Some new laser act by directly breaking down the molecules of the cells, but the precise mechanism of their action is not yet fully understood.

As the laser beam cuts through the tissue, it seals small blood and lymph vessels. This action reduces blood loss during the operation and lessens the risk of infection. Lasers also allow surgeons to make very precise cuts with minimal damage to surrounding tissue. Thanks to these advantages, doctors can perform operation that should be highly complicated or impossible with traditional methods.

Lasers are widely used in eye surgery. They seal leaking blood vessels in the retina and pierce tiny holes in the eyeball to prevent the buildup of fluid that occurs in glaucoma.

In neurosurgery, lasers are used for operations near delicate structures of the brain, such as the optic nerve. They can also burn off papillomas, benign tumours of the larynx, and remove pre-cancerous mouth lesions with minimal bleeding and scarring.

Lasers are now being used to reduce the intensity of portwine birthmarks by destroying the vessels that cause the reddish or purple colour of the mark. Doctors also employ them, on an experimental basis, to fragment kidney stones and, most recently, to open up clogged arteries in the legs and around the heart.

Since their first used in surgery in the 1960′s, many new types of laser have been created. Each has a different wavelength, which interacts best with a particular type of tissue.

What happens during laser surgery?
The choise between laser treatment and traditional surginal procedures is made individually for each specific medical case. Often, a laser procedure does not require hopitaliation. Doctors perform operations on the eye and carry out many other types of laser surgery in the outpatient clinic.

If, for example, a doctor is treating a birthmark, the patient will be seated in a chair and the eyes covered with protective goggles or a shield. The mark is then treated with a beam emerging from a small wand attached by a cord to a device that looks similar to a refrigerator, which as development proceeds is becoming smaller.

When the procedure involves internal organs, the doctor may perform the operation with an endoscope a long tube equipped with an optical device that allows one to see inside the body. The tube may be introduced through a small surgical incision or through the mouth or rectum. The doctor can activate the laser beam at the tube’s end and not have to open up the body to carry out the procedure.

Is laser surgery unpleasant?
On the whole, laser surgery is less traumatic than traditional surgery. Some types of eye surgery such as operations on the retina are completely painless. However, the doctor may give a sedative or local anaesthetic. The patient may see a bright flash or light every time the surgeon uses the laser.

Laser surgery using an endoscope may be a little uncomfortable. Patients receive local anaesthesia and a sedative to alleviate their anxiety. Sometimes, general anaesthetics may be used if discomfort or distress are likely.

How long does laser surgery take?
Laser surgery takes much less time than traditional operations. The actual application of the laser beam to the tissue lasts only seconds or fractions of seconds at a time, because the beam is so powerful. However, sometimes, more than one application is necessary. An eye operation in a clinic can take as little as 20 minutes, although other procedures may take longer.

In certain cases, a hospital stay of as long as 2 – 3 weeks can be reduced to a few days by treating a condition with laser surgery instead of conventionally. Or, the treatment can be carried out on out-patient basis.

Is laser surgery dangerous?
Laser beams have a great destructive capacity and can cause injury to the body, especially the eyes. If laser surgery is performed on your head for neck, you will be given protective eye gear to wear. There is a risk of burning the tissue around the laser incision but this should not occur under normal circumstances.

Laser surgery is relatively new and more clinical studies are needed. For example, controlling the depth to which the beam penetrates is a factor still needing improvement. When used to unclog arteries, there is a risk of the beam puncturing the artery walls. In general, doctors use laser surgery only when it has been established that traditional techniques cannot accomplish the same results.

Preparation
Since laser surgery does not entail as much cutting or blood loss as conventional surgery, it can usually be done on an outpatient basis. It is also relatively painless; and so it may be done with minimal anaesthesia. Even so, a sedative or tranquillizer is often given.

An appendicectomy is a surgical operation which removes the appendix – the worm-shaped tube that hangs into the lower abdominal cavity from the first segment of the large intestine. In humans the appendix has no known purpose, although some researchers believe that it may have performed some function at an earlier stage in our development.

Most people never have any trouble from their appendix. However, for reason that are not fully understood, this organ does sometimes become inflamed and filled with pus – a condition known as appendicitis. Although appendicitis can occur at any age, it is most commonly experienced by young adults, and rarely by children under two years of age. Indeed, only one person in 500 has an attack of appendicitis.

An Appendicectomy Operation

How does Appendicitis develop?

Abdominal pain is the hallmark of appendicitis, usually starting in the mid-abdomen, before travelling down to the right, to the area over the appendix. Symptoms such as nausea, vomiting and constipation may also be experienced.

If left untreated, the inflammation may worsen until the appendix ruptures. The contents of the appendix, which include faecal material and bacteria, then spill into the normally sterile peritoneal cavity. This can lead to peritonitis, a life-threatening inflammation of the peritoneum (abdominal lining). Abscesses may develop, threatening adjacent organs with infection. The passage of food through the intestines slows or stops. Shock, intestinal blockage, intense pain, and even death, may follow.

The diagnosis of appendicitis is mainly clinical. Laparoscopy is now commonly used for investigation and, if necessary, the removal of the appendix. This procedure involves looking into the abdominal cavity with a small telescope. Surgeons cannot predict whether or not an inflamed appendix will rupture. If they suspect abdominal pain is caused by appendicitis, they will remove the appendix as soon as possible in case a rupture occurs. Sometimes the pain is incorrectly diagnosed, and surgeons find the appendix is healthy. However, with the advent of laparoscopy, misdiagnosis is becoming a thing of the past.

