Special Services
in alphabetical order
Vitrectomy
Vitrectomy is a surgical procedure performed to treat a variety of retinal and vitreous disorders. During this surgery, the vitreous, a gel-like substance that fills the middle of the eye, is removed and replaced with a sterile solution. This allows the surgeon to access and repair the retina, the light-sensitive layer at the back of the eye that converts light into nerve signals sent to the brain.
The surgery is often performed when the vitreous is clouded by blood, scar tissue, or other damage, which can block light from reaching the retina and impair vision. Removing the vitreous also reduces tension on the retina and allows repair of retinal tears or other damage.
During vitrectomy, a retinal specialist ophthalmologist uses tiny instruments to cut and suction the vitreous. The retina may then be repaired, and the eye may be filled with air, silicone oil, or gas to hold the retina in place during healing.
Who Needs a Vitrectomy?
Vitrectomy may be recommended for patients with:
Diabetic retinopathy
Retinal detachment
Vitreous hemorrhage
Severe eye injuries
Intraocular infections
Macular holes (central retina)
Macular wrinkles
Complications after cataract surgery
If left untreated, these conditions can cause vision loss or blindness. In some cases, emergency vitrectomy is required, such as after trauma or severe infection.
Potential Risks and Complications
While vitrectomy is generally safe and successful, possible risks include:
Infection
Bleeding inside the eye
Increased intraocular pressure
Retinal detachment or tears caused by surgery
Accelerated cataract formation
Eye movement problems
Changes in vision or refractive errors
In some cases, a second surgery may be required if the initial procedure does not fully correct the problem. Overall, vitrectomy has a success rate above 90%, and serious complications are relatively rare.
Preoperative Preparation
Before vitrectomy:
Your ophthalmologist will perform a detailed retinal examination
Eye ultrasound may be needed to assess the retina
You may need to fast on the morning of surgery
Certain medications may need to be temporarily stopped
How Vitrectomy Is Performed
Vitrectomy may be done under local anesthesia with sedation or general anesthesia, depending on the patient and surgeon’s recommendation:
The surgeon makes small incisions in the sclera (white part of the eye).
The vitreous and any scar tissue or foreign material are removed.
Additional procedures, such as laser treatment, may be used to repair retinal tears.
The vitreous is replaced with air, silicone oil, or a sterile fluid to support the retina.
Incisions may be sutures that dissolve naturally, and antibiotic ointment is applied before bandaging the eye.
Postoperative Care
Most patients go home the same day, but should arrange for someone to drive them.
Follow all ophthalmologist instructions regarding eye drops and hygiene.
Some discomfort is normal; over-the-counter pain medication may be used.
An eye patch may be required for 1 or more days.
If a gas bubble was used in the eye, follow special positioning instructions (e.g., face-down posture) and avoid air travel until cleared by your doctor.
Rhinoplasty (Nose Surgery)
Rhinoplasty is a surgical procedure that reshapes the cartilage and bone of the nose to improve its appearance and proportion with the face. Patients may choose rhinoplasty for cosmetic or aesthetic reasons, including:
Reducing or increasing the size of the nose
Changing the angle of the nose
Smoothing or straightening the bridge of the nose
Refining the tip of the nose
Adjusting the size of the nostrils
Correcting a drooping tip
Addressing bumps, depressions, or other irregularities
Preparing for Rhinoplasty
Before surgery, the surgeon will:
Review your medical history to identify conditions that may increase surgical risk (e.g., bleeding disorders such as hemophilia).
Discuss your aesthetic goals, taking into account your facial structure and preferences.
Take photographs of your nose from different angles to guide the surgery.
Rhinoplasty is highly individualized, tailored to both your desired appearance and facial harmony.
Rhinoplasty vs. Other Nose Surgeries
Rhinoplasty specifically focuses on the appearance of the nose. Other nose surgeries, such as septoplasty, correct internal structures like a deviated septum, which may affect breathing rather than appearance.
