectively. Sometimes your muscles and shoulder joint may feel stiff. If you can’t move your shoulder normally, it may be painful or difficult to give the treatment. A physiotherapist may teach you some exercises to make the position for treatment feel easier.

Side effects of radiotherapy

Radiotherapy to the breast sometimes causes side effects such as reddening and soreness of the skin, tiredness and feeling sick (nausea). These side effects gradually disappear once your course of treatment has finished. The tiredness may continue for some months.

Perfumed soaps, creams or deodorants may irritate your skin and should not be used during the treatment. At the beginning of your treatment you will be given advice on how to look after your skin in the area being treated.

Radiotherapy may make your breast tissue feel firmer. Over a few months or years your breast may shrink slightly. The radiotherapy may also, rarely, leave small red marks on your skin, which are due to tiny broken blood vessels. For many women, however, the appearance of their breast is very good.

Radiotherapy to the breast can sometimes lead to long-term side effects. A few months after radiotherapy some women develop breathlessness (due to the effect of radiotherapy on the lung). This can usually be treated with a short course of steroids. In the longer term there may be some weakness of the ribs in the irradiated area, which makes them more likely to fracture than normal. If you have radiotherapy to your underarm (axilla) there is a very small risk of developing late side effects such as nerve pain, tingling, and weakness or numbness in the arm and hand (peripheral neuropathy).

Most of these long-term effects are very uncommon. If you are worried about the risk of developing particular side effects from radiotherapy, you can speak to your clinical oncologist (radiotherapist).

After your radiotherapy treatment, let your doctor know straight away if you have any pain in your arm, ribs, or if you feel breathless.

Surgery Choices for Women with Early-Stage Breast Cancer

As a woman with early-stage breast cancer (DCIS or Stage I, IIA, IIB, or IIIA breast cancer) you may be able to choose which type of breast surgery to have. Often, your choice is between breast-sparing surgery (surgery that takes out the cancer and leaves most of the breast) and a mastectomy (surgery that removes the whole breast). Research shows that women with early-stage breast cancer who have breast-sparing surgery along with radiation therapy live as long as those who have a mastectomy. Most women with breast cancer will lead long, healthy lives after treatment.

Treatment for breast cancer usually begins a few weeks after diagnosis. In these weeks, you should meet with a surgeon, learn the facts about your surgery choices, and think about what is important to you. Then choose which kind of surgery to have.

Most women want to make this choice. After all, the kind of surgery you have will affect how you look and feel. But it is often hard to decide what to do. This booklet has information that can help you make a choice you feel good about.

This booklet is for women who have early-stage breast cancer (DCIS or Stage I, IIA, IIB, or IIIA). If your cancer is Stage IIIB, IIIC, or IV this booklet does not have the information you need. To find information for you, see "Resources to Learn More."

sonic boom might be source of latest 'mystrey'shaking

The U.S. Geological Survey and Caltech are investigating whether a sonic boom is the likely cause of the latest round of mysterious window and door rattling in Orange County.

Residents across most of the county reported the rattling between 12:15 p.m. and 12:19 p.m. today. It’s not yet known whether the Navy or Marines have been flying supersonic F-18s off the coast.

“I was talking to (seismologist) Kate Hutton and she said she was getting reports of a possible sonic boom-like shaking just after noon,” said Bob Dollar, a seismologist with the U.S.G.S. “We’re looking into it.”

There have been no significant earthquakes in Southern California today. There was a 4.6 quake in the Gulf of California at 12:02 p.m., and many peope from Orange County reported feeling shaking from the event. But that’s likely an error, says Dollar.

“I’ve never heard of a quake of that size being felt that far away (more than 1,000 miles,” Dollar says.

Orange County experienced similar window and door rattling on March 3 and March 16. The precise cause of both events hasn’t been identified.

It also appears that the artillery fire going on at Camp Pendleton today didn’t cause the shaking.

Camp Pendleton issued a special advisory earlier this week saying that the base would be conducting round-the-clock artillery and high explosive exercises through Thursday that could produce sounds and vibrations felt up to 50 miles away — or all the way to the north end of Orange County.

