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16/Aug/2021

What is Endovascular Surgery?

Traditional open vascular surgery involves making a large incision on the area of defect to access the blood vessel to treat various cardiovascular conditions. The term endovascular refers to “inside a blood vessel.” Endovascular surgery is a minimally invasive surgical technique performed under local anesthesia and involves making a small incision instead of a large incision required for open surgery and passing devices through the blood vessel to repair, unblock, or reroute the blood vessels, often under image guidance.

Indications for Endovascular Surgery

Endovascular surgery is usually recommended when non-surgical treatments such as medications have failed to treat cardiovascular conditions. It is often performed to improve blood circulation to an area of the body where the blood vessels have been damaged or the blood flow has been obstructed, following injury, disease, or other conditions. Some of the common vascular conditions that may warrant endovascular surgery include:

  • Peripheral vascular disease: Peripheral vascular disease (PVD), also referred to as peripheral artery disease (PAD), is a common disease that occurs when the blood vessels that supply blood to the limbs and other organs of our body are partially or completely blocked due to plaque build-up, a condition called atherosclerosis.
  • Deep vein thrombosis: The condition in which a blood clot forms in the deep veins of the body is referred to as Deep Vein Thrombosis (DVT). Clots form when blood thickens and clumps together. A DVT occurs most often in the deep veins of the leg and thighs.
  • Abdominal aortic aneurysm: Aortic aneurysm is a condition characterized by an abnormal bulging of a section of the large blood vessel called the aorta. The aorta is the major blood vessel that carries oxygenated blood from the heart to the different parts of the body. In an abdominal aortic aneurysm, the aneurysm occurs in the section of the aorta that passes through the abdomen.
  • Carotid artery disease: Carotid artery disease occurs due to the deposition of plaque (fatty substances) inside the walls of your carotid (neck) arteries. These arteries supply oxygen-rich blood from the heart to your brain. Due to plaque accumulation, the arteries become narrow or even completely blocked. This reduces blood flow to your brain and creates oxygen deficiency, increasing your risk of having a stroke.
  • Varicose veins: Varicose veins are enlarged veins caused due to weak or damaged valves in the veins. They appear twisted, bulged, and blue, red, or flesh-colored. They are swollen and raised above the surface of the skin and are mostly found on the thighs, back of the calves, and inside of the leg.
  • Pulmonary embolism: Pulmonary embolism is a sudden blockage of an artery in the lung. The blockage is due to a blood clot in the pulmonary artery that carries blood from the heart to the lungs. Blood clots usually develop in the arteries of the leg or arm and travel to the arteries of the lung.
  • Coronary Artery Disease (CAD): CAD is the most common of all heart diseases, and a leading cause of death. CAD occurs due to atherosclerosis, a condition where cholesterol and a waxy substance called plaque accumulate in the coronary arteries (blood vessels supplying oxygen-rich blood to heart muscles) over time, thereby narrowing the artery and reducing the flow of oxygen-rich blood to the heart muscles.

Preparation for Endovascular Surgery

Preoperative preparation for endovascular surgery may involve the following steps:

  • A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
  • Depending on your medical history, social history, and age, you may need to undergo tests such as bloodwork and imaging to screen for any abnormalities that could compromise the safety of the procedure.
  • You will be asked if you have allergies to medications, anesthesia, or latex.
  • You should inform your doctor of any medications, vitamins, or supplements that you are taking.
  • You may need to refrain from supplements or medications such as blood thinners or anti-inflammatories for a week or two prior to surgery.
  • You should refrain from alcohol or tobacco at least a few days prior to surgery and several weeks after surgery.
  • You should not consume solids or liquids at least 8 hours prior to surgery.
  • A written consent will be obtained from you after the surgical procedure has been explained in detail.

Common Endovascular Surgery Procedures

Some of the common endovascular surgery procedures include:

