Treatments

Laser removal of varicose veins is a minimally invasive method of treating superficial vein insufficiency (i.e., varicose veins). The procedure involves closing ineffective venous trunks with thermal energy generated by a laser. The optical fiber of the laser device is inserted into the vein through a skin puncture. The procedure is conducted under local anesthesia and the patient can return home immediately after the procedure.

VeinOff is a method of gluing the veins with the use of a therapeutic agent – a tissue adhesive. During the procedure, a therapeutic agent is injected into the vessel. After the administration of a small amount of adhesive, the surgeon applies pressure to the injection site for about 2–3 minutes. The adhesion initiates local inflammation, which in a few weeks leads to fibrosis and complete closure of the dysfunctional vein. The procedure takes a few up to a dozen minutes and is performed during EVLT or sclerotherapy.

Mini-phlebectomy is a method of surgical removal of large, superficially located varicose veins. Small (2 to 3 mm) incisions are made to remove large, superficially located varicose veins with special surgical tools under local anesthesia. The incisions are usually so small that they do not require stitches, only sterile dressings.

Sclerotherapy is a method of vein closure with the use of a chemical sclerosant, which is a substance that once administered into the vessel causes swelling of the vascular wall and decrease in the flow, resulting in vessel fibrosis. The procedure is almost painless and anesthesia is usually not needed at all.

Vasculaze and Lumecca lasers are used for coagulation and closure of mild vascular lesions. During the procedure, a specially designed instrument head sends light impulses causing the blood vessels to disappear. Several procedures are necessary to achieve the desirable effect and the improvement in the treatment area is gradual.

Laser hemorrhoidoplasty is a minimally invasive method of treating hemorrhoids using a 1470 nm wavelength laser. The procedure is conducted under local anesthesia and the patient can return home immediately after the procedure.

The hemorrhoid sclerotherapy procedure is submucous injection of a chemical substance causing closure and constriction of the hemorrhoidal bundle vessels. As a result, hemorrhoids are reduced and pulled back into the anal canal and the bleeding subsides. The agent can be injected into all hemorrhoids during a single procedure.

The HemOff procedure consists of the injection of a substance from the cyanoacrylate family into the hemorrhoid. This small amount of glue initiates a local inflammation in the hemorrhoid, which in a few weeks leads to fibrosis and complete closure of the dysfunctional vein in the rectum. The procedure takes a few up to a dozen minutes.

The tension of the anal sphincter can be relieved by injecting botulinum toxin (“botox”). This substance that causes temporary muscle paralysis, which relieves tension. The toxin is diluted in saline solution and then administered to the sphincter muscle on both sides of the opening, sometimes also directly into the bottom of the wound. The effect of reduced tension of the sphincter muscle lasts for approximately 2 to 3 months and leads to a significant reduction in pain and accelerates the healing.

During fissurectomy, the fissure is excised with the enlarged skin fold and the sentinel pile. In case of high tension of the internal anal sphincter, the surgeon cuts through the muscle, which allows the wound to heal faster. The wound inside the anus is (optionally) sutured, leaving a few millimeters of the wound outside the anus with no sutures. Healing takes up to several weeks.

The procedure of rectal lesion resection is most often conducted under local anesthesia with 1% lidocaine solution. The lesion is resected radially, so that the wound descends towards the anal canal, unless the lesion is located deep inside the canal. The lesion can be removed with a surgical knife or by electrocoagulation. The wound usually does not need to be sutured, however sometimes it may be necessary if it is vast and bleeds profusely. The healing process takes 1–2 weeks and usually it is not associated with pain. If there are more lesions, they should be removed individually several weeks apart to avoid leaving many vast wounds in the rectum at one time. Each excised lesion is sent for histopathological examination.

The incision of the hematoma marginal clot is performed under infiltration anesthesia with a 1% lidocaine solution. The solution is administered subcutaneously around the lump (marginal thrombus) with a syringe and a small needle. A small incision is made over the lump, radially from the anus, and the surgeon uses a special tool to remove the clotted venous plexuses. The wound usually does not require stitching and heals by itself within a few days. The procedure provides immediate relief and the inflammation is resolved quickly.

TEST

The surgery for carpal tunnel syndrome involves making an incision in the skin on the palmar side of the wrist in the area of the flexor retinaculum and dissecting the tissues until the retinaculum is visible. The retinaculum is cut or (much less frequently) a Z-cut is made, which allows the retinaculum to be lengthened without cutting through it. The procedure takes up to 30 minutes and the patient can leave the facility immediately after the procedure.

Skin and subcutaneous tissue lesions are quite common. They are usually benign changes such as pigmented lesions, lipomas, atheromas, fibromas, or warts. They need to be removed for esthetic reasons but also because they are prone to recurrent inflammation and infections. The most serious threat are cancerous lesions, which may resemble or result from benign lesions (neoplastic transformation, malignancy). Skin lesions are removed under local anesthesia. After excision, the wound is stitched to leave a minimally visible scar. After the procedure, sterile dressing is applied on the wound and the patient may go home. Each excised lesion is sent for histopathological examination.

The doctor numbs the finger and disinfects both the skin and nail, and the removes the edge of the nail from the fold along with the nail with a surgical tool. The nail bed is trimmed marginally to leave a small gap between the nail and the fold. Then, an 88% phenol solution is administered to chemically denaturate the exposed matrix so the nail can grow narrower and will not grow into the nail fold. Next, a dressing is applied and sometimes stitches are necessary. Any stitches should be removed within the time recommended by the doctor, usually within 7 to 10 days. It takes about a month for the nail to heal, but function is restored after just a few or a dozen days.

The patient uncovers the neck and removes all jewelry. Then the patient lies on the couch, head tilted back. The doctor determines the optimal biopsy site using ultrasound guidance. During the puncture, the patient must not move, talk, or swallow saliva. Biopsy sample collection is painless and does not require anesthesia.

A biopsy allows for the evaluation of cells, and not entire tissue. The final diagnosis of thyroid diseases is based on the overall clinical picture, i.e., a clinical interview, examination, thyroid biopsy and cytology, and other additional tests.

In some cases, the biopsy samples may not contain thyroid cells, or contain too few of them to make a clear diagnosis. This is called a ”non-diagnostic biopsy” by pathologists (doctors who evaluate the biopsy sample) but it does not mean “poorly performed”.

The doctor performs the biopsy with the patient supine or slightly on their side. The biopsy site is disinfected before the procedure. The lesion is located under ultrasound guidance and 2% lignocaine solution is injected for local anesthesia. Then an approximately 1.5 to 3 mm diameter needle is inserted into the target site and the trigger mechanism is activated to collect a tissue sample. This is repeated several times to obtain the appropriate amount of material. The collected material is sent for histopathological evaluation, and the biopsy site is cleaned, disinfected, and wound dressing is applied. Core needle biopsy of the breast takes about 15 to 20 minutes to complete.

The doctor performs the biopsy with the patient supine or slightly on their side. The biopsy site is disinfected before the procedure. The lesion is located under ultrasound guidance and 2% lignocaine solution is injected for local anesthesia. Then an approximately 2 to 3 mm diameter needle is inserted into the target site and the vacuum mechanism is activated to collect a tissue sample through a special groove. The collected material is sent for histopathological evaluation, and the biopsy site is cleaned, disinfected, and wound dressing is applied. Core needle biopsy of the breast takes about 15 to 20 minutes to complete.