Image-guided surgery Health Dictionary

See MINIMALLY INVASIVE SURGERY (MIS).... keyhole surgery

See RECONSTRUCTIVE (PLASTIC) SURGERY.... plastic surgery

That branch of medicine involved in the treatment of injuries, deformities or individual diseases by operation or manipulation. It incorporates: general surgery; specialised techniques such as CRYOSURGERY, MICROSURGERY, MINIMALLY INVASIVE SURGERY (MIS), or minimal access (keyhole) surgery, and stereotactic sugery (see STEREOTAXIS); and surgery associated with the main specialties, especially cardiothoracic surgery, gastroenterology, GYNAECOLOGY, NEUROLOGY, OBSTETRICS, ONCOLOGY, OPHTHALMOLOGY, ORTHOPAEDICS, TRANSPLANTATION surgery, RECONSTRUCTIVE (PLASTIC) SURGERY, and UROLOGY. Remotely controlled surgery using televisual and robotic techniques is also being developed.

It takes up to 15 years to train a surgeon from the time at which he or she enters medical school; after graduating as a doctor a surgeon has to pass a comprehensive two-stage examination to become a fellow of one of the ?ve recognised colleges of surgeons in the UK and Ireland.

Surgery is carried out in specially designed operating theatres. Whereas it used to necessitate days and sometimes weeks of inpatient hospital care, many patients are now treated as day patients, often under local anaesthesia, being admitted in the morning and discharged later in the day.

More complex surgery, such as transplantation and neurosurgery, usually necessitates patients being nursed post-operatively in high-dependency units (see INTENSIVE THERAPY UNIT (ITU)) before being transferred to ordinary recovery wards. Successful surgery requires close co-operation between surgeons, physicians and radiologists as well as anaesthetists (see ANAESTHESIA), whose sophisticated techniques enable surgeons to undertake long and complex operations that were unthinkable 30 or more years ago. Surgical treatment of cancers is usually done in collaboration with oncologists. Successful surgery is also dependent on the skills of supporting sta? comprising nurses and operating-theatre technicians and the availability of up-to-date facilities.... surgery

Surgery done in a clinic or a hospital without an overnight stay either before or after the operation. Improvements in surgery – especially the introduction of MINIMALLY INVASIVE SURGERY (MIS) – as well as more e?ective methods of ANAESTHESIA have simpli?ed many procedures and reduced the physical and mental stress on patients. Patients undergoing day surgery should be accompanied home by a friend or relative. Occasionally a patient may develop complications that require a post-operative stay in hospital.... day surgery

Open-heart surgery permits the treatment of many previously inoperable conditions that were potentially fatal, or which made the patient chronically disabled. CORONARY ARTERY VEIN BYPASS GRAFTING (CAVBG), used to remedy obstruction of the arteries supplying the heart muscle, was ?rst carried out in the mid1960s and is now widely practised. Constricted heart valves today are routinely dilated by techniques of MINIMALLY INVASIVE SURGERY (MIS), such as ANGIOPLASTY and laser treatment, and faulty valves can be replaced with mechanical alternatives (see VALVULOPLASTY).

Heart transplant Replacement of a person’s unhealthy heart with a normal heart from a healthy donor. The donor’s heart needs to be removed immediately after death and kept chilled in saline before rapid transport to the recipient. Heart transplants are technically demanding operations used to treat patients with progressive untreatable heart disease but whose other body systems are in good shape. They usually have advanced coronary artery disease and damaged heart muscle (CARDIOMYOPATHY). Apart from the technical diffculties of the operation, preventing rejection of the transplanted heart by the recipient’s immune system requires complex drug treatment. But once the patient has passed the immediate postoperative phase, the chances of ?ve-year survival is as high as 80 per cent in some cardiac centres. A key di?culty in doing heart transplants is a serious shortage of donor organs.... heart surgery

A branch of surgery that treats deformities, injuries or diseases of the TEETH and JAW, as well as other areas of the face and mouth. Surgeons doing this work are usually quali?ed dentists who have done further training in oral and maxillofacial surgery.... oral surgery

An operation to remove a cancer, plus adjacent tissue and lymph nodes.... radical surgery

A person’s perception of the different parts of his or her own body.... body image

