Main Items of Medical Service

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Feature Summary

End-stage renal disease (ESRD) occurs when your kidney gradually loses its function and can no longer remove waste or excess fluid from your body. It is an advanced stage of renal failure and usually happens when the function of kidneys declined to below 15 percent of its normal function. Patients diagnosed with ESRD often suffer from general weakness, nausea, vomiting, limbs edema, arrhythmia, and dyspnea. When chronic kidney disease develops into ESRD, renal replacement therapy, which includes hemodialysis, peritoneal dialysis, and renal transplantation, is necessary.

 

Overview

Hemodialysis (HD) is a treatment for patients with advanced renal failure. A vascular access is "created" weeks or months before the treatment. HD helps remove fluid and uremic toxins from the patient's blood, and thus maintain the balance of fluid and various minerals. By extracorporeal circulation, blood passes through the dialyzer (artificial kidney). Waste and excess fluid are washed away during the process.

 

Features

Kidneys function to remove waste products, such as creatinine, urea, and excess water, from the blood. When there is a gradual loss of kidney function due to disease, dialysis is needed to prevent the accumulation of waste products in the body.

 

Procedure

An arteriovenous fistula, arteriovenous graft, or a double lumen catheter will be established as a vascular access for HD. Typically, HD is performed three times per week and each session requires 3-4 hours. Blood is drawn out from the vascular access, pumped through the dialyzer, and then pumped back. Uremic toxins and excess fluid will be removed from the blood to the dialysate, which is composed of minerals and high quality water from a water purification system. Blood pressure and heart rate are closely monitored. An anticoagulant like heparin is used to prevent intraluminal thrombosis. At the end of the treatment, puncture site hemostasis is ensured by a dialysis nurse.

 

Notification

Potential risks and complications include:

  • Intradialytic hypotension is the most common complication during hemodialysis. Nausea, vomiting, conscious disturbance, chest pain, and abdominal discomfort may develop due to hypotension-related poor organ perfusion.
  • Arrhythmia may happen, especially when the patient has underlying cardiovascular disease.
  • Seizure
  • Anemia
  • Bleeding due to anticoagulant use or difficult hemostasis of puncture site
  • Muscle cramps
  • Infection of vascular access
  • Allergic reaction
  • Air embolism
  • Clotting

 

Estimated Cost

The procedure cost is about 12,000 NTD/time, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

 

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Feature Summary

End-stage renal disease (ESRD) occurs when your kidney gradually loses its function and can no longer remove waste or excess fluid from your body. It is an advanced stage of renal failure and usually happens when the function of kidneys declined to below 15 percent of its normal function. Patients diagnosed with ESRD often suffer from general weakness, nausea, vomiting, limbs edema, arrhythmia, and dyspnea. When chronic kidney disease develops into ESRD, renal replacement therapy, which includes hemodialysis, peritoneal dialysis, and renal transplantation, is necessary.

 

 

Overview

A treatment option for patients with ESRD is peritoneal dialysis (PD). It uses the peritoneum in the abdomen as the dialysis membrane. Toxins and fluids are removed through the peritoneum into the dialysate, which is usually composed of minerals and dextrose water. There are mainly two types of peritoneal dialysis: continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). Individual PD regimen will be prescribed by a nephrologist. PD differs from HD (requires frequent hospital visits) in that it is usually manipulated at home by the patient or caregiver with proper training.

 

Features

Kidneys function to remove waste products, such as creatinine, urea, and excess water, from the blood. When there is a gradual loss of kidney function due to disease, dialysis is needed to prevent the accumulation of waste products in the body.

 

Procedure

A surgery for catheter implantation will be performed two weeks before PD. The catheter is inserted through the skin with one end in the peritoneum. After proper cleaning of catheter, PD solution is infused through the catheter and retained in the abdomen. Uremic toxins and fluids are removed via the peritoneum. The solution is drained out 4-6 hours later and another clean PD solution is infused. The peritoneal solution (dialysate) usually contains minerals and dextrose water at different percentages. The amount of PD solution, usually 1.5-3 liters per bag, the percentage of dextrose water ranging from 1.5% to 4.5%, the number of daily exchanges, and the dwell time will be prescribed by a nephrologist as individualized PD regimen after complete evaluation. APD works in the same way as CAPD, but can be carried out during the night by the machine.

 

 

Notification

Potential risks and complications include:

  • Infection around the catheter site or abdominal lining (peritonitis)
  • Hernia due to abdominal muscle straining
  • Hypokalemia
  • Hypotension
  • Hyperglycemia, especially in patients with diabetic mellitus
  • Inadequate dialysis
  • Fibrosis of peritoneum after long-term use of peritoneal dialysis
  • Hydrothorax due to leakage of diaphragm
  • Abdominal and genital leaks
  • Encapsulating peritoneal sclerosis, a rare but serious complication causing bowel obstruction, malnutrition, and intra-abdominal infection that may be fatal in some cases

 

Estimated Cost

Prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses

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Feature Summary

  • Immune disorders, such as lupus with central nervous system involvement, myasthenia gravis crisis, Guillain–Barré syndrome, multiple sclerosis, Goodpasture syndrome, hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, granulomatosis with polyangiitis, antiphospholipid antibody syndrome (APS or APLS), microscopic polyangiitis
  • Familial homozygous hypercholesterolemia
  • Hyperviscosity syndromes: cryoglobulinemia, paraproteinemia, Waldenström macroglobulinemia
  • Recurrent focal and segmental glomerulosclerosis in the transplanted kidney.

 

Overview

Plasmapheresis (PP) is the removal, treatment, and return or exchange of blood plasma or components thereof from and to the blood circulation.

Two general types of plasmapheresis can be distinguished:

  • Removing blood plasma, treating it in some way, and returning the blood cells to the same person
  • Removing blood plasma and exchanging it with blood products (donor plasma or albumin) to the recipient; this type is called plasma exchange (PE)

 

Features

  • Removal of harmful antibodies or toxins
  • Removal of excessive metabolic wastes (such as cholesterol)
  • Lowering the viscosity of the blood

 

Procedure

  1. A double-lumen catheter is usually implanted via femoral vein (near the inguinal area).
  2. During plasmapheresis, blood is initially taken out of the body through the catheter.
  3. Plasma is then removed from the blood by a cell separator.
  4. After plasma separation, the blood cells are returned to the person undergoing treatment, while the plasma will then be returned to the patient after the removal of the harmful antibodies.
  5. Medication, such as an anticoagulant to keep the blood from clotting, calcium to prevent cramping, and a steroid or anti-histamine for allergies, will be given to the patient during the procedure.
  6. The treatment time for this procedure usually takes about 2 hours.

 

Notification

  • Bleeding over the site of the implanted large intravenous catheter
  • Infection, if the catheter is left in too long
  • Blood loss due to blood clotting when the patient’s blood is outside of the body passing through the plasmapheresis machine
  • Muscle cramping due to hypocalcemia (low serum calcium concentration) may occur, because of the binding of calcium in the blood by citrate, which is contained in the donated plasma products as anti-coagulants; this can be prevented by the infusion of calcium intravenously during PP
  • Hypotension
  • Transfusion reactions or transfusion-transmitted diseases

 

Estimated Cost

Prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

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Feature Summary

End-stage renal disease (ESRD) occurs when your kidney gradually loses its function and can no longer remove waste or excess fluid from your body. It is an advanced stage of renal failure and usually happens when the function of kidneys declined to below 15 percent of its normal function. Patients diagnosed with ESRD often suffer from general weakness, nausea, vomiting, limbs edema, arrhythmia, and dyspnea. When chronic kidney disease develops into ESRD, renal replacement therapy, which includes hemodialysis, peritoneal dialysis, and renal transplantation, is necessary.

 

Overview

A kidney transplant is a surgical procedure performed to replace a diseased kidney with a healthy kidney from another person. The kidney may come from a deceased organ donor or a living donor. Family members who make a good match may be able to donate one of their kidneys. This type of transplant is called a living transplant, which has several advantages when compared to cadaveric transplants, including less waiting time, better surgical planning, and higher success rates for the health of the donor and recipient.

 

Features

Most transplanted kidneys work immediately, and creatinine levels return to normal levels within weeks. A few transplanted kidneys will take time to start working. When this happens, dialysis is needed until the kidneys can function normally.

 

Procedure

A series of blood tests (including cross matching and tissue typing) and imaging studies will be first conducted on both the donor and recipient to ensure compatibility for renal transplantation. During the procedure, the surgeon places the donor kidney off to one side of the lower abdomen and attaches the artery and vein of the transplanted kidney to the blood vessels of the pelvis. The surgery usually takes about 3 hours. Following surgery, a urinary catheter will be inserted to drain the urine from the bladder. The urinary catheter is usually removed after 5 days.

 

Notification

  • Risks related to surgery include:
  1. Allergic reaction to general anesthesia
  2. Bleeding
  3. Blood clots
  4. Urological complications (ureteral obstruction and urinary leak)
  5. Infection
  6. Rejection or failure of the donated kidney
  7. Heart attack
  8. Stroke
  • Risks not related to surgery include:
  1. Rejection of the donated kidney

It is the most serious risk of the transplant; however, the hospital estimates that 90% of living-related and 80% of deceased kidney transplant function for at least five years after surgery.

  1. Immunosuppressant drugs-related side effects include:
  2. Hypertension
  3. Cardiovascular disease
  4. Infection
  5. Weight gain
  6. Bone thinning
  7. Increased hair growth
  8. Skin lesions
  9. Development of certain cancers like non-Hodgkin's lymphoma

Estimated Cost

Prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

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 sarcoma biological reconstruction

Feature Summary

Biological reconstruction by use allograft or recycled autografts exhibit advantages in well host bone-graft incorporation, restore bone stock, good size and shape adaptation and gain better longevity.

 

Overview

After neoadjuvant chemotherapy, patients received wide tumor resection and reconstruction by recycle autografts. For the ECIR-treated autografts, the bone segment irradiated by a Linear Accelerator with a single dose of 150-300Gy. For the freezing-treated autografts, the resected segment was frozen in liquid nitrogen for 20 minutes followed by slowly thawing. After the treatment, the bone segment was returned immediately for continuing the reconstruction surgery.

 

Features

Between January 1998 and December 2012. More than two hundreds of sarcoma cases were reconstructed by recycle autografts. More thant 90% of grafts could achieved solid biological union in nine months and finally restore real bone stock. The five-year limb survival rate is 93% and graft survival rate is 88% which is much better than tumor prosthesis (60-70%). The average limb functional score is 88%. No tumor recurrence from the recycled autografts. The five-year patient survival rate is 83%. Thus, biological reconstruction is a safe and ideal method for limb reconstruction.

The average Limb survival rate is 93% and patient’s survival rate is 83%. The average functional score is 88%. Common complication including nonunion (10%) and infection (8%). Most of complications were occurred within the first 3 years after surgery. Afterwards the complication rates were significantly decreased. Most of the complications could be managed by additional surgery.

 

Procedure

After patients received wide resection of bone sarcoma. A huge bone defect will be occurred. Orthopedic tumor surgeon will reconstruct the bone defect by real bone, such as allograft or recycled autografts. high dose of irradiation (ECIR) or freezing are the most efficiency method for the recycled method.

 

For the ECIR-treated autografts, the bone segment was tightly wrapped with sterile drape and sealed in doubled-layered plastic bags. The sealed bone segment was irradiated by a Linear Accelerator with a single dose of 150-300Gy. Radiation field was ensured to adequately cover the tumor-bearing bone segment. The treated bone segment was returned immediately for reimplanted and fixed by osteosynthesis materials.

  Taiwan healthcare, Taiwan medical, Taipei veterans general hospital, biological reconstruction, osteosarcoma, sarcoma, limb salvage, limb reconstruction, extracorporeal irradiation

For the freezing treatment, the resected segment was frozen in liquid nitrogen for 20 minutes followed by slowly thawing at room temperature for 15 minutes and 10-minute successive thawing in distilled water. The freezing-treated autografts were reimplanted and fixed by osteosynthesis materials.

 Taiwan healthcare, Taiwan medical, Taipei veterans general hospital, biological reconstruction, osteosarcoma, sarcoma, limb salvage, limb reconstruction, freezing, liquid nitrogen

 

freezing autograft atuograft

 

Notification

There are possible risks and complications association with the surgery, including:
1. infection requiring antibiotics or surgical debridement.
2. Graft fracture requiring repeat surgical fixation.

There may some other alternative approaches to the biological reconstruction, including:
1. Amputation.
2. Tumor prosthesis reconstruction

 

Estimated Cost

The procedure cost is about 30,000 ~ 1,525,000 NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

 

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Feature Summary

The most important part of the surgery for bone sarcoma is to remove the tumor entirely. The surgical methods include either "amputation" or "limb salvage".

 

Overview

The so-called “limb salvage” is to only remove the tumor part from the body of the patient, rather than remove the entire limb. Following by reconstructing the bone defect.

