Surgery: Archives

Knee Replacement October 7, 2021

Traditional Vs Robotic Knee Replacement Surgery

Do you often skip taking the stairs and opt for elevators because of your knee pain? Does walking few meters feels like too much? If so then you are not alone, you are one of the millions of people who have been suffering from chronic knee pain. There is no point in sugar-coating it as we all know knee pain ruins the fun in life. The positive news is there are options available for those who are suffering from pain. At first, most doctors will try to treat in non-invasive ways that are non-steroidal anti-inflammatory drugs, therapy, or these days even stem cell-derived growth factor injection but if your knee pain is disabling and alternative treatments are not working, knee replacement surgery might be the best route for you.

A knee replacement surgery can be life-altering for patients with knee pain. This surgery eliminates pain and helps restore mobility so that the patients can resume their active lifestyle. A knee replacement surgery might sound intimidating but advanced technology has made this procedure more effective with the best outcomes. This can be performed in a conventional way where the surgeon seats the implants manually or with the assistance of a robotic arm controlled by the surgeon. Let us understand the difference between these procedures so that they can help you be more at ease.

Traditional Knee Replacement Surgery

Traditional knee replacement surgery has been existing for more than 70 years. This technique typically replaces only a part of the joint. Based on the x-ray an experienced surgeon will carefully examine the correct alignment and positioning for the metal implant. The surgeon then cements the prosthesis and all this is done manually by a surgeon. This replaces the damaged part of the knee which results in more natural feeling and movement. It facilitates quicker recovery and returns to normal activities.

Conventional knee replacement surgery started a revolution in the medical sector and with advanced research and development new forms of surgery have come up to benefit the patients in a better and effective way. It is one step ahead of traditional knee replacement surgery. With the intervention of robotics in medical science it has given another direction, it has touched the orthopedic sector and has proven beneficial in bringing effective results for the patients undergoing robotic knee replacement surgery.

Traditional Knee Replacement Surgery

Heart Attack September 28, 2021

USE HEART TO CONNECT – WORLD HEART DAY

World Heart Day is celebrated on 29^th September every year, to spread awareness on Cardiovascular Diseases and other heart conditions, while emphasizing the importance of heart health and how to maintain it.

Cardiovascular Diseases (CVDs) are the leading cause of death globally, and claim about 17.9 million lives approximately every year, according to the World Health Organization (WHO). World Heart Day provides an ideal platform for those suffering from CVDs to fight against it and reduce the global burden of the disease.

Created by the World Heart Federation, World Heart Day is a global campaign that informs people about the risk of cardiovascular diseases and highlights the actions one can take to keep heart diseases at bay.

World Heart Day 2021

This year, the theme of World Heart Day is Use Heart to Connect, which urges everyone to use their knowledge, influence, and the power of digital media to connect to the global community and ensure that everyone gets a chance to live a heart-healthy life.

COVID-19 has brought about a drastic change in the world and has posed a serious threat to everyone, making us increasingly aware of the importance to protect our health as well as that of our loved ones. For those living with CVD, COVID-19 has put them in a compromising situation, as they are at a higher risk of contracting the virus.

The goal of World Heart Day 2021 is to harness the power of digital health to improve awareness of the prevention and management of CVD, on a global level, with the help of three key pillars – equity, prevention, and community

Equity:

Due to the lack of internet facilities among half the world’s population, awareness on CVD prevention, treatment, and control are unavailable. It is important to use technology and data to bridge this gap with the use of digital tools and enable better prevention, diagnosis, and treatment of heart-related diseases.

Prevention:

Prevention is better than cure, To maintains a healthy heart, follow a healthy diet, avoid alcohol and tobacco abuse and follow a regular exercise regimen. If you are diagnosed with an underlying health condition such as diabetes, high blood pressure, obesity, or more, ensure regular check-ups with your medical practitioner.

Community:

According to the World Heart Federation, over 520 million people are living with CVD across the globe, and have been severely affected due to the COVID-19 pandemic, as they are highly prone to the infection, and have to be isolated. This has resulted in missing medical follow-ups and appointments, lack of contact with people, and reduced exercise. Through digital networks, those who are vulnerable can easily connect with their families, friends, and even doctors for support.

