Coronary balloon angioplasty
Coronary balloon angioplasty is a medical procedure in which a balloon is used to open narrowed or blocked blood vessels of the heart.

Balloon Angioplasty generally takes 1 to 2 hours. The patient is awake for the procedure but local anesthesia is used and pain medication can be given as needed. During the procedure the surgeon will insert a small balloon catheter into an artery in the groin or arm and advance it toward the narrowing in the coronary artery.  The balloon is then inflated to enlarge the narrowing in the artery.  In some cases, a stent of wire mesh inflates with the balloon and is left behind to support the artery walls.

When successful, Balloon Angioplasty can relieve chest pain of angina, improve the prognosis of patients with unstable angina, and minimize or stop a heart attack without having the patient undergo open heart surgery.

As with any surgery, there are risks, including the possibility of:

• Complications associated with anesthesia, including respiratory or cardiac malfunction
• Infection
• Bleeding in the groin (or other catheter access site)
• Complete obstruction of blood flow to an area of the heart (a small risk, less than 1%)
• Damage to a valve or blood vessel
• Stroke
• Arrhythmia
• Kidney failure
• Allergic reaction to X-ray dye

Balloon Angioplasty treats the condition, but does not cure the cause of narrowed arteries. Recurrent narrowing can be expected in up to a quarter of cases over a 6 month period. This recurrent narrowing may or may not require a repeat procedure.

Risks can be reduced by following the physician's instructions before and after surgery.

Alternatives
If the arteries are not sufficiently widened by angioplasty or the blockages are too severe to be treated by angioplasty, heart surgery may be recommended.

Candidate eligibility
The physician will make the final determination of each patient’s eligibility for the procedure after an examination and consultation with the patient.

Coronary revascularization
Is the process of restoring the flow of oxygen and nutrients to the heart. In other words: bringing blood to the heart. To restore blood flow, surgery is necessary to bypass blockages or obstructions in the coronary arteries. Once we´ve removed the obstacle, blood circulates to the heart again.

The most common type of revascularization procedure is Coronary Artery Bypass Grafting, sometimes called CABG ("cabbage"). We perform CABG techniques using on-pump and off-pump procedures.

Cardiac Ablation
Normally, electricity flows throughout the heart in a regular, measured pattern. This normally operating electrical system is the basis for heart muscle contractions.

Sometimes, the electrical flow gets blocked or travels the same pathways repeatedly creating something of a "short circuit" that disturbs normal heart rhythms. Medicine often helps. In some cases, however, the most effective treatment is to destroy the tissue housing the short circuit. This procedure is called cardiac ablation.

Cardiac ablation is just one of a number of terms used to describe the non-surgical procedure. Other common terms are: cardiac catheter ablation, radiofrequency ablation, cardiac ablation, or simply ablation.

The ablation process
Like many cardiac procedures, ablation no longer requires a full frontal chest opening. Rather, ablation is a relatively non-invasive procedure that involves inserting catheters – narrow, flexible wires – into a blood vessel, often through a site in the groin or neck, and winding the wire up into the heart. The journey from entry point to heart muscle is navigated by images created by a fluoroscope, an x-ray-like machine that provides continuous, “live” images of the catheter and tissue.

Once the catheter reaches the heart, electrodes at the tip of the catheter gather data and a variety of electrical measurements are made. The data pinpoints the location of the faulty electrical site. During this “electrical mapping,” the cardiac arrhythmia specialist, an electrophysiologist, may sedate the patient and instigate some of the very arrhythmias that are the crux of the problem. The events are safe, given the range of experts and resources close at hand, and are necessary to ensure the precise location of the problematic tissue.

Once the damaged site is confirmed, energy is used to destroy a small amount of tissue, ending the disturbance of electrical flow through the heart and restoring a healthy heart rhythm. This energy may take the form of radiofrequency energy, which cauterizes the tissue, or intense cold, which freezes, or cryoablates the tissue. Other energy sources are being investigated.

Patients rarely report pain, more often describing what they feel as discomfort. Some watch much of the procedure on monitors and occasionally ask questions. After the procedure, a patient remains still for four to six hours to ensure the entry point incision begins to heal properly. Once mobile again, patients may feel stiff and achy from lying still for hours.