Pendleton officials said such long distance vibrations would occur only if the “atmospheric conditions” were right. Usually, such vibrations and sounds travel farthest when there’s cloud cover and moisture in the air, says the National Weather Service. Most of the county is currently sunny. But clouds are expected to bring light showers later. There have been no significant earthquakes in Southern California today. unknown if the Navy or Marines are flying F-18s close to the coastline today at speeds fast enough to produce a sonic boom.

The latest shaking has been reported by people in Newport Beach, Tustin, Laguna Beach, Mission Viejo, Trabuco Canyon, Ladera Ranch, Yorba Linda and Laguna Niguel.

Cindy McNatt, a Register reporter, said by instant message, “I live in a glass house (in Tustin) — so I was watching the glass rattle, but didn’t feel anything on the ground.”

Erika Ritchie, another Register reporter, said, “I was sitting in my house and the windows on the top floor started to shake so loudly that my dog barked because it sounded like someone was trying to force open a door. The bamboo floor also began shaking beneath me.

A reader named Nate from Lake Forest e-mailed to say, “At about 12:19 p.m., a big rumble shook our house. Thought it may be a tremor or a small earthquake. But not sure what’s up.”

Science & Technology

Science and technology has been in the forefront of transforming the Indian economic structure helping India evolve as a globally competitive economic powerhouse. With the available scientific manpower--which is third largest in the world-- the Indian science and technology has been growing well above world average.

While the Indian output of science, as measured by the quality and quantity of Science Citation Index (SCI) papers, has been growing at a CAGR of 8 per cent in the past three years, the world average was only 4 per cent. Also, the number of technical workforce is also increasing at a rapid clip and is set to cross the 2 million mark, with the march from one million to two million happening in just about three years.

A number of world-class institutions have instrumental in this: 162 universities award 4,000 doctorates and 35,000 postgraduate degrees and the Council of Scientific and Industrial Research runs 40 research laboratories that have made some significant achievements.

Space Technology

India is one of the few countries with expertise to conceptualise, design and manufacture satellites and the capability to launch them into space. In fact, it has the largest constellation of remote sensing satellites in the world. Also, the Indian Space Research Organisation (ISRO) is the world's third non-US supplier of 1-metre imageries and holds nearly 25 per cent of the US$ 120-million global free-play imageries market.

The year 2007 saw several major accomplishments being made in the Indian space programme: successful orbiting and recovery of a space capsule (which is a prelude to the development of space recovery capsule), launch of Cartosat-2 (a remote sensing satellite with a resolution capacity below 1 metre) and successfully testing indigenously developed cryogenic upper stage among others.

India has also lined up some interesting projects for the future: a lunar mission, a project for manned space outing around 2015, development of space recovery capsule (which would lay the foundation for future returning missions) and establishing indigenous regional GPS by 2012 among others.

Renewable Energy

India has been tapping energy from renewable sources to meet its growing energy demands. This also helps in diversifying its sources of energy. Some notable achievements in this field are:

* India has the largest number of biomass gasifier systems in the world.
* India is the third largest producer of solar photovoltaic cells in the world
* India is the world's fourth largest wind power user.
* India has the ninth largest solar thermal power generation in terms of million units per square meter.

Science and Technology

India has a long and distinguished tradition in science and technology from the ancient times to great achievements during this century; the latter half prior to independence has been related largely to pure research. At the time of independence, our scientific and technological infrastructure was neither strong nor organised as compared to the developed world. This had resulted in our being technologically dependent on the skills and expertise available in other countries. In the past four decades, an infrastructure and capability largely commensurate with meeting national needs has been created minimising our dependence on other countries. A range of industries from small to the most sophisticated has been established covering a wide range of utilities, services and goods.
now a reservoir of expertise well acquainted with the most modern advances in basic and applied areas that is equipped to make choices between available technologies, to absorb readily new technologies and provide a framework for future national development.