What are Cardiovascular Diseases (CVDs)?

Cardiovascular Diseases (CVDs) refer to the set of conditions that affect the functioning of the heart and blood vessels such as:

Arrhythmia:

Arrhythmias refers to abnormal heart rhythms. In this condition, the heart either beats too slow or too fast. Bradycardia occurs when the heart rate is too slow (less than 60 beats per minute) and Tachycardia occurs when the heart rate is too fast (more than 60 beats per minute). When an arrhythmia occurs, the heart may not be able to pump enough blood required by the body.

Aortic Disease:

Aorta is the large artery through which oxygen-rich blood flows to the rest of the body. Sometimes, the aorta may widen or tear, which leads to a condition called Atherosclerosis. This condition develops when plaque builds up in the walls of the arteries, making blood flow difficult. This may even lead to a heart attack or stroke.

Heart Attack:

This occurs when blood flow to a part of the heart is blocked by a blood clot, leading to a lack of oxygen.

What are the risk factors of CVDs?

Some of the major risk factors of Cardiovascular Disease include:

High cholesterol levels
Diabetes
Lack of physical activity
Tobacco consumption
COVID-19

How can you prevent Cardiovascular Diseases?

There are several risk factors associated with CVDs such as the family history of heart diseases, that cannot be prevented or helped. However, certain risk factors such as high blood pressure, diabetes, cholesterol levels can be treated on time, reducing the risk of CVDs. If you are a frequent consumer of tobacco and alcohol, reducing the consumption of these can also help prevent heart diseases. It is also important to make several lifestyle changes such as a regular physical activity routine and incorporating a healthy diet, which will also help keep heart diseases at bay.

Some tips to keep the heart healthy

Now that we know the importance of keeping the heart healthy and how CVDs can affect our health drastically, here are some tips one can follow to ensure that the heart remains in a good shape. They are:

Eat Healthy: Avoid foods that are extremely rich in fat content, and eat fiber-rich foods. Also, make sure that you eat in moderation.

Get Active: It is also important to have a regular exercise routine and stay physically active. Also incorporate regular movement if your job requires you to sit at a desk for long hours, and maintain a healthy weight.

Quit Smoking: It is a well-known fact that smoking is one of the main causes and risk factors of heart disease. If you are a regular smoker, quit smoking immediately and avoid the risk of CVD.

Overall, it is extremely necessary to maintain your health and go for regular follow-ups if you have underlying conditions such as diabetes or high blood pressure. Though there are several treatment methods for different types of heart diseases, making certain lifestyle changes will ensure that you don’t develop the risk of CVDs at all. Remember, prevention is always better than cure!

Aortic Stenosis/TAVR/TAVI September 18, 2021

Dr. Karun Behal – Prevalence Of Aortic Stenosis In Elderly Population

When it comes to ailments of the heart, Aortic Stenosis (AS) is one of the most common diseases, especially when it comes to senior citizens. It occurs when the opening of the aortic valve gets narrowed. Through the right intervention, Aortic Stenosis can be tackled. But to do so, one needs to know what the ailment entails.

As mentioned, Aortic Stenosis is a disease that is more likely to occur among the elderly. That is why, on the eve of Senior Citizens Day, Dr. Karun Behal (MD, DM – Cardiology), Senior Consultant – Cardiology, Fortis Mohali, held a live session online where the specialist shared some vital insights on the ailment and various interventions that can be used to surpass it. Read on to know these key pointers from the live session.

To start with, what is Aortic Stenosis?

In aortic stenosis, the Aortic valve doesn’t open completely, restricting the blood flow from the left ventricle of the heart to the aorta and the rest of the body. It may also affect the pressure in the left atrium.

