SURGICAL CENTRE

The Surgical Centre is a multi-specialty surgery centre offering patient-centred, quality care in St. Petersburg, Russia. Our Surgery centre has five fully equipped state-of-the-art operating rooms, eight recovery beds and nine short-stay rooms. Surgeries and consultations with specialists are performed at the convenience of the patient and surgeon.

Surgical Centre surgeons and facilities are available for a broad spectrum of procedures ranging from plastic surgery, orthopedic surgery (orthopedic), general surgery to cosmetic surgery and injectables.

The information provided here will help you learn about the surgical techniques, the results and expectations, information on who is best suited to each surgical procedure and more. We’re committed to making your surgical experience as comfortable as possible. This is why we provide our staff with innovative technologies to help them provide the best quality and safety in patient care

We were the first facility in the region to install BIS™ brain monitors in our operating rooms to customize anesthesia to meet each patient’s unique needs. This reduces the risk of surgical awareness, and helps our patients awaken more quickly and feel better after surgery. State-of-the-art BIS™ monitors are just one way we are helping our patients and physicians access the latest medical technology. When it comes to assuring your comfort and well-being, we wouldn’t settle for anything less.

Endoscopies - Colonoscopy

What is the colon?

The colon, or large intestine, is the part of the digestive tract which stores stool (feces) until it is socially acceptable to pass it. The colon absorbs water and other substances from the stool. The lowermost part of the colon is the rectum. Altogether, the colon is approximately three feet long.

What is colon cancer?

Colorectal cancer (CRC) is the third most common cancer in Canada, after breast and lung cancer in women, and prostate and lung cancer in men.

Although colon cancer usually does not grow rapidly, it has often spread by the time symptoms develop. Almost all colon cancers begin as small benign growths called polyps. Not all polyps will become cancerous, but the only way of ensuring prevention of cancer is to remove any polyps that develop. Regular screening can diagnose the disease at an early stage when it is more treatable.

If colon cancer is so preventable, then why is it so common?

Until recently, little attention had been paid to colon cancer because of embarrassment about discussing this part of the body. Increasingly, people are requesting screening for colon cancer. This can be very effectively and efficiently done using colonoscopy.

What is colonoscopy?

Colonoscopy is a procedure that enables your specially trained physician to examine the inner lining of your colon for abnormalities including cancer and polyps. It involves gentle insertion of a flexible tube, about the thickness of your little finger, into the anus and up through your rectum and colon. It is done using a mild sedative to prevent discomfort. When the colon has been properly cleansed following the preparation instructions, the entire colon can be examined more than 95% of the time.

What can be expected during a colonoscopy?

The procedure usually takes 15 to 20 minutes. With modern sedative medications, there is rarely significant discomfort, and many people do not recall the procedure. A small IV needle is placed in the arm before the procedure, through which medications are given.

Following the procedure, you may feel drowsy, and you are advised not to drive or make important decisions until the next day. Before you leave, you will be given your results and if necessary, any follow-up instructions. You will need to be taken home by a responsible adult following the procedure.

Preparing for colonoscopy:

You will need to thoroughly cleanse your colon before the colonoscopy. Simple fasting, laxatives and/or enemas are usually not enough to clean the walls of the colon...it is truly surprising just how much stool our colon contains! Your last solid food should be not less than 36 hours before the colonoscopy, but you may drink liquids hours up until several hours before. Special liquid laxatives are required, and you will be given special directions about this in advance. Your doctor will need to know specific details about your medical history in advance in order to give individualized instructions regarding your usual medications.

Are there any risks involved in a colonoscopy?

Millions of colonoscopies are performed every year by trained gastroenterologists without any problems. The examination is generally considered to be extremely safe. However, as with any procedure, there is always a small risk of complications. These risks will be discussed with you upon consultation with one of our gastroenterologists, but for the majority of people the potential benefit of colonoscopy outweighs the small risks.

Gynecological Surgery

Women’s Health

Surgical Centre offers a range of gynecological procedures including:

Labiaplasty (Laser Assisted)

In this procedure, enlarged, asymmetrical or excessively long inner labia are reduced by using a laser and stitching.Many women choose to undergo this labiaplasty surgery for the purpose of improving the aesthetic appeal of the vulva structures.

