What are the advantages of robotic knee and hip replacement?

• it offers precision like no other technique
• The robotic arm provides tactile, visual and auditory feedback to assist the surgeon in achieving the desired orientation in the best way during the operation
• Less bone and soft tissue damage.
• Incisions are made only on the parts of the knee bones, where incisions are needed
• It is possible to return to daily life more quickly as it provides a faster recovery
• Fewer inpatient physical therapy sessions.
• More complete return of function

Before the surgery

First of all, a 3D virtual model of the joint is created with the X-ray and CT scan images of the patient’s knee
your surgeon may want you to have tests within 30 days before your operation.
These can include a physical exam, chest x-ray, or EKG.

During robotic knee and hip replacement

First of all, the surgeon exposes the joint and the anatomy of the knee joint is revealed. then certain points of the knee joint bones are marked and are compared with the result of the preoperative planning. Afterwards, the surgeon decides whether the joint replacement is suitable for the patient or not, if it is, bone incisions are made with the help of the robotic arm, under the control of the surgeon, and to the extent determined by the robotic system. This gives the operation great accuracy and preciseness When the surgeon finds the placement, alignment, and ligament balance appropriate, the original implant is placed.

Recovery after robotic knee and hip replacement operation

the recovery time varies widely depending on the patient’s, age, medical history, weight and condition.
What distinguishes robotic knee and hip replacement is that it is a minimally-invasive operation which means the patient can go home the day of the operation Once home, it may take up to six weeks to fully recover.
During this time, you’ll participate in physical therapy exercises because moving your new joint keeps it from becoming stiff.
During recovery, you also need to look out for signs of infection. An infection can prolong your recovery and cause other problems.

Candidates for robotic knee replacement

• Patients who have osteoarthritis may be good candidates for robotic knee surgery if their condition hasn’t progressed too extensively.
• Patients with rheumatic arthritis
• ACL tears or ligament injuries
• Fractures, torn cartilage, or other injuries that can cause permanent damage

Candidates for robotic hip replacement

• If you’re in good overall health and haven’t responded to conservative therapies
• The most common condition that results in the need for hip replacement surgery is arthritis.
• Patients who suffer from osteoarthritis
• Patients who suffer from rheumatoid arthritis
• When Nonsurgical management like exercise, walking aids, and anti-inflammatory medications hasn’t worked.
• When The hip joint damage is caused by an injury or fracture.

Gamma knife surgery indication

Gamma Knife can be used to treat any kind of neurological disorder including benign tumours like Meningioma, Pituitary Tumors, Vestibular Schwannoma (audio–balance nerve tumour), Trigeminal Schwannoma, Hemangioblastoma, Pineal Region Tumors, Craniopharyngioma, Glomus Jugular Tumors, Chordoma or malignant tumours like Metastasis, Uveal Melanoma, Some Glial Tumors, Hemangiopericytoma, Nasopharyngeal Carcinoma and many other diseases.

Before the Gamma knife procedure

patients visit the hospital for possible blood tests, and to meet with the doctors and nurses who will participate in the procedure
Don’t eat or drink anything after midnight the evening before your procedure (for AVM procedures only).
Stop taking certain medicines like blood thinners before the procedure, if instructed by your provider
Plan to have someone drive you home after the procedure
Wash your scalp the night before your Gamma Knife procedure.

During The Procedure:

The head frame that is made of aluminium and weighs less than two pounds is placed on the head. This is essential in keeping the target perfectly aligned during the precision treatment.
Then local anaesthesia is injected on each side of the forehead and the back of the head.
Then imaging scan, such as CT or MRI scan is performed with the head frame in place.
After the imaging studies are performed, you will be taken to a waiting room while your treatment is planned.
After the doctors plan your treatment, you will be brought to the Gamma Knife area and placed on the treatment bed, lying on your back.
When treatment starts, you will move into a large shielded sphere. Each “shot” of radiation will last one to several minutes.
The entire procedure from frame application until treatment completion usually takes most of the day.