The aortic valve has three leaflets, and it separates the aorta from the left ventricle. The main function of the aortic valve is to open and allow blood flow from the left ventricle of the heart to the aorta, through which blood flows to the rest of the body. It also prevents the backflow of blood from the aorta to the left ventricle. Aortic stenosis happens when the valve doesn’t open up completely, which in turn reduces or blocks the blood flow. Dr. Behal also mentioned that aortic stenosis is more prevalent in the elderly population.

How is Aortic Stenosis diagnosed?

Dr. Behal opined that to treat this condition, it is important to determine if the symptoms are mild, moderate, or severe. Depending on the severity of the condition, the right treatment method is suggested.

Aortic stenosis can be diagnosed clinically, where your doctor will use a stethoscope to look out for heart murmurs that may suggest an aortic valve condition. The doctor may also run several tests such as Echocardiography, which uses sound waves to create images of your heart. Echocardiography can also show the doctor how blood flows through the heart valves, and if there is an interference in the blood flow.

What are the symptoms of Aortic Stenosis that one needs to look out for?

Most cases of aortic stenosis are asymptomatic, or the symptoms are visible only during the later stages. Some of the most common symptoms of aortic stenosis are:

Heaviness/pain in the chest while indulging in physical activities
Shortness of breath
Fatigue
Dizziness
Palpitations

If these above-mentioned symptoms are persistent, it is important to talk to your medical practitioner immediately to diagnose aortic stenosis.

How is Aortic Stenosis treated?

Initially, aortic stenosis was treated through medications such as pain killers, blood thinners, and medicines that kept cholesterol levels and blood pressure in check, but it did not work on people with severe aortic stenosis. But nowadays, with the advancements in the medical field, severe aortic stenosis can be treated. Some of the most common treatment methods for aortic stenosis are:

Surgical Aortic Valve Replacement (SAVR): Surgery is one of the most popular methods to treat aortic stenosis. This is usually done through an incision in the chest. People who have undergone surgery for aortic stenosis have a better survival rate. However, surgery may not be recommended to elderly patients with aortic stenosis as it may lead to several health complications.

Transcatheter Aortic Valve Replacement (TAVR): This is a less invasive procedure for those who are at a higher risk of complications from surgical aortic valve replacement. In this procedure, the damaged valve is replaced with a bioprosthetic valve.

What are the advantages of TAVR?

TAVR is a huge advancement in the field of medical sciences in the past 15-20 years. Due to its less invasive nature, TAVR has replaced open-heart surgeries. At first, TAVR was recommended to only those patients who were unfit for surgery. An open heart surgery involves attaching a heart-lung bypass machine to the patient and opening the chest cavity, which may lead to several complications. Post-surgery, the patient would have to be under observation for 10-12 days, and the recovery would take about 1 – 2 months.

However, with TAVR, the chances of complications are reduced, and the patient can be discharged within 2-3 days of the procedure. The rate of recovery is also faster compared to SAVR. However, SAVR is cost-efficient in comparison to TAVR.

Many patients and caregivers who had joined in on the session had questions for Dr. Behal, especially on the long-term consequences of the ailment. Here are a few of them.

Can Aortic Stenosis cause sudden death?

Yes, aortic stenosis can cause sudden death, as the symptoms are not visible in the earlier stages. The patients do not recognize the signs until the later stages, during which treatment might be difficult, which may lead to sudden heart failure. The patients need to be mindful of the early signs and approach the doctor immediately to run diagnostic tests.

Does mild Aortic Stenosis require surgery?

No. SAVR and TAVR are recommended for those who are diagnosed with severe aortic stenosis. Mild and moderate symptoms can be treated with medications. However, the patient must frequently follow up with the medical practitioner to ensure that the symptoms do not worsen.

How long does a TAVI valve last?

In SAVR, two different types of valves are used – biological valves and prosthetic valves. Biological valves are made of animal tissues and last for about 10-15 years, while prosthetic valves are made of metal and last for about 20-25 years.

In TAVR, biological valves are used, and they last for 10-15 years.

What is the survival rate in Aortic Stenosis patients?

Aortic stenosis can either be asymptomatic or symptomatic. If the patient is asymptomatic and responds well to stress tests and other diagnostic tests, the outlook is positive, almost equivalent to the normal healthy adult population.