Uterine Balloon Therapy:

This is a new outpatient procedure to reduce excessive menstrual bleeding (menorrhagia). Unlike hysterectomy, a common treatment for menorrhagia, which takes out the entire uterus, this procedure just destroys the lining of the uterus with the use of heat.

Laser Vaginal Rejuvenation:

Laser Vaginal Rejuvenation is the reconstruction of vital vaginal areas essential to sexual gratification. The procedure restores the vitality and youthful appearance of the vagina. The best candidates for the surgery are women who experience little or no sensation during sexual intercourse, often a result of vaginal relaxation from childbirth

Transvaginal Taping (TVT):

TVT is a device available to most women with stress urinary incontinence (SUI). SUI is the unintentional release of urine during normal everyday activities, caused by an improperly functioning urethra. TVT is an innovative, minimally invasive surgical alternative that restores the normal position of the urethra by weaving a "sling" of GYNECARE TVT™ polypropylene mesh tape beneath it. This alternative avoids painful abdominal operations and the related potential complications.

Zudiex - non surgical stress urinary incontinence solution:

Surgical intervention is widely considered as the only effective option for stress urinary incontinence (SUI) however a surgical intervention is not always suitable for every patient. The Zudiex urethral injection represents an alternative, minimally invasive procedure which offers substantial relief of symptoms for most patients.

Other Gynecological Procedures:

• Screening cervical and uterine cancer

• Hymenoplasty

• Hysteroscopy

• Laparoscopy

Interventional Pain Management:

Definition of Interventional Pain Management and Nerve Block Services

1. Diagnostic and therapeutic nerve block service.

2. Objective assessment of physiological mechanisms and location underlying a patient's pain.

3. Diagnosis of pathways by which pain is transmitted.

4. Review current drug therapy and suggest alternatives or modifications.

5. Review and/or order further investigations (lab, radiographic, electrodiagnostic, MRI scans etc.)

6. Initiate further consultation with clinical sub-specialties if required (eg. physician or therapist).

7. Diagnostic and Therapeutic Surgical Procedures:
- Facet blocks (intra-articular or medical branch nerve block)
- Epidural blocks (translaminar or transforaminal)
- Epidural neuroplasty (translaminar or transforaminal)
- Myofascial pain (trigger point injection, Botox A or prolotherapy)
- Herpes Zoster and postherpetic neuralgia
- Complex Regional Pain Syndromes (RSD and Causalgia)
- Pain due to trauma or malignancy
- Radiofrequency neurotomy or pulse radiofrequency modulation
- Cryoablation

8. Evaluation for implantable technologies
- SCS (Spinal Cord Stimulator)
- DIS (Drug Infusion Systems)
- Epidural Systems
- Intrathecal/Spinal systems

Why do I need a Pain Block (nerve block)?

Introduction:

A pain or nerve block is a method by which pain can be controlled through the use of a local anaesthetic very similar to a "dental freezing" it is possible to provide a numbing effect to the painful area. The injection may in itself cause some discomfort during the injection and is no different from the expected discomfort after having received "dental freezing". By and large, the pain block is not particularly painful during the first two to six hours after it has taken. After the freezing has worn off, one can experience some discomfort for a period of hours to a few days. In many instances such as chronic pain, the painful site and accompanying nerve pathways are sensitized so that it is not unusual for the injection to cause discomfort for a slightly longer period of time than would normally be anticipated.

Local Anaesthetic Effects:

There are a number of different local anaesthetics all of which have different lengths of time that they produce their numbing effect. With this knowledge, it is possible to sort out the characteristics of the pain causing structures and to calculate the most reasonable sites or origins of the pain. At the time of the first visit or consultation, information is taken with respect to the history of the problem, findings on the physical examination and the available imaging or X-ray studies that have been performed. After reviewing this information, there are certain factors that are considered important in the decision to perform a nerve block. One of the most important factors in considering the nerve block is that the discomfort is fairly well localized and accessible through an injection.

