SURGERY & TREATMENT BRANCHES

CARDIOVASCULAR SURGERY

⦁ Coronary by-pass surgeries
⦁ Cover repairs and replacements
⦁ Surgical treatment of aortic aneurysms and rhythm disorders
⦁ Surgical treatment of aortic aneurysms and rhythm disorders
⦁ Pulmonary thromboembolism
⦁ Aortic diseases
⦁ Coronary by-pass surgeries
⦁ Cover repairs and replacements
⦁ Surgical treatment of aortic aneurysms and rhythm disorders
⦁ Surgical treatment of aortic aneurysms and rhythm disorders
⦁ Pulmonary thromboembolism
⦁ Aortic diseases
⦁ Coronary by-pass surgeries
⦁ Cover repairs and replacements
⦁ Surgical treatment of aortic aneurysms and rhythm disorders
⦁ Surgical treatment of aortic aneurysms and rhythm disorders
⦁ Pulmonary thromboembolism
⦁ Aortic diseases

ROBOTIC SURGERY

Robotic Surgery in General Surgery
One of the areas where robotic surgery systems are widely used is general surgery. As in all other areas, robotic surgery systems provide important advantages to both doctors and patients in general surgery operations. As with all other operations with da Vinci, the fact that the incision is low in general surgical procedures and consequently, the shortening and shortening of pain, bleeding and healing time offers great advantages for patients.
Obesity surgeries and colorectal, that is, large bowel surgery, are the most important operations where the robotic surgery system is applied most successfully.
Robotic Surgery in Urological Diseases

Urology is one of the most widely used fields for da Vinci robotic surgery. da Vinci robotic surgery is successfully used in radical prostatectomy (removal of the prostate) surgery, which is the surgical treatment of prostate cancer, and in many other urological surgeries.

Da Vinci robotic surgery, which has an increasing frequency of use thanks to the advantages it provides to the patient and the physician, radical nephrectomy (removal of the kidney part of the kidney), partial nephrectomy (removal of the tumor part of the kidney), pyeloplasty (correction of uretepelvic stenoses), radical cystectomy and bladder cancer in bladder cancers. It can also be applied successfully in operations such as removal of the bag formed in the bladder called diverticulum (bladder diverticulectomy).

In robotic surgery, features such as moving the image to the console in 3 dimensions and at least 12 times magnification, and the robot’s ability to move in many directions can be performed with great precision in every stage of the operations.

Robotic surgery in prostate cancer
Robotic surgery in kidney cancer
Robotic surgery in pyeloplasty-ureteropelvic junction stenosis
Robotic surgery in bladder cancer
Other urological surgery procedures

Surgical procedures that can be performed with da Vinci robot in urology

BRAIN SURGERY

BRAIN SURGERY SURGERY

Brain, spine and spinal cord tumors
All kinds of spinal diseases, especially in the back and neck hernia
Aneurysm (ballooning)
Arteriovenous malformation (AVM)
cavernous hemangioma
Diseases that develop during the formation of the nervous system that occurs with birth (such as meningomyelocele)
Other childhood diseases
Hydrocephalus
Carpal tunnel and other nerve jams
Head, spine and spinal cord injuries
Brain hemorrhagesBrain, spine and spinal cord tumorsAll kinds of spinal diseases, especially in the back and neck herniaAneurysm (ballooning)Arteriovenous malformation (AVM)cavernous hemangiomameningomyeloceleHydrocephalusCarpal tunnel and other nerve jamsHead, spine and spinal cord injuriesBrain hemorrhages

SCOLIOSIS SURGERY

Surgical treatment in scoliosis is applied to patients who have advanced and exceeded a certain degree of scoliosis.

Scoliosis above a certain degree (40 in the waist, 50 in the back) has two important features:

They usually start to become a cosmetic problem that can be noticed by others after these degrees.Even if the patient stops growing, he / she can progress.

How is it applied?

There are two main applications in scoliosis surgery:

The scoliosis of the patient is corrected and the spine is frozen in such a way that the recovery obtained is preserved. This application is usually done with the use of metal implants.
The use of implants that allow partial correction of scoliosis in young children, but can be extended with small (open or closed) interventions with the growth of the child.
Mainly, when we say implant today; The screws applied to the vertebrae and the rods connecting them later are understood. In implant applications; The screws hold the bone, and when they are attached to the rods placed in the corrected position, the spine is made to take the shape of the bar.