When is ablation appropriate
Many people have abnormal heart rhythms (arrhythmias) that cannot be controlled with lifestyle changes or medications. Some patients cannot or do not wish to take life-long antiarrhythmic medications and other drugs because of side effects that interfere with their quality of life.

Most often, cardiac ablation is used to treat rapid heartbeats that begin in the upper chambers, or atria, of the heart. As a group, these are know as supraventricular tachycardias, or SVTs. Types of SVTs are:

• Atrial Fibrillation
• Atrial Flutter
• AV Nodal Reentrant Tachycardia
• AV Reentrant Tachycardia
• Atrial Tachycardia

Less frequently, ablation can treat heart rhythm disorders that begin in the heart’s lower chambers, known as the ventricles. The most common, ventricular tachycardia, may also be the most dangerous type of arrhythmia because it can cause sudden cardiac death.

For patients at risk for sudden cardiac death, ablation often is used along with an implantable cardioverter device (ICD). The ablation decreases the frequency of abnormal heart rhythms in the ventricles and therefore reduces the number of ICD shocks a patient may experience.

For many types of arrhythmias, catheter ablation is successful in 90-98 percent of cases – thus eliminating the need for open-heart surgeries or long-term drug therapies.

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Arthroscopy
Arthroscopy is a surgical procedure orthopaedic surgeons use to visualize, diagnose, and treat problems inside a joint.

The word arthroscopy comes from two Greek words, "arthro" (joint) and "skopein" (to look). The term literally means "to look within the joint."

In an arthroscopic examination, an orthopaedic surgeon makes a small incision in the patient's skin and then inserts pencil-sized instruments that contain a small lens and lighting system to magnify and illuminate the structures inside the joint. Light is transmitted through fiber optics to the end of the arthroscope that is inserted into the joint.

By attaching the arthroscope to a miniature television camera, the surgeon is able to see the interior of the joint through this very small incision rather than a large incision needed for surgery.

The television camera attached to the arthroscope displays the image of the joint on a television screen, allowing the surgeon to look, for example, throughout the knee. This lets the surgeon see the cartilage, ligaments, and under the kneecap. The surgeon can determine the amount or type of injury and then repair or correct the problem, if it is necessary.

The procedure may perform in shoulder,knee and hip.

Arthroplasty
An arthritic or damaged joint is removed and replaced with an artificial joint, called a prosthesis. You will be given an anesthetic and the surgeon will replace the damaged parts of the joint. For example, in an arthritic knee the damaged ends of the bones and cartilage are replaced with metal and plastic surfaces that are shaped to restore knee movement and function.

In an arthritic hip, the damaged ball (the upper end of the femur) is replaced by a metal ball attached to a metal stem fitted into the femur and a plastic socket is implanted into the pelvis, replacing the damaged socket.

Although hip and knee replacements are the most common joint replaced, this surgery can be performed on other joints, including the ankle, foot, shoulder, elbow, and fingers.

The materials used in a total joint replacement are designed to enable the joint to move just like a normal joint.

The prosthesis is generally composed of two parts: a metal piece that fits closely into a matching sturdy plastic piece. Several metals are used, including stainless steel, alloys of cobalt and chrome, and titanium. The plastic material is durable and wear resistant (polyethylene). A plastic bone cement may be used to anchor the prosthesis into the bone.

Joint replacements also can be implanted without cement when the prosthesis and the bone are designed to fit and lock together directly.

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Spondylolisthesis
Spondylolisthesis occurs when one vertebra slips forward in relation to an adjacent vertebra, usually in the lumbar spine. The symptoms that accompany a spondylolisthesis include pain in the low back, thighs, and/or legs, muscle spasms, weakness, and/or tight hamstring muscles. Some people are symptom free and find the disorder exists when revealed on an x-ray. In advanced cases, the patient may appear swayback with a protruding abdomen, exhibit a shortened torso, and present with a waddling gait.

Spondylolisthesis can be congenital (present at birth) or develop during childhood or later in life. The disorder may result from the physical stresses to the spine from carrying heavy things, weightlifting, football, gymnastics, trauma, and general wear and tear. As the vertebral components degenerate the spine's integrity is compromised.