However, if the symptoms are severe, the outlook is negative. At this stage, it is important to run tests such as echocardiography to determine the damage done to the valve, and the treatment must be administered immediately.

What is the minimum age to undergo TAVI?

Initially, people above the age of 65 – 70 are considered for TAVI. And it is advisable for everyone above 75 to only opt for TAVR as the procedure is less invasive.

Does TAVR have any side effects?

Though TAVR is less invasive as compared to SAVR, there are several risks and complications associated with the procedure:

Internal bleeding
Pain
Stroke
Arrhythmia, requiring pacemaker implantation
Death

Who qualifies for the TAVR procedure?

TAVR is mostly recommended to patients who display severe symptoms. After being diagnosed with aortic stenosis, it is necessary to discuss with your heart surgeon about the advantages and disadvantages of SAVR and TAVR, to decide the right treatment method for you. Sometimes, TAVR is also recommended for patients with moderate symptoms.

While diseases like Aortic Stenosis are indeed common, leading a healthy lifestyle & timely intervention by your doctor can help go a long way in keeping the disease at bay!

Aortic Stenosis/TAVR/TAVI September 17, 2021

Tavr Procedure & Who Can Opt For It

There has been news of hope in recent years for the treatment of a common heart condition Aortic Stenosis, a procedure called transcatheter aortic valve replacement (TAVR). It was introduced in the mid-2000s since then as many as 400,000 patients across the world have had TAVR. According to the trials published in 2010, it was found that the TAVR procedure drastically reduced the risk of death among the inoperable patients. TAVR has been also found to be effective for patients with high and intermediate risk of serious complications from surgery or death. Whether or not you should undergo the procedure is entirely your doctor’s call, but even then, it is essential you know all that you can about the procedure.

What is TAVR used for?

TAVR is designed to treat Aortic stenosis hence it is important to understand the condition.

Aortic valve stenosis or aortic stenosis occurs due to narrowing of the aortic valve opening. It is one of the most common and serious valves disease problems. Aortic stenosis restricts the blood flow from the left ventricle to the aorta and also affects the pressure within the left atrium of the heart. Some people have stenosis due to a congenital heart defect called a bicuspid semilunar valve. During aging, this condition is developed commonly as calcium or scarring damages the valve and restricts the amount of blood flowing through.

Sometimes the left ventricle wall may show muscular thickening because the ventricle must have worked hard to pump blood through the narrow valve opening into the aorta. Appropriate treatment can help reverse or help slow down the progress of this disease.

Symptoms caused by Aortic Stenosis

Many people may not experience any symptoms until the amount of restricted blood flow becomes greatly reduced. Then the symptoms may include:

• Chest pain

• Difficulty in walking short distances

• Feeling dizzy or light-headed or even fainting

• Rapid, fluttering heartbeat

• Difficulty in sleeping or needing to sleep in the sitting posture

• Swollen ankles or feet

• Decline in energy levels

It may be important that someone suffering from aortic stenosis may not experience any of these symptoms. But if you observe a decline in routine physical activities or significant fatigue, it’s worth a doctor’s visit to check for reduced heart function.

Treatment for aortic stenosis

Your doctor may suggest a couple of tests to confirm or rule out aortic stenosis. Tests also help determine the cause and severity of the condition.

The treatment of aortic stenosis depends upon how severe your condition is. For mild or moderate cases your doctor may keep a check on you. You will have to get regular check-ups and echocardiograms. Your doctor may encourage you to make changes to improve your overall health. It might include:

• Working on weight loss

• Switching to a healthier diet

• Managing your stress

• Quitting smoking

• Exercising, depending on your symptoms

For patients with severe stenosis, treatment options may include surgical semilunar valve replacement (SAVR) or transcatheter semilunar valve replacement (TAVR).