  • Balloon angioplasty and stenting: Angioplasty and stenting is a procedure performed to open narrowed or blocked blood vessels as a result of accumulation of a fatty substance called plaque. During the procedure, a balloon catheter (thin tube) is inserted into the vessel and inflated at the site of the blockage to compress the plaque against the wall of the artery. Your surgeon may also insert a wire mesh tube called a stent along with the balloon catheter to help keep the artery open and prevent it from narrowing again.
  • Endovascular aneurysm repair: During an endovascular aneurysm repair, a small incision is made in the leg near the groin. A catheter is inserted into an artery and advanced imaging technique is used to monitor delivery of the catheter carrying the stent-graft to the area of the abdominal or thoracic aortic aneurysm. The surgeon fastens the stent-graft in correct position and removes the delivery catheter. The stent-graft placed inside the aorta prevents the aneurysm from bursting, allowing blood to flow freely without pushing on the weakened area of the artery.
  • Carotid endarterectomy: Carotid endarterectomy is a surgical procedure performed to treat carotid artery disease and involves removal of plaque from the carotid arteries of the neck. During the surgery, a small incision is made over the neck to expose the narrowed carotid artery. A plastic tube is placed into the blood vessel, above and below the narrowing or blockage, to re-route the blood flow around the narrowed or blocked area. The artery is then opened, and the plaque is removed. The plastic tube is then removed as normal blood flow has been restored and the artery and skin incisions are closed. The procedure reduces your risk of developing transient ischemic attacks (TIA) or stroke.
  • Coronary Artery Bypass Grafting (CABG): CABG is a surgical procedure to bypass a blocked artery of the heart.  It involves incising a small part of a blood vessel (most commonly a vein from the leg) and using it as a graft (a piece of living tissue that is transplanted surgically). The procedure is indicated for the treatment of narrowing and blockages in the coronary arteries, which can lead to serious complications if left untreated.
  • Thrombolytics therapy: Thrombolytics is the use of “clot-busting” drugs to dissolve or break down blood clots formed in blood vessels to prevent damage and death of tissues. It is often used as an emergency treatment for heart attack, pulmonary embolism, and stroke, when clots block blood vessels supplying the corresponding vital organs of the body – the heart, lungs, and brain. The procedure is also indicated to treat blood clots formed in bypass grafts (blood vessel implanted to bypass a blocked artery) and dialysis catheters (catheters implanted for kidney dialysis use). During the process of thrombolysis, clot-busting drugs are administered intravenously (IV) or with the help of catheters (flexible tubes) directly at the site of blockage. To do this, an incision is made at the groin, wrist, or elbow to access the underlying artery. The catheter is inserted through this incision and threaded to the region of the clot under the guidance of live X-ray imaging (fluoroscopy). Once the catheter reaches the clot, your doctor injects medication to dissolve it.
  • Endovenous Laser Ablation: Endovenous laser ablation is a procedure that utilizes heat produced from the laser to reduce varicose veins. During this procedure, a small cut is made on the leg and a catheter with a laser fiber is guided into the vein till it reaches the site of abnormality. On reaching the site of treatment, the fiber is made to emit the laser energy which produces heat near the blood vessel which causes blood to clot in the vessel and thus destroys the blood vessel. The damaged blood vessel will collapse, shrink, and finally disappear.

Post-Operative Care

Following the surgical procedure, you may experience pain or discomfort for which your surgeon will prescribe medications. You may be allowed to go home in a day or two after surgery. You can usually resume normal activities and return to work within 2 to 4 weeks post surgery. Refrain from strenuous activities and lifting heavy weights for a defined period. Keep your surgical site clean and dry. Instructions on surgical site care and bathing will be provided. You will be advised to take your prescribed medications and make a few lifestyle changes such as quitting smoking, exercising regularly, maintaining a healthy weight, and eating a healthy diet. A periodic follow-up appointment will be scheduled to monitor your progress.

Benefits of Endovascular Surgery

Endovascular surgery is a minimally invasive procedure and provides various benefits including:

  • Smaller scars
  • Decreased risk of infection
  • Less bleeding
  • Reduced requirement of transfusion
  • Less post-operative pain
  • Fast recovery
  • Shorter hospital stay
  • Quicker return to daily normal activities

Risks and Complications

Endovascular surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:

  • Infection
  • Bleeding
  • Blood clots
  • Allergic/anesthetic reactions
  • Damage to adjacent tissues or organs
  • Stroke
  • Heart attack
  • Death

16/Aug/2021

What is Minimally Invasive Vascular Surgery?

Vascular surgery refers to a variety of different surgical procedures performed to treat disorders of the arteries, veins, and lymph vessels of the body, excluding those in the heart and brain.

Open vascular surgery is a surgical technique in which large incisions are made on the area of the defect to repair or unblock arteries and veins using standard instruments. Minimally invasive vascular surgery is a surgical technique that is performed under general or local anesthesia and involves making smaller incisions to access the area of defect in the blood vessels and lymphatic system, without making larger incisions. Through these small incisions, tiny cameras and special instruments are used to magnify and project images of the veins and arteries onto a high-definition monitor and carry out the required repair more precisely.

Indications for Minimally Invasive Vascular Surgery

Minimally invasive vascular surgery is usually recommended when non-surgical treatments have failed to treat the diseases involving the arteries and veins. It is often performed to improve blood circulation to an area of the body where the blood vessels have been damaged or the blood flow has been obstructed, following injury, disease, or other conditions. Some of the common vascular conditions that may warrant minimally invasive vascular surgery include:

  • Peripheral vascular disease: Peripheral vascular disease (PVD), also referred to as peripheral artery disease (PAD), is a common disease that occurs when the blood vessels that supply blood to the limbs and other organs of our body are partially or completely blocked due to plaque build-up, a condition called atherosclerosis.
  • Deep vein thrombosis: The condition in which a blood clot forms in the deep veins of the body is referred to as Deep Vein Thrombosis (DVT). Clots form when blood thickens and clumps together. DVT occurs most often in the deep veins of the leg and thighs.
  • Abdominal aortic aneurysm: Aortic aneurysm is a condition characterized by an abnormal bulging of a section of the large blood vessel called the aorta. The aorta is the major blood vessel that carries oxygenated blood from the heart to the different parts of the body. In an abdominal aortic aneurysm, the aneurysm occurs in the section of the aorta that passes through the abdomen.
  • Carotid artery disease: Carotid artery disease occurs due to the deposition of plaque (fatty substances) inside the walls of your carotid (neck) arteries. These arteries supply oxygen-rich blood from the heart to your brain. Deposition of plaque causes the arteries to become narrower or even completely blocked, increasing your risk of having a stroke.
  • Varicose veins: Varicose veins are enlarged veins caused due to weak or damaged valves in the veins. They appear twisted, bulged, and blue, red, or flesh-colored. They are swollen and raised above the surface of the skin and are mostly found on the thighs, back of the calves, and inside of the leg.
  • Pulmonary embolism: Pulmonary embolism is a sudden blockage of an artery in the lung. The blockage is due to a blood clot in the pulmonary artery that carries blood from the heart to the lungs.

