Outpatient

No surgery is risk free. It is important to learn about the possible benefits and risks involved in the surgical procedure you are about to have. Research has shown that patients who are informed about their procedure can better work with their doctors to make the right decisions.

Getting a second opinion is important. Your doctor, surgeon, health plan, or local medical society can help you find someone who can give you a second opinion. Before seeking a second opinion, make sure your health plan will cover this expense.

Before having surgery, ask your physician these questions:

  • What operation are you recommending?
  • Why do I need the operation?
  • Are there alternatives to surgery?
  • What are the benefits of having the operation?
  • What are the risks of having the operation?
  • What will happen if I don't have this operation?
  • Where can I get a second opinion?
  • What has been your experience in doing the operation? How many have you performed?
  • Where will the operation be done?
  • What kind of anesthesia will I need?
  • How long will it take me to recover?
  • What are outpatient charges?

Remember, quality matters, especially when it comes to your health. For more information on health care quality and materials to help you make health care decisions, go to the federal AHRQ website

Surgery of the breast: any surgery involving the breast. These include reconstruction (rebuilding) of the breast after cancer treatment or surgery (called a mastectomy) to remove diseased tissue. It can also include making the breast smaller for health reasons. And it includes cosmetic surgery to enhance, lift, enlarge or reduce the shape and size of the breast.

Breast Surgery

How is it done? Breast surgeries are performed while the patient is under general anesthesia.
Breast augmentation surgery is the cosmetic or medically necessary procedure to change the shape and size of the breasts. The doctor cuts into the natural folds on the underside of the breast and around the areola (dark skin around the nipple). Skin and tissue is removed if the patient wants smaller breasts. If the patient wants enhanced or bigger breasts, a silicone or saline implant is put in. The doctor can move the nipple to a higher spot to remain in the center of the new breast shape.
Breast cancer surgeries (mastectomies) involve removing the tissue with cancer and some of the surrounding tissue. Some patients chose to reconstruct the breast at the same time; some choose to do it later.

Why is it done? Breast surgeries are done for many different reasons. The surgery may be to diagnose, treat. or repair or enhance the breast.
There can be medical reasons for a breast reduction surgery. A woman's bra might not provide enough support. She might have pain in the back, shoulders and neck. She might have headaches. There may be large stretch marks on the breasts. She may have trouble sleeping or poor posture.
Breast reduction surgery is also an option for men. It is called gynecomastia. Your doctor might suggest liposuction to remove excess tissue.
Mastopexy is a breast lift that reshapes sagging breasts. Another cosmetic surgery is breast enlargement. Saline or silicone-filled implants are available in different sizes and shapes. That way, the plastic surgeon and patient can select the look they want.

Cancer Surgery of the Breast

In a lumpectomy, the doctor removes a cancerous breast lump. The doctor can first test the lump with a needle biopsy, by inserting a needle into the lump and withdrawing fluid or tissue. That tissue can be tested for cancer or suspicious cell growth. If the signs point to cancer, the doctor might suggest removing the whole lump and some surrounding tissue. After that, the doctor might recommend radiation therapy or chemotherapy to make sure all cancer cells are destroyed.

Breast surgeries are also used to treat a serious disease, such as cancer. Doctors remove the diseased and surrounding tissue. Doctors today use better technology to pinpoint the cancerous tissue. So they are able to keep more of the breast than in the past. Radical mastectomies (the complete removal of the breast, chest wall muscles and surrounding lymph nodes) are rarely considered. The doctor will decide how to remove based on how far the cancer has spread. Your doctor will discuss your options, follow-up treatment and reconstruction surgery.

Are there alternatives? In cases of breast cancer, the patient and her doctor will decide what will give her the best chance of beating the cancer.
Your medical insurance might cover male or female breast reduction surgeries. It does not cover cosmetic surgery without a medical reason for it.

What are the risks? All surgery has some risks. Some people may get sick from the drugs used in anesthesia. Some people develop infections. Some have pain or tenderness in the breast. Some women might be unhappy with how they look after cosmetic surgery. Surgeons cut in places where scars won't be seen easily, but scar tissue does last a while. Some breast surgeries need to be repeated to keep the look or to replace the implant. Women who want to nurse their babies should ask about the chance of damage to the glands that produce breastmilk.
Some cancer patients may want to wait with breast reconstruction so they can focus their energy on fighting the disease.

How long is the recovery? Your doctor will tell you what to expect. You will likely be told to take it easy for a few days. You should not lift heavy objects or raise your arms above your head for several weeks.