Surgical Aortic valve replacement (SAVR) or transcatheter Aortic valve replacement

Traditional treatment of Aortic stenosis- Open Heart Surgery

Open heart surgery is considered a major operation. During an open-heart SAVR procedure, an incision is formed within the chest to access the heart during which the heart is stopped and blood is bypassed through a heart-lung machine. After which the diseased valve is removed and replaced with a replacement valve. SAVR has been the historical standard treatment for aortic stenosis for years.

For candidates who are suitable SAVR has given good outcomes to those patients. But the major drawback of SAVR is the long recovery period that generally requires five to seven days of hospitalization after surgery and more than six weeks for a full recovery. If the patient has too many medical conditions then it makes them unsuitable for SAVR.

A non-surgical treatment- TAVR

TAVR is a minimally invasive procedure. For severe aortic stenosis patients who cannot withstand open-heart surgery, it is now the first line of therapy. Unlike a SAVR procedure which involves opening the chest to exchange a patient’s semilunar valve with a mechanical or tissue valve, the TAVR approach delivers a collapsible replacement valve via catheter. This process involves inserting a hollow tube (catheter) into your aortic valve through the blood vessels. Once the new valve is placed, the balloon on the catheter’s tip is inflated to park the valve in the desired position. Once it’s done, the catheter is then removed and the new valve now does the job of regulating the blood flow.Patients who go under TAVR recover quicker compared to SAVR patients which allows them to leave the hospital and start cardiac rehabilitation sooner and that can help improve the quality of life. It is performed under sedative medication without giving general anesthesia and in most cases, the procedure takes 90 minutes.

The risks TAVR may present

TAVR has major benefits but it also has certain risks as it is a complicated procedure. The risks may include stroke, heart attack, bleeding, and the need for emergency surgery. The risks are low but there is also potential damage to the electrical system of the heart which may result in the need for the placement of a permanent pacemaker.

Is TAVR right for everyone?

Although it might seem like an obvious choice compared to the stress of open-heart surgery, a detailed review must come first because not everyone needs to undergo a TAVR procedure. All patients with severe aortic stenosis must be carefully evaluated to make the best choice for them. Patients in the high-risk category are usually likely candidates of TAVR. A potential patient must have severe aortic stenosis and a three-leaflet valve versus a two-leaflet valve. Patients who have an infection of the heart or associated aneurysms are also not advised for TAVR.

SAVR remains the preferred method for many patients, the surgical techniques have evolved and the valve technology has proven durability. Both the valves are tissue valves, the SAVR valve may be a fixed stent with an approximate lifetime of 15 years while as per The University of Texas Southwestern Medical Center TAVR valve which expands and contracts also has a lifespan of around 10 to 15 years.

If you think you have aortic stenosis, visit your doctor as soon as possible to minimize risks. Take a family member along with you for support and discuss all the options with your doctor. It is important to be evaluated by a heart team, which includes a clinical cardiologist, interventional cardiologist, and a cardiac surgeon. The team will review all your medical information and will provide you the treatment option that’s best for you along with the risks and benefits of the option.

Cancer September 13, 2021

Treating ovarian cancer through surgery

While the thought of cancer as a whole is daunting, one needs to understand that the disease presents itself in different forms. In essence, cancer is when the cells within a body start to mutate at an unnatural pace & cannot be stopped. While this is the common form, many women suffer from a variation of it called Ovarian Cancer.

Ovarian cancer occurs when cancerous growths begin at the ovaries. The female reproductive system has two ovaries on either side of the uterus. The ovaries are responsible for producing eggs (ova) as well as releasing the hormones estrogen and progesterone.

Ovarian cancer usually goes undetected in the early stages. In most cases, it is detected only when cancer has spread to the pelvis and the abdomen, making it difficult to treat. If the tumors are benign (non-cancerous) in nature, they are confined to the ovaries and do not spread. However, if the tumors are malignant, they spread to the nearby organs and can be fatal.

What are the types of ovarian cancer?

The ovaries are made up of three types of cells. Each of them can develop into a different kind of ovarian cancer. The different types of ovarian cancer are:

Epithelial Tumors: These tumors begin from the cells that cover the outer surface of the ovaries. Over 90% of ovarian cancers are epithelial tumors. These tumors can be benign (non-cancerous), borderline (low malignant potential), or malignant (cancerous).

