David R. Janfaza, MD
- pain medicine
Location and Office HoursBrigham & Women's Hospital Pain Management Center
Chestnut Hill, MA 02467
- BlueCross BlueShield of Massachusetts
- CIGNA HealthCare
- Harvard Pilgrim Health Care, Massachusetts
- TRICARE North/HealthNet Federal Services
- United Healthcare
- Brigham & Women's Hospital
What is morcellation?
Lauren Streicher, MD, Obstetrics & Gynecology, answeredMorcellation is a procedure used to take large structures out of small incisions; this technique is sometimes used to perform minimally invasive hysterectomies. Watch as OB/GYN specialist Lauren Streicher, MD, discusses this surgical method.
Who should deliver anesthesia during surgery in a doctor's office?
Ideally, anesthesia should be delivered or supervised by an anesthesiologist who, as a physician, is medically trained to evaluate your health needs, decide whether you are a good candidate for surgery in an office setting and then determine what medications are best for you before, during and after surgery. At a minimum, a person extensively trained in the delivery of anesthesia should be involved. If that person is not a physician, then a physician should directly supervise your anesthesia care. You will have the opportunity to talk with your anesthesia provider on the day of your surgery.
What are challenges involved in hand transplantation?
UCLA Health answered
The first successful hand transplant was performed in France in 1998, with the United States following the next year.
“The hand is an amazing tool. It has the power to swing a sledgehammer, yet at the same time it has the precision to play a concert piano,” says Kodi Azari, MD, associate professor in the UCLA Department of Orthopaedic Surgery and the Division of Plastic and Reconstructive Surgery and surgical director of the UCLA Hand Transplantation Program. “The precision is based on the balance between tendons on the back of the hand and the palm of the hand. These have to be absolutely perfectly balanced, and one of the critical elements in transplant surgery is reestablishing that balance.”
Both the preparation for the surgery and the procedure itself are complex and require a large team, which includes doctors from transplantation services and hand surgery, plastic and reconstructive surgery, orthopaedic surgery, psychiatry, pathology, anesthesia, internal medicine, radiology, neurology, ethics and rehabilitation services.
The procedure requires as many as 10 specialized doctors collaborating for eight to 12 hours to fix the bones and repair the arteries, veins, nerves and tendons, as well as to repair the skin. This type of multiple-tissue transplant presents immunological challenges, Dr. Azari notes. As with solid-organ transplants, people who undergo a limb transplant must take immunosuppressive medications to prevent rejection of the graft.
The other challenge is a functional one. “You don’t see your liver or your kidney, but you see and use your hand every day,” Dr. Azari says. “With other transplants, we don’t have to worry about return of nerve function, but we do with this one. Patients need to go through an intensive rehabilitation regimen to restore function to the transplanted hand.”
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