Side Effects:

Although there are certain side effects of the injection itself, these are uncommon and easily treated. Although uncommon or rare, some of these side effects might include infection, bleeding, prolonged nerve block, nerve damage or allergic reaction. Should the injection inadvertently gain access to an artery, it is possible to experience a brief seizure-like disorder which is self limited and relatively well treated. One of the most common side effects is a simple faint which again is self limited.

Monitoring the Response:

It is important to monitor the effects of the nerve block and you keeping a simple diary of how the nerve block influences your pain or more accurately through the use of a specific pain diary can do this. Since each individual patient has different ideas as to what their personal pain diary should be, we believe that a standardized diary is more appropriate and have devised a simple way of monitoring your pain in order that we better understand the effects of the pain or nerve block. You will be provided with this diary and instructed either by the physicians or nursing staff as to how this document should be filled out. If there are any questions, please do not hesitate to call the clinic for clarifications.

Conclusion:

We would like to emphasize that the pain or nerve block is not necessarily a permanent solution to your painful condition. Although certain medications can be injected along with the local anesthetic blocks, they may not necessarily result in complete resolution of the pain condition. If there are more permanent methods in treating your pain condition, this will be discussed with you by the physician.

What are Hemorrhoids?

Hemorrhoids are natural vascular tissue found in the anal canal. It is believed that their main function is to protect and cushion the anal canal. The term "prolapse" refers to the condition when the hemorrhoidal tissue enlarges and descends downward into the anal canal. Prolapse of the hemorrhoidal tissue, known as "piles", is a very common condition.

Why does hemorrhoidal tissue prolapse?

Numerous factors contribute to hemorrhoidal disease. Most commonly are:

• Constipation with prolonged straining

• Pregnancy

• Aging - the muscles and other anatomic structures that support the tissue weaken and help contribute to the prolapsation of the hemorrhoids.

What are the complications of hemorrhoidal prolapse?

Hemorrhoidal prolapse is often accompanied by bleeding, pain and the feeling of tissue in the anus. There may also be some mucus discharge.

What procedures are available for the treatment of hemorrhoids and prolapse?

There are several ways to manage hemorrhoids and prolapse. At Surgical Center, we offer a range of procedures from the traditional to advanced: banding, stapled hemorrhoidectomy (PPH) or conventional surgical hemorrhoidectomy.

New Technique: Procedure for Prolapse and Hemorrhoids (PPH) –Stapled Hemorrhoidectomy

A new process called procedure for prolapse and hemorrhoids (PPH) – also known as stapled hemorrhoidectomy - is less painful and allows patients to return to work and other normal activities much earlier than with conventional procedures. The new technique, which uses a stapling device, takes advantage of the fact that pain-sensing nerve fibers are absent higher in the anal canal where the wound will be placed.

PPH is a technique developed in the early 90’s that reduces the prolapse of hemorrhoidal tissue by excising a band of the prolapsed anal mucosa membrane with the use of a circular stapling. In PPH, the prolapsed tissue is pulled into a device that allows the excess tissue to be removed while the remaining hemorrhoidal tissue stapled. This restores the hemorrhoidal tissue back to its original anatomical position.

• Less painful

• Local anesthesia – return home the same day

• Shorter recovery period

Instead of the sharp pain of traditional methods, patients may feel a dull but tolerable ache for only a few days. In a recent study 20% of the patients returned to work one day after the operation and 99% of the patients made a full recovery within seven days. 93% of patients required no further therapy for their hemorrhoids. However, because this procedure is so new, it does not have the proven track record of conventional hemorrhoidectomy. Long-term recurrence rates are not known.

Hundreds of surgeons in Europe already use this new technique. More than a quarter million of these operations have been performed. This surgery is now available at Surgical Centre.

What are Varicose Veins?

Varicose veins are a common problem affecting millions of women and men. Varicose veins are dilated vessels just below the skin that can cause unsightly conditions, inflammation, pain and ulceration. Normal veins carry blood from the foot to the upper leg and body, but if the veins are not functioning properly, blood backs up causing the vessels to enlarge and cause the symptoms noted above. When one or more of the valves fails to close properly, the veins conduct blood back into the leg instead of up to the heart.