What does it cost? If you have health insurance call the number on your health insurance card to get a cost estimate. VHI has links to many health insurance companies. VHI includes median charges in their reports. Charges don't reflect discounts health insurance companies and government programs negotiate for the surgery. They may not reflect other costs of care.

Where can I go for more information?

Your doctor or other health care provider

For Reduction or enhancement breast surgery
Medline: http://www.nlm.nih.gov/medlineplus/ency/article/002984.htm
WebMD: http://www.webmd.com/hw/skin_and_beauty/tf2235.asp
http://www.webmd.com/content/article/76/90228.htm
http://www.mayoclinic.com/health/breast-reduction/WO00021

For safety of silicone gel breast implants
http://www.fda.gov/bbs/topics/NEWS/2006/NEW01512.html

For general breast cancer surgery
http://www.plasticsurgery.org/patients_consumers/procedures/BreastReconstruction.cfm
http://www.webmd.com/content/article/46/1662_52455.htm

Lumpectomy
http://www.nlm.nih.gov/medlineplus/ency/article/002918.htm

Mastectomy
http://www.nlm.nih.gov/medlineplus/ency/article/002919.htm
http://www.webmd.com/content/article/92/101463.htm

For Avoiding Complications Following Surgery
http://www.webmd.com/content/article/84/98283.htm

For General breast cancer information
American Cancer Society: www.cancer.org
Susan G. Komen Breast Cancer Foundation: www.komen.org

Colonoscopy: an examination of the large intestine (bowel) through a fiber optic tube inserted through the anus. It is used to find and treat diseases of the lower gastro-intestinal tract. A fiber optic tube is a fountain pen-size tube with special lights inside.

Colonoscopy

How is it done? A colonoscopy can be done as an outpatient or inpatient test. A gastroenterologist most often does the test. That is a doctor who is trained in disorders (or problems) of the stomach and intestines. The doctor sedates the patient, giving a sedative drug that puts the patient at ease or to sleep. The patient lies on his or her left side and a colonoscope, a fiber optic tube with a camera, is inserted into the anus. The doctor can control the camera to get a good view. Small surgical tools can be threaded through the tube. These tools can remove unusual growths or tissue for more testing.

Why is it done? The colon is about five feet long, with many twists and turns. A colonoscope is the only tool that lets a doctor see inside the whole large intestine. Your doctor might suggest this test for several reasons. These include changes in bowel movements, bleeding, severe constipation or the signs of colon cancer. This test is also used to check on patients who have had polyps removed. It lets doctors make sure no new polyps are forming. A polyp is a growth of extra tissue. Most smaller polyps are benign – which means they are not cancerous. But some polyps can become cancer. Are there alternatives? X-rays can be useful but the images can be shadowy. Some colon polyps cannot be seen in x-ray images. A similar procedure, sigmoidoscopy , is usually done without sedation. In this other test, the doctor uses a shorter tube that the lower two feet of the large intestine.

What are the risks? There are risks with nearly every medical procedure. But this test allows the doctor to see more of the large intestine than other tests. It is also less painful. The biggest risk is tearing the colon. A tear could be severe enough to need a surgical repair or antibiotics. Some people have a reaction to sedative drugs. Make sure you discuss all allergies and health conditions with your doctor. How do I prepare? Your doctor will review the procedure with you. Because the colon must be empty of stool, you will have to limit the food you eat. You may be told to eat no solid food and drink only liquids for one to three days before the test. The night before the procedure, you will be given laxatives to take at home.

How long is the recovery? The test takes about 30 minutes to 60 minutes. You'll also need time to recover while the sedative wears off. You won't be able to drive for several hours after because of the sedative drugs. You may feel some discomfort around the sedation injection site. You may also feel gassy, as air is pumped through the colonoscope to enlarge the area for the exam. You also may feel lightheaded from not having eaten solid foods recently.

What does it cost? If you have health insurance call the number on your health insurance card to get a cost estimate. VHI has links to many health insurance companies. VHI includes median charges in their reports. Charges don't reflect discounts health insurance companies and government programs negotiate for the surgery. They may not reflect other costs of care.

Where can I go for more information?

Your health care provider
Medline: http://www.nlm.nih.gov/medlineplus/ency/article/003886.htm
WebMD: http://www.webmd.com/hw/colorectal_cancer/hw209694.asp
American Cancer Society: http://www.cancer.org/docroot/SPC/content/SPC_1_Colonoscopy_and_Sigmoidoscopy_FAQ.asp
http://www.cdc.gov/cancer/colorectal/pdf/SFLY4_Brochure_Mar2003.pdf

Facial surgery: a number of cosmetic surgeries to sculpt or lift areas of the face and neck. Facial surgery is most often done to improve a patient's looks. But sometimes it can be done for medical reasons, such as after an accident or to fix a birth defect.