Preparation for Minimally Invasive Vascular Surgery

Preoperative preparation for minimally invasive vascular surgery may involve the following steps:

  • A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
  • Depending on your medical history, social history, and age, you may need to undergo tests such as bloodwork and imaging to screen for any abnormalities that could compromise the safety of the procedure.
  • You will be asked if you have allergies to medications, anesthesia, or latex.
  • You should inform your doctor of any medications, vitamins, or supplements that you are taking.
  • You may need to refrain from supplements or medications such as blood thinners or anti-inflammatories for a week or two prior to surgery.
  • You should refrain from alcohol or tobacco at least a few days prior to surgery and several weeks after surgery.
  • You should not consume solids or liquids at least 8 hours prior to surgery.
  • A written consent will be obtained from you after the surgical procedure has been explained in detail.

Common Minimally Invasive Vascular Surgeries

Some of the common minimally invasive vascular procedures include:

  • Angioplasty and stenting: Angioplasty and stenting is a procedure performed to open up narrowed or blocked blood vessels as a result of accumulation of fatty substance called plaque. During the procedure, a balloon catheter (thin tube) is inserted into the vessel and inflated at the site of the blockage to compress the plaque against the wall of the artery. Your surgeon may also insert a wire mesh tube called a stent along with the balloon catheter to help keep the artery open and prevent it from narrowing again.
  • Carotid endarterectomy: Carotid endarterectomy is a surgical procedure performed to treat carotid artery disease. The surgery involves making a surgical cut in the neck area where the carotid arteries are located and removing fatty deposits that are narrowing the arteries and blocking the blood flow to the brain. The procedure reduces your risk of developing transient ischemic attacks (TIA) or stroke.
  • Sclerotherapy: It is one of the common treatments for varicose veins. A sclerosing/irritant solution is injected to the target site where the varicose veins are present. The sclerosing solution irritates the lining of the blood vessel causing the vein to swell and stick together. Over time, the venous blemishes turn into scar tissue and may disappear.
  • Phlebectomy: Phlebectomy is a minimally invasive procedure performed to remove superficial varicose veins of the leg. It is usually indicated for larger veins bulging from the surface of the skin and is rarely used on smaller veins. It involves the removal of varicose veins through small incisions made in the skin near the affected vein.
  • Embolectomy: An embolus is a mass of fat, air, or other material carried by the blood circulation, which has the potential to clog or block a blood vessel and cause a life-threatening emergency. Embolectomy is a procedure performed to remove an embolus. The procedure is commonly performed to treat conditions such as pulmonary embolism (PE) – blood clot in the lung.
  • Abdominal aortic aneurysm repair: During a minimally invasive abdominal aortic aneurysm repair, your surgeon makes a small incision in the groin region and guides a catheter (thin tube) through the blood vessel (femoral artery) to the site of the aortic aneurysm to deliver a stent-graft, a tube made of thin metal mesh. The stent-graft is opened in the area of the aneurysm and secured in place for blood to flow and to prevent the aneurysm from rupture.
  • Peripheral angioplasty with stenting: This procedure is performed to widen the narrowed or blocked peripheral arteries in patients with peripheral arterial disease. The procedure involves passing a catheter (a small hollow tube) through a small incision into the blocked or narrowed section of the artery and inflating a small balloon located at the end of the catheter to push the plaque against the arterial walls to widen the vessel and improve blood flow. Peripheral angioplasty is often combined with the placement of a stent, a small tubular mesh, inside the artery. The stent maintains the patency of the artery and prevents it from future narrowing.

Post-Operative Care

Following the surgical procedure, you may experience pain or discomfort for which your surgeon will prescribe medications. You may be allowed to go home after 2 to 3 days. You can usually resume normal activities and return to work within 2 to 4 weeks after the surgery. Refrain from strenuous activities and lifting heavy weights for a defined period. Keep your surgical site clean and dry. Instructions on surgical site care and bathing will be provided. You will be advised to take your prescribed medications and make a few lifestyle changes such as quitting smoking, exercising regularly, maintaining a healthy weight, and eating a healthy diet. A periodic follow-up appointment will be scheduled to monitor your progress.