 

 

Features

The definition of wide resection is "excise at least two centimeters safe margin along the tumor margin.” And the surgeon should not rupture the tumor during the surgery. Otherwise it will cause tumor recurrence and even distal metastasis. But if the tumor is located in some critical area or if the tumor response to chemotherapy well, surgeon could excise the tumor with less safe margin. We called that marginal resection.

 

Notification

There are possible risks and complications associated with the surgery, including:
1. infection requiring antibiotics or surgical debridement.
2. Nerve, vessel injury during tumor resection.

 

Estimated Cost

The procedure cost is about 40,000 to 80,000 NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

 

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Feature Summary

There are numerous cancers may cause bony metastasis. Treatment is depending on the tumor location, bone destruction and patient's outcome and symptom. Currently, due to improving survival rate of cancer, the surgical treatment of bony metastasis becomes more important.

bone metastasis pqwu

 

Overview

Many cancers, such as lung cancer, breast cancer, thyroid cancer, kidney cancer and prostate cancer, could cause bony metastasis. According to some researches, there were 20% to 30% of lung and breast cancer whereas 10% to 40% of prostate cancer developing bony metastasis. Bony metastasis could cause the so-called SRE (skeletal related events), such as hypercalcemia, pathologic fracture and spinal cord compression. Currently, due to the improvement of the patients overall survival rate, in order to cure the disease and prevent from SRE, the surgical intervention for bony metastasis is more aggressive.

 bone metastasis pqwu

Procedure

The surgical treatment for bone metastasis depends on patient's demanding and prognosis. If the demanding is high and the prognosis of the disease is better, then wide resection of the tumor and reconstruction of the skeletal structure is indicated. By the wide resection, patients could achieve better local tumor control and long-term functional recovery. On the contrary, if the patient’s demanding is low and the prognosis of the disease is poor, intralesional curettage following cryotherapy and bone grafting wound be a better choice. By intralesional curettage, there is lower surgical risk, lesser surgical time and patient could regain functional recovery earlier.

 bone metastasis surgery pqwu

 

bone metastasis hemiarthroplasty nailing pqwu

 

Notification

There are possible risks and complications associated with the surgery, including:
1. infection requiring antibiotics or surgical debridement.
2. Nerve, vessel injury during tumor resection.

 

Estimated Cost

The procedure cost is about 150,000 to 300,000 NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

 

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Feature Summary

Cryotherapy by FNEC (Freezing Nitrogen Ethanol Composite) is a new-developing cryotherapy technique by Taipei Veterans General Hospital.

cryotherapy bone tumor pqwu

 

Overview

Some of the bone tumors such as aggressive benign bone tumors, low-grade malignant bone tumor and bony metastasis are easily cause local recurrence. Even by intensive intralesional tumor removal and radiotherapy, there is still 12% to 50% local recurrence rate. To decrease the risk of post-curettage recurrence, several types of local adjuvant treatments, for instance the use of polymethylmethacrylate, phenol, or liquid nitrogen, have been considered. Since the 1960s, cryotherapy by use of liquid nitrogen as the cryogenic source has been used in adjuvant treatment of some musculoskeletal tumors, including GCT, and showed that it is useful in reducing recurrence but is associated with complications related to the freezing.

 

The mechanisms of cryoablation-mediated cell death have been studied. In brief, rapid freezing induces intracellular ice crystallization and propagation of ice mediates mechanical stress, which causes damage to cellular organelles. The resulting ice recrystallization is accompanied by slow thawing that mediates further damaging stress. The ultimate goal is to eradicate tumor cells without damage to the adjacent healthy tissues. Directly pouring a cryogenic source such as liquid nitrogen into the surgical bone cavity was first introduced by Marcove. However, this treatment is associated with local complications like fracture in as many as 42% of patients; less commonly, skin necrosis and nerve palsy have been reported. These problems have caused investigators to question the merits of this approach. Complications of liquid nitrogen treatment may be caused directly by spills or overflow of the liquid, or by liquid nitrogen’s profound freezing effect ( 196° C) damaging the adjacent normal tissues. To avoid some of the disadvantages associated with the use of directly pouring liquid nitrogen into a tumor cavity after curettage, we explored the development of a novel cryogenic material, freezing nitrogen ethanol.

 cryotherapy bone tumor fnec pqwu

Procedure

The surgical technique was performed under tourniquet control. After exposure of the involved bone tissue, a cortical window the size of the longest longitudinal dimension of the tumor was made. After exposure the tumor,  the gross tumor was then removed by hand curettes carefully. After that, followed by high-speed burring to remove the tumor invasive into the peripheral area. To further kill all the possible residual tumor nearby, cryotherapy could be applied. We used a warm water-perfused gauze pad to insulate the normal tissues adjacent to the surgical lesions. The freshly prepared semisolid freezing nitrogen ethanol composite was scooped into the lesion cavity. The exterior surface of the freezing nitrogen ethanol composite preparation may melt faster. The melted freezing nitrogen ethanol composite was removed and additional fresh freezing nitrogen ethanol composite was added to ensure a consistent semisolid status. At least 5 minutes of exposure to freezing nitrogen ethanol composite was ensured for the entire bone cavity. Finally, the freezing nitrogen ethanol composite-treated tissue was thawed for 15 minutes. After thawing, bone defect reconstruction was conducted using bone grafts (artificial bone grafts or allografts) and internal fixation by osteosynthesis was dictated by the nature of the lesions.

 

Notification

There are possible risks and complications associated with the surgery, including:
1. infection requiring antibiotics or surgical debridement.
2. Nerve, vessel injury during tumor resection.

 

Estimated Cost

The procedure cost is about 150,000 to 300,000 NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

 

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Feature Summary

Tumor prosthesis reconstruction by use tumor prosthesis exhibit advantages in quicker functional recovery, immediately post-operatively weight bearing and restore limb length.

Procedure

After patients received wide resection of bone sarcoma. A huge bone defect will be occurred. Orthopedic tumor surgeon will reconstruct the bone defect by tumor prosthesis.

Surgeon measures the length bone defect before and also during the surgery. After the sarcoma was excised, a matched-sized tumor prosthesis was assembled. After checking the tension of the limb, the tumor prosthesis was cemented fixed into the bone defect.

 

Notification

There are possible risks and complications association with the surgery, including:
1. infection requiring antibiotics or surgical debridement.
2. Prosthesis loosening requiring revision surgery.

There may some other alternative approaches to the biological reconstruction, including:
1. Amputation.
2. Biological reconstruction

 

Estimated Cost

The procedure cost is about 300,000 ~ 1,525,000 NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

 

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Feature Summary

Benign bone tumors are very common bone disease. Most of the benign bone tumors cause no symptom. But some will cause symptom of pain or even pathologic fracture.

 benign bone tumor pqwu

Overview

Benign bone tumors such as giant cell tumor, chondroblastoma, aneurysmal bone cyst may easily cause pain and pathologic fracture. Aggressive surgical treatment including intralesional curettage, burring and cryotherapy is indicated. Firbrous dysplasia is also a common bone tumor. It will cause fracture and limb deformity while located in the hip area. Surgical tumor removal and bone grafting is also indicated.

 

Procedure

The surgical technique was performed under tourniquet control. After exposure of the involved bone tissue, a cortical window the size of the longest longitudinal dimension of the tumor was made. After exposure the tumor, the gross tumor was then removed by hand curettes carefully. After that, followed by high-speed burring to remove the tumor invasive into the peripheral area. To further kill all the possible residual tumor nearby, cryotherapy could be applied. The freshly liquid nitrogen was carefully poured into the bone cavity. At least 5 minutes of exposure to liquid nitrogen was ensured for the entire bone cavity. After thawing for 15 minutes, bone defect reconstruction was conducted using bone grafts (artificial bone grafts or allografts) and internal fixation by osteosynthesis was dictated by the nature of the lesions.

surgery for benign bone tumor pqwu

Notification

There are possible risks and complications associated with the surgery, including:
1. infection requiring antibiotics or surgical debridement.
2. Nerve, vessel injury during tumor resection.

 

Estimated Cost

The procedure cost is about 100,000 to 300,000 NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

 

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Feature Summary

Living donor liver transplantation is a not a simple operation but needs pre-operative careful evaluations for healthy live donors and sick recipients, delicate donor and recipient operations and complicated post-operative cares. The live donor operation is to harvest 60-70 % of liver (right liver) for an adult recipient or 15-40% liver (left liver) for a child recipient. The donor should be blood relatives or relatives in law.

 

Overview

Indications to living donor liver transplantation:

(1) End stage liver cirrhosis: In adult, the causes include chronic hepatitis, alcoholism, Wilson’s disease and autoimmune disease etc. In children, the main cause is biliary atresia.

(2) Metabolic liver disease: when the condition cannot be well controlled by special formula and drugs.

(3) Liver cancers: hepatocellular carcinoma (meet UCSF criteria) and hepatoblastoma resistant to chemotherapy and unrespectable.

(4) Other liver associated diseases which can be treated by replacement of a new liver.

 

Features

The liver transplantation is to replace patient’s native liver with a healthy whole or partial liver (living donor is partial liver). Under regular immune-suppressive medications, the implanted liver will function well and perform the functions of normal liver. This operation is a life-saving procedure.

 

Procedure

Donor and recipient operations are performed simultaneously in two operation rooms. There are two operative and anesthetic teams. The donor’s operation includes laparoscopic dissection of ligamentous attachment of donated part liver, midline incision to dissect portal hilum and dissection of liver parenchyma. The graft is taken out according to the recipient’s operation, which means at the time of diseased liver already removed. The graft is cold flushed and then taken to recipient’s operation room. The recipient’s operation includes a Benz incision, total hepatectomy and then implantation of the donor graft. The usual time for donor and recipient operations is 8 hours and 12 hours respectively.

 

 

 

Notification

  • Donor:
  1. Minor complications: bile leakage: 1-2%, post-operative bleeding needs reoperation: 0.5%, right pleural effusion needs aspiration of pleural fluid: 1-2%, post-operative intestinal ileus: 1-2%. Dyspepsia: 5-10%
  2. Major complications: biliary stricture: 0.5% thrombosis of inflow or outflow of residual liver: 0.5%.
  3. Surgical mortality: 0.1-0.3% for donation to adult patients, 0.1% for donation to children.
  • Recipient:
  1. Minor complications: bile leakage: 5%, post-operative bleeding needs reoperation: 5-10%, pleural effusion needs aspiration of pleural fluid: 10%, post-operative intestinal ileus: 5-10%, biliary anastomosis stricture: 20-30%.
  2. Major complications: thrombosis or stenosis of inflow or outflow of graft liver: 3-5%, sepsis: 3-5%, others: 5%.
  3. Surgical mortality: 3% non-acute liver failure patients, 10-20% for acute liver failure patients.

 

Estimated Cost

  • Donor:1,000,000 NTD
  • Recipient:2,500,000 NTD
  • Prices are subject to change without prior notice, and need to pay in accordance with the actual medical expenses.

 

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Overview

Vesicoureteral reflux (VUR), or the retrograde flow of urine from the bladder into the ureter, is an anatomic and functional disorder that can result in substantial morbidity, both from acute infection and from the sequelae of reflux nephropathy.

 

Features

Vesicoureteral reflux (VUR) is characterized by the retrograde flow of urine from the bladder to the kidneys. VUR may be associated with urinary tract infection (UTI), hydronephrosis, and congenital/secondary abnormal urinary tract development (duplications of ureters, horseshoe kidney, neurogenic bladder).

Unrecognized VUR with concomitant UTI may lead to long-term effects on renal function and overall patient health. Some individuals with VUR are at an increased risk for pyelonephritis, hypertension, and progressive renal failure. However, the severity of VUR greatly varies and thus may affect patients differently. Evaluation of VUR treatment outcomes should consider not only resolution of reflux over time but also resolution of UTIs and the overall health of the kidneys.

 

Procedure

The goal of treatment is to minimize infections, as it is infections that cause renal scarring and not the vesicoureteral reflux. When medical management fails to prevent recurrent urinary tract infections, or if the kidneys show progressive renal scarring then surgical interventions may be necessary. There are two main surgical interventions for pediatric VUR include endoscopic injection of hyaluronic acid (Trade name, Deflux) and open procedures for ureter reimplantation.

 

Notification

 

  • Stenosis of reimplanted ureteral orifice
  • Irritable urinary bladder after open procedure
  • Recurrence of VUR and infection
  • General risk of anesthesia

 

 

Estimated Cost

160,000~180,000 NTD

 

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Overview

During normal development before birth, the testes “descend” from inside the belly down to the scrotum. Sometimes, the development is abnormal and results in abnormal position of the affected testis, which is called an undescended testis. This condition affects about 3% of term male infants, and is more common in preterm babies. The scrotum can appear small and flat and the affected testis cannot be found inside.