People who have completed their growth (2 years after the first menstruation in girls, two years after adolescence sound thickening in boys) are always applied in option 1. In children under the age of 8, the second option is applied because the lengthening of their trunk (not their height) will be negatively affected when such surgery is performed with their current height. Since the age between eight and adolescence (around 11 years old) is considered as a gray area, the general development level and size of the child appear to be influential factors in the decision on which option to apply.

What are the benefits?
Since scoliosis surgeries are serious and large surgeries, it is very important to apply them at the right time and in the right way. Operation; In cases where other treatments are unsuccessful and with correct indications, it can save patients from disability psychology as well as life saving in very advanced curvatures.
The healing process:

In children and young adults, after scoliosis surgery (with some limited exceptions), standard practice is performed as follows:
The patient is mobilized in a controlled manner by lifting it to his feet the next day (day 1).
On day 2, independent mobilization is encouraged by reducing serum and other connections to a great extent.
When she becomes self-sufficient (going to the toilet, getting out of bed, etc.) (3rd or 4th day), she is taken home from the hospital.
After the 3rd week, he can go out of his home in a controlled manner.
After the 4th week, he can go to school in a controlled manner.
From the 4th week, he can do light body exercises (pilates band, light weight). You can walk unlimited, swim in the pool or sea to cool off.
From the end of the 2nd month, they can use public transport (including school shuttle).

From the end of the 3rd month, he can continue his normal daily life without any constraints (except home and school activities, sports), light individual jogging and sports swimming.

Starting from the end of the 6th month, he can do jogging and other individual sports (non-competitive racket sports, etc.) and can ride unlimited bicycles without competition.
After the 1st year (last routine check), he is released except for martial sports and especially dangerous activities (parachute, bungee jumping, etc.).

ORTHOPEDIC SURGERY

HAND SURGERY

Hand surgery; It is an area that requires serious patience, hand coordination and sensitive hand movements. It deals with hand injuries that require microscopic vascular nerve repair, tendon repair, and bone joint restoration. It also deals with trigger finger, polydactyly (6 fingers), syndactyly (fingers sticking), carpal tunnel (nerve congestion), hand deformities (tendon transfer) due to CP sequel.

Knee SURGERY, ARTROPLASTY AND ARTROSCOPIC APPLICATIONS
In the knee joint; Treatment methods such as closed (arthroscopic) or open surgery (knee prosthesis) in common diseases such as menusus rupture, ligament rupture, cartilage damage, joint narrowing, osteoarthritis.

ANKLE SURGERY AND ARTHOSCOPIC SURGERY
It deals with the treatment of diseases such as osteochondral damage in the talus dome region, impingement of the tibial distal end anterior (impingemen) synovitis and FHL tenosynovitis.
SHOULDER SURGERY, ARTROPLASTY ARTROPSCOPY AND ELBOW SURGERY
It deals with arthroscopic (closed) or open surgery of diseases such as shoulder joint dislocation, SLAP lesion (Biceps tendon injury), Impingement (tightening and pain due to bone elongation), Frozen shoulder (Frozen shoulder), Tennis elbow, Radius head dislocation.
HIP SURGERY ARTROPLASTY ARTROSCOPIC SURGERY
It deals with the treatment of diseases such as congenital hip dislocation, Impingement, (Bone tightness), Labral defect, Osteoconfral defect, Osteoarthritis (Calcification) with open surgery or closed (arthroscopic) surgery.
PEDIATRIC ORTHOPEDIC SURGERY
It deals with the treatment of diseases such as congenital hip dislocation, Perthes disease, Torticollis, Brachial plexus injury, PEV sequel.
ONCOLOGICAL ORTHOPEDIC SURGERY
It deals with benign or malignant tumors in one area of the skeletal system, such as bone, muscle, tendon, nerve, and joint.