Surgery using a rigid endoscope passed into the body through a small incision. Further small openings are made for surgical instruments so that the operation can be performed without a long surgical incision. Minimally invasive surgery may be used for many operations in the abdomen (see laparoscopy), including appendicectomy, cholecystectomy, hernia repair, and many gynaecological procedures. Knee operations (see arthroscopy) are also often performed by minimally invasive surgery.... minimally invasive surgery

An operation to correct deformity of the jaw and the severe malocclusion that is invariably associated with it. The bones of the jaw are repositioned under general anaesthesia, and often require splinting (see splinting, dental) until they heal.... orthognathic surgery

More popularly called ‘keyhole surgery’, MIS is surgical intervention, whether diagnostic or curative, that causes patients the least possible physical trauma. It has revolutionised surgery, growing from a technique used by gynaecologists, urologists and innovative general surgeons to one regularly used in general surgery, GYNAECOLOGY, UROLOGY, thoracic surgery, orthopaedic surgery (see ORTHOPAEDICS) and OTORHINOLARYNGOLOGY.

MIS is commonly carried out by means of an operating laparoscope (a type of ENDOSCOPE) that is slipped through a small incision in the skin. MIS now accounts for around 50 per cent

of all operations carried out in the UK. A small attachment on the end of the laparoscope provides an image that can be magni?ed on a screen, leaving the surgeon’s hands free to operate while his assistant operates the laparoscope. Halogen bulbs, ?breoptic cables and rod lenses have all contributed to the technical advancement of laparoscopes. Operations done in this manner include extracorporeal shock-wave LITHOTRIPSY for stones in the gall-bladder, biliary ducts and urinary system; removal of the gall-bladder; appendicectomy; removal of the spleen and adrenal glands; and thoracic sympathectomy. MIS is also used to remove cartilage or loose pieces of bone in the knee-joint.

This method of surgery usually means that patients can be treated on a day or overnight basis, allowing them to resume normal activities more quickly than with conventional surgery. It is safer and lessens the trauma and shock for patients needing surgery. MIS is also more cost e?ective, allowing hospitals to treat more patients in a year. Surgeons undertake special training in the use of MIS, a highly skilled technique, before they are permitted to use the procedures on patients. The use of MIS for hernia repair, colon surgery and repairs of duodenal perforations is under evaluation and its advantages will be enhanced by the development of robotic surgical techniques.... minimally invasive surgery (mis)

An operation to repair arteries that are narrowed, blocked, or weakened. Arterial reconstructive surgery is most often performed to repair arteries that have been narrowed by atherosclerosis. It is also used to repair aneurysms and arteries damaged as a result of injury. (See also angioplasty, balloon; coronary artery bypass; endarterectomy.)... arterial reconstructive surgery

Surgery performed to remove excess fat, skin, or both, from various parts of the body, especially the abdomen, thighs, and buttocks. Abdominal wall reduction, also known as abdominoplasty, involves removing excess skin and fat from the abdomen. With all of these procedures there is a risk of complications, and the wound may become infected.

In suction lipectomy (liposuction), a rigid hollow tube is inserted through a small skin incision and use to break up large areas of fat, which can then be sucked out through the instrument.

Minor irregularities and dimpling of the skin commonly occur after surgery.... body contour surgery

A type of mammoplasty.... breast enlargement surgery

The branch of surgery concerned with the heart and blood vessels.

Cardiovascular surgery includes operations to prevent or repair damage caused, for example, by congenital heart disease (see heart disease, congenital), atherosclerosis, or a myocardial infarction (heart attack).

Procedures include heart valve surgery, coronary artery bypass, and heart transplant.... cardiovascular surgery

Reconstructive surgery on the skin and underlying tissues that have been damaged or lost as a result of disease or injury. Congenital malformations are also remedied using reconstructive surgery. Surgeons graft healthy skin from another part of the body to repair skin damaged or destroyed by burns or injuries. New techniques are under development for growing new skin in the laboratory to be used in reconstructive surgery. Surgeons also repair damage using skin ?aps prepared in another part of the body – for example, a skin ?ap from the arm may be used to repair a badly injured nose or face. Reconstructive surgery is also used to repair the consequences of an operation for cancer of, say, the neck or the jaw. Plastic surgeons undertake cosmetic surgery to improve the appearance of noses, breasts, abdomens and faces.... reconstructive (plastic) surgery

Removal of the lens from the eye, performed to restore sight in people whose vision is impaired by a cataract. The lens is usually replaced with a plastic implant during the operation, although for young people and those with other eye disorders, a contact or spectacle lens fitted after the operation may be preferable.... cataract surgery

An operation performed to improve appearance rather than to cure or treat disease.