  • Only one of 6 in the world, the only one in India
  • The fastest available treatment in the world treats one number (1 Dioptre) in 1.6 seconds
  • 3 Types of customized treatments
  • This laser technology saves over 40% of corneal tissue compared to other lasers
  • Only laser technology stated by US FDA to improve night vision and enhance contrast
  • The laser system most respected by LASIK surgeons today

Concerto Vs Other Lasers

Accuracy of treatment since we use the fastest laser - takes 1/5th the time that other lasers take for similar numbers hence better patient compliance

Precision, even if your eyes move during treatment- as this laser has the Fastest Eye Tracker, which tracks your eye at 500 times a second

Faster healing and visual recovery

Saves upto 40% corneal tissue as compared to most lasers hence able to treat higher numbers much safer.

Due to corneal savings we can treat patients which other centers cannot who otherwise on other lasers would have been left with a residual error (number)

Most lasers have between -5.00 D and -7.00D as their upper limit of treatment hence higher chances of residual errors in spite of LASIK with such older technology. Our upper limit is -14.00D with far more safety as compared to other lasers
Why Choose Us?

The first and only Eye Hospital in India certified by the American Joint Commission International [JCI]-the Gold Standard in healthcare, from JCAHO, USA

The only Referral Center in India for our technology

24 X 7 technical support from Germany

Engineer trained from Germany runs checks before every treatment, which ensures accurate results.

Change the way you look at life

New Vision Laser Centers, India

A world where everything is bright, beautiful and clear. Where you can see things the way God meant you to. Where playing your favourite sport or getting a job isn't a problem because of your eyesight. Then welcome to New Vision Laser Centers. The pioneers of laser eye correction in India. Read on to learn more about us and what we can do for you. Rest assured, your prayers will be answered.

Allow us to open your eyes to the world.

Lasik Eye surgery

Now you can lose your glasses.... on purpose!!

Remember how your life changed when you had to get glasses? Now you can change it back and see naturally again. All this is possible now thanks to laser vision correction. We know you need more information to make an informed decision; so we would like to answer some of the questions you may have while considering this procedure.

Laser Assisted Stromal In-situ Keratomileusis [LASIK] is a method of re-shaping the external surface of the eye [the cornea] to correct low, moderate and high degrees of nearsightedness, astigmatism and far-sightedness. During the treatment, an instrument called the microkeratome creates a corneal flap to make it a painless procedure. The computerized Excimer laser then uses a cool beam of light to gently reshape the cornea so as to alter its curvature to the desired extent. The flap when replaced on the new corneal curvature allows images to be sharply focused on the retina. The goal is to eliminate or greatly reduce the dependence on glasses or contact lenses.
Lasik Lasik Eye Surgery Lasik Surgery
The treatment is for patients who have a refractive error and meet certain visual and medical criteria. In addition the best candidates tend to be those who are dissatisfied with their contact lenses or glasses and are motivated to make a change, whether it is due to occupational or lifestyle reasons. However, only a thorough examination by our LASIK team can evaluate whether or not you are medically suited for LASIK.

Yes. When choosing this method to improve your vision safety should be your first concern. It's ours too. New generation Excimer lasers and advances in technique offer the highest degree of accuracy and utmost safety. Recent studies conducted internationally and by us show it to be a very safe and effective procedure.

Yes. LASIK is a permanent treatment. However, patients who are 40 years and above may require reading glasses. Millions of patients worldwide and thousands at our centre have had an Excimer laser refractive procedure done on them successfully. During your consultation we will give you an idea of the procedure and the level of vision you can expect.

You may have heard about PRK [photo refractive keratectomy]. You may have also heard about the surgery known as RK [radial keratotomy]. You need to understand that these are two completely different procedures from LASIK with less predictable results.
The latest and most reliable procedure is wavefront-guided LASIK, a customized treatment for each eye. Our excimer lasers use high-speed sensitive eye trackers to ensure perfectly centered treatments. Wavefront procedures even often leave patients with eyesight better than normal. We are committed to providing our patients with the best that technology and technique has to offer.

No. There is no pain during the procedure. There may be mild discomfort for a few hours after the procedure.

This is an outpatient procedure. The laser treatment usually takes less than a minute. The entire procedure usually takes 5-10 minutes per eye. First you will lie on a motorised bed to which the laser is attached. Anesthetic drops will be placed in the eye. The head is positioned under the laser and the eyelids are gently and comfortably kept open during the treatment with the help of a soft clip. You will be asked to look at a blinking light during the entire procedure. Once the procedure is completed, a soft corneal protective shield is sometimes placed on the eye. A post-procedure eye examination is performed and eye drops are prescribed. We will inform you about the follow-up schedule.