GENERAL SURGERY

GENERAL SURGERY
Digestive System Surgery,
● Small Intestine, Large Intestine and Rectum
Diseases Surgery,
● Anal Region (Breech), Hemorrhoid Diseases
surgery,
● Breast Diseases, Breast Cancers
Surgery,
● Liver and Biliary Tract Diseases
surgery,
● Pancreatic Surgeries,
● Thyroid-Parathyroid Diseases Surgeries,
● Adrenal Gland Diseases Surgeries,
● Hernia Surgeries (Belly, Groin, Stomach etc.
Hernia),
● Spleen Surgery,
● Pilonidal Sinus (Hair Rotation) Treatment and
surgery,
● Varicose Veins Surgery,
● Skin – Subcutaneous Masses Surgery,
● Bariatric and Metabolic Surgery,
Surgical Treatment of Obesity,
● All Clinical Surgical Applications.
Oncological Surgery Operations
Thyroid Cancer Surgery,
● Esophageal Cancer Surgery,
● Stomach Cancer Surgery,
● Small and Large Bowel Surgery,
● Colon Cancer Surgery,
● Pancreatic Cancer Surgery,
● Gallbladder and Tract Cancer Surgery,
● Liver Tumor Surgery.
Closed Surgery (Laparoscopic Surgery)
Laparoscopic Surgeries for Diagnostic Purposes,
● Gallbladder Closed Surgery,
● Obesity Closed Surgery,
● Hernia Closed Surgery,
● Liver Closed Surgery,
● Spleen Closed Surgery,
● Stomach Closed Surgery,
● Pancreatic Closed Surgery,
● Small and Large Bowel Closed Surgery,
● Appendix Closed Surgery,
● Adrenal Gland Closed Surgery.
Endoscopic Surgeries
Nutritional Gastric Catheter (PEG)
Placing,
● Stomach Balloon Placement,
● Interventional Transactions,
● Endoscopy,
● Colonoscopy, Sigmoidoscopy,
● Rectoscopy.

OBASITY AND METABOLIC SURGERY

TUBE STOMACH

What is Tube Stomach Surgery (Stomach Reduction Surgery)?

Tube Stomach Surgery (Sleeve Gastrectomy): It is a restrictive obesity and metabolic surgery method. The purpose of this method is to decrease the capacity of the stomach in volume. 80% of the stomach is removed by laparoscopic surgery by stapling a portion as far as the width of the esophagus. It is also called tube stomach surgery, tube stomach surgery or stomach reduction surgery due to the shape of the stomach left behind.

Tube Stomach Surgery (Stomach Reduction Surgery) Technique

Tube stomach surgery (Stomach Reduction Surgery) is performed under general anesthesia by laparoscopic method. Tube stomach surgery (Stomach Reduction Surgery) can be performed through 5 holes or single hole.

After the vessels of the stomach are separated, a tube is inserted into the stomach and the stomach is cut from a tube adjacent by a tool called stapler. The stomach is taken out through the hole in the abdominal wall. After bleeding and leakage control is done, the tube is pulled and the cut part of the stomach is sewn again. No drain is left in the abdomen or nose after tube stomach surgery (Stomach Reduction Surgery).

What are the advantages of tube stomach surgery (stomach reduction surgery)?

It does not disrupt the anatomical structure and natural food flow direction,
• Technique is simpler than other methods, complication rates are lower.
• Anatomy, intestinal structure, physiological flow direction of foods are not disturbed,
• Dumping syndrome and no ulcers,
• The secretion of appetite hormone called Ghrelin decreases, appetite decreases from the first day,
• There is no need for vitamin-mineral supplements for life.
• In any case, the entire stomach can be visualized with the help of endoscopy.
• Since the pylor muscle of the stomach is protected, a feeling of clogging and saturation occurs.

What are the Disadvantages of Tube Stomach Surgery (Stomach Reduction Surgery)?

It is less than other obesity and metabolic surgery surgeries.

These;

It is irreversible.
• The effect of losing weight and saving from comorbid diseases is weaker than gastric bypass and duodenal switch, which cause absorption disorder.

Who Can Have Tube Stomach Surgery (Stomach Reduction Surgery)?

Those between the ages of 18-65,
• In special cases and if the board decides, under the age of 18 and over 65, tube stomach surgery may also occur.
• Those with a body mass index above 35,
• Body mass index is between 30-35 and additional weight-related diseases (hypertension, cholesterol, diabetes, sleep apnea, heart failure, metabolic syndrome etc.)
• Those who try and fail other treatment methods to lose weight,
• Those who are able to handle surgery and anesthesia,

They may have tube stomach surgery (Stomach Reduction Surgery).