Benefits of Minimally Invasive Vascular Surgery

Minimally invasive vascular surgery provides various benefits including:

  • Smaller scars
  • Decreased risk of infection
  • Less bleeding
  • Reduced requirement of transfusion
  • Less post-operative pain
  • Fast recovery
  • Shorter hospital stays
  • Quicker return to daily normal activities

Risks and Complications

Minimally invasive vascular surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:

  • Infection
  • Bleeding
  • Blood clots
  • Allergic/anesthetic reactions
  • Damage to adjacent tissues or organs
  • Stroke
  • Heart attack

16/Aug/2021

What is Minimally Invasive Lung Surgery?

Lung surgery is traditionally performed through an open method, where a long incision is made along the side of the chest between the ribs. The ribs are spread apart or a rib may be removed to access the lungs for the repair or removal of diseased lung tissue. Minimally invasive lung surgery is a method of performing surgery in the chest through tiny incisions, without making large incisions or spreading apart of the ribs. Tiny cameras and miniaturized surgical instruments are used to access the lungs through small incisions in between the ribs and carry out the required repair.

Indications for Minimally Invasive Lung Surgery

Lung surgeries that can be performed through a minimally invasive approach include:

  • Lung biopsy: A biopsy is a procedure employed to remove a small piece of lung tissue for laboratory examination.
  • Lobectomy: A lobectomy is a surgical procedure in which one or more lobes of a lung are removed for early-stage lung cancer.
  • Pneumonectomy: A pneumonectomy refers to the surgical removal of the entire lung to treat advanced-stage lung cancer.
  • Wedge resection: Wedge resection refers to the removal of a part of a lobe as a treatment for early-stage lung cancer.
  • Surgery to prevent the recurrence of fluid collection between the lung and chest cavity.
  • Surgery to remove accumulated blood or infection from the chest cavity.
  • Surgical removal of small balloons of tissue called blebs, which can cause lung collapse.

Preparation for Minimally Invasive Lung Surgery

Preoperative preparation for minimally invasive lung surgery may involve the following steps:

  • A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
  • Depending on your medical history, social history, and age, you may need to undergo tests such as bloodwork and imaging to screen for any abnormalities that could compromise the safety of the procedure.
  • You will be asked if you have allergies to medications, anesthesia, or latex.
  • You should inform your doctor of any medications, vitamins, or supplements that you are taking.
  • You may need to refrain from supplements or medications such as blood thinners or anti-inflammatories for a week or two prior to surgery.
  • You should refrain from alcohol or tobacco at least a few days prior to surgery and several weeks after surgery.
  • You should not consume solids or liquids at least 8 hours prior to surgery.
  • A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for Minimally Invasive Lung Surgery

Minimally invasive lung surgery can be performed with two different options: video-assisted thoracoscopic surgery (VATS) and robotic-assisted lung surgery. Both techniques make use of small surgical cuts for the insertion of a camera and miniature surgical instruments.

VATS procedure: In video-assisted thoracoscopic surgery (VATS), your surgeon will make several small incisions over your chest wall under general anesthesia. A long, thin tube (thoracoscope) with a camera attached to one end and small surgical instruments are inserted into the chest through the small incisions in between the ribs. The thoracoscope guides your surgeon visually through the surgery by projecting the internal images onto a monitor. Your surgeon then uses small surgical instruments inserted through the incisions to carry out the required repair based on the patient’s lung condition. This may also be coupled with other procedures. Once the surgery is completed, drains are placed, the incisions are closed, and you are taken to the intensive care unit for monitoring.  The drains are removed a day or two after the surgery. A VATS procedure is done to remove lung cancer or tumors, accumulated fluid, blood or blood clots, and infections from the chest cavity. They may also be used for biopsy and management of collapsed lung tissue and lung injuries.

Robotic-assisted lung surgery: The robotic system consists of a surgeon’s console, a patient-side cart with interactive robotic arms, a high-performance vision system (3D camera), and miniaturized surgical instruments. In a robotic-assisted lung surgery, your surgeon will be sitting at a console next to you in the operating room and control the instruments, including the camera, on the robotic surgical system. Under general anesthesia, your surgeon makes 3 to 4 small incisions on the sides of the chest wall in between the ribs. A small 3D high-definition camera is inserted through one of the small incisions to provide a fine view of the inside of the chest cavity, while wristed robotic instruments are placed through the other small surgical cuts. These instruments are held by robotic arms that are controlled by your surgeon at the console. The surgeon’s every move (of hands and wrists) is recognized by a computerized system that manipulates and translates them into corresponding scaled and accurate movements that are mimicked by the robotic arms. Your surgeon removes diseased lung tissue through one of the small incisions or carries out other required repairs accordingly. The utilization of the wristed instruments enables your surgeon to carry out the procedure without having to make larger cuts to open up the chest or spread the ribs apart, resulting in minimal muscle trauma.

Post-Operative Care

Following the surgical procedure, you may experience pain or discomfort for which your surgeon will prescribe medications. You may be allowed to go home after 2 to 3 days. You can usually resume normal activities and return to work within 2 to 4 weeks after the surgery. Refrain from strenuous activities and lifting heavy weights for a defined period. Keep your surgical site clean and dry. Instructions on surgical site care and bathing will be provided. To maintain a healthy lung, you will be advised to take your prescribed medications and make a few lifestyle changes like quitting smoking, exercising regularly, maintaining a healthy weight, and eating a healthy diet. A periodic follow-up appointment will be scheduled to monitor your progress.