Possible Risks and Complications
Like any surgery, rhinoplasty carries general risks such as:
Infection
Bleeding
Adverse reactions to anesthesia
Specific risks for rhinoplasty include:
Breathing difficulties
Nosebleeds
Numbness in the nose
Asymmetry of the nose
Surgical scarring
Important: Avoid medications that affect blood clotting (e.g., ibuprofen or aspirin) for two weeks before and after surgery to reduce the risk of excessive bleeding.
Recovery After Rhinoplasty
Nasal bones typically heal within 6 weeks, during which activities that may impact the nose should be minimized.
Sleep on your back to prevent pressure on the nose, reduce swelling, and make breathing easier.
Intranasal tampons, used to control bleeding and swelling, are usually removed 2–3 days after surgery.
Rhinoplasty can provide both functional and aesthetic improvements, but following your surgeon’s instructions before and after surgery is crucial for optimal results and minimizing complications.
Kidney Transplantation
In most cases of kidney transplantation, the patient’s original kidneys are not removed. The new kidney is implanted in a different location, typically in the lower abdomen. A successful transplant can significantly improve quality of life, reduce dependence on dialysis, and reverse the symptoms of uremia, such as elevated blood urea and creatinine levels.
Living Donor Evaluation and Selection
Selecting a suitable living donor involves several steps:
Psychological assessment – Ensures the donor is mentally prepared for surgery.
Blood type compatibility – ABO compatibility is essential to prevent transplant rejection. Rh factor (positive or negative) is not critical.
Genetic evaluation – Relatives are screened for hereditary kidney diseases.
Imaging studies – Typically, the left kidney is chosen due to its longer vein, which facilitates transplantation.
Immunological testing – A lymphocyte cross-match test ensures compatibility between donor and recipient.
Kidney Donation Surgery
The donor surgery can be performed using either open surgery or laparoscopic techniques:
Open surgery: A small incision is made on the donor’s side, and the kidney is removed, preserved on ice, and transferred to the recipient.
Recipient surgery: The surgeon makes an oblique incision in the lower abdomen, then connects the artery, vein, and ureter of the transplanted kidney to the recipient’s blood vessels and bladder.
Signs of Kidney Transplant Rejection
Transplant rejection may present with the following symptoms:
Stiffness or tenderness in the transplanted kidney
Fever
Swelling of the body
Rapid weight gain
Increased blood pressure
Decreased urine output
Elevated blood creatinine
Acute rejection (early after surgery) may require removal of the transplanted kidney.
Chronic rejection usually does not require kidney removal unless complications such as infection occur.
Postoperative Care
Proper care after kidney transplantation is essential for recovery and long-term success:
Avoid lifting heavy objects or strenuous activity for 6–8 weeks.
First 2–3 months: do not lift more than 9 kg
4–6 months: do not lift more than 18 kg
Sexual activity may be resumed 1 month after surgery; women should avoid pregnancy for 1 year.
Breastfeeding is not recommended while on immunosuppressive medications.
Avoid tight clothing or belts that may compress the surgical area.
Take prescribed immunosuppressive drugs to prevent rejection, while being aware of an increased risk of infection or certain cancers.
Maintain strict personal and environmental hygiene, including frequent handwashing.
Women should undergo regular Pap smears to monitor for cervical cancer.
When to See a Doctor Immediately
Contact your healthcare provider if any of the following occur:
Fever of 37.3°C (99.1°F) or higher
Flu-like symptoms
New pain around the transplant site
Sudden weight gain (≥1 kg within 24 hours)
Swelling or fluid accumulation in the body
Noticeable decrease in urine output
A kidney transplant can dramatically improve quality of life, but careful follow-up, adherence to medications, and prompt attention to symptoms are critical for long-term success.
Gastric Sleeve Surgery
Gastric sleeve surgery is a type of weight loss surgery designed to reduce the size of the stomach. During this procedure, approximately 70–80% of the stomach is removed, leaving only 20–30% of the original stomach. This smaller stomach limits food intake, helping patients feel full sooner and reducing overall calorie consumption.