Ovarian Stromal Tumors: These tumors start from the structural tissue cell that produces the female hormones – estrogen and progesterone. These tumors can be diagnosed at an earlier stage as compared to the other types of ovarian tumors.

Ovarian Germ Cell Tumors: Germ cells are responsible for producing eggs (ova) in women. These tumors begin in the germ cells. Most germ cell tumors are usually benign. This rare type of ovarian cancer tends to occur in younger women.

What are the symptoms of ovarian cancer?

In the early stage, ovarian cancer hardly causes any symptoms, making it difficult to diagnose. Advanced-stage ovarian cancer may cause certain symptoms that may often be mistaken for other common, benign conditions or illnesses.

Some of the most common symptoms of ovarian cancer include bloating/swelling in the abdomen, feeling full quickly while eating, change in bowel habits, pain/discomfort in the pelvic area, frequent urination, and loss of weight.

In case these symptoms are more frequent and don’t go away soon, it is advisable to visit your doctor and rule out the possibilities of ovarian cancer. If you have a family history of ovarian cancer, you may talk to a medical practitioner about the risk of developing the same.

How is ovarian cancer diagnosed?

After analyzing your symptoms, if the doctor suspects ovarian cancer, he/she will conduct a pelvic exam to diagnose the condition. During the pelvic exam, the doctor will insert gloved fingers into the vagina, while simultaneously pressing the abdomen to examine your pelvic organs. The doctor also examines your external genitalia and cervix visually.

The doctor may also suggest imaging tests such as an ultrasound or CT scan to determine the size and the shape of the ovaries. Imaging tests can also show if a mass of tissue is present in the pelvic area, but they cannot confirm if the mass is cancerous. Blood tests may also be conducted to determine the presence of tumor markers that indicate ovarian cancer.

After diagnosing ovarian cancer, the next step would be to stage cancer to finalize the treatment options.

What does ovarian cancer surgery involve?

Surgery is not only one of the main treatment methods for ovarian cancer, but it is also a diagnostic tool to determine ovarian cancer. The goal of the surgery for ovarian cancer is to know how far cancer has spread and removed as much of the tumor as possible. The type of surgery will depend on the stage of cancer and your overall health.

Before the surgery, your doctor may run blood and urine tests a week before to ensure that you are healthy enough to undergo the surgery. Your doctor may also take a chest x-ray and ECG to check your heart rhythm.

Surgery for ovarian epithelial tumors:

The surgery for ovarian epithelial cancer has 2 main goals – staging and debulking.

Staging: This is the first goal of ovarian cancer surgery. Staging is done to see how far cancer has spread from the ovary to the organs. This process involves removing the uterus, along with both the ovaries and fallopian tubes. Some samples of the lymph nodes in the pelvis and abdomen are taken through biopsy. Staging is extremely important as it helps determine the best way to treat the condition.

Debulking: The next goal of the surgery is to remove as much of the tumor as possible. This is known as debulking. This is especially important if cancer has spread across the abdomen. Debulking is done to ensure that no tumor larger than 1 cm is left behind.

Surgery for ovarian stromal tumors:

In most cases, ovarian stromal tumors are confined to just one ovary. So, the affected ovary will be removed through the surgical procedure. If cancer has spread further, the tissues in the surrounding areas may have been removed. The main goal of the surgery for ovarian stromal tumors is to remove cancer.

Surgery for ovarian germ cell tumors:

For most ovarian germ cell tumors, the uterus, both ovaries, and the fallopian tubes are removed. If the cancer is confined to just one ovary and you want to retain the ability to bear children, only the affected ovary and the fallopian tube are removed.

Depending on the type and stage of ovarian cancer, your doctor may choose the type of surgery along with other treatment methods such as chemotherapy. Though the surgery will ensure that the cancerous tumors have been removed, it is important to follow up with your healthcare practitioner on the after-care and the possible side effects of the surgery. You can also incorporate certain lifestyle changes to keep yourself healthy and prevent a relapse.