Who Cannot Take Tube Stomach Surgery?

Those who have serious and untreated psychiatric illness,
• Those who have substance or alcohol dependence,
Patients with severe hormonal and endocrine disorders,
• Patients who will not be able to make a necessary lifestyle change and diet after surgery,
• Those with disease that will prevent receiving anesthesia,
Cancer patients,
• Those who have planned pregnancy within 1 year in the near future,

They cannot have tube stomach surgery (Stomach Reduction Surgery).

What are the risks of tube stomach surgery?
Risk Ratios of Tube Stomach Surgery Published in the International Literature;

The risk of leak complications is 1-2% in a good center (1-2 percent)
Bleeding risk 2-3% (2-3 percent)
The risk of death passes in the literature as 0.1% – 0.2% (1-2 per thousand).

These risks are much higher in obstructive surgery operations such as Stomach Bypass surgery, Ileal Interposition, Transit Bipartition, SADI-S, and more complicated surgeries.
Tube Stomach Surgery Price is How Many Lira? How Does the Price Change?

Hospital segment is the leading factor affecting the prices of obesity and metabolic surgery surgery. What does this mean? Hospitals, just like hotels, are classified as A +, A, B, C according to some measures. Classification in hospitals is made according to the clinical department, technology, equipment, materials and imaging and laboratory types and equipment they host.

A + hospitals are a very limited number of hospitals that have the highest level of equipment and team and allow intervention, including any angio, in a sudden situation. Our interbariatrics team prefers Liv Hospital Ulus hospital in A + segment for surgery service.

The second factor affecting the price is the length of hospital stay. The hospitalization price range is very variable according to the hospital segments. Especially, monitoring in intensive care is a factor that significantly increases the cost. It should definitely be learned what is included in the package price given to the patient before the operation.
Sometimes it is very important whether the dietician package in the service you will receive at the prices given in accordance with the doctor’s fee or the examination fee. Because the price that seems appropriate may not be very economical when you add the fees you will pay later.
Consisting of associate professor or professor doctors in the field before surgery;

Cardiology,

Chest Diseases,
• Endocrine,
Expert Psychologist and
• Routine examination and preparation examinations with a team of specialist dieticians,
After Tube Stomach Surgery (Stomach Reduction Surgery); 1 night intensive care unit follow-up and 2 nights in the private room with the accompanying person,

After discharge;
5-year expert dietitian follow-up,
• Including doctor checks for 5 years, excluding examinations to be requested during your checks,
Unless otherwise stated, monthly obesity group support therapy meetings are included.

Revision Surgery

Sometimes things may not go as expected.
At this point, ‘Revision Surgery’ comes into play.
Revision surgery; is the name given to the second operation performed if any operation does not result in a patient-related or technical problem. Today, the most revision surgery; The “stomach clamp”, which we call the stomach band, is removed due to insufficient weight loss and complications, and the operation is converted into another obesity surgery.
So, do people who have stomach reduction surgery (Sleeve Gastrectomy) undergo revision surgery?
For 18 months, revision surgery may be needed if the person cannot establish healthy eating habits, cannot provide sufficient weight loss, or regain weight gain. As a result of technical inadequacies (the operation was not performed optimally), an inexperienced surgeon or revision surgery is not used when sufficient weight loss is not achieved.
We should know that revision surgery is a more difficult and demanding surgical intervention than the first surgery. The first surgery that you are in can be converted into many different operations with revision surgery.

Stomach reduction surgery (Sleeve Gastrectomy); Re-Sleeve Gastrectomy, ie smaller stomach volume or By-pass type surgical procedures,
By-pass surgeries; They can be revised to many types of surgery, such as Roux-N Y Gastric Bypass or Duodenal Switch.
If your doctor is an experienced doctor who has undergone revision surgery, it will be beneficial to have your second surgery in the same doctor.

Gastric By-Pass

In these methods, basically, it is aimed that the food that is taken by cutting or without cutting a part of the stomach directly to the last parts of the stomach without going through all or a large part of the stomach, the duodenum and the first parts of the small intestine. These methods are also applied laparoscopically successfully today. In addition to surgical complications, metabolic problems are also higher in the long-term postoperative period compared to stomach tube surgeries. Weight loss is greater and can last up to 2 years. While it causes the need for more vitamin supplements, it also brings with it problems such as chronic diarrhea and bad breath.

