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Frequently Asked Questions

Thyroid Surgery : Thyroidectomy

  1. Will I have a scar on my neck?

    Yes. But the incisions during surgery are made in such a way that they blend with the natural neck skin crease. Your scar will almost disappear in about 6 months unless there is a complication or keloid formation.

  2. Will I need medications post surgery related to thyroid?

    Yes. Depending on the pathology you will be asked to take medications to either suppress or enhance thyroid functions. Most of these medicines are taken for a lifetime. A calcium supplement may be given for a temporary period too.

  3. What are the major risks involved?

    The most major complications are those of damage to the recurrent laryngeal nerve (loss or change of voice) and damage to the parathyroid glands which are located close to the thyroid gland in which case you will require a lifelong supplementation of calcium. A calcium deficiency temporarily post surgery is fairly common and is easily manageable when you are under observation.

  4. Do I need a Total Thyroidectomy or a Lobectomy?

    When a diagnosis of cancer is known BEFORE the operation a total thyroidectomy is warranted. If there is not a clear diagnosis at the time of the operation half of the thyroid may be removed (lobectomy) for a final diagnosis. If cancer is found after the initial operation, reoperation depends on what the final pathology shows.

  5. What is Frozen Section and when is it used?

    Frozen section is a biopsy done during the operation. It is useful if you have had a suspicious biopsy prior to the operation or if a lymph node is found during the operation that does not appear to be normal. The frozen section can then be used to determine a diagnosis of cancer. If cancer is diagnosed, then a total thyroidectomy and possible removal of surrounding lymph nodes would be indicated. Frozen section is NOT a substitute for biopsy or may be indeterminate.

  6. How do I prepare for the surgery?

    You will be assessed by a physician. If you are on any blood thinners like aspirin then you must inform the physician and stop them accordingly.

  7. For how many days will I be hospitalized ?

    Most patients require about 2 days in the hospital including day of surgery if the post op period is smooth.

  8. What about my biopsy reports?

    Your biopsy results will be ready in 5-7 business days. You will be informed and asked to collect the same.

Surgery for Advanced cancer of the Larynx- Total Laryngectomy

  1. Will I always have to breathe through this opening?

    Yes, this is your new airway and you will breathe as naturally as you always have without thinking about it. You may initially have a lot of mucous and coughing, but you will get comfortable gradually.

  2. Can I use a shower?

    Shower aids are available to prevent water going into the stoma when you have a shower.

  3. What effects can I expect after total laryngectomy?

    After a laryngectomy, the air you breathe in through the stoma goes directly into the lungs and is no longer warmed and moistened by the nasal passages. The cooler, dry air going into the throat can irritate the lining of the throat and lungs. This can increase the production of mucus (phlegm) and may cause coughing.

    It’s very important to keep the laryngectomy stoma covered with a stoma cover or filter. It’s also important to avoid getting any liquid into the stoma.

    You won’t be able to sniff or blow your nose. When you cough, the mucus will be coughed up through the tracheostomy, not through your mouth.

  4. Will I be able to smell and taste again?

    After a total laryngectomy, your sense of smell and taste may be reduced. This can go back to normal after a few months, although some people may have long-term problems. You may be able to have some sense of smell by learning the ‘polite yawning technique’, where you yawn with closed lips. This draws air in through the nose, allowing you to smell. It can also improve your sense of taste.

  5. Will I be able to work again?

    Many laryngectomees have returned to their former jobs. The answer depends on many factors: your age, your health and the type of work you have been doing. The most important factor is YOU - your determination to recover and do what you feel is best for YOU.

Voice Restoration after Laryngectomy with Valve Prosthesis: TEP and voicing

  1. When can I get a TEP?

    In this practice, the TE puncture is created at the time of the laryngectomy surgery. After a period of sufficient healing (typically 2 weeks), the prosthesis is placed in the office. In the event you do not receive a TE puncture during your surgery (usually due to more extensive surgery/reconstruction), you will be punctured after a period of sufficient healing, usually around 3-4 months after surgery.

  2. How do I clean my voice prosthesis?

    Use a brush and flush technique similar to brushing your teeth. When using the brush to clean, followed by the flush, you are performing a similar process as when you use a toothbrush to clean your teeth and then rinse. The brush is effecting in loosening the debris while the flush ensures it is all rinsed well away.

  3. How often do I clean my voice prosthesis?

    We recommend cleaning twice a day. Once in the morning and once in the evening. You may also clean it, as needed during the day in the event it may not be functioning properly. You may find it helpful to clean it after each meal to assist with removing food debris that may be present.

  4. Is it normal for my voice prosthesis to spin in place?

    Yes! It is normal for the voice prosthesis to rotate within the TE tract and usually indicates a healthy tract. You should not be alarmed if you notice this.