Cosmetic surgery techniques include the removal of skin blemishes or dermabrasion; rhinoplasty to alter the shape or size of the nose; face-lifts; mammoplasty to reduce or enlarge the breasts; body contour surgery to remove excess body fat and tissue; hair transplants; blepharoplasty to remove excess skin on the eyelids; and mentoplasty to alter the size or shape of the chin.

All cosmetic surgery carries the risk of side effects from the anaesthetic, as well as of complications of the procedure itself.... cosmetic surgery

See otorhinolaryngology.... ear, nose, and throat surgery

See otorhinolaryngology.... ent surgery

Any operation that is carried out to investigate or examine part of the body to discover the extent of known disease or to establish a diagnosis. Advances in imaging techniques, such as MRI, have reduced the need for exploratory surgery.... exploratory surgery

See blepharoplasty.... eyelid surgery

See minimally invasive surgery.... minimal access surgery

Any operation on the heart in which it is stopped temporarily and its function taken over by a mechanical pump. The main forms of open heart surgery are correction of congenital heart defects (see heart disease, congenital), surgery for narrowed or leaky heart valves (see heart-valve surgery), and coronary artery bypass surgery. Once the pump is connected, the heart is opened, and the defects repaired. Surgical hypothermia is used to keep the heart cool and help prevent damage to the heart muscle from lack of oxygen (see hypothermia, surgical).... open heart surgery

See arterial reconstructive surgery; plastic surgery.... reconstructive surgery

An operation to correct a heart valve defect or to remove a diseased or damaged valve. A heart valve may have to be repaired, widened, or replaced because it is either incompetent (leaky) or stenotic (narrowed). Widening of a valve may involve valvotomy or valvuloplasty. A damaged valve can be replaced by a mechanical one (fashioned from metal and plastic), a valve constructed from human tissue, a pig valve, or a valve taken from a human donor after death. A heart–lung machine is used during replacement.After heart-valve surgery, symptoms such as breathlessness may take weeks to improve and require medication to be continued. Some people need longterm treatment with anticoagulant drugs to prevent the formation of blood clots around the new valve.... heart-valve surgery

A person’s view of his or her own personality and abilities. Some neurotic disorders stem from an incongruity between self-image and how others see one.

Psychotherapy treats neurosis by changing a person’s self-image.... self-image

Brain operations carried out by inserting delicate instruments through a surgically created hole in the skull and guiding them, with the aid of CT scanning, to a specific area.

Stereotaxic procedures can be used to treat pituitary tumours; for a brain biopsy; or to destroy small areas of the brain to treat disabling neurological disorders.... stereotaxic surgery

A surgical speciality concerned with operations on organs within the chest cavity. Sometimes, thoracic surgery is combined with heart surgery, in which case it is known as cardiothoracic surgery.... thoracic surgery

Replacement of a diseased organ or tissue with a healthy, living substitute. The organ is usually taken from a person who has just died. Some kidneys are transplanted from a patient’s living relatives (see organ donation). The results of surgery have also been improved by testing for histocompatibility antigens and tissue-typing.

Rejection is a major problem. However, a combination of a corticosteroid drug and ciclosporin are given in order to suppress this response.

Every patient who undergoes an organ transplant operation must take immunosuppressant drugs indefinitely. (See also heart transplant; heart–lung transplant; liver transplant; kidney transplant.)... transplant surgery

See traumatology.... trauma surgery

n. an impression of an image that is registered by the brain for a brief moment after an object is removed from in front of the eye, or after the eye is closed. A positive afterimage, which lasts a few seconds, retains the colour and brightness of the original image; the more common negative afterimage lasts longer and has colours and brightness that are complementary to the original.... after-image

a traditional X-ray image on film that is in shades that range smoothly from black to white with no appreciable steps from one shade of grey to the next (see grey scale). Analogue images can be converted to digital format (see digitization) for manipulation and storage by computers and other electronic devices.... analogue image

surgery performed for the purpose of weight loss in obese patients. Most procedures are restrictive, being designed to promote feelings of fullness and satiety after meals (see gastric banding; stomach stapling). See also gastric bypass surgery; jaw wiring.... bariatric surgery