COCHLEAR IMPLANT

The cochlear implant is an electronic medical device developed for people with severe or severe hearing loss. It works by converting sounds into electronic stimulation sent directly to the auditory nerve. This means that the sounds bypass the damaged parts of the ear.

Only your doctor or audiologist can determine if you are a candidate for a cochlear implant.

How does it work?

Conventional hearing aid captures sound, increases it and sends it through the normal ear. However, if the damage to your ear is too great, increasing the volume in this way will have no effect. The cochlear implant overcomes this problem by sending the signals directly to the auditory nerve. This means that, unlike conventional hearing aids, cochlear implants can pass the damaged areas of the ear. They capture, process and electronically stimulate the hearing nerve.

The cochlear implant consists of the outer part called the sound processor and the inner part called the cochlear implant.

The outer part is located behind the sound processor in the ear and allows the processor to be connected to the antenna. The antenna is magnetically attached to the skin directly above the interior.

The interior is a recipient placed on the skin above the temporal bone by surgical operation. The recipient has an electrode array placed in the cochlea.

The sound processor receives and digitizes the sound.
The antenna is magnetically attached to your skin and transfers digitalized sound from the sound processor to the implant receiver.
The magnetic implant receiver is placed directly under the skin under the antenna. It converts digital information into an electronic signal sent to the cochlea.
The electrode array is placed in the cochlea. Each electrode of the array corresponds to a signal frequency.
The hearing nerve is stimulated when the encrypted signal is transmitted to the corresponding electrode.
The brain receives the sound transmitted through the auditory nerve.

BONE MARROW TRANSPLANT

What Is a Bone Marrow Transplant?

A bone marrow transplant is a medical procedure performed to replace bone marrow that has been damaged or destroyed by disease, infection, or chemotherapy. This procedure involves transplanting blood stem cells, which travel to the bone marrow where they produce new blood cells and promote growth of new marrow.
Bone marrow is the spongy, fatty tissue inside your bones. It creates the following parts of the blood:

⦁ red blood cells, which carry oxygen and nutrients throughout the body
⦁ white blood cells, which fight infection
⦁ platelets, which are responsible for the formation of clots

Bone marrow also contains immature blood-forming stem cells known as hematopoietic stem cells, or HSCs. Most cells are already differentiated and can only make copies of themselves. However, these stem cells are unspecialized, meaning they have the potential to multiply through cell division and either remain stem cells or differentiate and mature into many different kinds of blood cells. The HSC found in the bone marrow will make new blood cells throughout your lifespan.
A bone marrow transplant replaces your damaged stem cells with healthy cells. This helps your body make enough white blood cells, platelets, or red blood cells to avoid infections, bleeding disorders, or anemia.
Healthy stem cells can come from a donor, or they can come from your own body. In such cases, stem cells can be harvested, or grown, before you start chemotherapy or radiation treatment. Those healthy cells are then stored and used in transplantation.

Why You May Need a Bone Marrow Transplant
Bone marrow transplants are performed when a person’s marrow isn’t healthy enough to function properly. This could be due to chronic infections, disease, or cancer treatments. Some reasons for a bone marrow transplant include:
⦁ aplastic anemia, which is a disorder in which the marrow stops making new blood cells
⦁ cancers that affect the marrow, such as leukemia, lymphoma, and multiple myeloma
⦁ damaged bone marrow due to chemotherapy
⦁ congenital neutropenia, which is an inherited disorder that causes recurring infections
⦁ sickle cell anemia, which is an inherited blood disorder that causes misshapen red blood cells
⦁ thalassemia, which is an inherited blood disorder where the body makes an abnormal form of hemoglobin, an integral part of red blood cells
What Are the Complications Associated with a Bone Marrow Transplant?
A bone marrow transplant is considered a major medical procedure and increases your risk of experiencing:
⦁ a drop in blood pressure
⦁ a headache
⦁ nausea
⦁ pain
⦁ shortness of breath
⦁ chills
⦁ a fever
The above symptoms are typically short-lived, but a bone marrow transplant can cause complications. Your chances of developing these complications depend on several factors, including:
⦁ your age
⦁ your overall health
⦁ the disease you’re being treated for
⦁ the type of transplant you’ve received
Complications can be mild or very serious, and they can include:
⦁ graft-versus-host disease (GVHD), which is a condition in which donor cells attack your body
⦁ graft failure, which occurs when transplanted cells don’t begin producing new cells as planned
⦁ bleeding in the lungs, brain, and other parts of the body
⦁ cataracts, which is characterized by clouding in the lens of the eye
⦁ damage to vital organs
⦁ early menopause
⦁ anemia, which occurs when the body doesn’t produce enough red blood cells
⦁ infections
⦁ nausea, diarrhea, or vomiting
⦁ mucositis, which is a condition that causes inflammation and soreness in the mouth, throat, and stomach