 

Features

Some of the undescended testes have the chance to descend to the scrotum within the first 6-12 months but most don’t. Most patients will require an operation at the age of 6-12 months to find the abnormally positioned testis and put the affected testis inside the scrotum. This surgery is called an “orchiopexy”. It is a relatively minor operation.

 

Procedure

Under general anesthesia, a small wound is made over the groin on the affected side and the abnormally positioned testis is found. The blood vessels supplying the testis and the vessel transporting the sperm (the vas deferens) was released and lengthened. The testis will then be put inside a subcutaneous pocket in the scrotum. The skin is then repaired with absorbable sutures, which means the sutures will not require removal. Skin adhesive and a dressing will then be applied. Sometimes, the surgery will require two stages due to inadequate length of the blood vessels.

 

Notification

  • 1-2% testis atrophy after operation
  • Higher than expected position of the testis several months or years after the surgery
  • Minor wound infection
  • Allergic reaction to the suture material
  • General risk of anesthesia

 

Estimated Cost

50,000~60,000 NTD

" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [4]=> array(8) { ["sn"]=> string(2) "18" ["classify"]=> string(1) "3" ["cover"]=> string(0) "" ["title"]=> string(12) "Buried penis" ["content"]=> string(2046) "

Overview

Buried penis is a congenital anomaly affecting the appearance and the function of the external genitalia in boys and men. The penis can look like a pyramid, or appear hidden within the fat over the lower part of the belly. This condition is frequently associated with insufficient outer prepuce, inadequate subcutaneous tissue attachment, excessive fat in front of the pubic bone, and a narrow opening of the penile skin. Some boys with severe buried penis will require an operation to improve and correct the appearance of the penis. This procedure is called a “penoplasty” surgery. It is a relatively minor operation and usually performed as an out-patient surgery. However, general anesthesia (putting the patient to sleep) and is required because the patient’s age.

 

Features

Penoplasty is mostly done to correct the appearance of the penis. Other indications of the surgery include difficulty in urination, deposition of urine in the penile skin (“ballooning”) and infection of the penile skin and the glans of the penis.

 

Procedure

Under general anesthesia, the tethered tissue between the penile skin and the tissue beneath is released and divided down to the base of the penis. The penile skin is then fixed at the base of the penis. After that, the penile skin is repaired with absorbable sutures, which means the sutures will not require removal and will dissolve after several weeks. Compressive dressing will then be applied to the wound around the penis.

 

Notification

  • Temporary edema of the penile skin after the surgery
  • Minor bleeding after the surgery
  • Allergic reaction to the suture material
  • General risk of anesthesia

 

Estimated Cost

75,000~80,000 NTD

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Feature Summary

Pediatric Airway Anomalies are challenging problems for patients, families and clinical team. In the past, most of these patients were sent to different hospitals with miserable outcomes because every single hospital is lack of experience in reconstructive surgery of the pediatric airway. For a long period, a dedicated team was established at our Institute. Taipei Veterans General Hospital Pediatric Tracheal Disorder Team includes different professionals, including pediatric surgeons, anaesthetists, intensive care specialists, neonatologists, pulmonologists, radiologists, and cardiovascular surgeons. The aim of this program was to provide these multidisciplinary patients, at any time, with intensive care, radiological investigations, diagnostic and intervention endoscopy, reconstructive surgery, ECMO or cardiopulmonary bypass.

 

Overview

Pediatric Airway Anomalies may be either disorders intrinsic to the trachea itself or may represent external forces compressing the airway. Although congenital tracheal malformations are by definition present at birth, at times they may not cause symptoms until far later in life. The primary presenting symptom is most commonly biphasic stridor, with a considerably prolonged expiratory phase. Nevertheless, other airway-related symptoms (eg, wheezing, cough, pneumonia, croup) may be present as well.  Many types of tracheal anomalies are listed and sorted by the anatomical classifications such as tracheal stenosis, tracheomalacia, vascular anomalies and tracheal cleft, etc.

 

Procedure

Many tests are available to assist in the workup of congenital tracheal malformations. The initial otolaryngologic evaluation should include a fiberoptic nasopharyngolaryngoscopy to rule out any supraglottic or glottic abnormalities. Radiographic imaging is helpful, with many available modalities to consider. CT scanning of the neck and chest provides additional data, while MRI together with magnetic resonance angiography (MRA) can provide detailed vascular information and may obviate the need for conventional contrast angiography. However, the criterion standard diagnostic modality is still direct laryngoscopy with rigid bronchoscopy and possible rigid esophagoscopy.

Intervention may be needed in children with life-threatening episodes of airway obstruction, recurrent infection, respiratory failure, or failure to thrive. Continuous positive airway pressure (noninvasive or invasive via tracheostomy) is the most widely used therapy. Surgical approaches such as tracheal reconstruction, placement of a tracheal stent, surgical suspension of the trachea (tracheopexy), tracheal plasty (segmental resection and anastomosis) have been conducted in our patients. Each patient is cared and managed by multidisciplinary team and the treatment will be tailored individually.

 

Notification

  • Re-stenosis of airway
  • ECMO related complications
  • Recurrence of TE fistula
  • General risk of anesthesia

 

Estimated Cost

The procedure cost is about 400,000 NTD. Prices are subject to change without prior notice, and need to pay in accordance with the actual medical expenses.

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Feature Summary

Endoscopic retrograde cholangiopancreatography (ERCP)

ERCP is a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain diseases of the biliary or pancreatic ductal systems.

 

Overview

The biliary tract diseases include bile duct stones, cholangitis, tumors, congenital bile duct anomalies or post-operative complications, leading to bile duct stricture and/or obstructive jaundice. Pancreatic cancer, pancreatic tumors, chronic pancreatitis and congenital pancreatic anomalies can result in pancreatic duct stricture, stone formation or chronic pancreatic pain.

 

Features

ERCP is used to diagnose and treat diseases of the biliary or pancreatic ductal systems. The therapeutic indications include endoscopic sphincterotomy, removal of stones, and insertion of bile duct stents for benign or malignant biliary and pancreatic strictures.

 

Procedure

Under sedation, an endoscope is inserted through mouth into the duodenum. Through the scope, a catheter is inserted into the ampulla of Vater and radiocontrast is injected into the bile ducts and/or pancreatic duct. Fluoroscopy is used to look for intra-ductal lesions, such as stones or stricture. Several therapeutic procedures can be performed during ERCP, including endoscopic sphincterotomy, removal of stones or other biliary debris, lithotripsy and insertion of bile duct stents. Cholangioscopy (SpyGlass) can also be performed with ERCP for direct visual diagnosis, biopsy, or laser lithotripsy.

 

Notification

  • GI tract bleeding, incidence rate around 0.8~2%。
  • GI tract perforation, incidence rate around 0.3~0.6%。
  • Acute pancreatitis, incidence rate around 1~7%。
  • Infection, such as cholangitis (<1%), cholecystitis (0.2~0.5%), aspiration pneumonia.
  • Unpredictable complications, such as arrhythmia, acute respiratory failure, shock.

 

Estimated Cost

Prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

 

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Overview

Early gastrointestinal neoplasm

Gastrointesitnal tract includes from esophagus, stomach, duodenum, small intestine to colon area. The early gastrointestinal neoplasm means superficial epithelial cancer with limited invasion (only to mucosa or submucosal layer) at these areas. Early diagnosis and treatment of early gastrointestinal neoplasm gets very good prognosis.

 

Features

Endoscopic submucosal dissection, ESD

ESD is a promising advance for treatment of early gastrointestinal neoplasm in recent 10 years. It can offer a comparable outcome to traditional surgical resection. Another benefit of ESD includes less invasiveness, preserved organ, no surgical wound, faster recovery and better life quality after treatment.

The goal of ESD is to completely resect resection of the neoplasm and finally cure the disease.

 

Procedure

Most patients who receive ESD should undergo moderate conscious sedation without respiratory machine support. The treatment procedure includes sedation, identify the neoplasma, circumferential incision and submucosal dissection of the neoplasma by specialized endoscopic equipment. Finally, remove the neoplasma without any surgical wound in the body surface. The duration of procedure time is about 2-4 hours.

 

Notification

  • Bleeding, about 5.5%. Treatment includes endoscopic bleeding control and blood transfusion
  • Gastrointestinal tract perforation, about 1.2-6%. Treatment includes endoscopic repair or emergent surgical repair (in 1-2% patients)
  • Gastrointestinal tract stricture. Mostly in patients who have large area of early esophageal cancer receiving ESD.

 

Estimated Cost

Prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

Early esophageal cancer

endoscopic submucosal dissection

Post ESD wound, immediately

Post ESD wound, 1 month later.
Preserved esophagus

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Feature Summary

pancreatic pseudocyst/abscess

Pancreatic pseudocysts and pancreatic abscess develop commonly in the setting of pancreatitis as a result of focal damage and/or necrosis to the pancreas. These lesions will not only compress or obstruct the duodenum, bile duct, or stomach but lead to sepsis or death.

 

Overview

Most infection of pseudocyst is severe and results in a sepsis syndrome. This often requires a surgical debridement or drainage for resolution. Linear EUS provides a new method for dynamic imaging, aspirating, and draining pseudocysts or abscess. Nowadays, external drainage using EUS guidance is the most common approach.

 

Features

To resolve symptom and treat infection related to pancreatic pseudocyst or abscess.

 

Procedure

Preparation for transgastric drainage is 12 hours fasting before the procedure. Mild sedatives can be used to relieve discomfort. Transgastric stenting of pseudocysts/abscess will be performed using EUS to determine the entry site for catheterization and then introduce the guidewire into the lesion cavity. X ray can be used to confirm the location. Therefore, more than one stents will be inserted into the cavity through guidewire.

 

Notification

Bleeding (<10%)

 

Estimated Cost

Prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

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Feature Summary

Hepatocellular carcinoma is a malignant tumor in liver. It is now the third leading cause of cancer deaths all over the world. It occurs predominantly in people with liver cirrhosis and chronic hepatitis, such as hepatitis B, hepatitis C, alcoholism and fatty liver disease.

 

Overview

Radiofrequency ablation is a technique to treat hepatocellular carcinoma. The localized tumor cell could be completely clean by heat during treatment. With minimal invasive procedure, the outcome is as good as open surgery in small tumors.

 

Features

Radiofrequency ablation aims to completely clean the early stage hepatocellular carcinoma under only minimal invasive procedure.

 

Procedure

During radiofrequency ablation, only localized anesthesia is required. The probe is placed into the liver percutaneously and generates heat by medium frequency alternating current. The tumor is thus ablated by the heat. The treatment course is completed in few minute, and the probe is removed. The patient restores usual life after hours of rest.

 

Notification

  • Pleural effusion
  • Abscess formation
  • Ascites
  • Hemorrhage
  • Thermal injury to adjacent organ

 

Estimated Cost

The procedure cost is about 70,000~100,000 NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

 

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Overview

Small bowel is in the middle of gastrointestinal tract. Due to its tortuosity and anatomic location, the diagnosis and management of small bowel diseases is challenging. Currently, video capsule endoscopy(VCE), computed tomography enterography (CTE), and double balloon enterscopy (DBE) are specific advanced methods used in managing small bowel disease. VCE and CTE are used for diagnosis while DBE is used in both diagnosis and management of small bowel disease.

 

Features

Double balloon enteroscopy is indicated in mid-gastrointestinal bleeding (obscure gastrointestinal bleeding), confirmation and treatment of abnormal findings in other examinations such as VCE or CTE, polyps of the small bowel, foreign body ingestion, small bowel tumors, incomplete colonoscopy due to technical difficulty, unexplained malabsorption, diarrhea and refractory celiac disease.

 

Procedure

Double balloon enteroscopy is a novel endoscopic technique in examining small bowel under anesthesia. The 2-meter-long enteroscope has a balloon attached at its tip with an overtube which is also fitted with a balloon. With its special design, it can be inserted from mouth or anus and passed through deep small intestine to visualize the small bowel lesion. Therapeutic maneuver including endoscopic biopsy, foreign body removal, endoscopic hemostasis, polypectomy and stricture dilation or stenting can be performed whereas suitable.

 

Notification

  • Bleeding (0.2%)
  • Intestinal perforation (0.1-0.4%)
  • Pancreatitis (0.2-0.5%)
  • Cardiac and respiratory arrest (0.05%)

 

Estimated Cost

The basic fee of double balloon enteroscopy examination is about $60,000 NTD.

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Feature Summary

The purpose of the cochlear implant surgery is for improvement of hearing so that one can be easy to connect with other people and ameliorating quality of life, including language and mental development, learning, communication and social ability.

 

Overview

Hearing handicapped

Children who have congenital severe to profound hearing loss causing problems of language learning and speech understanding or adult who have moderately-severe to profound bilateral sensorineural hearing loss with few or no useful benefit from hearing aids could be patient candidacy with consideration for cochlear implant surgery.