While patients often try to ignore varicose veins, treatment is important to prevent dilated, twisted veins, episodes of aching pain and leg ulcers on the surface of the skin. If left untreated, varicose veins can lead to more serious complications.

What procedures are available for the treatment of varicose and spider veins?

There are several ways to manage varicose veins. At Surgical Center, we offer a range of procedures from non-surgical to minimally invasive state-of-the-art vein surgeries.

For spider veins and simple varicose vein cases, sclerotherapy may be recommended. This is the use of a tiny needle to inject the vein with a medication that irritates the lining of the vein and serves to collapse the vein, which is then reabsorbed. During any one procedure, the surgeon may inject a vein region several times.

Surgical procedures range from vein stripping and phlebectomy to the advanced TriVex™ procedure.

What is the TriVex™ System?

The TriVex™ System is designed for use during a patented, clinically tested surgical technique for varicose vein removal called transilluminated powered phlebectomy. While traditional varicose vein surgery is a "blind procedure," meaning that surgeons cannot always see the vein or confirm removal, the TriVex™ System's unique illumination feature allows the surgeon to quickly and accurately target and remove the vein and then visually confirm its complete extraction.

In one study comparing results from minimally-invasive TriVex™ surgery to those obtained with the older technique of hook phlebectomy, the minimally-invasive procedure cut operating time in half, reduced the number of incisions by 50 to 75 percent, required less anesthesia and caused less post-operative pain than the older surgery. Studies suggest that this method not only reduces the pain associated with varicose vein removal but also reduces the potential post-operative infection.

Urology Procedures at Surgical Centre:

• Vasectomy

• Vasectomy Reversal

What is a Vasectomy?

Vasectomy is a safe, simple and effective birth control method.

A vasectomy is a minor surgical procedure used for male contraception. It is one of the most popular forms of contraception worldwide (as many as 30 million men), and is regarded as safe, simple and highly effective. A vasectomy is performed by cutting the vas deferens (the small tube that carries sperm from the testicles and mixes with prostatic fluid to become semen). Although the patient may continue to have sexual intercourse and climax as before, the semen does not contain sperm and a child cannot be fathered following a vasectomy.

It is a popular means of birth control for couples that have decided that their family is complete. It is nearly 100 % effective and is intended to be permanent but may be reversed.

There may be some swelling and minor pain in the scrotum for several days after the surgery. Most men can return to work in 1 or 2 days, unless their work is strenuous. They should avoid heavy lifting for a week.

A vasectomy does not interfere with a man's sex drive, ability to have erections, sensation of orgasm, or ability to ejaculate. Some men have occasional mild aching in the testicles during sexual arousal for a few months after the surgery.

Vasectomy Surgery:

A no scalpel vasectomy is offered. A vasectomy is performed on an outpatient basis, frequently in the office. The procedure takes about 15-30 minutes.

The scrotum is cleaned with an antiseptic; a small area of the scrotal skin is shaved. The scrotum is anaesthetized with local anaesthetic using a tiny needle and the vas deferens is gathered under the skin of the scrotum. A single small incision (usually 4-5mm) is made. The vas deferens is then brought through the incision, cut in two places, a 1-centimeter segment is removed and electrocautery is used to seal the ends. Each end of the vas deferens is surgically tied off and then placed back in the scrotum. The incision may need a single, dissolvable suture. A small dressing is applied.

Vasectomy Summary:

• A vasectomy is a safe, simple, fast and highly effective procedure. Complications are uncommon.

• It is one of the most common means for contraception.

• The procedure is over 99 % effective and intended to be permanent.

• Discomfort following the procedure is often mild and easily relieved; this normally decreases and disappears within days.

• Strenuous physical activity should be avoided for 4-5 days after. Return to a sedentary job may be on the same or next day.

• Although it is a simple, safe and common surgical procedure, any surgical procedure includes some risk.