In Vitro Fertilization (IVF)

What Is In Vitro Fertilization?
In vitro fertilization (IVF) is a type of as

sistive reproductive technology (ART). It involves retrieving eggs from a woman’s ovaries and fertilizing them with sperm. This fertilized egg is known as an embryo. The embryo can then be frozen for storage or transferred to a woman’s uterus.
Depending on your situation, IVF can use:
your eggs and your partner’s sperm
⦁ your eggs and donor sperm
⦁ donor eggs and your partner’s sperm
⦁ donor eggs and donor sperm
⦁ donated embryos
Your doctor can also implant embryos in a surrogate, or gestational carrier. This is a woman who carries your baby for you.
The success rate of IVF varies. According to the American Pregnancy Association, the live birth rate for women under age 35 undergoing IVF is 41 to 43 percent. This rate falls to 13 to 18 percent for women over the age of 40.
Why Is In Vitro Fertilization Performed?
IVF helps people with infertility who want to have a baby. IVF is expensive and invasive, so couples often try other fertility treatments first. These may include taking fertility drugs or having intrauterine insemination. During that procedure, a doctor transfers sperm directly into a woman’s uterus.
Infertility issues for which IVF may be necessary include:
⦁ reduced fertility in women over the age of 40
⦁ blocked or damaged fallopian tubes
⦁ reduced ovarian function
⦁ endometriosis
⦁ uterine fibroids
⦁ male infertility, such as low sperm count or abnormalities in sperm shape
⦁ unexplained infertility
Parents may also choose IVF if they run the risk of passing a genetic disorder on to their offspring. A medical lab can test the embryos for genetic abnormalities. Then, a doctor only implants embryos without genetic defects.
How Do I Prepare for In Vitro Fertilization?
Before beginning IVF, women will first undergo ovarian reserve testing. This involves taking a blood sample and testing it for the level of follicle stimulating hormone (FSH). The results of this test will give your doctor information about the size and quality of your eggs.
Your doctor will also examine your uterus. This may involve doing an ultrasound, which uses high-frequency sound waves to create an image of your uterus. Your doctor may also insert a scope through your vagina and into your uterus. These tests can reveal the health of your uterus and help the doctor determine the best way to implant the embryos.

Men will need to have sperm testing. This involves giving a semen sample, which a lab will analyze for the number, size, and shape of the sperm. If the sperm are weak or damaged, a procedure called intracytoplasmic sperm injection (ICSI) may be necessary. During ICSI, a technician injects sperm directly into the egg. ICSI can be part of the IVF process.
Choosing to have IVF is a very personal decision. There are a number of factors to consider.
⦁ What will you do with any unused embryos?
⦁ How many embryos do you wish to transfer? The more embryos transferred, the higher the risk of a multiple pregnancy. Most doctors won’t transfer more than two embryos.
⦁ How do you feel about the possibility of having twins, triplets, or a higher order multiple pregnancy?
⦁ What about the legal and emotional issues associated with using donated eggs, sperm, and embryos or a surrogate?
⦁ What are the financial, physical, and emotional stresses associated with IVF?
How Is In Vitro Fertilization Performed?
There are five steps involved in IVF:
⦁ stimulation
⦁ egg retrieval
⦁ insemination
⦁ embryo culture
⦁ transfer