Another type of spondylolisthesis is degenerative spondylolisthesis, occurring usually after age 50. This may create a narrowing of the spinal canal (spinal stenosis). This condition is frequently treated by surgery.

Kyphosis (Hunchback)
(Greek - kyphos, a hump) also called "hunch back", in general terms, is a common condition of a curvature of the upper (thoracic) spine. It can be either the result of bad posture (slouching) or a structural, muscular abnormality in the spine.

Scoliosis is a medical condition in which a person's spine is curved from side to side, and may also be rotated. It is an abnormal lateral curvature of the spine. On an x-ray, the spine of an individual with a typical scoliosis may look more like an "S" or a "C" than a straight line. It is typically classified as congenital (caused by vertebral anomalies present at birth), idiopathic (sub-classified as infantile, juvenile, adolescent, or adult according to when onset occurred) or as having developed as a secondary symptom of another condition, such as cerebral palsy, spinal muscular atrophy or due to physical trauma.

Disc Herniation
A slipped disc can happen anywhere in the spine, and surprisingly, a slipped disc does not actually slip. Instead, the disc, which is located between the bones of the spine (vertebrae), splits or ruptures. When this happens, the inner gel-like substance (nucleus pulposus) leaks out. This is called a herniation of the nucleus pulposus—or a herniated disc. People between the ages of 30 and 50 are most at risk for herniation because the elasticity and water content of the nucleus pulposus decrease with age.

Degenerative Disc Disease
Degenerative disc disease (DDD) is typically associated with aging. As you age, your discs, like other joints in the body, can degenerate (break down) and become problematic: that's a natural part of growing older as your body deals with years of strain, overuse, and maybe even misuse. However, DDD can occur in people as young as 20, so sadly, youth doesn't always protect you from this disc-related condition. In fact, some patients may inherit a prematurely aging spine.

Degenerative disc disease involves the intervertebral discs. Those are the pillow-like cushions between your vertebrae in your spine. They help your back carry weight and allow complex motions of the spine while maintaining stability. As you age, the discs can lose flexibility, elasticity, and shock absorbing characteristics. They also become thinner as they dehydrate. When all that happens, the discs change from a supple state that allows fluid movement to a stiff and rigid state that restricts your movement and causes pain.

If you have chronic back or neck pain, you may have degenerative disc disease. It commonly occurs in your low back (lumbar spine) or neck (cervical spine). Developing degenerative disc disease is a gradual process. As you can see in the illustration, there are even many stages and states your discs can go through as part of DDD. They can bulge, herniate, or thin. Because of disc changes, your vertebrae can be affected-you can see this in the illustration, too. For example, bone spurs (osteophytes) can form as your spine tries to adjust to the intervertebral disc changes.

Spinal Stenosis
The lumbar spine (lower back) provides a foundation to carry the weight of the upper body. It also houses the nerves that control the lower body. With aging, degenerative changes in the spine can occur. The disks between the vertebrae (bones) may become dehydrated, and the joints may become overgrown due to arthritis. Over time, these changes can also lead to narrowing, or stenosis, of the spinal canal.

The wear-and-tear effects of aging can lead to narrowing of the spinal canal, a condition known as spinal stenosis.

Narrowing of the lumbar spinal canal pinches the nerves that go to the skin and muscles of the legs. Sometimes, the pinched nerves become inflamed, causing pain in the buttocks and/or legs.

Degenerative changes in the lower back also can diminish the ability of the spine to carry the load of the upper body. This can lead to forward slippage of one vertebra on another, a painful condition called spondylolisthesis.

Lumbar spinal stenosis usually affects middle-aged and older adults. People who are born with narrower spinal canals are more likely to develop this problem.

Spinal injury and trauma
Spinal trauma may rupture ligaments or fracture vertebrae in the neck or back. More severe injuries can damage the spinal cord or nerve roots to cause paralysis or regional pain and weakness. Some injury patterns do not initially appear to be alarming, but can leave the spinal column unstable and subject to progressive deformity and/or chronic pain.