You will notice an improvement in vision within 4-6 hours and a restoration of functional vision by the next morning. However, complete recovery may take up to 48 hours. Some people get back to work the day after treatment.

FDA Approves New Robotic Surgery Device

The U.S. Food and Drug Administration has cleared for marketing a robotic device that enables a surgeon to perform laparoscopic gall bladder and reflux disease surgery while seated at a console with a computer and video monitor.
See also:
Health & Medicine

* Today's Healthcare
* Diet and Weight Loss
* Cosmetic Surgery

Matter & Energy

* Robotics Research
* Technology
* Medical Technology


* Laparoscopic surgery
* Robotic surgery
* Minimally invasive procedure
* Urology

The surgeon uses hand grips and foot pedals on the console to control three robotic arms that perform the surgery using a variety of surgical tools.

The product, the Da Vinci Surgical System, made by Intuitive Surgical, Inc., of Mountain View, Calif., is the first of its kind.

"This system is the first step in the development of new robotic technology that eventually could change the practice of surgery," said FDA Commissioner Jane E. Henney, M.D.

The robotic arms, which have a "wrist" built in to the end of the tool, give surgeons additional manipulation ability during laparoscopic surgery, enabling easier, more intricate motion and better control of surgical tools.

In standard laparoscopic surgery, surgeons pass a laparoscope, a flexible fiberoptic instrument equipped with biopsy forceps, scissors and other surgical tools, through a small incision in the abdominal wall to view the abdominal cavity and perform minor surgery.

The new robotic system is intended to be used in an operating room in laparoscopic procedures, for example for gall bladder disease or gastro-ensophageal reflux disease (severe heartburn).

FDA clearance was based on a review of clinical studies of safety and effectiveness submitted by the manufacturer and on the recommendation of the General and Plastic Surgical Devices Panel of FDA's Medical Devices Advisory Committee.

Intuitive Surgical studied use of the robotic system on 113 patients who underwent surgery for gall bladder or reflux disease, then compared them to 132 patients who received standard laparoscopic surgery.

Results showed that the robotic system was comparable to standard laparoscopic surgery in safety and effectiveness. While the surgical procedures with the robotic device took 40 to 50 minutes longer than standard laparoscopic surgery, this was attributed, in part, to lack of surgical experience with the new technology.

Because of the expected learning curve with the new system, Intuitive Surgical is developing a training program for surgeons in collaboration with FDA.

Robot During Cardiac Bypass Surgery On A Beating Heart

The University of Pittsburgh is the first center in the United States to use the ZEUS™ Robotic Surgical System during a beating-heart cardiac bypass operation. Surgeons used the three-armed robot during the most important part of the operation -- when the artery being used as the bypass graft is connected to the heart's main coronary artery.
See also:
Health & Medicine

* Heart Disease
* Stroke Prevention
* Today's Healthcare

Matter & Energy

* Robotics Research
* Engineering
* Medical Technology


* Robotic surgery
* Laparoscopic surgery
* Minimally invasive procedure
* Liver transplantation

The 63-year-old male patient underwent multivessel off-pump coronary artery bypass surgery at UPMC Presbyterian Hospital on April 5 as part of a national, multi-center trial seeking to evaluate whether the robotic system can be helpful to surgeons and be safely used for the surgical connection of the left internal mammary artery graft to the left anterior descending artery.

The University of Pittsburgh is one of 12 centers in the research study and the first U.S. center to use the ZEUS in a beating-heart bypass operation. The robot had been used in 32 patients at three centers as part of a phase one trial, but in all of these cases, the operation involved the use of a heart/lung machine while surgeons operated on a stopped heart.

Marco A. Zenati, M.D., assistant professor of surgery and principal investigator at the Pittsburgh site, operated the robot while seated at a console about 10 feet from the patient. One arm of the robot, which responded to his voice commands, positioned the endoscope, an instrument with a tiny camera that magnifies the operative site up to 10 to 15 times. While viewing the magnified image of the heart and vessels on a high-resolution monitor, Dr. Zenati controlled the action of surgical instruments attached to the two other robotic arms by operating handles that resemble conventional surgical instruments, in much the way joysticks are used to control the action of a video game.