After gamma knife surgery

you will be transferred to a recovery room.
If you experience a headache or nausea or vomiting, you’ll be given medication.
Discharge and follow-up instructions will be explained and you’ll receive an instructional handout.
It is usually recommended that the patient refrains from physical activity over the next 18 to 24 hours.
you may wash your hair/scalp 48 hours after your surgery. This allows the pin sites to begin to heal and prevents infection from developing in the wounds.

Risks and Side Effects of Gamma Knife Surgery

Any medical procedure has certain risks and potential side effects. Possible side effects of gamma knife surgery are Headache, Scalp swelling, Seizures, and Bleeding (brain haemorrhage). Difficulty with balance, Vision or hearing deficits Reddening and Irritation of Skin Within the Treatment Areas, Hair loss can occur as a temporary side effect is localized and superficial lesions, Numbness/tingling sensation on the scalp at the pin placement sites.

Types of radiotherapy

There are two types of radiation therapy, external beam radiation therapy which is the most commonly used and internal beam radiation therapy.

External beam radiotherapy

External radiotherapy uses radiotherapy machines that aim radiation beams at cancer. The machines focus the radiation beam on the exact location in such a way to maximize the radiation reaching cancer, but also to limit the effect on normal tissues as little as possible. The machine is large and may be noisy. It does not touch you, but can move around you, sending radiation to a part of your body from many directions.
The length of your treatment depends on many factors, including your type and stage of cancer. A course of EBRT involves several daily treatments (fractions) over a few days to a few weeks and the treatment is designed and monitored by a radiation oncologist, a doctor who specializes in treating cancer with radiation.

Internal beam radiotherapy

Internal radiation therapy is a treatment in which a source of radiation is put inside your body. The radiation source can be solid or liquid.
There are two main types of internal radiotherapy: radioactive liquid treatment (radioisotope or radionuclide therapy), or brachytherapy (radioactive implant treatment)

Brachytherapy

brachytherapy allows a higher dose of radiation in a smaller area than might be possible with external radiation treatment. Different types of implants can be used but No matter which type of implant is used, it is placed in your body, very close to or inside the tumour. This way the radiation harms as few normal cells as possible.

There are two main types of brachytherapy:

1. low dose rate brachytherapy
   In this procedure, small radioactive ‘seeds’ are permanently implanted near or in the tumour. Which will stay permanently in place, releasing small amounts of radiation over several weeks or months. Or some implants are left in from 1 to a few days and then removed. You’ll probably have to stay in the hospital, sometimes in a special room, during treatment. For larger implants, you might have to stay in bed and lie still to keep it from moving.
2. high dose rate brachytherapy
   This procedure is similar to the low dose rate brachytherapy but different in a few points like the radioactive sources are removed from the patient at the end of each treatment session. yet the applicator might be left in place between treatments, or it might be put in before each treatment. And this procedure allows a person to be treated for several minutes at a time with a powerful radioactive source that’s put in the applicator.

Radiotherapy side effects

Many people who get radiation therapy have fatigue
In some people, radiotherapy can make the skin sore and red or darker than usual
Hair loss in the area that is being treated is a common side effect of radiotherapy
Feeling nausea and sick and losing appetite
Radiotherapy to your chest can irritate your oesophagus which can temporarily make swallowing uncomfortable
Diarrhoea is a common side effect
can sometimes make your joints and muscles in the area being treated feel stiff, swollen and uncomfortable.
can affect your sex life and fertility, especially if your lower tummy, pelvic area or groin is treated.
It also can slightly increase your risk of developing another type of cancer in the years after treatment.

Candidates for Kidney Transplant

• they’re well enough to undergo the surgery
• the person is willing to follow recommended treatments required after the transplant – such as taking immunosuppressant medication and attending regular follow-up appointments
• the transplant has a relatively good chance of success

Contraindications for Kidney Transplant

• Advanced age
• Dementia or poorly controlled mental illness
• Active or recently treated cancer
• Reversible kidney failure
• Uncontrolled psychiatric disease
• Severe heart disease
• Alcohol or drug abuse
• Any other factor that could affect the ability to safely undergo the procedure and take the medications needed after a transplant to prevent organ rejection

Kidney transplant indications:

Indications for kidney transplantation include chronic kidney disease (CKD), renal tumours, Polycystic kidney disease or other inherited disorders, Lupus and other diseases of the immune system and Other conditions, such as congenital defects of the kidneys.
In children, the most cause of end-stage kidney disease is congenital malformations of the kidney and urinary tract, followed by hereditary\genetic kidney diseases and glomerular disorders.