Facial Surgery

How is it done? Most facial surgery patients can go home the same day. The surgery can be done in a hospital, clinic or surgeon's office. The patient is given drugs to numb the pain and/or bring on sleep.
These are the more common facial surgeries.

  • Blepharoplasty is eyelid surgery to remove fat and excess skin from the upper and/or lower eyelids. It can reduce the look of droopy eyes and may reduce the dark circles under eyes.
  • Facelift or rhytidectomy
  • Facial and neck liposuction
  • Forehead/brow lift
  • Facial implants, or silicone sacs to shape cheeks, jaws, chin or nose.
  • Facial surgeries follow several patterns. In a facelift or brow lift, the doctor will cut behind the hairline and remove excess skin and tissue. Or the doctor might suggest an endoscopic lift. The cuts can be smaller because the doctor uses an endoscope - a pen-size tube with a tiny camera. The doctor can thread small tools through the tube and watch the progress on a video screen. Lifts reduce lines and wrinkles, and can make the patient look younger.
  • Liposuction is used in some facial surgeries to sculpt areas with stubborn fat.
  • Implants are used to change the shape of an area of the face. Silicone forms are inserted through small incisions to shape or contour the chin, jaws, nose or cheekbones.
Many cosmetic surgery patients choose to have several facial surgeries done at the same time.

Why is it done? If it's done to change the way you look, or to look younger, medical insurance will not pay for the surgery. But if there is a medical reason for it, your insurance might pay some of the cost. Talk to a doctor who specializes in facial surgery to find out if surgery is right for you.

Are there alternatives? There are options that might help you look younger. These include injections of Botox or wrinkle-fillers, chemical or laser skin peels to reduce the appearance of sun damage and age spots. There are also creams and makeup.

What are the risks? There are risks to any surgery. Some people get sick from the drugs used in anesthesia. You can also get an infection. Some swelling and numbness follows facial surgery. Those feelings can last a few days or weeks, or even be permanent. As you age, new wrinkles will come, so some people repeat surgeries. A final risk is that you are not happy with the change.

How long is the recovery? Most patients can go home the day of surgery. You will be told to take it easy for a few days. Swelling and bruising may last for several days. The areas where the doctor cut may be sore and itchy.

What does it cost? If you have health insurance call the number on your health insurance card to get a cost estimate. VHI has links to many health insurance companies. VHI includes median charges in their reports. Charges don't reflect discounts health insurance companies and government programs negotiate for the surgery. They may not reflect other costs of care.

Where can I go for more information?

Your health care provider
Medline: http://www.nlm.nih.gov/medlineplus/ency/article/002989.htm
WebMD: http://www.webmd.com/content/pages/23/110168.htm

From the American Association of Oral and Maxillofacial Surgeons:
http://www.aaoms.org/facial_cosmetic_surgery.php

From the American Society of Plastic Surgeons:
http://www.plasticsurgery.org/

From the American Society for Dermatologic Surgery:
http://www.asds-net.org/

From the American Society of Maxillofacial Surgeons:
http://www.maxface.org/

Gall bladder removal: surgery of the belly area that is opened to remove the gall bladder. Gall bladder removal is used to treat symptomatic gallstones. Gallstones are a relative common condition that causes severe pain in the abdomen due to stones that move and block the cystic duct. The pain is located mainly on the right side of the stomach after you eat fatty foods.

Gallbladder Removal

How is it done? There are two surgical choices. The first method is known as open cholecystectomy. The second method is known as laparoscopic cholecystectomy, which is done with scopes and smaller incisions. Both surgeries are performed under general anesthesia.

In an open cholecystectomy, the surgeon removes the gall bladder through a 5-7 inch incision. The abdominal cavity is then entered and the gall bladder is then removed. X-rays may be taken during surgery to determine if stones are stuck in the common bile duct. If stones are present in the bile duct, the duct may be opened and the stones removed. If the bile duct is explored, a special drain is inserted in it and taken to the outside from the side of the abdomen to help the duct heal. This drain is taken out several days or weeks later, depending on the nature of the drain. The surgeon then closes the incision.

Why is it done? Special juices called 'bile' are made in the liver. The bile helps you digest food. The gall bladder is a small pouch that sits under the liver on the right side of the abdomen. Bile passes from the liver to the gall bladder where it is stored. The gall bladder stores the bile until it is needed. When you eat fatty foods, the gall bladder squeezes the bile through the cystic duct to the common bile duct.