"ZEUS is designed to give a surgeon greater precision while performing microsurgical tasks, and to be able to use it during a beating heart operation is quite significant. Essentially, it may allow surgeons to perform superhuman tasks, because the robot overcomes our dexterity and precision limitations," said Dr. Zenati.

The hand movements of the surgeon are scaled. For instance, one inch of movement by the surgeon results in a 1/4 inch movement by the robotic surgical instruments. Hand tremor is filtered by the computer and translated via the robotic arms into precise micro movements at the operative site. According to Computer Motion, Inc., the Santa Barbara-based company that developed ZEUS, the possible benefits of using ZEUS in a closed-chest heart bypass surgery include less patient pain and trauma, quicker recovery times and reduced health care costs. That is because robotics and computers provide enhanced dexterity, steady visualization and improved ergonomics for the surgeon. The reduced trauma to the patient, from a minimal incision and the avoidance of the heart-lung machine, can translate into reduced costs.

"The use of robotics for cardiac surgery is an extremely exciting development for the field. It is anticipated that the future will soon see all cardiac procedures employing such technology, and surgery will become less and less invasive for the patient," said Bartley P. Griffith, M.D., Henry T. Bahnson professor of surgery and chief, division of cardiothoracic surgery at the University of Pittsburgh School of Medicine. Dr. Griffith is a co-investigator of the study and assisted Dr. Zenati during the operation. Dr. Zenati also was assisted by Larry Shears, M.D.

Penn Surgeons Use Completely Robotic Surgery To Treat Prostate Cancer

Prostate cancer is the second leading cause of death among American men. It is estimated that one in six males will develop the disease during his lifetime. However, promising new treatment options have been developed to help combat this threatening disease.
See also:
Health & Medicine

* Men's Health
* Prostate Cancer
* Today's Healthcare

Matter & Energy

* Robotics Research
* Medical Technology
* Technology


* Laparoscopic surgery
* Robotic surgery
* Urology
* Minimally invasive procedure

One of the most innovative of these treatments is robotic-assisted laparoscopic prostatectomy (removal of the prostate). The University of Pennsylvania Health System is currently one of only a handful of facilities across the country offering this minimally invasive, high-tech treatment. David I. Lee, M.D., a national expert in robotic surgery, was recruited to Penn and named Chief of the Division of Urology at Penn Presbyterian Medical Center, where the robotic prostate program is based.

There are many factors that make robotics an exceptionally valuable tool in the operating room during prostate surgery, for both the patient and surgeon. “Perhaps two of the most-feared possible long-term effects of a radical prostatectomy are erectile dysfunction and urinary incontinence,” says Dr. Lee. “My specially-trained team and I have discovered that by using the robotic technique there is greater nerve sparing, which provides patients with the best chance for maintaining potency and continence.”

Robotic technology offers a number of advantages during surgery. For instance, the robotic “arms” filter even minute tremors of the human hand so to provide steadiness. The robot’s camera also provides a three-dimensional, stereoscopic image of the body’s interior, as opposed to a two-dimensional image on a flat screen. This improved perspective enables depth perception that sharpens the visualization of the prostate and the network of nerves and tissue surrounding it. Additionally, by scaling down the motion of the robotic instruments, the surgeon can perform extremely precise, intricate movements during the procedure. For example, if the surgeon’s hand moves five centimeters, he/she can scale the robotic hand to move only one centimeter.

Robotic technology also offers a number of advantages after surgery. Because laparoscopic surgery is minimally invasive and no large incisions are involved, robotic-assisted surgery provides numerous benefits for prostate cancer patients, including: less pain and scarring, diminished blood loss, a shorter hospital stay and reduced recovery period for a quicker return to daily activities.