Kidney Transplant Risks and Complications

Infection is a significant cause of death after kidney transplantation and this happens due to the immunosuppressant drugs that are taken after the transplant to prevent the body from rejecting and attacking the new kidney
Cardiovascular disease is the major cause of death and graft loss in patients with diabetes
Hypertension: this happens in 50 to 80 % of the kidney transplant population
Obesity is a common issue and it can be due to the use of corticosteroids after the transplantation
Diabetes mellitus usually starts in the first few months after the transplantation
Hematologic issues like low leukocytes and anaemia and low thrombocytes and erythrocytosis
cancers

kidney Transplant Surgery

Kidney transplant surgery takes 2-4 hours.
You will be put to sleep under a general anaesthetic while the transplant takes place.
there are many different ways that a kidney can be transplanted, so, your surgeon will explain their preferred technique.
Once you’re asleep, your doctor makes an incision in your abdomen and places the donor kidney inside.
The doctor then connects the arteries and veins from the kidney to your arteries and veins. This will cause blood to start flowing through the new kidney.
The new kidney’s ureter is attached to your bladder to allow urine to pass out of your body.
Your original kidneys will stay in their place unless they are causing problems like infections or high blood pressure then they will be removed.

After Kidney Transplant Surgery

Your new transplanted kidney may start working immediately. Or, sometimes it needs days or weeks to start functioning in this case you may need dialysis temporarily until it starts working.
you will feel sore for a few days after the surgery and need strong painkillers
You can expect to be in hospital for at least a few days or even a week or more
You’ll need to take your immunosuppressant drugs as directed. Your doctor will also prescribe additional drugs to reduce the risk of infection.

Indications:

Acute liver failure (they have the highest priority): because those patients can have a complete recovery or die
Cirrhosis: not every patient with cirrhosis is a candidate. there is a score called a model for end-stage liver disease (MELD-Na score) if the patient score is 15 or higher then they are candidates for liver transplantation.
Liver neoplasms: patients with some primary liver neoplasms may be candidates for liver transplantation if the neoplasms meet specific criteria.
Metabolic disorders: severe metabolic disorders with systemic manifestations can be treated with liver transplantation. Examples: familial amyloid polyneuropathy, cystic fibrosis, primary hyperoxaluria, alpha-1 antitrypsin deficiency and many other

Contraindications:

If the patient has:

• The cardiopulmonary disease that cannot be corrected
• AIDS (acquired immunodeficiency syndrome)
• Cancer outside the liver
• Liver cancer with metastatic spread
• Hemangiosarcoma
• If the transplantation is not possible due to anatomic abnormalities
• Uncontrolled infection

Before Transplantation:

Specific tests, procedures and consultations you may undergo include: tests to evaluate the cardiovascular system like ultrasound and ECG. Laboratory tests, such as blood and urine tests assess the health of your organs, including your liver. Imaging tests, such as an ultrasound of your liver and X-rays

Living-donor liver transplant:

A living-donor liver transplant is a surgery in which a portion of the liver is from a healthy living person. For adult donors, the larger right side (lobe) is removed for transplantation. For children, the smaller left lateral lobe is removed for transplantation.
Both the donor’s and recipient’s livers will regrow over the next few months.
Who can be a living donor?

• Above 18
• Healthy with no serious diseases
• Not be engaged in active drug or substance abuse
• Be able to understand the risks and benefits of living donation

Should be medically compatible (this includes the directed donation which is when the donor is relative to the patient and non-directed donation which is when the donor is a stranger to the patient)

Deceased donor liver transplantation:

this is the most common procedure when it comes to liver transplantation. Deceased donor livers come from people who have died suddenly, usually from an accident or bleed into the brain who are under 70 and were relatively healthy before the death. many studies – such as ABO blood type and HLA matching – are performed to ensure that the organs are functioning properly as well as screen for hepatitis viruses and HIV. As soon as a deceased donor is declared brain-dead, the liver is removed and placed in sterile fluid similar to fluid in body cells. It is then stored in the refrigerator. For a maximum of 24 hours before the liver is transplanted.