Stones can form in the gall bladder and can move and block the cystic duct and cause severe pain. This pain is located mainly in the right side of the abdomen after you eat fatty foods. Stones could also cause nausea, vomiting, fever and infection. If stones move to the common bile duct and gets stuck, it can cause pain, yellowish discoloration of the skin, known as 'jaundice,' and inflammation.

Patients can suffer from similar symptoms of pain and discomfort even though there are no gallstones. In these cases, the gall bladder may not be functioning properly. Doctors can order special radiological tests to check the function of the gall bladder.

What are the risks? This surgery is very safe. However, there are possible risks and complications. The risks can be related to anesthesia and those related to any type of surgery. Risks related to anesthesia include, strokes, kidney failure, pneumonia, and blood clots in the legs. It is important to let your doctors know if any of these symptoms occur.

Some of the risks seen in any type of surgery include:

  1. Infection, deep or at the skin level. Infections can involve the abdomen incision. Deep infections may involve the abdominal cavity itself. This is known as peritonitis. Treating deep infections may require long-term antibiotics and possibly surgery.
  2. Bleeding, either during or after the operation. This may require a blood transfusion or another operation.
  3. Skin scar.

Other risks related specifically to this surgery are rare but it's important to know about them. Structures in the abdomen could be damaged such as the liver and the common bile duct. The intestines and stomach could be perforated. Blood vessels going over the liver could be affected. Death may result from these complications but are extremely rare. Hernias through the incisions are possible. Diarrhea that could last for a long time can occur after a gall bladder operation, but it is rare.

How long is the recovery? After the surgery, you are transferred to the recovery room and then to a regular room. A tube will be connected to your vein to give you nourishment. A nurse will help you walk around as soon as possible to circulate the blood in your legs and to prevent blood clots.

You can go home the same day or in a few days, depending on which procedure you had and how well you are doing.

How much does it cost? If you have health insurance call the number on your health insurance card to get a cost estimate. VHI has links to many health insurance companies. VHI includes median charges in their reports. Charges don't reflect discounts health insurance companies and government programs negotiate for the surgery. They may not reflect other costs of care.

General Laparoscopy: surgery in the belly (abdomen) using a tiny video camera and fiber optic instrument. Laparoscopy is used to find and/or treat pelvic or abdominal problems.

Laparoscopy

How is it done? Most often, laparoscopy is done in a hospital while the patient is under general anesthesia . The doctor will make a small cut below the navel (belly button). A small tube - about the size of a fountain pen - is inserted through that cut. A tiny video camera is passed through the tube. Carbon dioxide (a harmless gas) is pumped into the belly to expand the space so the doctor can see better. The doctor watches a video screen to see the organs in the belly. Small surgical tools can be threaded through the tube. That way the doctor can make repairs or remove tissue.

Why is it done? This kind of surgery lets a doctor see see, and find and treat what might be causing pain or other problems. The incisions or cuts needed are very small. Because doctors aren't cutting as much skin, tissue and muscle, patients feel better faster. Your doctor might want to see if there are tumors, ovarian cysts, appendicitis or other problems .

Are there alternatives? X-rays or CT scans can be used to find some problems, but sometimes doctors need to see inside the belly. Your doctor might suggest laparoscopy because it avoids a large cut.

What are the risks? This kind of surgery has less risk than open surgery (long cuts). Some people may get sick from the drugs used in anesthesia. Some people have bleeding or get an infection. There is also a risk that the doctor accidentally tears or pokes a hole in an organ. If that happens, the doctor can switch to an open surgery.

How long is the recovery? Many people spend just a few hours in the recovery room before going home. You might feel some pain and see bruises around the cut. The gas used can also make your belly swell or give you a shoulder ache. Recovery after this kind of surgery is much shorter than open surgery.

What does it cost? If you have health insurance call the number on your health insurance card to get a cost estimate. VHI has links to many health insurance companies. VHI includes median charges in their reports. Charges don't reflect discounts health insurance companies and government programs negotiate for the surgery. They may not reflect other costs of care.

Where can I go for more information?
Your health care provider Medline: http://www.nlm.nih.gov/medlineplus/ency/article/007016.htm
WebMD: http://www.webmd.com/hw/digestive_problems/hw231905.asp

Hernia repair: surgery to repair a hernia. A hernia occurs when tissue or an organ pushes out beyond its usual space. The organ or tissue bulges through a weak spot in the muscle or fat around it.