Diagnostic Dilemmas
Many patients are afflicted with neck or back pain and/or arm or leg weakness without a clear explanation. Some have had unsuccessful surgical procedures. Chronic back pain or weakness may result from continued nerve root compression after disc or decompression surgery, early degenerative changes that do not show up on x-ray or unsuspected non-union after fusions that were thought to be successful but were not. We utilize a systematic approach that may include MRI, myelography, CT scans, facet injections, nerve root blocks, provocative discography and quantitative motion studies and trial casting. A careful history and exam combined with one or more of the listed studies often yield a clear explanation for the previously unexplained pain or weakness. If a cause can be identified and verified, treatment is usually successful.

Failed Fussions
The purpose of a spinal fusion is to stop motion between painful vertebrae. A fusion between two spinal vertebrae is similar to a weld between two pieces of metal. In a good weld, you are left with one piece of metal. After a successful spinal fusion, the bone graft joins two vertebrae into one immovable piece of bone. Hence, any painful joints or discs in between no longer move and are, therefore, no longer painful.

It can be very difficult to determine if a spinal fusion is successful. The x-ray can show substantial new fusion bone, but that does not mean the two vertebrae have actually fused into one piece of bone. CT scans and other studies are equally inaccurate. As a result, a surgeon can believe that he has achieved a solid fusion, when, in fact, motion remains and can explain the patient’s persistent pain.

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Cornea and external disease
Surgical treatment of disease or injury to the front of the eye. Treatments include small incision cataract surgery, corneal transplants and refractive surgery

Phaco and IOL
Phacoemulsification, or phaco, is method of cataract surgery in which the eye’s internal lens is emulsified using ultrasonic energy and replaced with an intraocular lens implant, or IOL.

Phaco surgery is performed with a small ultrasonic probe that is inserted into the eye via a two-to-three millimeter incision. This probe breaks the cloudy lens into tiny pieces and sucks the fragments out of the eye. Your doctor will place a permanent artificial lens (called an intraocular lens or IOL) where the natural lens used to be. Surgery is performed under a local anesthetic, which prevents movement of the eye. Or topical anesthetic may be used to numb the area. Most procedures take between 15 minutes and one hour.

A cataract clouds the lens of the eye causing vision loss that interferes with daily activities. The only effective means of restoring full and clear vision that has been compromised by cataracts is to perform surgery to remove and replace them with permanent artificial lenses.

Complications are infrequent and usually minor. However, as with any surgery, there are risks, including the possibility of:

• Infection requiring antibiotics and in some cases hospitalization
• Inflammation (redness, swelling) of the eye
• Corneal swelling
• Vision loss
• Retinal detachment
• Development of secondary cataracts

Risks can be reduced by following the surgeon's instructions before and after surgery.

Alternatives
For less severe cataracts, vision may improve by changing eyeglasses, using a magnifying glass or increasing lighting. Beyond these measures surgery is the only effective treatment. The surgeon may discuss alternative surgical approaches to Phacoemulsification including direct surgical removal of the entire lens and/or lens capsule.

Candidate eligibility
Phacoemulsification and intraocular lens implant surgery is ideal for individuals with no other eye disease. Patients with diabetes are known to be at a high risk for worsening eye problems after this procedure. The surgeon will make the final determination of each patient’s eligibility for the procedure after an examination and consultation with the patient.

Glaucoma
Surgical management of glaucoma and other disorders that may cause optic nerve damage by increasing pressure within the eye

Neuro-ophthalmology
Surgical services for diseases of the optic nerve, visual pathways, eye movements and pupils, often the result of head trauma, brain tumors, strokes or other neurological disorders

Ocular Oncology
herapeutic and surgical techniques used to remove tumors on the inside of the eye and the surrounding areas

Ophthalmic plastic surgery
Upper facial reconstructive procedures following trauma or tumors, as well as cosmetic procedures for the eyelid and surrounding area of the eye

Pediatric ophthalmology
Surgical treatment of children's eye disorders including strabismus (crossed eyes), amblyopia (lazy eyes), and genetic and developmental abnormalities

Retina and vitreous surgery
Surgery to correct diseases such as diabetic retinopathy and degenerative disease, as well as retinal tears or detachments

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According to WHO statistics 33% of cancers are preventable (by avoiding unnecessary habits and addictions), 33% are curable (early detection and treatment) and balance 33% need palliative care. Therefore, awareness creation, preventive medicine, early detection and appropriate treatment can cure 66% of all Cancers.

