Fiber Optic Scope Source

Liver Retractor

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Miltex Wullstein Endaural Retractor $306.94 Features of the Miltex Wullstein Endaural Retractor: 5" Wullstein endaural retractor. 3" x 3" sharp teeth. Ebony non-glare finish.

Medline Rectal Retractor, Hill Ferguson $106.99 Rectal Retractor, Hill Ferguson, 3X1-3/16, Lg.

Liver $93.99 Liver. Proteins produced and secreted by the liver, Human serum albumin, Alpha fetoprotein, Liver disease, Hepatitis, Non alcoholic fatty liver disease, Wilsons disease, Cancer, Liver transplantation, Artificial organ, Bile 8, Bile canaliculus, Hepatocyte, Liver function tests, Liver shot Author: Miller, Frederic P./ Vandome, Agnes F./ McBrewster, John Binding Type: Paperback Number of Pages: 116 Publication Date: 2009/10/26 Language: English Dimensions: 5.98 x 9.01 x 0.27 inches

Trim Plate Retractor And Protroller Kit(Pack of 1) $107.99 Nauticus Trim Plate Retractor And Protroller Kit

Abdominal Retractor, O'Sullivan-O'Connor $240.25 Abdominal Retractor, O'Sullivan-O'Connor consists of frame, 110 mm x 70 mm blade and two 80 mm x 45 mm blades.Image shown is the 110mm x 70 mm blade.

The Iron Liver $8.99 The Iron Liver

Tab Ctrller w/Led Indicators & Retractor(Pack of 1) $1052.99 Lenco Tab Ctrller W/ Led Indicators & Retractor

Self Retaining Retractor, Beckmann-Adson $250.94 Self Retaining Retractor, Beckmann-Adson, Blunt, 4 x 4 Prongs, 12", 31 cm, 25 mm x 31 mm.

Liver Bird $24.99 Liver Bird - Photographic Print

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Medline Ribbon Retractor, Malleable, 13, 33 cm, 25 mm $25.49 Medline Ribbon Retractor, Malleable, 13", 33 cm, 25 mm

9388GS Single Incision Sleeve Gastrectomy Using a Completely Intracorporeal Liver Retractor

Travel to India for Your Adrenal Surgery

 

When Adrenal Surgery Needed?

Surgical removal of the adrenal gland (adrenalectomy) may be recommended in situations of hormone overproduction or if there is a concern that a mass of the adrenal gland may be a cancer.

Three main situations exist where hormone overproduction is an indication to have an adrenalectomy. The first is Cushing's syndrome in which excess steroid production (cortisol) is caused by a tumor of the adrenal cortex. The second is Conn's Syndrome in which a tumor of the same area produces excess aldosterone, which may cause problems with high blood pressure and blood potassium levels. The third is a tumor of the medulla which is called a pheochromocytoma. This tumor may manufacture excess adrenaline and cause problems such as high blood pressure, excess sweating, tremor, and anxiety.

Preoperative measures for Adrenal Surgery:

1. A History and Physical Examination:
   It is important to know patient’s full health history and any and the entire medicines patient takes. Depending on patients other medical problems, patient may need to be seen by another specialist before operation.
2. Blood work and Tests: According to patient’s age, medical condition, and the type of surgery planned, patient may be asked to have an EKG (heart tracing), chest x-ray, or blood work before the surgery.

3.      Anesthesia Evaluation: The anesthesiologist will see patient on the morning of surgery if patient is generally in good health.

Type of Adrenal Surgery:

Either one (unilateral) or both (bilateral) adrenals can be removed, the decision depending on which glands are affected and what the underlying problem is. The operation of choice for adrenalectomy is now laparoscopic surgery. The open approaches for the right and left adrenalectomy differ in detail but in essence there are four main types of operation.

Laparoscopic approach

This is "key-hole surgery". Rather than large incisions being made, a few (3-5) small holes are made in the abdomen of the patient through which a camera and surgical instruments are introduced. This is expected to further reduce patients' pain and recovery time post-operatively. However, this can only be used for small tumors, and where surgeons are adequately trained in this relatively new technique. The advantage of the laparoscopic approach is that there is less scarring and quicker recovery after surgery. Anterior approach

The adrenal glands are accessed from the front of the patient via an incision just underneath the ribs. This approach is used when the tumor is suspected to be malignant as it exposes a greater area and provides good access to the gland and surrounding structures.

Thoracoabdominal approach

A more radical version of the anterior approach, where parts of the thoracic (chest) cavity are exposed. This provides the greatest access when removal of surrounding tissues as a single block may be needed (e.g. where malignant cancers are very large, 10-15 cm, and may have spread).

Posterior approach

Incision is made on the back of the patient. It involves injury to fewer tissues, improving the patient's recovery time with less pain and better post-operative bowel function than the anterior approach. However it can only be used for small tumors where diagnosis by radiology has confidently excluded malignancy.

Procedure of Adrenal Surgery:

All are performed under general anesthesia.

Anterior approach

A midline incision or bilateral sub costal incisions are made to access the abdomen. Initial exploration of the abdomen should be made for evidence of metastatic spread and provides an opportunity for biopsy or excision of suspicious lesions to be made.