There are different types of hernias.
An umbilical hernia is near the navel or bellybutton. Part of the small intestine squeezes through the abdominal wall.
An inguinal hernia happens in adult men. Part of the small intestine or bladder squeezes through the abdominal wall into the inguinal canal, or groin area.
A femoral hernia is more common in women. It is located in the groin area near the top of the thigh.
A hiatal hernia means part of the stomach pushes into the chest through a hole in the diaphragm.
An incisional hernia occurs if there's a weak spot in the abdominal wall because of an earlier surgery.
Physical stress -- from sports, heavy lifting, strained bowel movements or intense coughing – can also cause a hernia.

Hernia Repair

How is it done? There are two surgical choices. One is open surgery, which uses long cuts. The other is laparoscopic surgery, which uses tiny cuts and a small tube with a mini camera.
Open surgery patients are given drugs to numb them from the waist down. The doctor pushes the bulge back into place. Then he or she patches the weak spot in the tissue with a special mesh.
In laparoscopy, the doctor can thread tiny tools through the tube to make repairs. The patient is given drugs to sleep through the surgery. Because the cuts are smaller, most of these patients feel better more quickly.
But this choice cannot be used if the patient is pregnant, overweight or a child. It also cannot be used for emergency surgery.

Why is it done? Not all hernias need surgery. Babies' umbilical hernias often heal without help. The risk is that the blood supply to the bulging tissue can get cut off. Without blood pumping through, the tissue can become infected or die. This is called strangulation or incarceration.

Are there alternatives? If the hernia has already been strangulated (blood supply cut off), surgery is usually the only option. If that hasn't happened, there could be some simpler steps. The doctor gently can try to push the hernia back into place. Then the patient can wear a truss -- a special belt that keeps gentle pressure on the area. Some studies are suggesting “watchful waiting” for inguinal hernia patients without symptoms.
Some hernias can be diagnosed simply by feeling the bulge. Others can be diagnosed by x-ray or scan.

What are the risks? Every surgery has some risk. Some patients get sick from the drugs used. Some get an infection. With laparoscopy, there is also the chance that the doctor will accidentally poke or tear nearby tissue. There is also the chance a hernia can come back.

How long is the recovery? Many hernia repair patients do not have to stay in the hospital overnight. But some people do need a few days in the hospital. Most patients feel better about one to two weeks after laparoscopic surgery. Open surgery patients usually feel better in about two to four weeks. Doctors will tell all patients to take it easy for about four weeks. It will take longer before they can lift heavy objects.

What does it cost? If you have health insurance call the number on your health insurance card to get a cost estimate. VHI has links to many health insurance companies. VHI includes median charges in their reports. Charges don't reflect discounts health insurance companies and government programs negotiate for the surgery. They may not reflect other costs of care.

Where can I go for more information?

Your health care provider
General hernia information:
http://www.webmd.com/content/article/10/1680_54702.htm
http://www.nlm.nih.gov/medlineplus/ency/article/002940.htm

Inguinal hernia information:
http://www.nlm.nih.gov/medlineplus/ency/article/000960.htm

Open inguinal hernia repair:
http://www.webmd.com/hw/hernia/hw170381.asp

Laparoscopic inguinal hernia repair:
http://www.webmd.com/hw/hernia/hw170282.asp

Femoral hernia repair:
http://www.nlm.nih.gov/medlineplus/ency/article/001136.htm

Umbilical hernia:
http://www.nlm.nih.gov/medlineplus/ency/article/003277.htm

Considering surgery:
http://www.webmd.com/hw/health_guide_atoz/hw169199.asp?navbar=hw170282

Journal of the American Medical Association abstract on "watchful waiting"
http://jama.ama-assn.org/cgi/content/abstract/295/3/285?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=inguinal+hernia&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

Hysterectomy : a surgical procedure whereby the uterus (womb) is removed. Hysterectomy is the most common non-obstetrical surgical procedure of women in the United States.

Hysterectomy

How is it done? In the past the most common hysterectomy was done by an incision (cut) through the abdomen (abdominal hysterectomy). Now most surgeries can utilize laparoscopic assisted or vaginal hysterectomies (performed through the vagina rather than through the abdomen) for quicker and easier recovery. The hospital stay generally tends to be longer with an abdominal hysterectomy than with a vaginal hysterectomy, and hospital charges tend to be higher. The procedures seem to take comparable lengths of time (about two hours), unless the uterus is of a very large size, in which case a vaginal hysterectomy may take longer. Prior to a hysterectomy, women should have the following tests in order to select the optimal procedure:

  1. Complete pelvic exam including manually examining the ovaries and uterus.
  2. Up-to-date Pap smear.
  3. Pelvic ultrasound may be appropriate, depending on what the physician finds on the above.
  4. A decision regarding whether or not to remove the ovaries at the time of hysterectomy.
  5. A complete blood count and an attempt to correct anemia if possible.

