Surgery

Unless it is an emergency, you and your doctor may discuss surgery as a way to correct your condition on diagnosis. This decision is based on careful evaluation of your personal medical history and subsequent medical tests, such as blood tests, X-rays, MRI, CT scan, electrocardiogram, or other laboratory work performed to determine the exact diagnosis.

What are the Different Types of Surgery?

Depending on the diagnosis, a patient has several surgery options:

• Elective surgery. A procedure you choose to have, which may not necessarily be essential to continue a good quality of life. An example would be to have an unsightly mole or wart removed.
• Required surgery. A procedure that needs to be done to ensure a healthy quality of life in the future. An example would be having kidney stones removed if other forms of medication and treatments are not working. Required surgery, unlike emergency surgery, does not usually have to be done immediately.
• Urgent or emergency surgery. This type of surgery is done because of an urgent, possibly life-threatening, medical condition, such as acute appendicitis or trauma.

With technical advances today, surgery does not necessarily mean large incisions and longer healing times, as in the past. Depending on the type of surgery, there are several surgery methods that may be performed:

Open surgery. An "open" surgery means the cutting of skin and tissues so that the surgeon has a full view of the structures or organs involved.

Minimally invasive surgery. Minimally invasive surgery is any technique involved in surgery that does not require a large incision. This relatively new approach allows the patient to recuperate faster with less pain. Not all conditions are suitable for minimally invasive surgery. The UK Center for Minimally Invasive Surgery features the da Vinci Surgical System. This system’s 3-D imaging and 360 degree instrumentation allow better visibility and improved outcomes over standard minimally invasive surgical techniques. Many surgery techniques now fall under minimally invasive surgery:

• Laparoscopy. A minimally invasive procedure in the abdominal cavity that uses a tube with a light and a camera lens at the end (laparoscope) to examine organs and check for abnormalities. Laparoscopy is often used during surgery to look inside the body and avoid making large incisions. Tissue samples may also be taken for examination and testing.
• Endoscopy. A test that uses a small, flexible tube with a light and a camera lens at the end (endoscope) to examine the inside of the hollow organs of the digestive tract. Tissue samples from inside the digestive tract may also be taken for examination and testing.
• Arthroscopy. Surgeons can look at the interior of a joint with the use of an arthroscope. This technique is most often used to inspect and possibly repair the inside of the knee, shoulder, or hip joint.
• Bronchoscopy. The examination of the bronchi (the main airways of the lungs) using a flexible tube (bronchoscope). Bronchoscopy helps to evaluate and diagnose lung problems, assess blockages, obtain samples of tissue and/or fluid, and/or to help remove a foreign body.
• Thoracoscopy. Minimally invasive surgery in the chest cavity. 
• Cystoscopy. Inserting a viewing tube up the urethra to examine the urethra and bladder cavity.
• Gastroscopy. Evaluation of the stomach with an endoscope, a long viewing tube.
• Hysteroscopy. A visual inspection of the cervical canal and uterine cavity with an endoscope.
• Laryngoscopy. Inspecting the larynx (voice box) with a mirror or viewing tube.
• Sigmoidoscopy. Examination of the rectum and sigmoid colon with a viewing tube.

Programs using minimally invasive surgery include:

• Cardiac surgery
• General surgery 
• Hernia surgery 
• Obstetrics and gynecology 
• Neurosurgery 
• Pediatric surgery 
• Plastic surgery 
• Thoracic surgery 
• Transplant surgery 
• Urology 
• Vascular surgery 

If you need surgery, there's a better-than-average chance that you'll have it and go home the same day. Thanks to advances in technology and anesthesia, nearly 6 of every 10 surgeries performed at hospitals are done as "outpatient" procedures, which means you go home the same day you have your surgery. Nearly 35 million such surgeries are performed each year in the U.S., according to the Agency for Healthcare Research and Quality (AHRQ).

Why?

Some reasons outpatient surgery has become more popular with patients and health care providers:

• Convenience. With outpatient surgery, a person returns home on the same day as the procedure.
• Advances in medical technology. These advances allow doctors to use less invasive procedures than were once needed.
• Lower cost. Care costs are much lower for outpatient surgery because there are no charges for hospital rooms and care.
• Less stress. Most people find outpatient surgery less stressful than inpatient surgery because they can recover at home.

What?

Procedures routinely done in outpatient settings include removal of tonsils and adenoids, adding ear tubes, hernia repairs, gallbladder operations, colonoscopies, hemorrhoid repairs, cataract surgery, liposuction, cosmetic surgery, and some foot, ankle, and hand operations.

Where?

Outpatient surgeries are performed in a variety of settings:

• Hospital outpatient centers. These are hospital-owned and operated facilities (on hospital grounds) that specialize in outpatient surgery.
• Freestanding surgery centers. These are owned by a group of physicians or for-profit companies.
• Physicians' offices. Doctors can perform minor procedures in their offices. These include skin biopsies, mole removal, and wrinkle removal.

Many surgeons order routine laboratory tests before admission to the hospital, or even before certain outpatient procedures, to identify potential problems that might complicate surgery if not detected and treated early. Some of the most common tests performed before surgery (and possible reasons or symptoms for which they are performed) are included in the following list:

• Chest X-rays 
• Electrocardiograms (ECG or EKG)  
• Urinalysis 
• White blood count (WBC) 

The following tests, used on blood and urine specimens, measure certain substances and electrolytes in the body which should be normalized as much as possible before surgery:

• Glucose  
• Potassium  
• Sodium  
• Complete blood count (CBC) 

If you have questions or concerns about any of the tests ordered by your doctor, and the importance of having them, be sure to address them before having surgery.