 

Features

Cochlear implant is indicated in moderate to severe hearing handicapped. The modern cochlear implant is a device designed to receive environmental sound (receiver-stimulator) then convert into electrical impulses that are delivered along a multiple electrode array(electrode) situated in close proximity to the cochlear (auditory) nerve. As this paradigm does not necessarily rely upon hair cell transduction mechanisms, it is ideal for patients with significant hair cell loss.

 

Procedure

Complete pre-operative examination will be conducted, including pure tone audiometry, speech discrimination test, sound field audiometry, auditory brain stem response, otoacoustic emission, etc. High resolution computerized tomography helps determine the better ear for implantation, and magnetic resonance imaging will also be arranged to rule out the possibility of acoustic neuroma if necessary. The process of operation is under general anesthesia. At first, postauricular incision will be made. After elevation of the skin and scalp, drilling out of the skull followed by placement of the receiver-stimulator will be done. Then performing mastoidectomy and posterior tympanotomy till expose of round window niche clearly. Finally, insertion of electrode after cochleostomy is completed. After the surgery, the radiograph should be obtained to document intracochlear placement of the electrode.

 

Notification

Risks & complications

  • Postoperative infection

Since the implant will be placed in the body permanently, there is risk for infection. However, prescription of proper antibiotics will reduce the risks.

  • Facial paralysis

The facial nerve will possibly be encountered during surgery. If injury of the nerve is happened, transient or long-term unilateral paralysis of face will be noted. However, this event could be avoided by experienced operator and using facial nerve monitor.

  • Cerebrospinal fluid (CSF) leakage

Though little possibility, rupture of dura might be happened and it would cause cerebrospinal fluid leakage. Repair of dura with autologous soft tissue and nonautologous glue will solve this problem during operation.

  • Device failure

The implant is not functional well because of integrated etiology, such as anatomy, age of the patient, previous medical underlying, etc.

 

Estimated Cost

The procedure cost is about 1,100,000 NTD; prices are subject to change without prior notice, and need to pay in accordance with the actual medical expenses.

 

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Feature Summary

To rescue the ischemic brain tissue by reopening cerebral arteries as soon as possible. This is proved to be associated with good functional outcomes after ischemic stroke.

 

Overview

Acute ischemic stroke is characterized by the sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of neurologic function. Acute ischemic stroke is caused by thrombotic or embolic occlusion of a cerebral artery.

Features

Our current managements of acute ischemic stroke is based on the duration from the onset time of symptoms according to the international guidelines. If the onset time is within 3 hours, we activate the evaluation protocol of recombinant tissue plasminogen activator (rt-PA) injection. We give rt-PA therapy if patient is qualified according to the criteria. We also arrange advanced angiographic imaging after injection of rt-PA for further intra-arterial thrombectomy evaluation. If patient arrive the emergency department within 6 hours from onset, we initiate intra-arterial thrombectomy protocol after major artery occlusion being identified. For patients arriving our hospital out of the time window mentioned above, we start the acute medical treatment and arrange brain MRI as well as further examinations for etiology survey. Admission for comprehensive care followed by rehabilitation referral will also be arranged.

 

Procedure

We arrange precise evaluation to find out the legit patients for acute management. The rt-PA therapy is non-invasive, and is applied via intravenous dripping. You won’t feel pain or significant discomfort during entire treatment. The intra-arterial thrombectomy is an advanced and invasive procedure. A puncture will be made through your femoral artery at the groin and catheters being inserted retrograde to your intra-cranial arteries under conscious sedation or generalized anesthesia. We use stent-retriever or intracranial suction catheter to extract intra-arterial thrombus. The patient treated with rt-PA or intra-arterial thrombectomy will be admitted to our stroke care unit for intensive care.

 

Notification

  • Intracranial hemorrhage (3-10%)
  • Internal bleeding, e.g.: Gastric bleeding (<10%)
  • Severe brain edema (The incidence varies according to the stroke severity)

 

Estimated Cost

The procedure cost is about 300,000~600,000 NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [1]=> array(8) { ["sn"]=> string(2) "36" ["classify"]=> string(1) "8" ["cover"]=> string(0) "" ["title"]=> string(26) "Botox for chronic migraine" ["content"]=> string(3037) "

Feature Summary

To reduce the frequency and severity of headache attacks in patients with Chronic Migraine.

 

Overview

It is estimated migraine occurs in 10-15% of the general population, and migraine is the 8th leading causes of disability among all non-fatal sequelae of diseases and injuries according to the World Health Organization. Chronic Migraine (CM) is defined as headache occurring at a frequency of more than 15 days a month, at least 8 of which are migraine, for at least 3 months. About 2% of the general population suffers from CM, and it is a major cause of migraine-related disability.

 

Features

Treatment options approved for the treatment of CM is limited, and onabotulinumtoxinA injection is one of them. The evidence of onabotulinumtoxinA injection is derived from the PREEMPT 1 and PREEMPT 2 studies, which are double-blind placebo-controlled international trials designed to verify the efficacy of onabotulinumtoxinA injection in CM. According to the published results, regular injections result in significant reduction of migraine attacks and cumulative headache duration.

 

Procedure

OnbotulinumtoxinA injection is carried out at regular intervals of 12 weeks for patients with confirmed diagnosis of CM, and patients are asked to keep a headache diary to monitor the frequency and severity of their headache attacks. The PREEMPT protocol consists of two parts. At the first part, 31 injections are given in a fixed-site-fixed-dose fashion for the designated cranial and cervical muscles. For patients with more extensive involvement, additional injections are delivered in a follow-the-pain fashion, and muscles at certain locations with focal tenderness are treated. Patients are monitored for 10-20 minutes for potential side effects.

 

Notification

Side effects of onabotulinumtoxinA injection are not uncommon, although discontinuations due to adverse events occurs in only 3.8% of patients according to the PREEMPT 1 & 2 trials. Commonly reported side effects are listed as follows:

  • Neck pain (6.7%)
  • Muscular weakness (5.5%)
  • Eyelid ptosis (3.3%)
  • Musculoskeletal pain (2.2%)
  • Injection site pain (3.2%)

However, it is noteworthy that for East Asian patients, lateral eyebrow elevation is reported in 1/4 to 1/5, which could be manageable or preventable by giving additional injection at lateral frontal regions.

 

Estimated Cost

The procedure cost is about 24,400-36,600 NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

 

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Overview

Stroke is the leading causes of death globally in the last 15 years, and the most common factor for acquired disability in adulthood. Carotid/cerebral artery stenosis, which refers to narrowing of the carotid/cerebral artery caused by atherosclerosis or other pathology, is one of the most important risk factors for ischemic stroke. The most common sites of atherosclerosis is the origin of the internal carotid artery at the carotid bifurcation, followed by the origin of the vertebral artery (proximal extracranial vertebral artery stenosis). Revascularization of carotid/cerebral artery stenosis in selective patients, including endarterectomy or stenting, has been shown to be effective at preventing stroke over long-term follow-up.

 

Features

Carotid/cerebral artery stenting re-opens obstructed arteries that have become narrowed or blocked by atherosclerotic plaques or other pathology (Such as: dissection, inflammation, post-radiation injury…etc.). This is one of the approved and mostly adopted therapies to treat carotid/cerebral artery stenosis. The patients remain awake during the procedure.

Indications:

  • >50-60% of stenosis at internal carotid artery in patients with ipsilateral ischemic stroke, transient ischemic attack or amaurosis fugax.
  • >70-80% of stenosis at internal carotid artery in patients without ipsilateral ischemic stroke, transient ischemic attack or amaurosis fugax.
  • Significant stenosis of verterbobasilar artery in patients with associated ischemic stroke or symptoms of vertebrobasilar insufficiency.
  • Severe stenosis of subclavian artery stenosis in patients with subclavian steal syndrome.
  • Significant carotid artery stenosis after neck irradiation
  • Restenosis after endarterectomy or stenting

 

Procedure

Endovascular treatment of carotid/cerebral artery stenosis involves insertion of a catheter usually in the femoral artery at the groin under local anesthesia, which is then advanced to the site of stenosis. Next, a special filter is delivered through the catheter and placed just beyond the narrowed part of the artery, which is designed to catch thrombus or emboli that may be released during the procedure. Thereafter, a small, deflated balloon through the catheter is placed to the blocked part and then is inflated. After the balloon is deflated, a small metal mesh stent will be implanted

in the artery and is expanded to reopen the artery. Finally, the balloon, filter and catheter are removed. The stent remains in place to help prevent future narrowing of the carotid/cerebral artery.

 

Notification

  • Hematoma over puncture site (<2%)
  • Stroke or transient ischemic attack (<3%)
  • Hyperperfusion syndrome (1-2%)
  • Carotid/cerebral artery dissection or perforation (<1%)
  • Restenosis or reoccurrence of the artery narrowing around or within the stent (The incidence varies according to the disease nature of stenosis, post-procedural medical treatment and underlying risk factors)

 

Estimated Cost

The procedure cost is about 100,000~200,000NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

 

" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [3]=> array(8) { ["sn"]=> string(2) "38" ["classify"]=> string(1) "8" ["cover"]=> string(0) "" ["title"]=> string(74) "Spontaneous intracranial hypotension (SIH)/Epidural blood patching (EBP)" ["content"]=> string(2999) "

Feature Summary

In the past, localization of spinal CSF leaks could only be done with invasive imaging techniques, such as CT mylography (CTM). Therefore, targeted EBPs are often reserved for those not responsive to non-targeted EBPs. With the advent of HT2W MRM, early detection of spinal CSF leaks becomes feasible. Targeted EBP could be carried out early in the course, thus preventing potential complications.

 

Overview

Spontaneous intracranial hypotension (SIH) is characterized by an orthostatic headache that occurs in an upright posture and subsides after the patient lies flat. There may be accompanying nausea, vomiting, neck stiffness, hearing alteration or visual problems. It is caused by spinal cerebrospinal fluid (CSF) leaks, which results in reduced intracranial pressure and volume. One of the most dreaded complications is subdural hemorrhage (SDH), which occurs in 1/5 of patients and is a major cause of morbidity or even mortality.

 

Features

The mainstay of treatment for SIH is epidural blood patching (EBP), which involves injection of autologous blood into the epidural space. EBPs delivered at the location of spinal CSF leaks (targeted EBPs) are more effective that those delivered somewhere else. With the advent of heavily T2-weighted magnetic resonance myelography (HT2W MRM), which is a imaging technique developed by our staffs in the Departments of Neurology and Radiology, spinal CSF leaks could be clearly localized, and EBP is therefore feasible early in the course.

 

Procedure

For patients with suspected SIH, brain MRI with contrast and HT2W MRM are acquired at the same session. After localization of spinal CSF leaks, targeted EBP is delivered at the identified spinal CSF leaks. For those with residual orthostatic symptoms, HT2W MRM is repeated to localize residual leaks, and additional EBPs are delivered accordingly until complete resolution is achieved. For those with SDH of more than 10mm or with impaired consciousness, early surgical intervention is carried out after spinal CSF leaks are adequately treated.

 

Notification

  • HT2W MRM is a non-invasive radiation-free imaging technique, and is associated ordinary MRI risks, such as claustrophobia.
  • Commonly reported side effects of EBP consist of injection-site pain, which could be local or radicular, and rebound increase in intracranial pressure, which are usually transient and self-limited.

 

Estimated Cost

The procedure cost is about 152,500~305,000 NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

 

" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [4]=> array(8) { ["sn"]=> string(2) "39" ["classify"]=> string(1) "8" ["cover"]=> string(0) "" ["title"]=> string(16) "Epilepsy surgery" ["content"]=> string(3519) "

Feature Summary

To improve the outcome of epilepsy surgery, a comprehensive presurgical evaluation provides detailed information about possible localization of epilepsy onset and eloquent brain area.

 

Overview

Epilepsy surgery is an alternative treatment choice of drug resistant epilepsy. Presurgical evaluation of epilepsy surgery in Taipei Veterans General hospital started since 1987. We provided more than 100 cases per year for epilepsy presurgical evaluation. In addition, we had a total of more than 100 cases of invasive presurgical evaluation. Less than 1% had complications during presurgical evaluation. Team members are all experienced, including examiner with EEG certification examination board and member of ILAE task force of Neurophysiology.

 

Features

We provide 6 beds for Video-EEG recordings. Six experiences epileptologists review the whole recordings, and conclude the possible seizure onset region. During admission, we offer patients high resolution MRI, brain PET, brain SPECT and neuropsychological tests, which are essential to provide information about epileptogenic lesion and functional deficit regions. In addition, we provided MEG, WADA test, fMRI, ictal SPECT for selective patients. We will conclude the results in seizure conference and discuss the next step with the patient and his/her family. If the patient needs invasive EEG studies, both subdural grid and stereotactic EEG could be provided.

 

Procedure

 

  • Non-invasive multidisciplinary evaluation, including

(1) Neuro-Electrophysiological Studies: Video-EEG, MEG,

(2) Neuroimages: high resolution MRI, fMRI,

(3) Nuclear medicine: PET, SPECT,

(4) NeuroPsychological tests.