There are several different types of surgical techniques for performing hysterectomies. The ideal surgical procedure for each woman depends on her particular medical condition. Below are the different types of hysterectomies with a general guideline about which technique is considered for which type of medical situation.

  1. Total Abdominal hysterectomy - This is the most common type of hysterectomy. During a total abdominal hysterectomy, the doctor removes the uterus, including the cervix. The scar may be horizontal or vertical, depending on the reason the procedure is performed, and the size of the area being treated. Cancer of the ovary(s) and uterus, endometriosis, and large uterine fibroids are treated with total abdominal hysterectomy. Total abdominal hysterectomy may also be done in some unusual cases of very severe pelvic pain, after a very thorough evaluation to identify the cause of the pain, and only after several attempts at non-surgical treatments. Clearly a woman cannot bear children herself after this procedure, so it is not performed on women of childbearing age unless there is a serious condition, such as cancer. Total abdominal hysterectomy allows the whole abdomen and pelvis to be examined, which is an advantage in women with cancer or investigating growths of unclear cause.
  2. Vaginal hysterectomy - the uterus is removed through the vagina. A vaginal hysterectomy is appropriate only for conditions such as uterine prolapse, endometrial hyperplasia, or cervical dysplasia. These are conditions in which the uterus is not too large, and in which the whole abdomen does not require examination using a more extensive surgical procedure. The woman will need to have her legs raised up in a stirrup device throughout the procedure. Women who have not had children may not have a large enough vaginal canal for this type of procedure. If a woman has too large a uterus, cannot have her legs raised in the stirrup device for prolonged periods, or has other reasons why the whole upper abdomen must be further examined, the doctor will usually recommend an abdominal hysterectomy (see above). In general, laparoscopic vaginal hysterectomy is more expensive and has higher complication rates than abdominal hysterectomy.
  3. Laparoscopy-assisted vaginal hysterectomy (LAVH) - similar to the vaginal hysterectomy procedure but it adds the use of a laparoscope. A laparoscope is a very thin viewing tube with a magnifying glass-like device at the end of it. Certain women would be best served by having laparoscopy used during vaginal hysterectomy because it allows the upper abdomen to be carefully inspected during surgery. It is a more expensive procedure, is more prone to complications, requires longer to perform, and is associated with longer hospital stays. Just as with simple vaginal hysterectomy without a laparoscope, the uterus must not be excessively large. The physician will also review the medical situation to be sure there are no special risks prohibiting use of the procedure, such as prior surgery that could have increased the risk for abnormal scarring (adhesions). If a woman has such a history of prior surgery, or if she has a large pelvic mass, a regular abdominal hysterectomy is probably best.
  4. Supracervical hysterectomy - is used to remove the uterus while sparing the cervix, leaving it as a "stump." The cervix is the area that forms the very bottom of the uterus, and sits at the very end (top) of the vaginal canal. The procedure probably does not totally rule out the possibility of developing cancer in this remnant "stump." Women who have had abnormal Pap smears or cervical cancer clearly are not appropriate candidates for this procedure. Other women may be able to have the procedure if there is no reason to have the cervix removed. In some cases the cervix is actually better left in place, such as some cases of severe endometriosis. It is a simpler procedure and requires less time to perform. It may give some added support of the vagina, decreasing the risk for the development of protrusion of the vaginal contents through the vaginal opening (vaginal prolapse).
  5. Laparoscopic supra cervical hysterectomy - The laparoscopic supra cervical hysterectomy procedure is performed like the LAVH procedure, although usually cautery is used to cut the cervix off at the cervical stump, and the tissue is all removed through a laparoscopic tool. Recovery is very quick. Cervical preservation is less likely to result in menses (menstruation) as the endocervix is usually cauterized.
  6. Radical hysterectomy - The radical hysterectomy procedure involves more extensive surgery than a total abdominal hysterectomy because it also includes removing tissues surrounding the uterus and removal of the upper vagina. Radical hysterectomy is most commonly performed for early cervical cancer. There are more complications with radical hysterectomy compared to abdominal hysterectomy. These include injury to the bowels and urinary system.
  7. Oophorectomy and salpingo-oophorectomy (removal of the ovaries and/or Fallopian tubes) - Oophorectomy is the surgical removal of the ovary(s), while salpingo-oophorectomy is the removal of the ovary and its adjacent Fallopian tube. These two procedures are performed for ovarian cancer, removal of suspicious ovarian tumors, or Fallopian tube cancer (which is very rare). They may also be performed due to complications of infection, or in combination with hysterectomy for cancer. Occasionally, women with inherited types of cancer of the ovary or breast will have an oophorectomy as preventive (prophylactic) surgery in order to reduce the risk of future cancer of the ovary or breast.