Purpose of Gastric Sleeve Surgery
The main goal of gastric sleeve surgery is weight loss by reducing stomach volume. Unlike procedures that bypass part of the digestive tract, gastric sleeve surgery works by:
Limiting the amount of food the stomach can hold
Reducing hunger by decreasing the secretion of ghrelin, the “hunger hormone”
This helps patients eat smaller portions while still feeling satisfied, leading to sustainable weight loss.
Expected Weight Loss
Patients typically lose 50–70% of their excess weight after gastric sleeve surgery. Some individuals may achieve even higher weight loss, up to 80% of excess body weight, which is difficult to achieve safely with other methods.
Additional Benefits
Reduces appetite and feelings of hunger
Minimally invasive, as it is performed laparoscopically
No strict dietary restrictions required
Minimal scarring
Short recovery period
Improves obesity-related health conditions, including diabetes, hypertension, and sleep apnea
Who is Eligible?
Gastric sleeve surgery may be suitable for individuals who:
Have a body mass index (BMI) of 40 or higher
Have a BMI of 35 or higher with severe obesity-related health conditions
Are in generally good health
Have been unsuccessful with other weight loss methods
Preoperative Preparation
Proper preparation before surgery is crucial for safety and success:
Medical tests and imaging
Following a preoperative diet
Avoiding smoking and alcohol
Stopping certain medications (e.g., blood thinners, aspirin)
Taking prescribed medications
Psychological counseling to ensure readiness
How the Surgery is Performed
Gastric sleeve surgery is performed under general anesthesia using laparoscopic techniques, which involve several small incisions instead of a large open surgery. The steps include:
Administering anesthesia
Making small abdominal incisions (1–2 cm)
Expanding the abdomen for laparoscopic instruments
Inserting a camera to guide the surgery
Cutting and removing a portion of the stomach
Stapling the remaining stomach
Checking for leaks along the staple line
Removing instruments and closing the incisions
The procedure typically takes 30 minutes to 2 hours, depending on the complexity.
Recovery and Postoperative Care
After surgery, patients are usually monitored in a recovery room before being transferred to a hospital ward. Standard hospitalization is one night. At home, patients must follow post-surgical guidelines, including:
Following the surgeon-recommended diet for about a month
Gradually reintroducing solid foods
Attending follow-up appointments to monitor progress
Possible Side Effects and Complications
As with any surgery, gastric sleeve surgery carries some risks, though serious complications are rare. Possible side effects include:
Hair loss (temporary)
Wound infection (rare)
Bleeding
Gastrointestinal symptoms such as nausea, vomiting, or diarrhea (sometimes called “dumping syndrome”)
Corneal Transplant (Keratoplasty)
A corneal transplant, also called keratoplasty, is a surgical procedure in which a damaged or diseased cornea is replaced with a healthy donor cornea. The donor tissue is usually obtained from a deceased individual with no known infectious or serious diseases. This surgery is performed by an ophthalmologist, often under local or general anesthesia, depending on the patient’s condition.
Types of Corneal Transplants
Standard corneal transplant – Replaces the damaged cornea with donor tissue.
Artificial cornea transplant (keratoprosthesis) – Used when the patient’s corneal stem cells are severely damaged or when previous donor transplants have failed. An artificial cornea is implanted instead of human tissue.
Who Can Benefit from a Corneal Transplant?
Corneal transplantation may be recommended for patients with:
Corneal scars from injury or infection
Scratches or thinning of the cornea
Keratoconus
Cloudiness or swelling of the cornea
Hereditary or congenital eye disorders
Vision problems following previous eye surgeries
How the Surgery Is Performed
Anesthesia: The patient receives local anesthesia via injection around the eye, often combined with anesthetic eye drops to prevent pain and minimize eye movement.
Eye preparation: A lid speculum keeps the eyelid open during surgery.