  • Seziure conferences to conclude the results of presurgical evaluation. Patient and the family can join and discuss with the epileptologists and neurosurgeon.
  • Invasive electroencephalography (EEG), including subdural grid EEG and stereotactic EEG

 

Notification

  • There is no risk or complication for non-invasive presurgical evaluation.
  • For invasive presurgical evaluation, risk varies, which depends on the type of evaluations. The common complications were hemorrhage (prevalence 1.0%) and infection (prevalence 0.8%).

 

Estimated Cost

  • The procedure cost:

Non-invasive pre-surgical evaluation: 305,000~457,500 NTD

Invasive pre-surgical evaluation: 305,000~457,500 NTD

  • Prices are subject to change without prior notice; need to pay in accordance with the actual medical expenses.

   

" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [5]=> array(8) { ["sn"]=> string(2) "40" ["classify"]=> string(1) "8" ["cover"]=> string(0) "" ["title"]=> string(79) "Genetic test For Inherited Neurological Diseases and Neurodegenerative Diseases" ["content"]=> string(2544) "

Overview

Genetic tests are inevitable for precise diagnosis of inherited neurological diseases and a few of neurodegenerative diseases caused by genetic mutations. In addition to making a diagnosis in a patient who already has disease symptoms, genetic tests can also help find out whether asymptomatic people have a mutation for a disease. Although there is no cure for many inherited neurological diseases or neurodegenerative diseases, the genetic test results still may help make important life decisions, such as family and life planning.  

 

The Neurogenetics Unit at the Department of Neurology, Taipei Veterans General Hospital offers a comprehensive genetic testing service encompassing clinical Spinocerebellar ataxia (SCA), Huntington's disease (HD), neuromuscular disorders including Amyotrophic lateral sclerosis (ALS), Charcot-Marie-Tooth disease (CMT), Familial amyloidotic polyneuropathy (FAP) and spinobulbar muscular atrophy (SBMA).

 

Features

The items of the genetic tests we can provide are listed in the following:

  • SCA groups: SCA1,2,3,6,7,10,12,17,DRPLA
  • HD
  • Familial ALS: SOD1 mutation, TARDBP mutation, FUS mutation, C9ORF72 C2G4 repeat expansion
  • CMT: CMT1A (PMP22 duplication), CMT1B (MPZ mutation), CMT1X (GJB1 mutation)
  • FAP: TTR mutation
  • SBMA

 

Procedure

The patients who suffered from symptoms and signs of the above disease, the clinical physician can referred the patients to our department of neurology’s outpatient department. After clinical assessment and diagnosis, our doctors will transferred the patients to our neurogenetics unit for molecular genetic testing and counseling. We will obtain the patient‘s DNA from their blood samples for genetic testing. All genetic testing requires consent. The laboratory assumes that provision of a clinical sample, and a completed referral form, implies that consent has been obtained by the referring clinician.

 

Estimated Cost

The cost of genetic testing can range from 6,100NTD to 30,500NTD per item, depending on the nature and complexity of the test. The cost increases if more than one test is necessary or if multiple family members must be tested to obtain a meaningful result. From the date that a sample is taken, it may take two months to give a report.

" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } } } [8]=> array(2) { ["name"]=> array(6) { ["id"]=> string(1) "9" ["zh-TW"]=> string(9) "皮膚部" ["english"]=> string(25) "Dermatology (Skin) Center" ["jp"]=> string(0) "" ["zh-CN"]=> string(9) "皮膚部" ["classOrder"]=> string(1) "0" } ["items"]=> array(2) { [0]=> array(8) { ["sn"]=> string(2) "41" ["classify"]=> string(1) "9" ["cover"]=> string(0) "" ["title"]=> string(23) "Medical Cosmetic Center" ["content"]=> string(3466) "

Overview

We provide individualized aesthetic medical options for our visitors to improve your skin problems (including aging, scars, skin laxity, black spot, moles, wrinkles, acne, dull skin, and spider veins, etc).

An experienced and exquisitely skilled medical team of dermatologists would use different kinds of ways and facilities—Botulism injecion, hyaluronic acid fillers injection, chemical peeling, UltraSkin facelift, dye laser, Er-YAG laser, Nd-YAG laser, Fractional CO2 laser, hair removal laser, intense pulse light— to meet your expectation for appearance!

 

Features

Skin rejuvenation, facelift, wrinkle treatment, scar treatment, moles removal, spots removal, freckles removal, laser toning, soft peel, tattoo removal, acne and other skin problems managements

 

Procedure

We will make a discussion with you and choose the best treatment for you. We will explain the whole process to you in detail, including how to care the skin after treatment, the risk and complications of the treatment, and when you will see the treatment effect.

 

Notification

Different kinds of treatments are suitable for different skin problems, and would lead to different results.

The most common side effects are listed below. If you want more information, please discuss with your doctor.

  • Laser:
  1. You might feel a little pain or have mild bleeding over laser site. Mild swelling with erythematous change is a normal reaction. The crust over face would shed off spontaneously after 5-7 days.
  2. Some people could have burn injury, hematoma, persistent bleeding or skin infection after laser treatment.
  3. Post laser hyperpigmentation happens sometimes. Please do sun protection well after laser therapy.
  • UltraSkin Facelift

You might have swelling, erythematous change, muscle tenderness, burn injury, blisters, or transient neuritis over treated area.

  • Botulism injection
  1. The most common side effects are hematoma, ptosis or headache, which are transient and recover after 2-6 weeks.
  2. Rare cases showed botulism spreading to other sites, which induced swallowing difficulty, pneumonia or death.
  • Hyaluronic acid fillers injection
  1. After injection, you might feel mild itchiness or swelling over injection site and it is a normal phenomenon for few days. However, if the symptoms persist, please tell your doctor.
  2. Few cases showed skin necrosis, abscess formation, granuloma formation or immediate allergic reaction.
  3. The injection site could induce recurrent herpes zoster.
  4. Severe complications like stroke or blindness had happened. If you have blurred vision, slurred speech or hemifacial palsy, please come back as soon as possible.

 

Estimated Cost

Prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

 

" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [1]=> array(8) { ["sn"]=> string(2) "42" ["classify"]=> string(1) "9" ["cover"]=> string(0) "" ["title"]=> string(21) "Cutaneous amyloidosis" ["content"]=> string(2253) "

Overview

Amyloidosis is a disease with amyloid (abnormal protein) accumulating in one or more organs and causes organ dysfunction. If it deposits in the skin, we call it cutaneous amyloidosis.

 

Features

Cutaneous amyloidosis is a common skin disorder among Asians and South Americans. As the disorder is pruritic and not good looking, it may affect one's social and emotional status. However, the disease is resistant to most conventional treatments. Dr. Lee, a specialist in our hospital, has engaged in this area for many years and has a good skill to manage this disease by CO2 laser or Er-YAG laser. To get rid of the annoying problem, our medical cosmetic center would be the best choice!

 

Procedure

We will explain to you detailedly about how the treatment is done, how to care the skin after treatment, the risk and complications of the treatment and when you will see the effect. Before treatment, we will do local anesthesia to decrease pain. Then the amyloid lesions will be ablated by laser. The treated area will be covered with antibiotic ointment and gauze. If you have any discomforts during laser therapy, please tell the doctor.

 

Notification

  • You might feel a little pain or have mild bleeding over laser site. Mild swelling with erythematous change is a normal reaction. The crust would shed off spontaneously after 5-7 days.
  • Wound infection after the treatment is very rare.
  • Post-laser hyperpigmentation happens sometimes. Please do sun protection well after laser therapy.

 

Estimated Cost

Prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.


Before treatment


After treatment


Not treated (right half) and treated (left half)


Not treated (right half) and treated (left half)

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Feature Summary

Spine surgery is typically recommended only when a period of nonsurgical treatment — such as medications and physical therapy — has not relieved the painful symptoms caused by your back problem. In addition, surgery is only considered if your doctor can pinpoint the exact source of your pain, such as a herniated disk or spinal stenosis.

Minimally invasive techniques have been used for a wider range of spine procedures, such as decompression and spinal fusion since the 1990s. Decompression relieves pressure put on spinal nerves by removing portions of bone or a herniated disk. Spinal fusion corrects problems with the small bones of the spine (vertebrae). The basic idea is to fuse together the painful vertebrae so that they heal into a single, solid bone.

 

Overview

Spinal stenosis is a narrowing of the open spaces within your spine, which can put pressure on your spinal cord and the nerves that travel through the spine to your arms and legs. Spinal stenosis occurs most often in the lower back and the neck.

While spinal stenosis may cause no signs or symptoms in some people, other people may experience pain, tingling, numbness, muscle weakness, and problems affecting normal bladder or bowel function.

 

Features

Spine surgery is traditionally done as "open surgery," meaning the area being operated on is opened with a long incision to allow surgeons to view and access the anatomy. In recent years, however, technological advances have allowed more back and neck conditions to be treated with a minimally invasive surgical technique.

Minimally invasive spine surgery (MISS) was developed to treat spine problems with less injury to the muscles and other normal structures in the spine. Other advantages to MISS include smaller incisions, less bleeding, and shorter stays in the hospital.

 

Procedure

The surgeon accesses the spine using small instruments. Any bone or disk material that is removed exits through special retractors, and any devices necessary for fusion — such as screws or rods — are inserted through the retractor.

In order to see where to place the incision and insert the retractor, the surgeon is guided by fluoroscopy or O-arm navigation,. This method displays real-time x-ray images of the patient's spine on a screen throughout the surgery. The surgeon also uses an operating microscope to magnify the view through the retractor.

 

Notification

  • Infection: Antibiotics are regularly given to the patient before, during, and often after surgery to lessen the risk of infections.
  • Bleeding: A certain amount of bleeding is expected, but this is not typically significant.
  • Recurrence: Some patients may experience a recurrence of their original symptoms.
  • Nonunion Patients who smoke are more likely to develop a pseudarthrosis. This is a condition where there is not enough bone formation. If this occurs, a second surgery may needed in order to obtain a solid fusion.
  • Nerve damage: It is possible that the nerves or blood vessels may be injured during these operations; rather these complications are very rare.
  • Hematoma: Another uncommon complication is the formation of blood clots in the operation area and cause radiculopathy or cauda equine syndrome.

 

Estimated Cost

The cost depends on how many levels are being treated. On average, it will cost 17,000 NTD for each level. Prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

 

" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [1]=> array(8) { ["sn"]=> string(2) "44" ["classify"]=> string(2) "10" ["cover"]=> string(0) "" ["title"]=> string(43) "Herniated Lumbar Intervertebral Disc (HIVD)" ["content"]=> string(2664) "

Overview

The human backbone, or spine, consists of 26 bones called vertebrae. Between each vertebrae lies rubbery, cushion-like pads referred to as "disks." These disks help keep the vertebrae in place and act as shock absorbers. A herniated disk occurs when some of the soft interior slips out through a crack in the disk's wall. Most commonly, this occurs in the back, but it can also happen in the vertebrae of the neck.

A herniated disk can lead to numbness or weakness in one or more limbs. Conversely, some people experience no associated pain with a herniated disk, particularly if the disk does not press on any nerves.

  

Features

Discectomy is done when conservative treatment fails to prevent further nerve compression and damage. Conservative treatments include medication such as NSAIDs, physical therapy, or rehabilitation.

The traditional open discectomy was published by Ross and Love in 1971. In traditional discectomy, a laminotomy is often involved to permit access to the intervertebral disc. In this procedure, a small piece of bone (the lamina) is removed from the affected vertebra, allowing the surgeon to better see and access the area of disc herniation.

 

Procedure

For MIS discectomy, a small incision, which is usually less than 1 cm, is made over the location of the herniated disk. The surgeon removes a small amount of the lamina bone under microscope or endoscope which provides the view of the spinal nerve and the disk. The surgeon carefully retracts the nerve, removes the damaged disk microscopically or endoscopically.

 

Notification

  • Infection: Antibiotics are regularly given to the patient before, during, and often after surgery to lessen the risk of infections.
  • Recurrence: A recurrence of original symptoms may be caused by residual disc herniation.
  • Nerve damage: It is possible that the nerves or blood vessels may be injured during these operations; rather, these complications are very rare.
  • Hematoma: The formation of blood clots in the disc area to compression the nerve root and cause radiculopathy or cauda equine syndrome.

 

Estimated Cost

The procedure cost is about 20,000 NTD for each level averagely; prices are subject to change without prior notice, and need to pay in accordance with the actual medical expenses.

 

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Feature Summary

The operation for scoliosis is a spinal fusion. The basic idea is to realign and fuse together the curved vertebrae so that they heal into a single, solid bone. This will stop growth completely in the abnormal segment of the spine and prevent the curve from getting worse.