What are the risks? Complications of a hysterectomy include infection, pain, and bleeding in the surgical area. An abdominal hysterectomy has a higher rate of post-operative infection and pain than does a vaginal hysterectomy.

Knee Arthroscopy: surgery done with the help of a miniature camera. It is used to treat and repair knee injuries. It can also be used to relieve some symptoms of arthritis.

Knee Surgery (Arthroscopy)

How is it done? A tiny camera, about 1/4 inch diameter, is inserted into a small incision or cut. The doctor sees the images on a video monitor. Other small cuts can be made to insert other surgical tools. Doctors use drugs to numb the knee area. But if the surgery could last longer, or much needs to be done, the doctor may suggest sedative drugs, or general anesthesia.

Why is it done? Mainly for two reasons, explained below.
· Knee injuries are fairly common sports injuries. These can range from damaged ligaments (the tissue that connects joints), a torn meniscus (thin cartilage or disc on the knee) or a damaged knee bone. Even an inflamed lining of the knee joint can be treated arthroscopically.
· Knee arthritis can also be treated with this surgery – but often as a last resort. First, try losing weight, becoming more active or walking with a cane. Your doctor might also recommend steroid shots.

Are there alternatives?
With knee injuries, doctors like knee arthroscopy better because the cuts in the knee are smaller. So patients feel better faster. During the surgery, doctors can repair or remove damaged tissue, shave bone spurs, or repair a damaged knee cap (called the patella). If the pain isn't too bad, you can wait to see if it heals on its own. Or the doctor might order a magnetic resonance image (MRI) to see what the problem is.
Arthroscopy cannot cure knee arthritis. But doctors can remove or repair tissue so that patients might be able to move their knees more easily. Your doctor will suggest you try other things first. If the arthritis is bad, your doctor might discuss replacing some or all of the knee.

What are the risks? Every surgery has some risk. Some people get sick from the drugs used or get an infection. The surgeon could damage normal knee tissue. But these risks are fairly small. A bigger risk is that the surgery is not a guarantee. Your knee may never be the same after an injury or once arthritis has set in. Your doctor can talk about risks and what to expect in more detail.

How long is the recovery? How quickly you feel better depends on what was done. You may need to walk with crutches to shift some of your weight away from your knee. Your doctor will tell you how long crutches are needed.

What does it cost? If you have health insurance call the number on your health insurance card to get a cost estimate. VHI has links to many health insurance companies. VHI includes median charges in their reports. Charges don't reflect discounts health insurance companies and government programs negotiate for the surgery. They may not reflect other costs of care.

Where can I go for more information?

Your health care provider
Medline: http://www.nlm.nih.gov/medlineplus/ency/article/002972.htm
WebMD: http://www.webmd.com/hw/rheumatoid_arthritis/aa18749.asp
ADAM: http://adam.about.com/reports/000123.htm

Liposuction: a surgery to remove fat from under the skin. Liposuction is used to shape the body. As a cosmetic surgery, it is not covered by most insurance plans. There are a few cases in which liposuction may be considered medically necessary.

Liposuction

How is it done? Liposuction most often is done by a plastic surgeon or dermatologist (a doctor who treats skin disorders). The patient is given drugs to numb pain. The doctor marks with a pen the areas where fat will be removed. Small cuts or incisions are made. The physician inserts a cannula (a hollow tube about the size and shape of a pen). It is used to suction the fat and injected solutions. The physician collects the removed fluid and fat, so he or she can monitor the amount.
Your doctor may talk about a newer technique called tumescent liposuction. A lot of anesthetic solution is injected into the fatty area. The fat expands and becomes firm. The suctioning tube can move more freely. Ultrasound-assisted liposuction uses ultrasound energy to liquefy the fat, also making it easier to remove.

Why is it done? Liposuction is usually a cosmetic procedure to improve the way a patient looks. It is not a weight loss procedure. It is done to remove stubborn pockets of fat or sculpt the body. Liposuction can be used to remove fat from the belly, chest, buttocks, thighs and legs, upper arms, back, neck and face. It can also be used in male breast reduction and the removal of fatty tumors.

Are there alternatives? You could choose not to have it done. Exercise and diet can also reduce fat. Some people also chose to be content with how they look.