Cornea replacement: The surgeon measures the thickness of the cornea and removes the damaged tissue, replacing it with donor or artificial corneal tissue.
Postoperative care: Stem cells or additional therapies may be used to support healing and reduce the risk of rejection.
Preoperative Care
Patients are advised to:
Fast for 6–8 hours before surgery
Bathe the day before the procedure
Inform the medical team of current medications
Maintain calmness and mental preparedness
Postoperative Care
Proper care after surgery is crucial for a successful outcome and includes:
Using an eye shield for 2–3 weeks
Correct sleeping positions to protect the eye
Taking prescribed medications as directed
Avoiding exposure to polluted air, heavy work, and eye strain
Refraining from makeup or rubbing the eyes
Recognizing Signs of Corneal Graft Rejection
Early detection of graft rejection is critical. Symptoms may appear weeks, months, or even years after surgery and include:
Decreased vision
Eye pain or discomfort
Redness of the eye
Increased sensitivity to light
If rejection occurs, timely intervention by an ophthalmologist can save the graft. In some cases, a second transplant may be necessary.
Recovery and Vision After Surgery
Vision may be blurred in the days immediately following surgery
Full recovery and adaptation to the new cornea can take several months to a year
Many patients experience a reduction in nearsightedness or astigmatism, though glasses may still be needed
Possible Complications
Although corneal transplantation is generally safe and highly successful, potential complications include:
Graft rejection (occurs in about 10% of patients)
Infection or bleeding
Increased intraocular pressure
Corneal swelling
Clouding of the lens
Retinal detachment
When to Contact a Doctor
Seek immediate medical attention if you experience:
Sudden decrease in vision
Severe or persistent eye pain
Redness, swelling, or inflammation
Sudden pain above the eyebrows
Sensitivity to light
Feeling of a foreign object in the eye
Bone Marrow (Stem Cell) Transplant
A bone marrow transplant, also known as a stem cell transplant, is a medical procedure used to replace damaged or destroyed bone marrow with healthy stem cells. This treatment is often associated with cancer care and has been especially effective in treating leukemia, lymphoma, multiple myeloma, and neuroblastoma. Research is ongoing to expand its use to other cancers.
Why is a Bone Marrow Transplant Needed?
Chemotherapy and radiation therapy are essential in treating many cancers, but they can also damage the bone marrow, the tissue responsible for producing blood cells. A bone marrow transplant helps:
Restore healthy blood cell production after high-dose chemotherapy or radiation
Enhance the body’s ability to fight residual cancer cells, as transplanted cells can attack remaining cancerous cells
What Are Stem Cells?
The stem cells used in these transplants are hematopoietic stem cells, which are responsible for producing blood cells. These are different from the fetal stem cells sometimes mentioned in the media. Hematopoietic stem cells are collected either from the patient’s own body or from a compatible donor.
Who Is Eligible for a Stem Cell Transplant?
Stem cell transplants are not suitable for all patients. Eligibility is determined by:
Type and stage of cancer
Previous treatments and overall health
Genetic and laboratory tests
Potential risks and benefits
Your medical team will carefully evaluate your condition to determine if the procedure is appropriate.
Sources of Stem Cells
Stem cells for transplantation can come from:
Autologous transplant – Stem cells collected from the patient before chemotherapy or radiation, frozen, and reintroduced after treatment.
Allogeneic transplant – Stem cells from a compatible donor, usually a sibling.
Syngeneic transplant – Rare, from an identical twin.
Matched unrelated donor (MUD) – From a donor found through a bone marrow registry.
Umbilical cord blood – Stem cells collected from the umbilical cord or placenta after birth, often used for children due to limited cell quantity.
Compatibility is determined through HLA (human leukocyte antigen) testing to reduce the risk of rejection.
What Happens During the Transplant?
After completing chemotherapy or radiation therapy:
Collected stem cells are thawed and infused into the patient through an IV, similar to a blood transfusion.