 

Overview

Scoliosis is a sideway curve in the spine commonly seen in children and adolescents. There are several different types of scoliosis. By far, the most common type is "idiopathic," which means the exact cause is not known. Treatment for scoliosis may take several forms depending on the age of the patient, the type of scoliosis and the tendency of the curve to worsen. Severe scoliosis needs surgical correction to prevent low back pain later in life, trunk deformity, and even daily activities limitation.

 

Features

Scoliosis surgery typically has the following goals:

  • Stop the curve’s progression. When scoliosis requires surgery, it is usually because the deformity is continuing to worsen. Therefore, scoliosis surgery should at the very least prevent the curve from getting any worse.
  • Reduce the deformity. Depending on how much flexibility is still in the spine, scoliosis surgery can often de-rotate the abnormal spinal twisting in addition to correcting the lateral curve by about 50% to 70%. These changes can help the person stand up straighter and reduce the rib hump in the back.
  • Maintain trunk balance. For any changes made to the spine’s positioning, the surgeon will also take into account overall trunk balance by trying to maintain as much of the spine’s natural front/back (lordosis/kyphosis) curvature while also keeping the hips and legs as even as possible.

 

Procedure

The scoliosis correction surgery will be done in a traditional open approach, which means a longitudinal posterior incision will be made and to exposure the spine bony structure. The correction happens when metal rods insertion. The rods are attached to the spine by screws, hooks, and/or wires. Metal rods are typically used to hold the spine in place until fusion happens.

 

Notification

Risks and complications

  • Infection: Antibiotics are regularly given to the patient before, during, and often after surgery to lessen the risk of infections.
  • Bleeding: A certain amount of bleeding is expected, but this is not typically significant. A portion of the blood lost during surgery may be saved and given back to the patient. This is known as cell saver. It is not unusual for a patient having spine surgery to require a blood transfusion even if a cell saver is used.
  • Pseudarthrosis: Older teenagers and adults who smoke are more likely to develop a pseudarthrosis. This is a condition where there is not enough bone formation. It can cause pain or rod breakage. If this occurs, a second surgery may be needed in order to obtain a solid fusion.
  • Nerve damage:It is possible that the nerves or blood vessels may be injured during these operations. The nerve function will be monitor throughout surgery to lessen the risk. These complications are very rare.

 

Estimated Cost

The cost depends on how many levels are being treated. On average, it will cost 170,000 NTD. Prices are subject to change without prior notice, and need to pay in accordance with the actual medical expenses.

" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [3]=> array(8) { ["sn"]=> string(2) "46" ["classify"]=> string(2) "10" ["cover"]=> string(0) "" ["title"]=> string(37) "Anterior cruciate ligament (ACL) tear" ["content"]=> string(3298) "

Feature Summary

The ACL is one of the major stabilizing ligaments in the knee. It is a strong rope like structure running from femur to tibia. It prevents the anterior translation of the lower leg and provides the rotational stability of the knee. ACL injury is the most common type of knee injury during sports exercise. It often leads to the feeling of instability of knee.

 

Overview

When ACL tears, it does not heal by itself. The effect of direct repair is still unsatisfactory. The current treatment of ACL tear is reconstruction, which means replacing the ligament with a graft.

 

Features

The ACL reconstruction was done to regain the stability of knee.

 

Procedure

ACL reconstruction is performed arthroscopically with minimal incisions. After the debridement of the torn ligament, tunnels are drilled on the femur and tibia to accept the new graft. The hamstring tendon is harvested as the graft to replace the torn ACL. The graft is then prepared and passed through the drilled tunnels of the bone. The new ligament is then fixed to the bone with absorbable screw or other devices. The other structures inside the knee can be also checked. Any other cartilage or meniscal lesions can be treated. A drain would be placed to prevent joint swelling. The drain would be removed 2 days after surgery. There are only several stitches need to be removed after the surgery.

After the ACL reconstruction, knee protection with a knee brace is required. The doctor will arrange the rehabilitation protocol in the following months.

 

Notification

Complications are not common but can occur.

  • Graft failure
  • Joint stiffness
  • Infection
  • Allergic reactions to medications
  • Deep vein thrombosis
  • Excessive swelling & Bruising
  • Damage to nerves or vessels
  • Donor site pain

 

Estimated Cost

The procedure cost is about 176,000 NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

A knee that was viewed arthroscopically. The ACL is invisible due to tear. ACL reconstruction with graft. Fixing the graft with screw.
 
The surgery is performed arthroscopically. The wound of ACL reconstruction.  

 

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Overview

The shoulder joint has the largest range of motion among all the joints in our body. It can turn in many directions but is associated with risk of instability. The stability of shoulder joint is maintained by bony structure of the joint surfaces, the ligaments, capsule and muscles. Shoulder instability occurs when the head of the humerus is forced out of the shoulder socket. Once a shoulder has dislocated, it is vulnerable to repeat episodes. Instability of the shoulder joint can be in one direction (anterior or posterior) or in more than one direction (multidirectional instability). The most common form of instability is anterior shoulder instability.

 

Features

The cause of shoulder instability can be “post-traumatic” or “naturally loosed”:

  • Post-traumatic: Patient suffers from shoulder trauma and then experiences shoulder dislocation. When the dislocation occurs, the force stretches or tears the labrocapsular ligamentous complex of the shoulder away from the bone. When the tear of labrocapsular ligamentous complex happens in the anteroinferior glenoid, it is called a “Bankart lesion.”
  • Naturally loosed: People who naturally have loose shoulder joints. The direction of instability often happens in more than one direction (multi-directional instability). Their joint may not be completely dislocated but the feeling of instability interferes their exercise.

 

Procedure

The goal of Bankart lesion repair is to re-attach the torn labrocapsular ligamentous complex to its anatomic insertion. It is performed arthroscopically with minimal incisions. There are about 3 small incisions made on the skin of the shoulder for the device of arthroscopy to work. With the technique of arthroscopic surgery, the whole shoulder is fully examined. The doctor will identify the injured labrum and elevated it form the glenoid neck. The anatomic insertions of the labrum are then prepared. Then the suture anchors are implanted into the prepared insertion. Sutures of the anchors are passed into the edge of the torn labrum. The labrum is then pulled over the insertion and tied securely. After the surgery, shoulder protection with an arm sling for 6 weeks is required. The doctor will arrange the rehabilitation protocol in the following months.

 

Notification

Complications are not common but can occur.

  • Joint stiffness: Most common. Most of the stiffness ended in 6 to 12 months after the surgery.
  • Infection: 1%
  • Allergic reactions to medications
  • Excessive swelling & Bruising
  • Damage to nerves or vessels: 1~2 %

 

Estimated Cost

The procedure cost is about 154,000 NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

A shoulder joint that was viewed arthroscopically. The anterior labrum is tear. Bankart lesion repair with suture anchors. The labrum is reattach to the humeral head.
   
The surgery is performed arthroscopically. The wound of Bankart lesion repair  
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Overview

The rotator cuff is a group of four muscles that move and stabilize the humerus (arm bone) in the shoulder joint. The four muscles are supraspinatus, infraspinatus, subscapularis and teres minor muscle. The supraspinatus tendon is the most common tendon where tears happen. There are two main causes of rotator cuff tears: acute injury and degeneration.

  • Acute injury: Acute RCT may happen due to trauma. For example, when your fall down on outstretched arm or lift something heavy with a jerking motion.
  • Degenerative tear: Most tears happen due to wearing and degeneration of the tendon. Several factors contribute the tear, such as repetitive tendon stress, bony spurs of acromion or lack of blood supply due to aging.

Patient may experience arm weakness due to tendon tear. In addition, the patient may feel painful because of the inflamed shoulder bursa.

 

Features

The rotator cuff repair was done to regain the strength and decrease the pain of shoulder.

 

Procedure

The goal of rotator cuff repair is to re-attach the torn tendon to its anatomic insertion. It is performed arthroscopically with minimal incisions. There are about 4 small incisions made on the skin of the shoulder for the device of arthroscopy to work. With the technique of arthroscopic surgery, the whole shoulder is fully examined. The doctor will identify the edge of the tears of rotator cuff and debride the inflamed bursa or synovium. The anatomic insertions of the rotator cuff tendons are prepared with a burr to create a bleeding bed. Then the suture anchors are implanted into the prepared insertion of humerus. Sutures of the anchors are passed into the edge of the torn tendon. The rotator cuff tendon is then pulled over the insertion and tied securely. The biceps tendon is also checked. Tenotomy or tenodesis of the biceps tendon will be performed if necessary. In addition to rotator cuff repair, the subacromial decompression will also be performed to remove the spur of the acromion with a burr, preventing further impingement of rotator cuff.

After the surgery, shoulder protection with an arm sling for 6 weeks is required. The doctor will arrange the rehabilitation protocol in the following months.

 

Notification

Complications are not common but can occur.

  • Joint stiffness: Most common. Most of the stiffness ended in 6 to 12 months after the surgery.
  • Infection: 1%
  • Allergic reactions to medications
  • Excessive swelling & Bruising
  • Damage to nerves or vessels: 1~2 %

 

Estimated Cost

The procedure cost is about 264,000 NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

A shoulder joint that was viewed arthroscopically. The rotator cuff is tear. Rotator cuff repair with suture anchors. The tendon is reattach to the humeral head.
 
The surgery is performed arthroscopically. The wound of Rotator cuff repair  
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Feature Summary

To resolve the discomfort resulted from menopause or peri-menopause.

 

Overview

Endogenous hormone production of women declines with age, which leads to menopause finally. Menopausal symptoms, in many cases, can significantly affect the quality of life. It is appropriate to seek medical treatments and, after thorough evaluation, individually by person as well as by timing there are various options available.

 

Features

Hormone therapy for menopause

The main component to resolve menopausal symptoms is estrogen; however, adding progestogen is essential for women with uterus or with history of endometriosis. For women with breast cancer who suffer from menopausal discomfort, there is non-hormone therapy.

 

Procedure

There are different routes of hormone therapy: Estrogen—transdermal or oral; Progestogen-oral or intrauterine device, or vaginal (less recommended in menopausal hormone therapy). After evaluation and discussion, we can decide the dosage and route for you.

 

Notification

  • Without appropriate evaluation, hormone therapy might predispose high-risk population to develop stroke, thromboembolism, or cardiac vascular disease.
  • The risk ratio of breast cancer is more or less elevated under hormone therapy, according to different regimen and subjects; however, the risk is reversible after stopping hormone therapy.
  • For these reasons, consultation and evaluation are important.

 

Estimated Cost

The cost of medication ranges from 150 NTD/month to 1,500 NTD/month (not including relevant exams for evaluation), prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

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Features

The Division of Obstetrics and High Risk Pregnancy supports women throughout their journey to parenthood. Beginning with antenatal visits to the time of delivery, we have a staff comprising of doctors, surgeons, certified nurses and nurse practitioners that will attend to your needs. Our obstetrical staff works with specialists in maternal and fetal medicine, medical genetics and other medical and surgical specialties.

 

Procedure

Antenatal Visits

We provide comprehensive and personalized care depending on maternal conditions. Regular visits will be arranged based on gestational age. Routine check-up consists of 10 visits where different examinations will be periodically performed such as routine blood works, 1st trimester Down Screen (nuchal translucency, NIPT), 2nd trimester Down Screen (Quad screen), Amniocentesis, High Level ultrasound, Gestational Diabetes Screening, General Obstetrics Ultrasound and Group B Streptococcus Screening.

 

Delivery

Every woman’s labor and delivery experience is unique. As your due date approaches, you can discuss with your doctor regarding your concerns and ask what is to be expected. Staff members assist in delivery of over 2,000 babies each year. Eight rooms are devoted to labor and recovery, two rooms for delivery, and two obstetric operating rooms. A 24 hour anesthesiologist is available for epidural anesthesia or emergent cesarean sections. We are committed in giving you and your family an unforgettable experience and look forward in welcoming the new member of your family.

 

Notification

Special conditions such as antepartum hemorrhage, placenta previa, gestational hypertension or diabetes, epilepsy, or other maternal diseases, may warrant closer follow-up.

 

Estimated Cost

  • The procedure cost:

Natural Spontaneous Delivery: 30,000NTD

Cesarean Section: 50,000 NTD

Epidural Anesthesia: 10,000 NTD

  • Depending on the availability of rooms, a sub-charge will be added to the type of room the client requests when transferred to the postpartum ward. Cost of newborn will depend on gestational age delivered and status of baby.
  • Prices are subject to change without prior notice; need to pay in accordance with the actual medical expenses.

 


Obstetrical Operating Room


Delivery Room


Labor and Recovery Room


Private Room

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Feature Summary

Vaginal sling procedures are done to treat stress urinary incontinence. Before discussing surgery, your doctor will have you try bladder retraining, Kegel exercises, medicines, or other options. If you tried these and are still having problems with urine leakage, surgery may be your best option.