What are the risks? There are some risks with any surgery. Some people get sick from the drugs used. Some people develop infections or have pain after surgery. A rare risk is that a clot of fat breaks loose and enters the bloodstream through broken veins. This is called a fat embolism. The doctor could also poke or tear a nearby organ or tissue. And some people feel numb in the area where fat was removed. Studies have different data on the risk of death. Some studies say it is as low as three deaths for every 100,000 procedures. Others say it can be between 20 and 100 deaths per 100,000 procedures.
Burns are a risk with ultrasound-assisted liposuction because the equipment used can become very hot. The surgery also takes longer, so the patient is drugged longer.
One other risk is that you may not be happy with the result. Also, fat may build up in the same area again.

How long is the recovery? How soon you feel well depends on how much fat was removed. If a lot of fat from a lot of places was removed, it will take longer to feel well. Your doctor will tell you how much or little you should do. You will also need to wrap tightly the areas where fat was taken away. Wraps will keep the swelling down. Swelling and/or numbness in the areas can last for weeks.

What does it cost? If you have health insurance call the number on your health insurance card to get a cost estimate. VHI has links to many health insurance companies. VHI includes median charges in their reports. Charges don't reflect discounts health insurance companies and government programs negotiate for the surgery. They may not reflect other costs of care.

Where can I go for more information?

Your health care provider
US Food and Drug Administration: http://www.fda.gov/cdrh/liposuction/what.html
WebMD: http://www.webmd.com/hw/weight_control/tf2436.asp
Medline: http://www.nlm.nih.gov/medlineplus/plasticandcosmeticsurgery.html
Tumescent liposuction (from the American Society of Plastic Surgeons) http://www.plasticsurgery.org/patients_consumers/procedures/LiposuctionTumescentTechnique.cfm?CFID=68601263&CFTOKEN=64081148

Other gynecological procedures: D & C (Dilation and Curettage) - is a surgical procedure often performed after a first trimester miscarriage. Dilation means to open up the cervix; Curettage means to remove the contents of the uterus.

Other gynecological procedures

D & C (Dilation and Curettage) - is a surgical procedure often performed after a first trimester miscarriage. Dilation means to open up the cervix; curettage means to remove the contents of the uterus. Curettage may be performed by scraping the uterine wall with a curette instrument or by a suction curettage (also called vacuum aspiration), using a vacuum-type instrument.

How is it done? A D&C procedure may be done as an outpatient or inpatient procedure in a hospital or other type of surgical center. A sedative is usually given first to help you relax. Most often, general anesthesia is used, but IV anesthesia or paracervical anesthesia may also be used. You should be prepared to have someone drive you home after the procedure if general or IV anesthesia is used.

  1. You may receive antibiotics intravenously or orally to help prevent infection.
  2. The cervix is examined to evaluate if it is open or not. If the cervix is closed, dilators (narrow instruments in varying sizes) will be inserted to open the cervix to allow the surgical instruments to pass through. A speculum will be placed to keep the cervix open.
  3. The vacuum aspiration (also called suction curettage) procedure uses a plastic cannula (a flexible tube) attached to a suction device to remove the contents of the uterus. The cannula is approximately the diameter in millimeters as the number of weeks gestation the pregnancy is. For example, a 7mm cannula would be used for a pregnancy that is 7 weeks gestation. The use of a curette (sharp edged loop) to scrape the lining of the uterus may also be used, but is often not necessary.
  4. The tissue removed during the procedure may be sent off to the pathology lab for testing.
  5. Once the health care provider has seen that the uterus has firmed up and that the bleeding has stopped or is minimal, the speculum will be removed and you will be sent to recovery.

Why it is done? Not all women who miscarry undergo a D&C procedure. Women can safely miscarry on their own, with few problems in pregnancies that end before 10 weeks. After 10 weeks, the miscarriage is more likely to be incomplete, requiring a D&C procedure to be performed. Choosing whether to miscarry naturally (called expectant management) or to have a D&C procedure is often a personal choice, best decided after talking with your health care provider.

What are the risks? Risks associated with anesthesia such as adverse reaction to medication and breathing problems, hemorrhage or heavy bleeding, infection in the uterus or other pelvic organs, perforation or puncture to the uterus, laceration or weakening of the cervix, scarring of the uterus or cervix, which may require further treatment, and an incomplete procedure which requires another procedure to be performed.

How long is the recovery? Most women can return to normal activities within a few days, and some feel good enough to return to normal non strenuous activity within 24 hours. You may experience some painful cramping initially, but this should not last longer than 24 hours. Light cramping and bleeding can be expected from a few days to up to 2 weeks. Ibuprofen is usually suggested for treating cramps. You should not insert anything into the vaginal area, including douche and sexual intercourse, for at least 2 weeks or until the bleeding stops.