The actual robot consists of a tower that manipulates instruments controlled from a console that is situated a few feet from the patient. At the console, the surgeon operates four robotic “arms” and “wrists” using hand and foot controls. One of the robotic arms holds a tiny video camera, one works as a retractor and the other two replicate the surgeon’s exact hand movements. The camera and instruments are inserted through small keyhole incisions in the patient’s abdomen. The surgeon then directs the robotic instruments to dissect the prostate gland and surrounding tissue.

Unlike standard laparoscopic approaches that require counter-intuitive movements by surgeons (whereby the surgeon must move his hand to the left in order to move the mechanical device to the right), the robotic technology affords surgeons the direct, “intuitive” control they exercise in traditional open surgical procedures, seamlessly translating their natural hand, wrist and finger movements at the console into corresponding micro-movements of laparoscopic surgical instruments inside the patient’s body.

Penn has been using fully robotic surgery for cardiac patients for the past three years and is currently studying its use for head and neck cancer surgeries. “The robotic prostate program is a continuation of Penn’s commitment to finding and applying the most precise, most beneficial surgical techniques to put patients on a quicker road to recovery with better outcomes,” said Dr. Lee.

How Robotic Surgery Will Work

Introduction to How Robotic Surgery Will Work
­Just as computers revolutionized the latter half of the 20th century, the field of robotics has the potential to equally alter how we live in the 21st century. We've already seen how robots have changed the manufacturing of cars and other co­nsumer­ goods by streamlining and speeding up the assembly line. We even have robotic lawn mowers and robotic pets. And robots have enabled us to see places that humans are not yet able to visit, such as other planets and the depths of the ocean.

In the coming decades, we may see robots that have artificial intelligence. Some, like Honda's ASIMO robot, will resemble the human form. They may eventually become self-aware and conscious, and be able to do anything that a human can. When we talk about robots doing the tasks of humans, we often talk about the future, but robotic surgery is already a reality. Doctors around the world are using sophisticated robots to perform surgical procedures on patients.

Not all surgical robots are equal. There are three different kinds of robotic surgery systems: supervisory-controlled systems, telesurgical systems and shared-control systems. The main difference between each system is how involved a human surgeon must be when performing a surgical procedure. On one end of the spectrum, robots perform surgical techniques without the direct intervention of a surgeon. On the other end, doctors perform surgery with the assistance of a robot, but the doctor is doing most of the work [source: Brown University].

­Honorable Discharge
The military is responsible for many of the advances in robotic surgery. That's because military officials hoped that robotic surgery would provide a way for doctors to help patients on the front lines of combat zones without putting themselves in danger. So far, latency issues make long-distance telesurgery difficult, but civilian doctors have put the technology to good use.

While robotic surgery systems are still relatively uncommon, several hospitals around the world have bought robotic surgical systems. These systems have the potential to improve the safety and effectiveness of surgeries. But the systems also have some drawbacks. It's still a relatively young science and it's very expensive. Some hospitals may be holding back on adopting the technology.

Why would a hospital consider a robotic surgery system in the first place? Find out in the next section.

Advantages of Robotic Surgery

In today's operating rooms, you'll find two or three surgeons, an anesthesiologist and several nurses, all needed for even the simplest of surgeries. Most surgeries require nearly a dozen people in the room. As with all automation, surgical robots will eventually eliminate the need for some personnel. Taking a glimpse into the future, surgery may require only one surgeon, an anesthesiologist and one or two nurses. In this nearly empty operating room, the doctor sits at a computer console, either in or outside the operating room, using the surgical robot to accomplish what it once took a crowd of people to perform.

The use of a computer console to perform operations from a distance opens up the idea of telesurgery, which would involve a doctor performing delicate surgery miles away from the patient. If the doctor doesn't have to stand over the patient to perform the surgery, and can control the robotic arms from a computer station just a few feet away from the patient, the next step would be performing surgery from locations that are even farther away. If it were possible to use the computer console to move the robotic arms in real-time, then it would be possible for a doctor in California to operate on a patient in New York. A major obstacle in telesurgery has been latency -- the time delay between the doctor moving his or her hands to the robotic arms responding to those movements. Currently, the doctor must be in the room with the patient for robotic systems to react instantly to the doctor's hand movements.