Vasectomy Reversal

A urology surgeon performs vasectomy reversal when a man has had a vasectomy, and now wants to have children. Vasectomy reversal reconnects the tubes ( vas deferens ) that were cut during a vasectomy. Vasectomy reversal is done as an outpatient procedure - without an overnight stay. General anaesthesia (or spinal) is commonly used to ensure the patient remains completely still during the surgery.

Vasectomy reversal usually requires approximately 2 to 4 hours, followed by a few more hours for recovery from the anaesthetic. You can expect to go home on the same day as a routine vasectomy reversal.

Pain is mild to moderate and similar to a vasectomy. You should be able to resume normal physical activities, including sex, within 3 weeks.

Chances for success depend on many factors. These include the microsurgical skill and experience of the surgeon, the method of vasectomy that was done and most importantly the length of time since the vasectomy was performed.

Within 5 years of the vasectomy, pregnancy rates are up to 75%. At 10 years or longer following the vasectomy, the pregnancy rates are less than 35%. A sperm count of more than 90% can be expected if the vasectomy has been done within 5 years and over 80% after 10 years. The formation of anti-sperm antibodies will often prevent pregnancy from occurring despite a good sperm count after the vasectomy. Conception will usually occur a year or so after the reversal.

Vasectomy Reversal Surgery:

Most patients request a general anaesthetic for their comfort, but the procedure can also be performed under regional or local anesthesia with sedation. Generous us of local anaesthetic combined with general anaesthesia makes for a very light general anaesthetic, which makes the procedure very safe. A small incision is made in the scrotal skin over the old vasectomy site. The two ends of the vas deferens are identified and freed from the surrounding scar tissue.

A drop of fluid from the testicular end of the vas deferens is placed on a glass slide and examined using a light microscope. This is a crucial part of the operation because the information obtained is used to decide what type of microsurgical reconstruction needs to be performed to re-establish sperm flow, a vasovasotomy or a vasoepididymostomy .

• Vasovasostomy , which is for the simpler cases, reconnects the two cut and blocked ends of each vas deferens.

• Vasoepididymostomy is performed for more complex cases (when a large portion of the vas has been removed at vasectomy or when a portion of the epididymis has become blocked) connecting the vas deferens to the epididymis.

Typically, a two-layer anastamosis is performed. At least 6 sutures are used for the first layer followed by a similar number for the outer layers providing a “watertight” join.

Vasectomy Reversal Summary:

• Vasectomy reversal procedures are considered safe with low risk for complications.

• Reconnecting the cut ends of the vas deferens is delicate microsurgery.

• Compared to prior vasectomy experience, a reversal usually produces a slightly longer period of discomfort and recovery.

• The procedure can require two to four hours, usually with a general anesthesia.

• Some discomfort is to be expected, but most signs and symptoms diminish within the first few days.

• You can expect a gradual return to normal activities, typically within two - five weeks as indicated by your doctor.

• Individual cases will vary and it's important to discuss success factors with a doctor.

• Success factors include: the skill of the surgeon, the condition of tissue and the time that has passed since the original vasectomy.

• Results are not immediate; it may be months or more before fertility and a normal sperm count is restored.

• A successful reversal can lead to conception, typically, within 12 to 24 months.Surgical Centre offers a broad range of orthopaedic surgery procedures performed by specialists and sub-specialists in their fields. Amongst the orthopedic surgery procedures offered include:

• Repair or resection of torn cartilage (meniscus)

• Reconstruction of anterior cruciate ligament (ACL)

• Removal of inflamed lining (synovium)

• Repair of torn ligaments

• Removal of loose bone or cartilage

• Uni-lateral knee replacements

Surgeons at this Centre perform orthopaedic surgery on ankles, knees, wrists, elbows, shoulders, and hands.
Many of these procedures are performed by arthroscopic surgery, a surgical procedure in which the inside of the joint can be evaluated and treated using surgical instruments placed into the joint through small incisions (portals) measuring one centimeter or less (less than half an inch).

Hand Injuries:

Surgical Centre has a comprehensive surgical program for all types of hand injury. Some of the more common procedures include carpal tunnel surgery and the repair of ligament, tendon, nerve and artery. Surgical Centre has three board certified plastic surgeons that are sub-specialized to treat hand injuries.