Stimulation

A woman normally produces one egg during each menstrual cycle. However, IVF requires multiple eggs. Using multiple eggs increases the chances of developing a viable embryo. You’ll receive fertility drugs to increase the number of eggs your body produces. During this time, your doctor will perform regular blood tests and ultrasounds to monitor the production of eggs and to let your doctor know when to retrieve them.
Egg Retrieval
Egg retrieval is known as follicular aspiration. It’s a surgical procedure performed with anesthesia. Your doctor will use an ultrasound wand to guide a needle through your vagina, into your ovary, and into an egg-containing follicle. The needle will suction eggs and fluid out of each follicle.
Insemination
The male partner will now need to give a semen sample. A technician will mix the sperm with the eggs in a petri dish. If that doesn’t produce embryos, your doctor may decide to use ICSI.
Embryo Culture
Your doctor will monitor the fertilized eggs to ensure that they’re dividing and developing. The embryos may undergo testing for genetic conditions at this time.
Transfer
When the embryos are big enough, they can be implanted. This normally occurs three to five days after fertilization. Implantation involves inserting a thin tube called a catheter inserted into your vagina, past your cervix, and into your uterus. Your doctor then releases the embryo into your uterus.
Pregnancy occurs when the embryo implants itself in the uterine wall. This can take 6 to 10 days. A blood test will determine if you’re pregnant.

What Are the Complications Associated with In Vitro Fertilization?

As with any medical procedure, there are risks associated with IVF. Complications include:
⦁ multiple pregnancies, which increases the risk of low birth weight and premature birth
⦁ miscarriage (pregnancy loss)
⦁ ectopic pregnancy (when the eggs implant outside the uterus)
⦁ ovarian hyperstimulation syndrome (OHSS), a rare condition involving an excess of fluid in the abdomen and chest
⦁ bleeding, infection, or damage to the bowels or bladder (rare)

What Is the Long-Term Outlook?

Deciding whether to undergo in vitro fertilization, and how to try if the first attempt is unsuccessful, is an incredibly complicated decision. The financial, physical, and emotional toll of this process can be difficult. Speak with your doctor extensively to determine what your best options are and if in vitro fertilization is the right path for you and your family. Seek a support group or counselor to help you and your partner through this process.

DEEP BRAİN STİMULATİON

Deep brain stimulation (DBS) is an elective surgical procedure in which electrodes are implanted into certain brain areas. These electrodes, or leads, generate electrical impulses that control abnormal brain activity. The electrical impulses can also adjust for the chemical imbalances within the brain that cause various conditions. Stimulation of brain areas is controlled by a programmable generator that is placed under the skin in the upper chest.

The DBS system involves three distinct components:

⦁ The electrode, or lead, is a thin, insulated wire inserted through a small opening in the skull and implanted into a specific brain area.

⦁ The extension wire is also insulated and passed under the skin of the head, neck and shoulder, connecting the electrode to the internal pulse generator (IPG).

⦁ The IPG is the third piece of the system and is usually implanted under the skin in the upper chest.

Conditions that are treated using DBS are:
Dystonia
Epilepsy
Essential tremor
Obsessive-compulsive disorder
Parkinson’s disease

Causes

DBS is a surgical intervention used to treat patients with movement disorders such as essential tremor, Parkinson’s disease and dystonia. It can also be used to control symptoms of obsessive-compulsive disorder and epilepsy. This procedure is utilized when medications are no longer effective for patients maintaining good quality of life.

These diseases affect hundreds of thousands of people worldwide. DBS has been used to treat over 160,000 people for various neurological conditions.

Symptoms

Each disease type has a variety of symptoms that patients may experience. Common ones are:
Dystonia

⦁ Involuntary muscle contractions occurring during specific actions (e.g. writing)
⦁ Muscle contractions worsen with stress, fatigue or anxiety

Epilepsy

⦁ Temporary confusion

⦁ A staring spell

⦁ Loss of consciousness

⦁ Uncontrollable jerking movements of arms or legs

⦁ Emotional responses such as fear, anxiety or déjà vu

Essential Tremor

⦁ Tremor occurring during daily activities like writing or drinking

Obsessive-compulsive Disorder

⦁ Fear of germs or contamination
⦁ Aggressive thoughts towards others or one’s self
⦁ Having things in symmetrical or in perfect order
⦁ Excessive cleaning or handwashing
⦁ Compulsive counting
⦁ Checking things repeatedly (e.g. oven is off, door is locked, etc.)

Parkinson’s Disease

Tremor
Bradykinesia – slowing down of movement
Stiffness
Abnormal walking

When & How to Seek Medical Care

DBS is used when medications are no longer effective for patients maintaining good quality of life. See your doctor if any of the above symptoms are persistent for an extended period to discuss if DBS is the right treatment.