For the right adrenal

First the right lobe of the liver must be mobilized and retracted anteriomedially. Then the hepatic flexure and transverse colon are freed and retracted medially. The duodenum and head of pancreas are then elevated to expose the inferior vena cava (IVC), aorta, the right kidney and the right adrenal gland. The retroperitoneal space is then entered and the adrenal fully exposed. Starting from the superiomedial aspect, the adrenal gland is then dissected out and the smaller feeding arteries clipped and divided from the gland. A careful dissection of the IVC posteriolaterally then allows the right adrenal vein (which unlike the left adrenal vein drains directly into the IVC) to be identified. This is then ligated with a suture and divided close to the IVC. The major feeding arteries are then identified, clipped and divided, this time proceeding from the superiolateral aspect medially. The gland can then be removed.

For the left adrenal

The left colon is first freed from its peritoneum and reflected down inferiorly. Then the spleen is delivered medially from the left upper quadrant to allow the division of the splenocolic ligament and its mobilisation. This allows retraction of the stomach, the pancreatic tail and the spleen medially, exposing the left kidney and the left adrenal gland. The left adrenal vein, which drains into the left renal vein, is ligated and divided close to the renal vein. Arteries are then clipped and divided starting superiolaterally and proceeding medially until the gland is entirely freed for removal. A standard abdominal closure concludes the operation.

Thoracoabdominal approach

This is essentially the same as the anterior approach but involves more extensive thoracic exploration for removal of large and malignant tumors to minimise the chance of leaving malignant cells behind.

Posterior approach

This is a less extensive operation, with incisions being made in the back. The patient is obviously prone (on their front) but flexed at the waist to encourage descent of the abdominal organs away from the retroperitoneum, minimising interference in the surgical field. The operation is the same for the right or left adrenal gland.

An initial incision is made in a curvilinear fashion from the midline at the level of the 10th rib inferiolaterally to the superior border of the posterior iliac crest. Then the surgeon dissects down through the fat and latissimus dorsi muscle to the thoracolumbar fascia. Here, a longitudinal incision is made; exposing sacrospinalis muscle that is retracted medially. The 12th rib and its associated vascular bundle are retracted as medially as possible. The 12th intercostal nerve is then retracted (gently) superiorly exposing the retroperitoneum. This is entered and the diaphragm elevated from Gerota's fascia (the fascia lining the kidney). The pleuron is then separated from the diaphragm and the diaphragm is divided to allow access to Gerota's fascia. This is then incised, the kidney retracted inferiorly to expose the adrenal gland, allowing the adrenal to be isolated. Clipping and division of arteries proceeds from the superior aspect inferiorly. The adrenal vein is then ligated (either at the left renal vein on the left or the IVC on the right) and the gland freed proceeding from superior to inferior, followed by removal. The diaphragm, muscle and fascia, and skin are then repaired.

Laparoscopic adrenalectomy

This is a relatively new procedure, a so-called minimally invasive technique, facilitated by the advent of microcameras and the development of specialist surgical instruments that can be introduced into the abdomen via small holes. Due to the fact there is a smaller area for removal of any affected structures this operation is used for smaller, generally non-malignant tumors. The precise operation depends on the surgeon, but a standard one is described below.

The patient is positioned on their side (the affected side uppermost). First three equally spaced ports are introduced in a transverse line, from the lateral edge of the rectus sheath of the affected side to the mid-axillary line between the costal margin and the iliac crest. An initial exploration of the abdomen is made using a camera introduced into the medial-most port (nearest the middle). This is then transferred to the middle port and a fan retractor introduced into the medial-most port to retract the viscera from the field, aided by hyper-extending the patient at the waist. Instruments are then introduced through the lateral-most port.

Adrenal Surgery in India:

With half a million doctors, over 700,000 nursing professionals and established hospitals, India’s importance as a center for high-tech healing is growing. Patients from neighbouring countries also came down for routine and complex surgeries. Non Resident Indians, frustrated by long waits for treatment in the West, chose to get their procedures done in India when on vacation. Most recently, westerners have started coming for a range of treatments. India has many world-class hospitals and medical facilities at its disposal. They definitely have an advantage over others, as apart from the cost factor, most foreign nationals are used to getting treated by Indian nationals abroad. Indian medical professionals settled abroad are associated with high quality care. Compared to countries like the UK or the US, minor treatments like those for dental problems or major procedures like bypass surgery or angioplasty come at a fraction of the cost in India, even though the quality of doctors and medical equipment is comparable to the best in the world.

 

To know more about Hospitals in India and adrenal surgery packages available in Hospitals,

Please visit- www.forurhealthcare.com

Important Details:

Medical Tourism to India -http://www.forurhealthcare.com 

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About the Author

Forur Health Care is a leading virtual medical service provider with an international standard of the art medical facilities based in INDIA, with accomplished and distinguished physicians and surgeons with vast experience in various medical disciplines including cardiothoracic surgery cosmetic and plastic surgery, laparoscopic surgery, endoscope surgery, microsurgery, joint replacements and highly advanced form of ophthalmic and ear surgery.

The group makes a unique offer to provide FREE MEDICAL EVALUATION service to assist the client in better understanding of his/her medical issues better. After you send us your clinical profile, it will be discussed by our expert team of doctors and you will be conveyed the suggested line of treatment, all free of cost thru our secure web site. All the communication between the patient and the doctors will be strictly kept confidential.