(image-guided surgery, surgical navigation) a technique by which a virtual image or map of the patient is created from CT scans, MRI scans, X-rays, or ultrasound scans and loaded into a computer. Special instruments connected to the computer are then applied to certain reference points on the patient. The computer can then produce a picture of the location of the instrument within the patient.... computer-assisted surgery

surgical procedures that can be performed in a single day, without the need to admit the patient for an overnight stay in hospital. Modern techniques of surgery and anaesthesia now enable many surgical cases of minor and intermediate degrees of severity to be treated in this way: examples include many breast lesions, dilatation and curettage, and operations for hernia and varicose veins. Special units are established in many hospitals.... day-case surgery

an image made up of *pixels. Each pixel has numbers (digits) to describe its position and shade on the *grey scale. The more shades available, described by the number of computer bits required to store the shade of grey, the more accurately the image represents the original tissue contrast. An 8-bit computer image shows 28 (256) possible shades of grey, close to the maximum the human eye can differentiate. 12-bit (4096 levels of grey) images are of much higher quality and take up more memory. They can be manipulated more easily by computer using image enhancement techniques. Compare analogue image.... digital image

(ESS) surgery of the *paranasal sinuses using endoscopes. Functional endoscopic sinus surgery (FESS) clears inflamed tissue from routes of sinus drainage and aeration to allow the other sinuses to return to normal.... endoscopic sinus surgery

(FGCS) surgery to alter the size or shape of the *vulva and/or vagina when these are a cause of significant distress or sexual dysfunction. FGCS includes labioplasty (reduction or alteration of the labia), clitoral hood reduction (excision of excess skin in the fold surrounding the clitoris), and hymenoplasty (partial or complete reconstruction of the hymen).... female genital cosmetic surgery

(FESS) see endoscopic sinus surgery.... functional endoscopic sinus surgery

any of several procedures of *bariatric surgery that allow food to bypass parts of the gut in order to reduce absorption of nutrients and calories. Such operations often lead to greater weight loss than restrictive procedures, such as *gastric banding and *stomach stapling, but there are significant long-term complications relating to chronic malabsorption and patients must remain under long-term specialist follow-up.... gastric bypass surgery

(IGRT) the process of imaging during a course of radiation treatment to verify the internal position of the target in comparison to the initial planning scan. This enables adjustment of *treatment fields to improve coverage and allows the use of smaller treatment volumes. The possible methods for IGRT include cone beam CT, *tomotherapy, *cyberknife, and ultrasound and kilovoltage X-rays of implanted fiducial markers.... image-guided radiotherapy

an electronic device that provides a TV image from an X-ray source. The X-rays strike a fluorescent screen after passing through the patient, giving off electrons, which are accelerated using an electron lens before striking a second fluorescent screen, which is usually attached to a video camera. The acceleration of the electrons amplifies the signal from the original image, giving a brighter picture, so that the radiation dose can be reduced. Images can be taken from the camera to be observed in real time on a video monitor or, using a brief higher-dose exposure, to provide a more detailed static image (see digital spot imaging).... image intensifier

a surgical technique used for removing primarily high-risk nonmelanoma skin cancers, particularly basal cell carcinoma. The technique allows the surgeon to see beyond the visible tumour as the specimen is removed and the histology checked in stages. At each stage, if the tumour involves the margins, further tissue is resected until they are clear. There is an extremely high cure rate. [F. E. Mohs (1910–2002), US surgeon]... mohs’ micrographic surgery

an electronic image taken during radiotherapy treatment to verify the position of radiation beams.... portal image

any surgical procedure that has as its primary objective the correction of any refractive error. It includes such procedures as clear lens extraction, *LASIK, *LASEK, and photorefractive *keratectomy.... refractive surgery

a type of laparoscopic surgery in which the operating surgeon controls the instruments via a robot. The surgeon sits at a console away from the patient and controls the robot’s operating arms.... robotic surgery

(TORS) a form of robot-assisted surgery used for treating difficult-to-access tumours of the pharynx and larynx.... trans-oral robotic surgery