Medical Oncology & Haemato Oncology
In Medical Oncology, Chemotherapy is an expanding modality in the care of cancer patients. This treatment along with various modalities of Hormonal Therapy can achieve good systemic control of Cancer, taking care of macro and micro metastases. Concurrent Day Care and Indoor Chemotherapy facilities are available and both National and International protocols are followed. The Hemato Oncology department treats large number of Leukemia and Lymphoma patients, especially children.

The Blood Bank successfully facilitates with the help of component therapy in supportive care to these patients including Fresh Frozen Plasma, Human Albumin, Platelet Concentrate, Coagulation Factors etc.

Surgical Oncology
Surgery plays the most important role in cancer treatment. State of the art Operation Theatres with all the latest equipments along with a fully integrated Endoscopy suite and Intensive Therapy Unit for post-operative care and other emergencies of the patients. Eminent Onco Surgeons of the city are attached to this wing.

All disciplines of surgery like Breast, ENT, Gynaecology, Gastro Intestinal Surgery, Head & Neck, Orthopedic, Peripheral Surgery, Thoracic, Urology, Plastic Reconstructions are regularly undertaken. The Laparoscopic Surgery Unit is equipped to do many major types of diagnostic & thera-peutic procedures. For a comprehensive list of Surgeries.

Breast Surgery

• Radical / Modified / Toilet Mastectomy
• Breast Conservation Surgery
• Microdochectomy
• Lumpectomies and wide excision
• Breast Reconstructive Surgery
• Sentinel Node Biopsy

ENT Surgery

• Total Laryngectomy
• Lateral Rhinotomy
• Culdwell Luc`s operation
• Direct Laryngoscopy & Biopsy
• Tracheostomy

ENT Surgery

• Total Laryngectomy
• Lateral Rhinotomy
• Culdwell Luc`s operation
• Direct Laryngoscopy & Biopsy
• Tracheostomy

GI / Abd. Surgery

• Liver Resections
• RadioFrequency Isolation
• Oesophago-Gastrectomy
• Total Oesophagectomy
• Radical Gastrectomy / Gastrostomy
• Whipple's Surgery (Pancreatectomy)
• Splenectomy
• Triple Bypass
• Cholecystectomy (Open, Radical Laparoscopic)
• Hemicolectomies / Colostomies

Anterior Resections with Sphincter Preservation (Low/ Ultra-Low) with Staplers

• APR
• Laparoscopic Surgeries

Gynae. Surgery

• TAH BSO
• Radical Vulvectomy
• Wartheims' Operation
• Mitra's Operation
• Diagnostic D & C
• Laparoscopic Surgery

Ortho. Surgery

• Amputations - Foot, B/Knee, Thigh
• Ray Amputation
• Hind Quarter amputation
• Limb Preserving Surgeries
• Implants & Prostheses

Head & Neck / Maxillo-Facial Surgery

• Hemi / TotalThyroidectomy
• Complete Resection- Floor of mouth
• Mandibulectomy / Maxillectomy
• Cheek Commando with PMMC flap
• Parotidectomy
• Glossectomies
• Radical neck dissections
• All Reconstructive Surgeries

Urology

• TURBT / TURP
• Adrenalectomy
• Nephroureterectomy
• Nephrectomy / Nephrostomy
• Total Cystectomy with Ileal Conduit
• Neo-bladder
• Cystoscopy / Cystodiathermy
• Ureteric Stenting
• Laparoscopic Surgeries

Peripheral Surgery

• Inguinal Block Dissection
• Wide Excision - Soft Tissue Sarcomas, Melanomas etc.
• Enucleation of Eyes

Plastic Surgery

• Large area Skin Grafting
• All types of Hernia repair
• Wide excision and rotational Flap
• Micro-Vascular Flaps

Thoracic Surgery

• Pneumonectomies/ Lobectomies
• Oesophagectomies
• Thymic tumours
• Bronchoscopy/ Mediastinoscopy

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Laparoscopic Cholecystectomy
The gallbladder is a pear-shaped organ that sits beneath the liver in the right-upper abdomen.  It is attached to the liver and its function is to store bile.  These ducts carry bile from the liver to the gallbladder and intestine where the bile helps digest food.  The gallbladder is not required to keep you alive, but when there are problems with it, it can seriously affect your quality of life.  If you need a gallbladder surgery, also known as a laparoscopic cholecystectomy, it’s time to take advantage of Panama’s health tourism and have your surgery done at Hospital Punta Pacifica.