The infusion is generally painless and takes about 1–5 hours.
Over time, the transplanted stem cells migrate to the bone marrow and begin producing healthy blood cells.
Summary
Bone marrow transplantation is a life-saving treatment for patients with certain cancers. It allows the body to regenerate healthy blood cells, helps fight residual cancer, and improves long-term outcomes when performed under expert medical supervision.
Arthroplasty and joint replacement
Arthroplasty, also known as joint replacement surgery, is a procedure in which the damaged surfaces of a joint are removed and replaced with artificial components. This surgery aims to restore joint function, reduce pain, and improve mobility in patients with severely worn or damaged joints.
In essence, arthroplasty reconstructs the joint by replacing its surfaces. When a joint is significantly damaged, an artificial joint (prosthesis) can be implanted to restore proper function.
Common Indications for Joint Replacement
Joint replacement may be recommended in cases of:
Severe osteoarthritis or rheumatoid arthritis
Joint damage from trauma or fractures
Untreated ligament injuries causing instability and joint destruction
Intra-articular infections
Bone or soft tissue tumors affecting the joint
Certain types of synovitis, such as those associated with hemophilia
When is Knee Joint Replacement Needed?
Knee replacement is considered when the cartilage in the knee is worn out, causing bones to rub against each other. This leads to:
Pain and stiffness
Progressive joint damage
Reduced mobility
Failure of non-surgical treatments such as medication or physical therapy
Preoperative Evaluation
Before joint replacement, patients typically undergo:
Imaging studies: X-rays, CT scans, or MRI of affected and adjacent joints
Laboratory tests: Blood work for anemia, infection, inflammation, coagulation, blood-borne diseases, and blood typing
Specialist consultations: Anesthesia, cardiology, internal medicine, nephrology, infectious disease, or neurology assessments as needed
Risks and Complications
Joint replacement is generally safe, especially with modern prosthetics, skilled surgeons, and proper postoperative care. Complications occur in 3–5% of cases and can usually be managed if detected early. Common risks include:
Infection and bleeding
Blood clots (venous thromboembolism) and pulmonary embolism
Loosening or dislocation of the prosthesis
Ligament or bone injury around the joint
Nerve or vascular damage
Skin necrosis or allergic reactions to prosthetic materials
Postoperative Care
Successful outcomes depend not only on surgical technique and prosthesis quality but also on postoperative care, including:
Proper wound care and dressing management
Safe bathing techniques
Timely removal of stitches or staples
Balanced nutrition and medications (painkillers, anti-inflammatories, anticoagulants, antibiotics)
Early physiotherapy and joint exercises under supervision
Gradual weight-bearing using crutches, walkers, or braces as recommended
Home safety measures to prevent falls
Follow-up with the surgeon before dental procedures or if any infection occurs
Recovery Timeline (Approximate)
Hospitalization: 1–4 nights, depending on tests and consultations
Surgery duration: ~1 hour per joint, plus preparation and recovery time
Walking with assistance: 1–2 days post-surgery
Weaning off crutches/walker: Days to months, depending on strength and other joints
Desk work: After a few weeks
Light exercise and heavy activity: After a few months
Driving: ~1.5–2 months
Suture removal: 2–3 weeks
Physiotherapy: Until full recovery and muscle strength are restored
Timing for Joint Replacement
Joint replacement is recommended when:
Pain and functional limitation persist despite conservative treatments
Walking is difficult, and quality of life is significantly affected
Delaying surgery in severe cases can lead to:Dysfunction in adjacent joints
Muscle weakness and falls
Increased risk of fractures
Progressive immobility, depression, and secondary health conditions (obesity, diabetes, hypertension)
Knee Joint Replacement Procedure
Knee replacement involves reconstructing the joint surfaces of damaged bones. Depending on the patient’s condition:
Partial replacement: Only the damaged surfaces are replaced
Total replacement: All joint surfaces are reconstructed to restore alignment, mobility, and stability