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Trabeculectomy, also called Filtration Surgery, is a surgical procedure performed for treatment of glaucoma. The treatment involves removing part of the trabecular meshwork and creating a new escape route for the aqueous humor. When successful, it allows the aqueous fluid to drain from the eye into an area underneath the conjunctiva where it is subsequently absorbed by the body's circulatory system or filtered into tears.
In this procedure:
- A conjunctival pocket is created and maybe treated with Mitomycin or other antimetabolites for a few minutes. These drugs are used to prevent scarring of the operation site. Scarring, if occurs, may clog the new drainage canal, and is therefore the major reason the procedure may fail.
- A half thickness flap is then made in the sclera and is dissected all the way to the clear cornea.
- A block of scleral tissue including part of the trabecular meshwork and Schlemm's canal is then removed to make a hole into the anterior chamber of the eye.
- As the iris may plug up this hole from the inside, a piece of the iris maybe removed at this time. This is called iridectomy.
- The scleral flap is then sutured loosely back in place. These sutures can be released gradually during a couple of weeks after surgery. This allows adjustment of the aqueous flow in order to achieve target pressure and to avoid the complication of having a too low intraocular pressure.
- The conjunctiva is sewn back in place to cover the area.
After surgery, aqueous humor drains into a filtering area called a "bleb" under the conjunctiva. Since the surgery is usually performed near the top of the eye, the bleb can easily be concealed behind the upper eyelid.
They are the leaders of the pack when it comes to minimally invasive surgeries. Laparoscopic and robotic. Different techniques with the same benefits.
"There's significantly less blood loss, it's a quicker procedure, quicker recovery, less scarring, less chance for post operative wound complications or infections," says Dr. Darren Miter, laparoscopic surgeon with Lee Memorial Health System.
In a laparoscopic procedure surgeons operate through a series of poke holes, manually inserting thin cutting tools and a camera to provide magnified vision. It's used in a variety of surgical specialties.
"The vast majority of gallbladder surgeries are performed laparoscopically. A single incision in the belly button, one up under the breastbone and either one or two in the right upper side of the belly. Using long skinny instruments and looking up at a TV monitor, remove the gallbladder that way," says Dr. Miter.
While laparoscopic is a hands-on approach, robotic procedures are surgeon-controlled. Working at a console, surgeons direct the robotic arms, which have super-human capabilities and 3D, hi def vision.
"I mean you have to see it to believe it, that's a great tool to have. You got a very good depth perception. Plus the other thing when you're working with your hands it's more intuitive," says Dr. Nagesh Ravipati, colorectal surgeon with Lee Memorial Health System.
The robotic system performs maneuvers the human hand can't.
"Especially if you have to do any suturing, it is so much simpler with the robots because you can just turn around 360 degrees," says Dr. Ravipati.
Robotic surgery is gaining momentum in precise procedures, including the field of cancer.
"The robot is good when you're going to operate on just one field. For rectal surgery you're in one place, it's docked. It gives you the best 3 dimensional vision," says Dr. Ravipati.
Robotic and laparoscopic. Both cutting edge options, with less cutting.
View More Health Matters video segments at leememorial.org/healthmatters/
Lee Memorial Health System in Fort Myers, FL is the largest network of medical care facilities in Southwest Florida and is highly respected for its expertise, innovation and quality of care. For nearly a century, we've been providing our community with everything from primary care treatment to highly specialized care services and robotic assisted surgeries.
Visit leememorial.org
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This video tutorial discusses an Introduction to Histology (study of tissues):
0:00. Intro
0:35. Hierarchical organization of living matter
1:56. H&E stains
3:00. Epithelium overview (characteristics and classifying scheme)
- 9:12. Simple squamous epithelium
- 11:05. Simple cuboidal epithelium
- 12:20. Simple columnar epithelium
- 13:36. Stratified squamous epithelium
- 15:51. Urinary epithelium (transitional epithelium)
- 16:45. Pseudo-stratified ciliated columnar epithelium (respiratory epithelium)
18:55. Connective tissue overview (characteristics and classifying scheme)
- 21.14. Connective tissue proper (loose CT, dense irregular CT, dense regular CT, adipose tissue)
- 24:50. Cartilage (hyaline cartilage, elastic cartilage, fibrocartilage)
- 26:04. Bone (osteoblasts, osteocytes, osteoclasts, calcium ...)
- 27:34. Blood (RBC, WBC, platelet, plasma)
28:54. Muscle tissue (skeletal muscle, cardiac muscle, smooth muscle)
32:54. Nervous tissue (neurons and glial cells)
36:58. In-a-Nutshell
37:07. Acknowledgements
For a more detailed study of histology go to The Histology Wizard: https://www.youtube.com/channe....l/UCAeLLruy9RkUWaW_r
Next to esophagojejunostomy stapling for the reconstruction following total gastrectomy, several silk stitches anchoring the jejunum to endoabdominal fascia are made to restore the function of phrenoesophageal ligament.
anchoring suture reduces the impairment of the anastomotic blood flow that is caused by gravitational tension and so is useful to protect the esophagojejunostomy after total gastrectomy.
32 year old Dede Kosawa, also known as 'Tree Man', is one of the world's most extraordinary people. He lives in a remote village in Indonesia with his two children, trying to care for them. Dede, a former fisherman, has an incredible skin condition: he has root like structures growing out of his body - branches that can grow up to 5cm a year and which protrude from his hands and feet, and welts covering his whole body.
He is known locally as ‘Tree Man’ and his condition has baffled local doctors for 20 years. In an attempt to earn a living to support his family, he is part of a circus troupe, displaying his 'Tree Man' limbs along with others afflicted with skin deformities in ‘freak’ shows.
Dr Anthony Gaspari, a world expert in skin conditions from the University of Maryland travels to Indonesia to attempt to diagnose 'Tree Man' Dede’s mysterious condition. He takes skin samples for biopsies back in the USA. What will he discover?
We go on an intimate journey with the extraordinary 'Tree Man' Dede, as he tries to eek out a living in a circus troupe to support his family, and as he is given medical help by Dr Gaspari. The identification and possible cure of his condition, could change his whole life.
Half way across the world, in Romania, farmer Ion Toader is discovered to have a similar extraordinary ‘Tree Man’ condition, with growths all over his hands. He has not been able to drive a tractor for five years. A Romanian surgeon offers to give him an operation to remove his growths.
Will it be successful, and how will it change Ion’s life?