Benefits of Minimally Invasive Lung Surgery

Minimally invasive lung surgery provides various benefits against the traditional open method including:

  • Smaller scars
  • Decreased risk of infection
  • Less bleeding
  • Reduced requirement of transfusion
  • Less post-operative pain
  • Fast recovery
  • Shorter hospital stays
  • Quicker return to daily normal activities

Risks and Complications

Minimally invasive lung surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:  

  • Infection
  • Bleeding
  • Blood clots
  • Allergic/anesthetic reactions
  • Damage to adjacent tissues or organs
  • Abnormal heart rhythms
  • Leakage of air from lungs

16/Aug/2021

What is Minimally Invasive Heart Surgery?

Heart (cardiac) surgeries are traditionally performed through an open method, where a long incision of 6 to 8 inches is made down the chest, and the breastbone (sternum) is separated to expose the heart. Minimally invasive heart surgery does not require splitting of the breastbone, rather it is performed through small incisions on the side of the chest between the ribs using a scope and special surgical instruments.

Minimally invasive cardiac surgery includes robotic-assisted cardiac surgery, thoracoscopic surgery, and direct less invasive access heart surgery (surgery through a small incision in the chest). In all the types of minimally invasive procedures, your surgeon will reach your heart through tiny incisions between the ribs of your chest.

Benefits of Minimally Invasive Heart Surgery

Minimally invasive heart surgery provides various benefits against traditional open method including:

  • Smaller scars
  • Decreased risk of infection
  • Less bleeding
  • Reduced requirement of transfusion
  • Less post-operative pain
  • Fast recovery
  • Shorter hospital stays
  • Quicker return to daily normal activities

Anatomy of the Heart

The heart is a fist-sized muscular organ that works around the clock, pumping blood to various parts of the body. It is located between the right and left lungs in the middle of your chest, and is covered by a three-layered, fluid-filled sac called the pericardium.

The heart has four muscular chambers, the upper two chambers are called the right and left atria, and the lower two chambers are called the right and left ventricles. With the help of blood vessels called arteries and veins, the heart and its chambers pump blood, supplying oxygen and nutrients to all parts of the body and collecting carbon dioxide and wastes from the body for purification.

Types of Minimally Invasive Heart Surgery

Several types of cardiac surgeries can be performed through a minimally invasive approach, including:

  • Aortic valve replacement
  • Mitral valve repair or replacement
  • Atrial septal defect and patent foramen ovale closure
  • Tricuspid valve repair or replacement
  • Coronary artery bypass surgery
  • Atrioventricular septal defect surgery
  • Maze procedure for atrial fibrillation

Indications for Minimally Invasive Heart Surgery

Your surgeon may recommend minimally invasive heart surgery for the treatment of cardiac conditions such as:

  • Coronary artery disease
  • Heart failure
  • Plaque buildup in the arteries
  • Faulty heart valves
  • Abnormal heart rhythms
  • Diseased or dilated major blood vessels (such as the aorta)

Preparation for Minimally Invasive Heart Surgery

Preoperative preparation for minimally invasive heart surgery may involve the following steps:

  • A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
  • Depending on your medical history, social history, and age, you may need to undergo tests such as bloodwork and imaging to screen for any abnormalities that could compromise the safety of the procedure.
  • You will be asked if you have allergies to medications, anesthesia, or latex.
  • You should inform your doctor of any medications, vitamins, or supplements that you are taking.
  • You may need to refrain from supplements or medications such as blood thinners or anti-inflammatories for a week or two prior to surgery.
  • You should refrain from alcohol or tobacco at least a few days prior to surgery.
  • You should not consume solids or liquids at least 8 hours prior to surgery.
  • A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for Minimally Invasive Heart Surgery

Minimally invasive heart surgery is performed under general anesthesia. Depending on the type of surgery, a few small incisions of approximately 3 to 5 cm may be made on your chest. You are connected to a heart and lung machine which performs the normal function of the heart during the surgery.

Robot-assisted minimally invasive heart surgery: The robotic system consists of a surgeon’s console, a patient-side cart with interactive robotic arms, a high-performance vision system (3D camera), and miniaturized surgical instruments. Through small incisions on the chest, your surgeon inserts an endoscope (a flexible tube with a small camera at the end) and other instruments. These instruments are held by robotic arms that are controlled by your surgeon at the console. The surgeon’s every move (of hands and wrists) is recognized by a computerized system that manipulates and translates them into corresponding scaled and accurate movements that are mimicked by the robotic arms. With the help of the endoscope, your surgeon can clearly view the treatment area as 3D images on a computer screen. With the help of the other surgical instruments, your surgeon exposes the treatment area and performs the required repair to enable its normal functioning.

Minimally invasive thoracoscopic surgery: In this surgery, a thoracoscope – a thin, long tube with a tiny high-definition video camera at the end – is inserted through a small incision between your ribs. The thoracoscope guides your surgeon visually through the surgery by projecting the internal images onto a monitor. Your surgeon then uses small surgical instruments inserted through the other tiny incisions on the chest to perform the required repair. Once the surgery is completed, drains are placed, the incisions are closed, and you are taken to the intensive care unit for monitoring.  The drains are removed a day or two after the surgery.