Laparoscopic cholecystectomy and open abdominal cholecystectomy are the two methods for this surgery.  Before the laparoscopic method, doctors used the open abdominal method.  It required a 3 to 7 inch incision across the abdomen and up to a week in the hospital.  With the advent of laparoscopic surgery, the gallbladder can be removed with only a series of small incisions and it is frequently done as outpatient surgery, meaning the patient can go home the same day.  Recovery time is virtually eliminated and the risks are greatly reduced.

The patient receives general anesthesia.  A small incision is made at the navel and a thin tube carrying the video camera is inserted.  Your surgeon will then inflate your abdomen with carbon dioxide, a harmless gas, for easier viewing as well as to provide room for the surgery to be performed.  Next, two needle-like instruments are inserted in other incisions in your abdomen; these instruments serve as tiny hands within the abdomen.  They can be used to move the gallbladder and intestines around and generally assist the surgeon.  Finally, several different instruments are inserted into a fourth incision to clip the gallbladder artery and bile duct, and to safely dissect and remove the gallbladder and stones.  When the gallbladder has been disconnected, it is then removed through the navel incision.  The entire procedure normally takes 30 to 60 minutes.  The three puncture wounds require no stitches and may leave very slight blemishes.  The navel incision is barely visible and will fade with time.

One of the main benefits of this procedure is the ease of recovery for the patient.  Since there is no large incision, there is no incision pain.  The patient is up and about the same day and in 90% of the cases, patients go home the same day. The remaining patients are usually discharged the next day. Within several days, normal activities can be resumed because the recovery time is so quick.  And the best news is no 7 inch scar to keep you out of your bathing suit and off the beach!

Because of the relatively safe nature of a laparoscopic cholecystectomy, the side effects are rare and usually minor.  In about 5 to 10% of cases, the gallbladder cannot be safely removed by laparoscopy and an open abdominal cholecystectomy is then immediately performed.  Nausea and vomiting are both possibilities and may occur after the surgery.  Injury to the bile ducts, blood vessels, or intestine can also occur, requiring corrective surgery.

Laparoscopic Nissen Fundoplication
The Fundoplication is a surgery done to control Gastroesophageal Reflux Disease(GERD). This condition if left untreated can cause a variety of complications including esophageal cancer and lung damage. Most reflux is controllable by the use of medications but occasionally the medications don’t work or just aren’t enough. When this is the case, the doctors have to turn to surgery. Here is a description of what happens in the surgery.  

The "fundus" (hence the term fundoplication) of the stomach (top portion of the stomach) is wrapped around the back of the esophagus until it is once again in front. The portion of the fundus that is now on the right side of the esophagus is sutured to the portion on the left side to keep the wrap in place. When completed, the fundoplication resembles a buttoned shirt collar. The collar is the fundus wrap and the neck represents the esophagus inside the wrap. This has the effect of creating a one-way valve in the esophagus to allow food to pass into the stomach, but prevent stomach acid from flowing into the esophagus and thus prevent GERD. If the child also has a hiatal hernia this will be repaired at the same time.

The procedure is performed with the patient under general anesthesia in one of 2 ways ether 'open' or 'laparoscopically'. The laparoscopic is the more popular way of doing it because it is less invasive. Five small incisions are made in the abdomen rather than one larger one used in the open. One is used for the laparoscope, the other four are used to retract and manipulate structures in the abdomen. Often a gastrostomy tube will be placed to help with the post op recovery. If one is placed it will usually only be in place for a few months unless needed for feeding or continuing gas bloat issues. There can also be another procedure done at the same time as the fundoplication for children with Delayed Gastric Emptying (DGE) this is called a pyloriplasty and it helps the stomach empty faster. If this is done your hospital stay will be a few days longer.

In a small number of patients (approx. 5%) it may not be possible to operate via the laparoscope due to adhesions from previous operations, bleeding obscuring vision, awkward fatty tissue or other technical problems. It may then be necessary to revert to the standard (open) operation.  

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