 

Overview

If you leak a bit when you laugh, cough, sneeze, jog, or lift something heavy, you may have stress incontinence. This is the most common bladder control problem in younger women. Stress incontinence happens when the muscles and tissues around the opening of the bladder get weak. When there's more pressure against the bladder and this opening doesn't stay closed, leakage happens. Pressure from coughing or laughing may be all it takes for you to leak. They may be stretched by weight gain, a sports injury, or pregnancies and vaginal childbirths.

 

Features

The gold standard of treatment for stress urinary incontinence is a mid-urethral sling or Tension-Free Vaginal Tape (TVT). The polypropylene sling is placed without tension around the urethra. The sling treats incontinence by providing support under the urethra when abdominal pressure is increased. Success rates of the TVT for patients with no prior incontinence surgery is over 90%. Success rates in patients with prior incontinence surgery may be lower, depending on the individual patient.

 

Procedure

You have either general anesthesia or spinal anesthesia before the surgery starts.

  • With general anesthesia, you are asleep and feel no pain.
  • With spinal anesthesia, you are awake, but from the waist down you are numb and feel no pain.

A catheter (tube) is placed in your bladder to drain urine from your bladder.

The doctor makes one small surgical cut (incision) inside your vagina. Another small cut is made just above the pubic hair line or in the groin. Most of the procedure is done through the cut inside the vagina.

The doctor will use slings made by synthetic material. The sling is passed under your urethra and bladder neck and is attached to the strong tissues in your lower belly. The traditional trans-vaginal mid-urethra sling will create two small incision wound over bilateral inguinal area. For self-pay mid-urethra sling, you won’t have wound over your perinea skin.

 

Notification

Risks and Complications

  • More difficulty emptying your bladder, and the need to use a catheter
  • Erosion of the synthetic material through your normal tissue
  • Damage to the urethra, bladder, or vagina
  • Abnormal passage (fistula) between the vagina and the skin
  • Irritable bladder, causing the need to urinate more often
  • Worsening of urine leakage

 

Estimated Cost

The procedure cost is about 170,000~185,000 NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [3]=> array(8) { ["sn"]=> string(2) "52" ["classify"]=> string(2) "11" ["cover"]=> string(0) "" ["title"]=> string(23) "Robotic staging surgery" ["content"]=> string(2655) "

Overview

Endometrial cancer is the most common female genital cancer in the developing world, with adenocarcinoma of the endometrium the most common type.

Approximately 75% of women with endometrial cancer are postmenopausal, and the most common symptom is abnormal vaginal bleeding. We could perform transvaginal ultrasound to estimate the thickness of endometrium, and endometrial biopsy for diagnosis. Standard management of endometrial cancer at diagnosis involves surgery, followed by chemotherapy with or without radiation therapy. For early stage primary endometrioid adenocarcinoma of the endometrium, laparoscopy and laparotomy are associated with similar rates of disease-free and overall survival and that laparoscopy is associated with reduced operative morbidity and shorter hospital stays. Robotic technique is also suitable for endometrial cancer treatment.

 

Features

The goal of staging surgery is to treat and stage endometrial cancer. Compare with traditional laparoscopy and laparotomy surgery, robotic surgery showed less blood loss, length of postoperative hospitalization, and complications.

 

Procedure

We perform the pelvic lymphadenectomy prior to the hysterectomy and the aortic node sampling after the hysterectomy. First, we injected fluorescence dye into cervix. Under the scopy, we open retroperitoneal space and identify anatomy. Later, lymphadenectomy is done, including distal common iliac nodes, the nodes surrounding the external iliac artery and vein and the obturator lymph nodes. Paraaortic lymph node is sampling later. Fluorescence dye make us identify lymph node more precisely. These lymph nodes are collected to tissue bag. Then, hysterectomy and bilateral salpingo-oophrectomy is performed. The specimen is removed from vagina, and we close vaginal cuff and surgical wound.

 

Notification

Risks & complication

  • Intraoperative complication: vessel injury, bladder/ ureter injury, bowel injury
  • Leg pain/ edema
  • Vaginal vault bleeding, infection, leakage
  • Infection: wound, urinary tract infection, pelvic abscess, peritonitis
  • Chyle ascites
  • Hematoma
  • Severe muscle strain

 

Estimated Cost

The procedure cost is about 700,000-750,000 NTD, prices are subject to change without prior notice; need to pay in accordance with the actual medical expenses.

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Feature Summary

Myomectomy and uterine reconstruction continues to be the procedure of choice for symptomatic women desiring fertility or the preservation of reproductive potential.

 

Overview

Uterine fibroid disease affects 20%–30% of women of child- bearing age and 70% of those >49 years of age. According to different location, we classify these fibroid to submucosal, intramural, and subserosal. Women are often asymptomatic. Others will have mass related complaints such as heaviness, urinary frequency, constipation or low back pain. Abnormal uterine bleeding, dysmenorrhea, or cyclic cramping may also occur. Patient with submucosal or intramural and distorting the endometrial cavity may have infertility problems. Patients with symptoms are indicated for treatment.

 

Features

Under the scope, we identification of the myoma, enucleation, myometrial reconstruction, and adhesion prevention. Robotic myomectomy compared with traditional laparoscopic myomectomy, we used robotic arm to perform the procedure. There are advantages of 3D visualization, magnification of the operating field tremor filtration, stability of the image, micro-motion of the instruments, 360 amplitude, 7 freedom, facilitated dissection, improved accessibility and easy suturing.

This suggests the robot allowed for the completion of more complex surgical cases as compared with laparoscopic.

 

Procedure

Robot-assisted laparoscopic myomectomy is performed with the use of the monopolar scissors and the dipolar grasping device, sometimes with the use of the fourth arm of the robot for myoma traction. After the incision in the uterus, the fibroid is excised and extracted from the surrounding uterine tissue. Finally, the uterus is sutured before removing the robot. The myomectomy site is sutured by robotic arms. Then a contained morcellator is used to cut the fibroid into smaller pieces in tissue bag to reduce the possibility of dissemination. An antiadhesion material may be applied when the procedure is finished.

 

Notification

Risk and complications

  • Adhesion at the site of the myomectomy
  • Hemorrhage or major vessel perforation
  • Postoperative infection
  • Major organ injury
  • Uterine rupture in future pregnancy

 

Estimated Cost

The procedure cost is about 610,000-650,000 NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

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Feature Summary

The goal in surgically correcting prolapse defects is to restore normal anatomical support as a mean to enhancing function with the end results of improving patient symptoms and quality of life.

 

Overview

Pelvic organ prolapsed is a common problem reported in up to 50% of parous women, which is a medical condition that the bladder, uterus, vagina, and/or rectum descend from their normal positions within the pelvis. These organs can sometimes protruding through the opening of the vagina. In may associated with protrusion symptoms and complicit with voiding, defecatory, and sexual dysfunction. Quality of life is also impacted by pelvic organ prolapsed.

 

Features

Sarcrocolpopexy has been the most important operation for repair of enterocele and vaginal vault prolapse. In may also be utilized for apical support with concurrent hysterectomy. Suspension of the vaginal apex to the anterior longitudinal ligament overlying the sacral promontory is performed. The procedure may be approached abdominally, laparoscopically, or robotically.

 

Procedure

Under scopy, the peritoneum over the first sacral joint is opened to exposure the anterior longitudinal ligament and middle sacral vessels. Then, the peritoneum over the vagina is opened to develop the rectovaginal and vesicovaginal spaced. Once these spaces are opened and the bladder and rectum are mobilized, an assessment is made of length for the mesh arms. Y-shaped mesh with a tail is attached to the sacrum with two or three sutures and make a permanent suture through the full thickness of the anterior and posterior vaginal wall. The peritoneum is then closed over the mesh to cover the bridge of mesh between vaginal apex and sacrum in an attempt to decrease the risk of adhesion and bowel obstruction.

 

Notification

Risk and complication

  • Bladder, ureter and bowel injury
  • Recurrent prolapsed
  • Urinary tract infection
  • Hemorrhage
  • Ileus
  • Dyspareunia
  • Mesh exposure/erosion
  • Urinary incontinence

 

Estimated Cost

The procedure cost is about 640,000-690,000 NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

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Feature Summary

It would release following problems

  • A bulging, pressure or heavy sensation in the vagina that worsens by the end of the day or during bowel movements.
  • The feeling of “sitting on a ball”.
  • Needing to push stool out of the rectum by placing fingers into or around the vagina during a bowel movement.
  • Difficulty starting to urinate or a weak or spraying stream of urine.
  • Urinary frequency or the sensation that you are unable to empty the bladder well.
  • Lower back discomfort.
  • The need to lift up the bulging vagina or uterus to start urination.
  • Urinary leakage with intercourse.Though unusual, severe prolapse can block the flow of urine and cause recurrent urinary tract infections or even kidney damage.

 

Overview

Pelvic organ prolapse refers to the prolapse or drooping of any of the pelvic floor organs, including:bladder, uterus, vagina, small bowel or rectum. You may hear them referred to in these ways:

  • Cystocele: A prolapse of the bladder into the vagina, the most common condition
  • Urethrocele: A prolapse of the urethra (the tube that carries urine)
  • Uterine prolapsed
  • Vaginal vault prolapse: prolapse of the vagina
  • Enterocele: Small bowel prolapsed
  • Rectocele: Rectum prolapse

 

Features

There are two types of prolapse surgery: obliterative and reconstructive.

Obliterative surgery:Closes off part or all of the vagina. This may be an option if surgery hasn’t worked and you can’t tolerate another procedure. After this operation you will no longer be able to have sex.

Reconstructive surgery:Aims to repair the pelvic floor and return organs to their original position. There are a number of reconstructive surgeries:

  • Sacrospinous fixation and uterosacral ligament suspension.
  • Anterior and posterior colporrhaphy.
  • Sacrocolpopexy and sacrohysteropexy.
  • Vaginal mesh.

 

Procedure

Obliterative surgery:Closes off part or all of the vagina.

Reconstructive surgery:

  • Sacrospinous fixation and uterosacral ligament suspension:Your own tissue is used to fix or suspend the sagging pelvic organs. Your surgeon will make a cut in the vagina and use stitches to attach the vaginal vault to a ligament in the pelvis. The stitches may be permanent or dissolve over time.
  • Anterior and posterior colporrhaphy:The goal here is to make the tissue that holds the pelvic organs in place tighter and stronger. Anterior repair is used when the bladder drops and presses against the front of the vagina. Posterior repair is used when the rectum drops and pushes into the back of the vagina. This procedure is also done through the vagina by using your own tissues or vaginal mesh to repair the prolapse.
  • Sacrocolpopexy and sacrohysteropexy:These procedures use surgical mesh to fix and anchor organs that have dropped down. Sacrocolpopexy is used to repair prolapse of the vaginal vault. Sacrohysteropexy is used to fixed prolapse of the uterus. These operations are done with cuts in the abdomen. They can also be done laparoscopically or robatically.
  • Vaginal mesh:It repairs prolapse by putting mesh under the vaginal skin to help lift sagging organs into place.

 

Notification

Risks and Complications

  • Pain during sex
  • Pelvic pain
  • Trouble holding your pee (urinary incontinence)
  • Wound infection
  • Mesh erosion while use mesh for repair

 

Estimated Cost

The procedure cost is about 270,000-285,000 NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.


 

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Feature Summary

The indications for operative hysteroscopy include: abnormal uterine or heavy menstrual bleeding, submucosal leiomyoma, uterine polyps, uterine septum, uterine adhesion, or blockage of fallopian tubes.

 

Overview

Intrauterine diseases are usually involved with pathologic lesions (like endometrial polyp, submucosal myoma, or uterine synechiae) or congenital malformation of uterus (like bicornuate or septate uterus). Diagnostic hysteroscopy provides the most direct way to visualize and evaluate the interior of the uterus. When the patients with intrauterine disease suffer from symptoms of abnormal vaginal bleeding, spontaneous abortion or infertility, an operative hysteroscopy would be a therapeutic treatment for these conditions.

 

Features

The operative hysteroscope can serve not only for the insertion of ancillary devices (ex. scissors or grasper) to perform surgical procedures inside the uterine cavity, but also assist some specific procedures like cannulation of fallopian tube under hysteroscopy. A specialized electrosurgical hysteroscope, called resectoscope, would be also commonly utilized to do the resection of endometrial polyp, uterine myoma or uterine septum.

 

Procedure

  • The patient is placed in a lithotomy position and is given anesthesia.
  • The cervical canal is carefully dilated with Hegars dilators, and the operative hysteroscope is inserted into the uterine cavity under direct vision.
  • During the process, we instill the media (usually normal saline) to distend the uterine cavity sufficiently, and the cavity could be scanned with all of the landmarks.
  • The operative procedure is then performed through the system of operative hysteroscope.
  • Sometimes, a simultaneous laparoscopy is required during specific situations.