Post-Operative Care

Following the surgical procedure, you may experience pain or discomfort for which your surgeon may prescribe medications. You may be allowed to go home after 2 to 3 days. You can usually resume normal activities and return to work within 2 to 4 weeks after the surgery. Refrain from strenuous activities and lifting heavy weights for a defined period. Keep your surgical site clean and dry. Instructions on surgical site care and bathing will be provided. To maintain a healthy heart, you will be advised to take your prescribed medications and make a few lifestyle changes like quitting smoking, exercising regularly, maintaining a healthy weight, and eating a healthy diet. A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Minimally invasive heart surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:

  • Infection
  • Bleeding
  • Blood clots
  • Stroke
  • Heart rhythm problems
  • Damage to adjacent tissues or organs
  • Death (rarely)

06/Aug/2021

What is Thromboembolism?

Thromboembolism is a condition in which a blood clot formed inside a blood vessel breaks free and is carried in the bloodstream to block a blood vessel inside another organ, causing organ damage. The affected organs can be lungs (pulmonary embolism), brain (stroke), gastrointestinal tract, kidneys, or legs.
Two diseases typical to thromboembolism include DVT or deep vein thrombosis (blood clot in a deep vein) and PE (pulmonary embolism). These conditions may develop as a result of complications of cancer-related surgery.

Risk factors of Thromboembolism

Several risk factors for the development of thromboembolism in cancer patients have been identified and include site and stage of cancer, type of cancer, advanced disease, patient comorbidities, specific therapeutic agents, surgery, chemotherapy, and hospitalization.

Symptoms of Thromboembolism

Nearly 50 percent of patients with thromboembolism does not show any symptoms. Also, symptoms of thromboembolic diseases such as DVT may go unnoticed for a while as they are similar to various other health problems. Typical symptoms include swelling, tenderness, change in skin color, and warmth over the affected area. Additional symptoms such as coughing up blood, sharp chest pain, and shortness of breath may be noticed if a blood clot breaks free and travels to the lungs, leading to pulmonary embolism.

Diagnosis of Thromboembolism

As a part of the diagnosis, your doctor will conduct a physical examination. He/she may ask questions related to your overall health and assess your medical history to exclude other causes. Your physician may also order tests specific to DVT such as a Duplex ultrasound, venography, and MRI.

Treatment for Thromboembolism

The aim of the treatment is three-fold and includes:

  • Preventing the clot from getting bigger
  • Preventing the clot from loosening and breakage
  • Reducing the chances of DVT recurrence

Treatment options involve the use of blood-thinning medications such as heparin and warfarin. In severe cases, clot-buster medications such as tissue plasminogen activator (TPA) may be prescribed. Other treatment measures include inserting filters into veins to prevent clots from breaking loose and going to the lungs. Also, compression stockings may be worn for preventing blood from pooling and clotting.


06/Aug/2021

What is Sclerotherapy?

Varicose veins are blood vessels that are abnormally dilated which appear swollen, twisted and can be painful. Varicose veins can form anywhere in the body, but they are usually seen in the back of the calf or on the inside of the leg. They occur when the valves in the veins do not function properly and the blood leaks down and collects in the veins. This causes the veins to enlarge. Women are more likely to get varicose veins than men. Puberty, hormonal changes, weight gain, lack of physical activity, pregnancy, birth control pills, sitting, or standing for a long time are some of the factors that cause varicose veins. Varicose veins appear as blue, purple, or red veins and look twisted and bulging.

The non-surgical treatment options for varicose veins include:
Sclerotherapy: It is one of the common treatments for varicose veins. A sclerosing/irritant solution is injected into the target site where the varicose veins are present. The sclerosing solution irritates the lining of the blood vessel causing the vein to swell and stick together. Over time, the venous blemishes turn into scar tissue and may disappear. The number of veins treated in one session will be decided by your dermatologist based on the size and location of the veins. There will be a two-week interval between first and second treatments and then a 1-month period to assess response.

In micro-injection sclerotherapy, tiny needles are used to inject a sclerosing solution into the abnormal tiny veins to close off the vein.
Sclerotherapy slowly clears leg veins and may be completely resolved in two to six months, depending on the vessel size.

Ultrasound-guided sclerotherapy: Ultrasound-guided sclerotherapy technique involves injecting a sclerosing substance, a mild detergent solution, directly into the varicose vein using a very fine needle. The procedure takes about 15 to 30 minutes. An ultrasound is used to track the foam which makes sure that foam enters the varicose veins and not normal veins. The target veins are compressed by a bandage and a surgical stocking is placed over this bandage. The sclerosing solution irritates the lining of the blood vessel causing the vein to swell and stick together. Over time, the venous blemishes turn into scar tissue and may disappear.

Advantages of Sclerotherapy

The advantage of using Ultrasound-guided sclerotherapy is that it requires no incision, less time for recovery, no scar formation and does not require an overnight stay in the hospital.


06/Aug/2021

What is Telemedicine?