What happens during an Appendicectomy?

Before the operation the patient will be sedated with a tranquillizer and then given a general anaesthetic. The surgeon cleans the skin over the site of the appendix with an antiseptic solution and makes an incision through the skin, underlying layers of fat and the muscle, to expose the appendix.

The blood vessels leading to the appendix are tied off with sutures (stitches) and the inflamed organ is snipped off at its base. The base is buried in the wall of the intestine using a purse-string suture. A drain may be left in the wound temporarily to remove any pus and other fluids which collect. The surgeon then repairs each tissue layer until reaching the incision, which is closed with more sutures.

If a laparoscope is used, the surgeon is able to make smaller incisions in the skin and to dissect the appendix inside the body before removing it.

The operation is more complicated if the appendix ruptures and abscesses have formed. These must be drained, so tubes may be left in the surgical wound to allow the continued removal of pus and fluids after the incision is closed. Doses of antibiotics are given to resolve the peritonitis.

Is an Appendicectomy dangerous?

An appendicectomy is a standard, safe operation that is usually followed by a rapid recovery. It makes about half an hour. However, complications may sometimes set in from the accidental release of tiny amount of infected matter into the peritoneum during the operation. For this reason, antibiotics are usually prescribed routinely in order to prevent or treat any infection of this nature.

Warning / Precaution

Constipation commonly accompanies appendicitis. Taking a laxative increases the chance that the inflamed appendix will rupture.

Never take a laxative if there is abdominal pain, vomiting, or other symptoms suggesting the possibility of appendicitis.

IMPORTANT

Children frequently complain of stomach-aches. The symptom is usually nothing to worry about, but if the pain seems unusual or intense, or if it is accompanied by a fever, nausea, vomiting, or other symptoms, you should see your doctor.

Any severe abdominal pain which persists for more than four hours will require medical attention.

Hip joint replacement, or arthroplasty, is the surgical procedure in which damaged joint surfaces are replaced by metal and plastic components. This procedure has been widely used for about 25 years, and the results have generally been excellent.

Hip joint replacement is most often performed when arthritis has severely damaged the joint. The wearing away of cartilage, the smooth, hard material that protects the ends of the bones, occurs in both rheumatoid, arthritis and osteoarthritis (degenerative joint disease).

When this damaged is extensive, cartilage erosion can cause severe or constant pain, stiffness, loss of function, and deformity. Walking may become difficult or even impossible.

What happens during Hip Joint Replacement?

Hip joint replacement surgery requires hospitalization and anaesthesia. The length of the operation is normally at least an hour, while the hospital stay depends upon the person’s overall health. the procedure is performed by an orthopaedic surgeon with special training and experience in joint replacement.

This operation is one of the most dramatic success stories in orthopaedic surgery.  More than 90% of hip joint replacements are termed successful, and the majority of people who undergo them report remarkable relief of pain and improvement in mobility. One or both hips may be replaced.

Hip replacement may be carried out in later life following childhood problem such as Perthe’s disease (a condition in which the blood supply to the head of the femur or thigh bone is impaired leading to degeneration). In rare cases the hip may be dislocated at birth and therefore does not develop properly. This may lead to arthritis in later years.

In deciding whether to perform a hip replacement, the surgeon will consider both the condition of the bones and the patient’s age. Until recently, hip replacement was only performed on people over the age of 60 because of the likelihood that the artificial joint would loosen with ageing, requiring another replacement during the patient’s lifetime.

Advances both in the design of the synthetic joint and in surgical techniques have made hip replacement increasingly possible in younger people. Although some still have to undergo a second or third replacement.

The cement now used for anchoring an artificial hip can be expected to stay intact for many years, although loosening can still sometimes be a problem. The development of new joint designs that do not rely on cement to hold them in place continues to go on.

The operation involves the removal of the diseased portion of the head of the femur and replacing it with a metal component which is pushed down the shaft of the bone. In most cases this is secured in position using a special type of cement.

The socket of the joint is cleared of damaged cartilage and replace with a plastic cup into which the head of the femoral component is placed. The muscles are stitched back into place over the artificial joint and the skin is closed over the muscles. High dose antibiotics are usually prescribed to prevent infection.

Hip resurfacing is a less drastic procedure that is an alternative to total joint replacement. Here, the diseased part of the top of the thigh bone is cleaned away and capped with a metal covering. At the same time, the hip socket is cleaned and lined with plastic. It is seldom performed, however, since most specialists feel that it will not last as long or be as effective as a total joint replacement.

After the Hip Joint Replacement Operation

- A drain may be placed in the wound to prevent a build-up of fluid.
- A blood transfusion may be required.
- It will be possible to start getting mobile once the surgeon is happy with your post-operative x-rays, which are taken one to two days after the operation. This will be followed by a rehabilitation programme. You should avoid crossing your legs for several months, to prevent any risk of dis-location, and you should also sleep on your back with a pillow between your thighs. Make sure you find out how to get in and out of the bath without disturbing the joint.
- You will need to walk with crutches for approximately six weeks after the operation, and then to use a walking stick. You should be able to resume normal activities after about six months.
Warning

Infection after joint replacement can be very serious, especially if it invades the bones or spreads through the bloodstream. Call your doctor immediately if you experience symptoms such as fever, deep joint pain or inflammation of overlying skin.