Liver transplantation indications in children:

When the child has a genetic disorder causing damage to the liver like Biliary atresia, Alagille syndrome, Primary sclerosing, cholangitis, Hepatoblastoma, Acute liver failure, Alpha-1-antitrypsin deficiency, Wilson disease, or other.

How does it work?

The implant consists of a pair of cylinders in the penis, a pump placed inside the scrotum (near your testicles), and a reservoir of saline (saltwater solution) in your lower abdomen. Squeezing the pump moves the saline into the cylinders, creating a rigid erection that feels very natural. The erection stays for as long as desired. Even after climax, the implant will stay inflated. There is a deflate button on the pump that returns the penis to a flaccid, soft state.

What are the types of implants?

There are several different types of penile implants available. The type that is used will depend on the needs and preferences of the man.

Three-piece inflatable pump
The three-piece inflatable pump involves placing two cylinders in the penis, an inflatable pump in the scrotum, and a fluid-filled container in the abdomen. All of these components are connected by special tubing.
Squeezing the pump in the scrotum causes fluid to move from the container into the cylinders, creating an erection. When the release valve is squeezed, fluid moves out of the cylinder and back into the container, making the penis flaccid.
When inflated, a three-piece inflatable pump implant acts and feels like a natural erection. The implant also feels natural and comfortable when flaccid.

Two-piece inflatable
This type of implant is similar to the three-piece inflatable device and works in the same way. However, instead of a separate fluid-filled container, the fluid is kept within the pump in the scrotum.
However, the two-piece inflatable device is not as rigid as the three-piece implant.

Semi-rigid or malleable rods
This type of penile implant involves a surgeon implanting two flexible rods into the penis. The implants never change in size or stiffness and maintain a semi-rigid state. They can, however, be set in different positions easily.
The implants are usually bent downward but can be straightened into an upward position when needed for sexual intercourse.
Even though they are very easy to use, many men find their constant rigid state to be uncomfortable.

Instructions before surgery may include:

• not eating or drinking anything for a set amount of time before surgery
• leaving valuables at home
• shaving or cleaning the area
• having someone available to drive home

During the surgery :

• The procedure itself usually lasts for 1–2 hours and takes place at a hospital or outpatient surgery centre. It takes place under anaesthesia to prevent the man from feeling what is happening.
• During the procedure, the surgeon will cut the penis below the head, and place the implant inside. It is important to customize the size of the implant based on both body and penis size.
• For inflatable implants, the surgeon makes small cuts in the scrotum to place the pump and valve. If the surgeon is implanting a three-piece system, they will also make incisions in the abdomen to put the fluid container in place.

Recovery Guideline After Prosthesis:

Most patients recover fairly quickly after the procedure but the swelling associated with the surgery may take weeks to resolve. Pain should improve during the first week after surgery.

How Effective Are the Implants?

About 90%-95% of inflatable prosthesis implants produce erections suitable for intercourse. Satisfaction rates with the prosthesis are very high, and typically 80%-90% of men are satisfied with the results and say they would choose the surgery again.

Is the Prosthesis Noticeable?

While men who have had the prosthesis surgery can see the small surgical scar where the bottom of the penis meets the scrotal sac, or in the lower abdomen just above the penis, other people probably will be unable to tell that a man has an inflatable penile prosthesis.

Is the Implant Safe?

No surgery is free of possible complications. Complications associated with penile implants include:
Uncontrolled bleeding after the surgery possibly leading to re-operation
Infection
Scar tissue formation
Erosion (tissue around the implant may break down) requiring removal
Mechanical failure leading to re-operation and removal

Outlook:

The implant is an effective treatment for ED, Most men and their partners are quite happy with their implant and find it to be very effective.
The life expectancy of the implant will depend on the specific device used. Around 60–80 per cent of devices will continue to work for 10 years.