Telemedicine is the remote delivery of real-time healthcare services to patients using information and/or telecommunications technology. It allows a patient to receive medical care at home, workplace or virtually anywhere with good internet connectivity using state-of-the-art video-conferencing tools, audio communication, or text messaging.

How Do You Use Telemedicine Services?

On your smartphone, tablet or computer:

  • Visit your doctor’s website/download an app
  • Fill in your basic details
  • Choose a convenient time slot
  • Make your payment online
  • Follow the instructions to initiate the consultation

What Happens During a Telemedicine Appointment?

A Telemedicine consultation typically involves a real-time audiovisual communication with your doctor. Your doctor will provide clinical care and services such as evaluation, diagnosis, treatment plan, and monitoring from a remote location and advise you on how to better manage your condition. Your doctor may also prescribe certain diagnostic tests or medications, refill prescriptions, schedule a follow-up appointment, or instruct you to visit a specialized hospital depending on your condition.

When Can You Use Telemedicine?

You can utilize telemedicine services for:

  • Preventative care and support
  • Management of chronic conditions
  • Medication management
  • Post-hospitalization care
  • Specialist consultation
  • Follow-up appointments
  • Second opinions

Benefits of Telemedicine

Telemedicine has several advantages for both patients and healthcare providers such as:

  • Easier availability of care, especially for senior citizens and people with limited mobility
  • Avoids the need to travel to a physical meeting
  • No exposure to or spread of contagious diseases
  • No risk of hospital-acquired infections
  • Little to no waiting time for a consultation
  • Quicker second opinions
  • Access to high-quality health care for rural communities
  • Improved patient engagement and satisfaction
  • Reduced costs

Significance of Telemedicine During Pandemics

Telemedicine is proving to be necessary with the advent of the pandemic leading to individual self-quarantining and extensive lockdowns of geographical areas, making access to medical facilities difficult.

Telemedicine can act as the first line of defence, helping to curb self-medication and reduce overcrowding at hospitals and clinics. It can also help provide medical attention and solve critical health issues while avoiding person to person contact, without possibly exposing them to contagious diseases.

How Do I Get Started with a Telemedicine Appointment?

To schedule a telemedicine appointment with Wael Tamim, MD, FACS, please call (954) 616-1916

Disclaimer: Telemedicine is not appropriate for emergency situations. In the event of a health emergency, please contact your local emergency services.


06/Aug/2021

What is Telemedicine?

Telemedicine is the remote delivery of real-time healthcare services to patients using information and/or telecommunications technology. It allows a patient to receive medical care at home, workplace or virtually anywhere with good internet connectivity using state-of-the-art video-conferencing tools, audio communication, or text messaging.

How Do You Use Telemedicine Services?

On your smartphone, tablet or computer:

  • Visit your doctor’s website/download an app
  • Fill in your basic details
  • Choose a convenient time slot
  • Make your payment online
  • Follow the instructions to initiate the consultation

What Happens During a Telemedicine Appointment?

A Telemedicine consultation typically involves a real-time audiovisual communication with your doctor. Your doctor will provide clinical care and services such as evaluation, diagnosis, treatment plan, and monitoring from a remote location and advise you on how to better manage your condition. Your doctor may also prescribe certain diagnostic tests or medications, refill prescriptions, schedule a follow-up appointment, or instruct you to visit a specialized hospital depending on your condition.

When Can You Use Telemedicine?

You can utilize telemedicine services for:

  • Preventative care and support
  • Management of chronic conditions
  • Medication management
  • Post-hospitalization care
  • Specialist consultation
  • Follow-up appointments
  • Second opinions

Benefits of Telemedicine

Telemedicine has several advantages for both patients and healthcare providers such as:

  • Easier availability of care, especially for senior citizens and people with limited mobility
  • Avoids the need to travel to a physical meeting
  • No exposure to or spread of contagious diseases
  • No risk of hospital-acquired infections
  • Little to no waiting time for a consultation
  • Quicker second opinions
  • Access to high-quality health care for rural communities
  • Improved patient engagement and satisfaction
  • Reduced costs

Significance of Telemedicine During Pandemics

Telemedicine is proving to be necessary with the advent of the pandemic leading to individual self-quarantining and extensive lockdowns of geographical areas, making access to medical facilities difficult.

Telemedicine can act as the first line of defence, helping to curb self-medication and reduce overcrowding at hospitals and clinics. It can also help provide medical attention and solve critical health issues while avoiding person to person contact, without possibly exposing them to contagious diseases.

How Do I Get Started with a Telemedicine Appointment?

To schedule a telemedicine appointment with Wael Tamim, MD, FACS, please call (954) 616-1916;

Disclaimer: Telemedicine is not appropriate for emergency situations. In the event of a health emergency, please contact your local emergency services.


06/Aug/2021

What is Video-Assisted Thoracic Surgery (VATS)?

Video-Assisted Thoracic Surgery (VATS) is a minimally invasive alternative to diagnose and treat a wide range of disorders of the chest and lungs that were traditionally managed through a sternotomy or open thoracotomy. VATS utilizes a special instrument called a thoracoscope that has a built-in camera. During the surgery, the thoracoscope and special surgical instruments are inserted through small incisions over the chest. The thoracoscope transmits the images of the surgical area to a monitor which aid the surgeon during the procedure.