  5. Is it normal for my voice prosthesis to stick out further than it used to?

    During the first 12 months following a laryngectomy, the healing process that evolves may also result in the TE party wall (the segment of tissue where the voice prosthesis is placed) thinning somewhat. There may also be changes to the location of the prosthesis or the angle in which it is sitting. Generally speaking, these are normal changes that occur during the recovery process over the first 12 months.

    As the TE party wall thins, the prosthesis may now appear to be too long. Although the prosthesis is fitted to sit well within the party wall, extra length may not necessarily be a problem.

  6. What do I do when my voice prosthesis leaks?

    You should first determine if the leakage is coming through the center of the prosthesis or from around the outside of the prosthesis. This can be done by drinking a colored beverage (not red) and watching when the leakage occurs.

  7. What should I do if my voice prosthesis falls out?

    Although it is very rare that the indwelling-type prostheses will dislodge on their own, should this happen, it is important you:

    - Insert the "emergency catheter" given to you . This is a slim, rubber tube. Insert the rounded tip directly into the tract (the "hole" left by the missing TEP). Pass this at least 6 inches into your esophagus.

  8. When does my voice prosthesis need to be changed?

    A voice prosthesis needs to be changed when it is no longer functional. The most common reason to change a voice prosthesis is due to leakage through the center of the prosthesis that occurs when the valve is no longer able to seal properly, allowing liquids from the esophagus to pass into the trachea during swallowing.

Breast Cancer: Removal of entire breast-Modified Radical Mastectomy

  1. When should I decide about reconstruction?

    You do not have to address this issue immediately. Reconstruction can always be done later if not at the time of surgery. Whether you are a candidate for reconstruction during the same sitting depends on various points like requirement of chemo and radiotherapy later which sometimes affect the reconstruction negatively.

    What kind of implants are to be put, and the timing will be decided by the surgeon only. Feel free to consult and clear all your queries before reaching a decision.

  2. What if I want to look like before without reconstruction?

    Plenty of good quality prosthesis are available for the same. These are extremely easy to wear and use.

  3. How long will I be in the hospital?

    If there are no underlying medical conditions and complications post surgery, most patients go home in about2-3 days. A rest period of about 4 weeks is required for you to feel normal again.

  4. Genetic counseling in breast cancer: Should I?

    If you have a first blood relative, who has had breast or ovarian cancer at a young age (premenopausal or before 50 years), men with breast cancer, multiple candidates of cancer in the family, or a known case of BRCA 1 or BRCA2 gene mutation, you must go in for genetic counseling. If you don’t have a family history you need not go in for counseling.

    It is a fairly expensive test and you will have to devote some time for sessions before your family history is obtained.

    Studies suggest that there may be a strong link between breast cancer and ovarian cancer. Women who have an altered BRCA1 gene have a 40 to 60 percent risk of developing ovarian cancer by age 85. Studies suggest that ovarian cancer risk is 16 to 27 percent in women with an altered BRCA2 gene.

    If you are tested positive for a gene mutation you have higher chances of developing cancer. The further plan will be decided by our team of doctors and counselors.

Robotic Surgery

  1. What is robotic surgery?

    Building on the techniques for laparoscopic surgery, the surgical tools inserted into the patient through the ports are connected to robotic arms rather than held by the surgeon. The robotic arms, however, are fully controlled by the surgeon. The level of surgical precision in robotic surgery is unsurpassed, and there are numerous other advantages as well.

  2. What are the advantages of robotic surgery?

    The advantages of robotic surgery for the patient include:

    • Shorter hospital stay
    • Less blood loss
    • Fewer complications
    • Less need for narcotic pain medicine
    • Faster recovery
    • Smaller incisions resulting in minimal scarring

    The small incisions made to allow access for the surgical tools and camera mean less blood loss, lower risk of blood transfusion and infection, a shorter hospital stay, decreased need for pain medication and a quicker recovery and return to normal function.

    Patients also benefit from the high-tech nature of the equipment. The robotic camera provides ten-fold magnification and three-dimensional vision rather than the two-dimensional vision of a laparoscope. The robotic arms move with incredible precision, moving in, out and with a wrist-like turning motion of 360 degrees. Human tremor is filtered out completely. The surgeon and surgical team work from a comfortable, ergonomic position, resulting in less fatigue during long complex cases.

  3. Is everyone a candidate for robotic surgery?

    Robotic surgery is appropriate for many different types of conditions, including cancer and non-cancerous procedures, and is available for adults and for children.

    There are instances when patients may not be able to continue with a robotic surgery. Some people cannot tolerate the inflating of the abdominal area with carbon dioxide. This is most common in smokers who already have higher levels of carbon dioxide in the blood. If it's not possible to safely provide enough oxygen to the body, the robot would be removed and an open incision made to complete the surgery.

    Body positioning can also occasionally be an issue. A patient may be tilted on the operating table so that organs naturally shift away from the surgical site, allowing the surgeon better access. If this position makes it difficult to provide oxygen at a safe pressure to the lungs, sometimes an issue with overweight patients, the robot would be removed and an open incision made to complete the surgery.

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