Arthroscopy
Arthroscopy, used to diagnose and repair many joint problems, is one of the most common orthopaedic procedures done in the United States. In arthroscopy, the surgeon uses a lighted, tube-shaped instrument called an arthroscope. He/she inserts the arthroscope, which is the width of a pencil, into a small incision (a cut called a portal) in the side of the joint.
The arthroscope contains optic fibers that transmit an image of the inside of the joint through a small camera to a video monitor in the operating room. The surgeon can clearly examine the area and determine the source of the problem. He/she can repair the problem by inserting tiny surgical instruments through other portal incisions in the joint. These incisions are so small that they usually don’t need stitches.
Most commonly used for knee and shoulder problems, arthroscopy can also be done on the elbow, wrist, hip, and ankle. Arthroscopy is done using a local anesthetic and/or a sedative. Most patients can go home the same day. Some need to stay in the hospital overnight.
Endoscopy
Endoscopy is used to diagnose and treat many types of problems, including problems in the ear, gallbladder, knee, nose, and throat, and in tubal ligation and plastic surgery. The surgeon inserts a thin, flexible tube (the endoscope) into a natural opening in the patient’s body, such as the mouth or the rectum, or through incisions (cuts) that are less than an inch long each.
The endoscope contains a fiber-optic light and a video camera at its tip, which transmits an image of the inside of the body to a video monitor in the operating room. The surgeon can look closely at areas inside the body. If tissue looks abnormal, he/she can insert tiny instruments through the endoscope to remove or sample it.
Endoscopy is done using a local anesthetic and a sedative. Most patients can go home the same day. Some need to stay in the hospital overnight.
Laparoscopy
Laparoscopy is used to diagnose and treat many types of abdominal problems, including some cancers, obstetric/gynecologic problems, and urological problems. It enables surgeons to look into the abdomen (including the adrenal glands, appendix, gallbladder, intestines, kidneys, liver, pancreas, spleen, and stomach) and at the reproductive organs.
A laparoscope is a small telescope that is inserted into the abdomen through a small incision (cut). It brings light into the abdomen so that the surgeon can see inside. He/she can repair the problem by inserting tiny surgical instruments through other incisions in the abdomen.
Laparoscopy is done using general anesthesia. Some patients can go home the same day. Others need to stay in the hospital overnight.
daVinci® Surgical System
The daVinci Surgical System is a laparoscopic surgical robot that combines computer technology and the surgeon’s skill. It enhances the surgeon’s ability to perform complex minimally invasive surgery, providing more precision, an increased range of motion, improved dexterity, and enhanced 3D visualization. The daVinciÒ Surgical System is currently being used in some heart, kidney, and prostate procedures.
To use the daVinci Surgical System, the surgeon makes three small incisions (cuts) in the patient and inserts the robotic arms into these incisions; two arms hold surgical instruments and the third has a tiny video camera. He/she then sits at a computer console, where the camera transmits a 3-D magnified image of the patient’s insides. The surgeon places his/her hands in holders that control the robotic arms and performs the procedure while seated at the computer console.
Procedures performed with the daVinci Surgical System require general anesthesia and a hospital stay.
Video-Assisted Thorascopy
Video-assisted thorascopy is used for chest surgery. This surgical technique eliminates the need to spread the ribs during chest surgery, and requires only a one-inch incision and three ¼” to ½” incisions. A miniature video camera is inserted into one of these small incisions, enabling the surgeon to clearly see the area being operated on. Video-assisted thorascopy can be more accurate and provides an easier recovery than traditional surgery.
Video-assisted thorascopy is done under general anesthesia. Some patients can go home the same day. Others need to stay in the hospital overnight.
Extracorporeal Shock Wave Lithotripsy (ESWL)
Extracorporeal shock wave lithotripsy, used in minimally invasive urological surgery, uses x-rays and/or ultrasound to produce high energy shock waves outside of the body. These soundwaves are focused on a kidney or ureteral stone, causing the stone to break into tiny pieces which pass easily in the urine.
No anesthesia is necessary for extracorporeal shock wave lithotripsy. Patients can go home the same day.
Ureteroscopy
Ureteroscopy, used in minimally invasive urological surgery, is done to destroy, remove, or repair ureter stones, tumors, and strictures. Ureteroscopes have a lens on their tip which gives the surgeon a magnified view of the ureter (the tube that carries urine from each kidney to the bladder for excretion) and one or two working ports through which the surgeon can insert small instruments such as lasers, graspers and balloon dilators. They enable the surgeon to see and access the ureter stone, tumor, or stricture.
Ureteroscopy is done under local anesthesia. Most patients can go home the same day. Some patients need to stay in the hospital overnight. After ureteroscopy, some patients need a temporary internal catheter; this is usually removed within 3-10 days.
Endovascular Surgery
Endovascular surgery is done from within the blood vessel. It is used to treat the two major problems that can develop in blood vessels: an aneurysm (an abnormal blood-filled dilatation of a blood vessel) and a narrowing (also called occlusion or stenosis).
The surgeon reaches the aneurysm or narrowing by inserting a catheter (a long hollow tube) into a smaller artery and using x-ray imaging to advance it into the aneurysm or narrowing. Usually, the catheter is placed into the femoral artery in the groin.
To repair an aneurysm, the surgeon pushes a hollow tube (a graft with metal attachments) through the catheter to the aneurysm and anchors it in place. To open a narrowing, the surgeon does an angioplasty with stenting. In angioplasty, a balloon is inserted and advanced to the narrowing. The balloon is then inflated, and a stent (a small, mesh-like stainless steel tube) is moved to the narrowing. The balloon is deflated and removed, and the stent expands and presses against the inner walls of the artery, keeping it open.
Endovascular surgery is done under local anesthesia. Most patients can go home the same day. Some patients need to stay in the hospital overnight.