Testing & Diagnosis

There is a multidisciplinary team of professionals including a neurologist, neurosurgeon, neuropsychologist and psychiatrist that may care for patients. Often patients with Parkinson’s disease or tremor may undergo testing of motor symptoms on and off medications to assess the severity of the disease. Epilepsy testing may include electroencephalography, including more advanced testing. Certain patients may undergo neuro-psychological evaluation during evaluation. Obsessive-compulsive disorder patients must complete Yale-Brown Obsessive Compulsive scale (YBOCs) testing.

Prior to surgery, patients undergo:

⦁ Blood and urine Tests

⦁ This helps identify toxins and abnormalities
⦁ MRI and/or CT Scans
⦁ Imaging can help doctors target the right area of the brain for symptom relief.
⦁ Medical Clearance

Candidates for DBS meet these criteria:

⦁ Symptoms are substantially reducing quality of life.
⦁ Symptoms are uncontrolled despite receiving the suitable dose of medications.
⦁ Side effects stemming from current medications cannot be tolerated

Treatment

Non-Surgical Treatments

Before being considered for surgical interventions such as DBS, doctors may consider any of the following treatments.
⦁ Medications
⦁ Physical Therapy

Surgery

Advantages

⦁ Can be performed on one or both sides of the brain, depending on symptoms.
⦁ The effects are reversible and can be customized individually for each patient’s clinical status.
⦁ Stimulation settings can be modified to diminish potential side effects and improve effectiveness over time.
⦁ The device can provide continuous symptom control 24 hours a day.
⦁ Patients who have undergone DBS can participate in other treatments, such as stem cell or gene therapy, when they become available.
Risks

In patients who are properly selected, DBS is safe and effective. Risks and potential side effects do exist, but they are generally mild and reversible.

Risks may include:

⦁ 1% risk of brain hemorrhage, including stroke
⦁ Infection
⦁ Device malfunction
⦁ Lack of benefit for certain symptoms
⦁ Headache
⦁ Worsening mental or emotional status
During stimulation, side effects may include:
⦁ Temporary tingling in the face or limbs
⦁ A feeling of pulling in muscles
⦁ Speech or vision problems
⦁ Loss of balance

GAMMA KNİFE

Gamma Knife® radiosurgery, also known as stereotactic radiosurgery, is a form of radiation used to treat brain disorders. Despite its name, this procedure does not involve a surgical incision into the brain. Also, the “blades” of the gamma “knife” are actually beams of highly focused gamma ray radiation. Up to 192 beams of radiation are precisely focused on the lesion/targeted area in the brain. Because the beams are so highly focused, there is little damage to the surrounding healthy tissue.
Compared with traditional surgery, Gamma Knife® radiosurgery does not require general anesthesia. It also avoids other risks and complications of surgery (such as bleeding and infection). There is also little or no post-treatment discomfort or pain. Gamma Knife® radiosurgery is usually performed as an outpatient procedure. Sometimes, however, patients may stay in the hospital overnight. Most patients can resume their usual activities in a day or two. Physical therapy or other rehabilitation is not needed.
What conditions does Gamma Knife® radiosurgery treat?
Gamma Knife® radiosurgery can treat several brain disorders, including:
⦁ Acoustic neuroma – a non-cancerous tumor that develops around the balance and hearing nerves that connect the inner ear with the brain
⦁ Arteriovenous malformations (AVMs) – abnormal, snarled tangles of blood vessels
⦁ Brain tumors (both cancer and non-cancer) – including pituitary adenomas, pinealomas, craniopharyngiomas, meningiomas, chordomas, chondrosarcomas, metastases, and glial tumors
⦁ Tremors due to essential tremor or Parkinson’s disease
⦁ Trigeminal neuralgia – an ongoing condition that affects a certain nerve in the face, causing extreme pain
⦁ Some types of epilepsy
The Gamma Knife® can be helpful in patients with brain lesions that cannot be reached by traditional surgery techniques and in those who are unable to undergo surgery due to their condition or age. It can also be combined with traditional surgery to prevent tumor regrowth. Because Gamma Knife® results occur slowly over time, this is not a procedure for conditions that need immediate treatment.