Having fewer personnel in the operating room and allowing doctors the ability to operate on a patient long-distance could lower the cost of health care in the long term. In addition to cost efficiency, robotic surgery has several other advantages over conventional surgery, including enhanced precision and reduced trauma to the patient. For instance, traditional heart bypass surgery requires that the patient's chest be "cracked" open by way of a 1-foot (30.48-cm) long incision. However, with the da Vinci system, it's possible to operate on the heart by making three or four small incisions in the chest, each only about 1 centimeter in length. Because the surgeon would make these smaller incisions instead of one long one down the length of the chest, the patient would experience less pain, trauma and bleeding, which means a faster recovery.

Welcome to the Robotic Surgery Institute

USC Robotic Surgery Institute is the brainchild of Vaughn A. Starnes, M.D., a pioneering cardiothoracic surgeon who was one of the first of his peers to see the potential for robotic surgery. He and his colleagues led the effort to become the first surgery team in Southern California to perform heart surgery using the da Vinci Surgical System, repairing the mitral valve of a patient using robotic surgery.

Vaughn A. Starnes, MD at the daVinci Surgical System surgeon's console

* Robotic Cardiac Surgery
* Robotic Thoracic Surgery
* Benefits of Robotic Surgery
* Future of USC Robotic Surgery

The USC Robotic Surgery Institute is devoted to conducting clinical and bench research to advance the use of robotic techniques in the fields of heart and lung surgery. While its initial efforts will focus on cardiothoracic techniques, the lab will eventually encompass all surgical specialties that could benefit from robotic surgery such as general surgery, urology and orthopedics.

Making History

da Vinci Surgical Arm CartWhen Vaughn A. Starnes, M.D., professor and chairman of the Department of Cardiothoracic Surgery at the Keck School of Medicine of the University of Southern California, took a seat at the instrument control console of the da Vinci Surgical System on April 27, 2001, he prepared to make history yet again -- becoming the first cardiothoracic surgeon in Southern California to perform heart surgery using a robot.

With the introduction of groundbreaking robotic heart surgery and off-pump, beating heart surgery, USC Cardiothoracic Surgeons continues its tradition of visionary innovation. Our goal? To focus our clinical and research efforts on expanding the treatment alternatives for our patients with cardiothoracic conditions. We want to give patients direct access to the latest treatment approaches, using innovation as a guide when conventional therapy is not an option.

With cardiothoracic surgery leading the way, the Robotic Surgery Institute promises to create new treatment alternatives for patients – and a new era of excellence for USC.

Abdominoplasty Surgical Sculpture of the Abdomen - Introduction.

The abdomen or tummy comes in many different sizes and shapes. Time, gravity, weight loss, and pregnancies take their toll on our abdominal region. What we perceive as a "normal" stomach is influenced by television, magazines, art, and advertising.

Choosing your surgeon is very important. Not all surgeons offer the same methods of tummy tuck abdominal sculpture. There is much to learn about this surgery. This website is but an introduction to what we have to offer at Bermant Plastic Surgery. We take our patient's education, sculpture, after care, and comfort very seriously.

Bermant AbdominoplastyThe following pages have actual patients Dr. Bermant has operated on, their before, during, and after surgery photographs. Since his Tumescent Techniques have limited bruising, we can show images of very early results. Some may want to learn about the surgical details shown on other pages. Others may wish to avoid the actual in surgery graphic images. Read our patient's comments about Dr. Bermant's Tumescent Anesthesia.

The body is three dimensional. The excess sagging tissues can extend from the front, to the sides, and to the back. That is why Dr. Bermant includes so many pictures for each patient. Surgery can extend to treat these other areas or settle with a compromise transition zone from what was sculpted to what was left alone.

Gynecomastia male breast surgery

Gynecomastia is a medical term that comes from the Greek words for "woman - like breasts." Though this oddly named condition is rarely talked about, it is actually quite common. Gynecomastia affects an estimated 40% to 60% of men.

It may affect only one breast or both. Though certain drugs and medical problems have been linked with male breast over development, there is no known cause in the vast majority of cases. The enlargement can be from excess glandular tissue or fat or both.

For men who feel self-conscious about their appearance, breast-reduction surgery can help. The procedure removes fat and or glandular tissue from the breasts, and in extreme cases removes excess skin, resulting in a chest that is flatter, firmer, and better contoured.