Indications of Video-Assisted Thoracic Surgery

Some of the indications for video-assisted thoracic surgery (VATS) include:

  • Lung, diaphragmatic and pleural biopsies
  • Removing lymph nodes
  • Treatment of various lung disorders like pleural effusion in which fluid accumulates in the lining of the lung
  • Lung resection to treat cancer or other lung diseases
  • Decortication
  • Anti-reflux procedures
  • Diaphragmatic plication

Benefits of Video-Assisted Thoracic Surgery

As VATS is performed through small incisions, it minimizes trauma and provides various other benefits as well that include:

  • Less post-operative pain
  • Fewer operative complications
  • Shorter hospital stay
  • Smaller scars
  • Fast recovery
  • Quicker return to daily normal activities

06/Aug/2021

What is Mitral Valve Regurgitation?

Mitral valve regurgitation, also called mitral regurgitation or mitral insufficiency, is the incorrect flow of blood due to incomplete closure of the mitral valve within the heart. Thus, when the left ventricle (lower chamber of the heart) contracts, the blood flows in two directions, from the left ventricle into the aorta and back into the left atrium (upper heart chamber) instead of flowing unidirectionally.

Anatomy of the Heart

Your heart is located slightly to the left of your breastbone, in the center of your chest, between your lungs. It is enclosed by a double-layered membrane called the pericardium which acts as a shock absorber providing protection to your heart. The inside of your heart is hollow and four-chambered and is divided into the atria: the two top chambers, which receive blood from your veins, and the ventricles: the two bottom chambers, which pump blood into your arteries.

There are four heart valves within your heart: aortic valve, mitral valve, tricuspid valve, and pulmonary valve. These valves prevent the blood from flowing in the wrong direction.

Causes of Mitral Valve Regurgitation

Mitral valve regurgitation may be caused due to the following reasons:

  • Congenital heart defects: Being born with malformed heart valves
  • Prolapsed mitral valve: Mitral valve flaps bulge backwards into the left atrium during the heart’s contraction
  • Heart disorders including endocarditis, infection of the endocardium (inner lining of the heart), cardiomyopathy, abnormal expansion of the heart muscles and atrial fibrillation, abnormal heart rhythm
  • Heart attack
  • Rheumatic fever
  • Trauma due to a vehicular accident
  • Certain drugs
  • Radiation therapy focused on the chest region

Signs and Symptoms of Mitral Valve Regurgitation

Some people with mitral valve disease may not experience any symptoms as mitral valve regurgitation progresses slowly.

Upon progression, the common signs and symptoms may include:

  • Dyspnea (shortness of breath), especially when you lie down or upon exertion
  • Heart palpitations
  • Fatigue
  • Swollen ankles or feet
  • Abnormal heart sounds (murmur) heard through a stethoscope

Diagnosis of Mitral Valve Regurgitation

Your doctor will note your present symptoms, medical history and your family history of heart disease. You will undergo a thorough physical exam that includes listening to your heartbeat using a stethoscope.

Your doctor may also order diagnostic tests like a chest X-ray, cardiac MRI, echocardiogram, electrocardiogram (ECG), exercise or stress tests, cardiac computed tomography (CT) scan or cardiac catheterization to confirm mitral valve regurgitation.

Treatment Options for Mitral Valve Regurgitation

Treatment depends on the severity of mitral valve regurgitation. The different approaches to treat mitral valve regurgitation include:

Medications

Your doctor may prescribe:

  • Blood pressure medications to control your high blood pressure
  • Blood thinners to prevent blood clots and provide symptomatic relief from atrial fibrillation
  • Diuretics to reduce fluid accumulation in your legs or lungs

Surgery

You may be recommended surgery if medications don’t improve your condition. Mitral valve regurgitation can be treated either through repair or replacement of the mitral valve.

Surgical Procedure

Mitral valve surgery can be performed through any of these approaches:

  • Open-heart surgery that involves making a relatively large incision in your chest
  • Minimally invasive heart surgery that involves making one or two smaller incisions in your chest using specialized instruments
  • Robot-assisted heart surgery, a type of minimally invasive surgery where your surgeon views a magnified high-definition 3-D view of your heart on a screen and uses robotic arms to duplicate specific movements used in open-heart surgeries

These treatments aim to treat your signs and symptoms, improve your heart’s function and avoid future complications.

Lifestyle Modifications

Your doctor may suggest the following lifestyle changes:

  • Consume a healthy diet low in trans and saturated fats, salt and sugar. Avoid refined grains like white bread. Include fruits, vegetables, nuts, and whole grains.
  • Keep your blood pressure under control.
  • Maintain a healthy weight.
  • Reduce alcohol intake and refrain from smoking.
  • Perform regular physical activities.
  • Visit your doctor regularly.

For a woman with mitral valve regurgitation, it’s important to visit your doctor before planning for a baby and during your pregnancy as pregnancy puts an extra load on your heart and makes it work harder.

 



Wael Tamim

Personalized Care, Starts Here




Wael Tamim

Personalized Care, Starts Here