If you are considering surgery to correct gynecomastia, these web pages will give you a basic understanding of the operation, when it can help, how it is performed, and what results you can expect. This can only be an introduction. Our patients can continue their exploration of this problem with an in office consultation with Dr. Bermant. After an examination and evaluation, we can better tailor your education for your particular condition and anatomic problem.
Gynecomastia male breast reduction in men picts before and after male breast reduction. Images of nipple, areola, gland, and glandular male breast and fat suction or liposuction treatment. Photographs of lyposuction. We see patients from richmond, virginia, VA, MD, NC, north carolina, washington, DC,D.C., fairfax, alexandria, fredericksburg, williamsburg, newport news, hampton, virginia beach, lynchburg, roanoke, charlottesville, charlotte, and raleigh.
The best candidates for gynecomastia correction Before Surgery 5 Weeks After Surgery

Surgery to correct gynecomastia can be performed on healthy, emotionally stable men of any age. The best candidates for surgery have firm, elastic skin that will reshape to the body's new contours.

This is not the way to lose weight. Surgery may be discouraged for obese men, or for overweight men who have not first attempted to correct the problem with exercise or weight loss. Individuals who drink alcoholic beverages in excess or smoke a significant amount of marijuana are usually not considered good candidates for surgery. These drugs, along with anabolic steroids, may cause gynecomastia. Stopping these drugs may reverse the breast enlargement, and you may be able to avoid the surgery or at least require a smaller operation.

All surgery carries some uncertainty and risk
When male breast-reduction surgery is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Dr. Bermant has been resculpting male breasts for many years. Nevertheless, as with any surgery, there are risks. These include infection, skin injury, excessive bleeding, adverse reaction to anesthesia, and excessive fluid loss or accumulation. The procedure may also result in noticeable scars, permanent pigment changes in the breast area, or slightly mismatched breasts or nipples. If asymmetry is significant, a second procedure may be performed to remove additional tissue.

The temporary effects of breast reduction include loss of breast sensation or numbness, which may last up to a year.

Your consultation with Dr. Bermant
Since Dr. Bermant sees patients from around the world, some prefer to start the process with his preliminary remote package to minimize travel to Richmond. Call our office or E-mail us to learn more about this process.

The initial consultation with us is very important. We will need a complete medical history, so check your own records ahead of time and be ready to provide this information. Bring your medications or a complete list with dosages and frequency. There are many medical problems and conditions that can cause gynecomastia:

* impaired liver function
* use of estrogen containing medications
* other medications
* use of anabolic steroids
* herbal testosterone additives
* problems of testicular hormone production
* and many others

If a medical problem is the suspected cause, you will be referred to an appropriate specialist.

Dr. Bermant will then examine you. There are many anatomic conditions resulting in enlarged breasts. By examining the problem, the exploration of what needs to be done can be individualized. In some cases you will need a mammogram, or breast x-ray. This will not only evaluate the very small possibility of breast cancer, but will reveal the breast's composition.

Solutions depend how much gland, fat, and extra skin are present. With the anatomic problem defined, Dr. Bermant can outline a surgical approach to best suit your needs.

Don't hesitate to ask Dr. Bermant or our staff any questions you may have during the consultation, including your concerns about the recommended treatment or the costs involved. Treatment of gynecomastia may be covered by medical insurance, but policies vary greatly. Check you policy or call your carrier to be sure. If you are covered, make certain you get written pre-authorization from your insurance company for the treatment recommended by Dr. Bermant.

Otoplasty, Pinback or Reduction Surgery can help Protruding Ears.

Ears stick out from the head and when they excessively protrude, the deformity can be very disturbing. Otoplasty surgery is the name for a number of operations to resculpt and reshape the ear.

A prominent ear that sticks out too much is often the focus of ridicule. People stare at the deformity. Kids tease and can be cruel at times. Victims of unkind nicknames such as “Dumbo” or “Mickey Mouse” are prime candidates for this operation. However, the surgery can be done at any age. Although hair styles can cover the ears, this is not always convenient nor desired. Either a single ear or both ears may be involved.