 

Notification

The process of an operative hysteroscopy carries risks, including:

  • Distending media-related adverse events: excessive fluid absorption (fluid overload) and electrolyte imbalance
  • Uterine perforation
  • Intra-operative bleeding
  • Thermal injury: such injury may occur at adjacent sites like cervix, vagina, and vulva; it could also occur to intraperitoneal structures like bowel if a perforation of uterus happens
  • Infection of endometrium or myometrium
  • Post-operative intrauterine adhesion

 

Estimated Cost

The procedure cost is about 90,000~100,000NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.


Cutting loop is used to shave the myoma body


Hysteroscopic resection of uterine septum

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Feature Summary

Myomectomy preserves the uterus while treating fibroids. It may be a reasonable treatment option if you have:

  • Anemia that is not relieved by treatment with medicine.
  • Pain or pressure that is not relieved by treatment with medicine.
  • A fibroid that has changed the wall of the uterus. This can sometimes cause infertility. Before an in vitro fertilization, myomectomy is often done to improve the chances of pregnancy.

 

Overview

Fibroid tumors are composed of renegade muscle cells that come together to form a fibrous "knot" or "mass" within the uterus. Although all uterine fibroids are the same, they are categorized based on their location:

  • Submucosal fibroids are located just under the uterine lining.
  • Intramural fibroids lie between the muscles of the uterine wall.
  • Subserol fibroids extend from the uterine wall into the pelvic cavity.

For some women fibroids cause no symptoms, but when they do, doctors say problems often involve heavy menstrual periods, prolonged bleeding or bladder compression which induced frequent voiding.

 

Features

Myomectomy is the surgical removal of fibroids from the uterus. It allows the uterus to be left in place and, for some women, makes pregnancy more likely than before. Myomectomy is the preferred fibroid treatment for women who want to become pregnant.

 

Procedure

The method used depends on the:

  • Size, location, and number of fibroids.

Hysteroscopy can be used to remove fibroids on the inner wall of the uterus that have not grown deep into the uterine wall.

Laparoscopy is usually reserved for removing one or two fibroids, up to about 2 in. (5.1 cm) across, that are growing on the outside of the uterus.

Laparotomy is used to remove large fibroids, many fibroids, or fibroids that have grown deep into the uterine wall.

  • Need to correct urinary or bowel problems. To repair these problems without causing organ damage, laparotomy is usually needed.

 

Notification

Risks and Complications

  • Infection of the uterus, fallopian tubes, or ovaries (pelvic infection) may occur.
  • Removal of fibroids in the uterine muscle (intramural fibroids ) may cause scar tissue.
  • In rare cases, scarring from the uterine incision may cause infertility.
  • In rare cases, injuries to the bladder or bowel, such as a bowel obstruction, may occur.
  • In rare cases, uterine scars may break open (rupture) in late pregnancy or during delivery.
  • In rare cases, a hysterectomy may be required during a myomectomy. This may happen if removing the fibroid causes heavy bleeding that cannot be stopped without doing a hysterectomy.

 

Estimated Cost

The procedure cost is about 55,000-65,000 NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

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Overview

Enlarged uterus due to adenomyosis or polyfibromatous with complaints of pain or abnormal blood loss( generally heavy bleeding) or compression of bladder of bowel. Diagnosis is made clinically and can be confirmed by ultrasound if necessary. We can check hemoglobin for anemia. This is an indication for an hysterectomy.

 

Features

A hysterectomy is an operation to remove a woman's uterus. In a supracervial or subtotal hysterectomy, a surgeon removes only the upper part of the uterus, keeping the cervix in place. A total hysterectomy removes the whole uterus and cervix. In a radical hysterectomy, a surgeon removes the whole uterus, tissue on the sides of the uterus, the cervix, and the top part of the vagina. Radical hysterectomy is generally only done when cancer is present.

  • Uterine fibroids that cause pain, bleeding, or other problems
  • Uterine prolapse, which is a sliding of the uterus from its normal position into the vaginal canal
  • Cancer of the uterus, cervix, or ovaries
  • Endometriosis
  • Abnormal vaginal bleeding
  • Chronic pelvic pain
  • Adenomyosis, or a thickening of the uterus

 

Procedure

An abdominal hysterectomy is an open surgery. This is the most common approach to hysterectomy, accounting for about 65% of all procedures.

To perform an abdominal hysterectomy, a surgeon makes a 5- to 7-inch incision, either up-and-down or side-to-side, across the belly. The surgeon then removes the uterus through this incision.

Following an abdominal hysterectomy, a woman will usually spend 2-3 days in the hospital. There is also, after healing, a visible scar at the location of the incision.

 

Notification

Risks and Complications

Wound infections, blood clots, hemorrhage, and injury to surrounding organs. Fistula formation (an abnormal connection that forms between the vagina and bladder) or intra-abdomen adhesion which induced chronic pain.

 

Estimated Cost

The procedure cost is about 120,000-130,000 NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

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Feature Summary

Infertility issues for which IVF may be necessary include:

  • female factor: advanced age, fallopian tube blockage, ovulation disorder, endometriosis, uterine fibroids
  • male factor: oligoasthenoteratozoospermia (OAT), azoospermia
  • unexplained infertility
  • genetic disorders: it would be indicated for preimplantation genetic diagnosis

 

Overview

Infertility is the failure to conceive after 1 year of regular unprotected intercourse. About 40% of cases, infertility can be traced to the woman. About a third, it is because of the man. The rest could be related to both partners’ problems and sometimes no cause can be found. There are specific treatments like fertility drugs, assisted reproductive technology, and surgeries for the couple to achieve pregnancy.

 

Features

In vitro fertilization (IVF) is a treatment for infertile couples. During IVF, a good number of high quality eggs are wanted to maximize success rates. Mature eggs are retrieved from the wife’s ovaries and fertilized by husband’s sperm in a lab. The fertilized eggs (embryos) could be transferred into uterus either within the fresh cycle, or be cryopreserved and then transferred in subsequent frozen-thawed cycles.

 

Procedure

One cycle of IVF takes about two weeks. It involves:

  • Ovarian stimulation: there are fertility drugs (injectable FSH product is commonly used) to stimulate multiple follicular development
  • Egg retrieval: when the follicles are mature (determined by ultrasound measurements of follicle size and hormone measurements), the transvaginal follicle aspiration is done to take the eggs out
  • Fertilizing the eggs in the laboratory : it could be done through conventional IVF or ICSI (Intra-cytoplasmic sperm injection). ICSI means that the embryologist selects a single sperm to be injected directly into an egg, instead of fertilisation taking place in a dish where many sperm are placed near an egg
  • Embryo transfer to the uterus. Supplement of progesterone are prescribed for use following the embryo transfer and a pregnancy test is done approximately two weeks after the embryo transfer.

 

Notification

The process of an in vitro fertilization (IVF) cycle carries risks, including:

  • Ovarian hyperstimulation syndrome: signs and symptoms typically include abdominal pain, bloating, nausea, and vomiting. Rarely, it's possible to develop a more-severe form of ovarian hyperstimulation syndrome that can cause rapid ascites accumulation and shortness of breath.
  • Complications from egg-retrieval procedure: bleeding, infection or damage to the bowel, bladder or a blood vessel
  • Ectopic pregnancy
  • Multiple births
  • Premature delivery and low birth weight

 

Estimated Cost

The procedure cost is about 180,000~30,000 NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

Ultrasound picture of follicles (black circular areas) in a stimulated ovary Transvaginal ultrasound-guided oocyte retrieval
Day 3 embryo Day 5 blastocyst

 

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Feature Summary

Destroying the heart tissue with abnormal electrical conduction helps restore the regular heart rhythm.

 

Overview

Cardiac arrhythmias

Cardiac arrhythmias is a disorder of electrical conduction in heart, including atrial fibrillation (AF) and ventricular arrhythmia which can lead to palpitation, chest tightness, heart failure, and even sudden death. AF is the most common cardiac arrhythmia seen in clinical practice. AF affects approximately 3 million North Americans and 4.5 million Europeans, particularly the elderly. In the United States, about 75% of individuals with AF are 65 years of age or older. It can induce cardiac dysfunction, stroke and even mortality. Ventricular arrhythmia is a common and lethal complication after myocardial infarction and heart failure which often results in sudden cardiac death. Catheter ablation plays an important role in treatment of cardiac arrhythmia.

 

Features

Catheter ablation is a procedure that uses radiofrequency energy (or cryo energy) under X-ray fluoroscopy to destroy a small area of heart tissue that is causing abnormal electrical conduction. Damaging this tissue helps restore the regular heart rhythm. Using 3D mapping system in catheter ablation of complex arrhythmia allows for nonfluoroscopic catheter mapping, voltage and activation mapping, and precise identification and tagging of ablation sites to facilitate creation of contiguous lesions around anatomic structures.

 

Procedure

During this procedure, the tip of a catheter is guided under X-ray fluoroscopy to the area of heart tissue that is producing abnormal electrical signals. Then the catheter emits a pulse of painless radiofrequency energy that destroys the abnormal tissue and corrects the irregular heartbeat.

 

Notification

Risks & complications

The risks and complications are depended on the type of arrhythmia. In complex arrhythmia such as AF, the incidence of major complications for example, femoral pseudoaneurysm, cardiac tamponade, stroke, pulmonary vein stenosis was 4.5%. Rarer complications may result in permanent injury, requiring intervention and prolonged hospitalization.

 

Estimated Cost

The cost depends on the type of arrhythmia. We will fully discuss with the patient about the medical devices and perform the catheter ablation under the agreement of the patients. 

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Structural Heart Team of Taipei VGH

Click the photo to learn more about the treatment and medical team. 

 

 

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    The number of cases of aortic stenosis has risen along with the increasing elderly population around the world. Among people aged 75 years or older, 3.4% of them have severe aortic stenosis. If symptoms appear, the standard treatment is surgical aortic valve replacement. However, over 30% of patients are not able to undergo surgery due to their advanced age or combination of other diseases. Once the symptoms of severe aortic stenosis appear (chest pain, syncope, and heart failure), the death rate for patients receiving medication and not undergoing surgery reaches up to 50% within one year. The five-year survival rate is almost 0%. So, the mortality risk is not less than cancer. Transcatheter aortic valve implantation (TAVI) is a less invasive approach which offers a new alternative for those patients deemed inoperable or of high surgical risk.

    Taipei Veterans General Hospital was a piorneering hospital in Taiwan to perform TAVI procedure. The first case in VGH was performed in 2010. Professionals in the fields of cardiology, cardiac surgery, anesthesia, radiology, and neurology have joined together to form the specialized TAVI team. As of today, a total of 150 operations have been performed. The team has also pioneered non-intubated procedure with local anesthesia and use of the percutaneous vascular closure device in 2013 to minimize operative complications. The 3M principle ─ multidisciplinary, multimodality, a minimalist approach ─ was applied successfully during procedures, establishing a model for interdisciplinary team cooperation.

    Taipei Veterans General Hospital was the forerunner in Taiwan to perform TAVI procedure and its multidisciplinary team was the few team in Taiwan to receive IRB approval from the Department of Health to perform TAVI procedure. The TAVI team pioneered non-intubated procedure with local anesthesia in 2013. A total of 138 procedure has been completed. Despite our patients had a predicted mortality rate according to EuroSCORE reaching 20 %, we achieved the lower complication rate and mortality rate than most countries in the world. These outstanding results have made our team the envy of the world:

Medical Service Results

  1. We are the few hospital in Taiwan which is able to perform valve implantation via six different routes including femoral artery, subclavian artery, aorta, apex, abdominal aorta and carotid artery. This gives patients with peripheral vascular disease more options and reduces the risk of major vascular complications. The mortality rate increases by 50% when there is a rupture of large blood vessels and severe bleeding. Since we can provide more valve implantation routes to patients with a peripheral vascular disease, our major vascular complication occurrence is 3.4%, which is lower than 4.1% to 10.9% occurrence rate in the U.S. and Europe.Table1
  2. If a stroke occurs during the procedure, the 30-day mortality rate is 3.5 times higher. Our stroke rate is 1.3%, which is lower than 1.5% -4.0% occurrence rate in the U.S. and Europe.Table1
  3. If moderate or severe paravalvular aortic regurgitation occurs after the procedure, not only the heart failure symptoms of the patient will persist but also the mortality rate of the patient will get higher (3.8 times). Before we perform the procedure, each patient undergoes detailed imaging (including transthoracic echocardiography, transesophageal echocardiography, cardiac catheterization and computed tomography with three-dimensional reconstruction) evaluation and we participate in detailed discussions during the pre-procedural meeting. Meticulous implantation technique is also taken during the procedure. As a result, the occurrence rate of moderate or severe paravalvular aortic regurgitation has been reduced to 2.0%, which is lower than 5.1% -16.2% occurrence rate in the U.S. and Europe.Table1
  4. The electrical conduction system of the heart locates below the aortic valve. Therefore, a significant percentage of patients must have a permanent pacemaker implanted to treat their slow heart rate after TAVI. However, implantation of a permanent pacemaker not only extends the hospital stay, but also carries a risk of complications, and increases the likelihood of heart failure and repeated hospitalization of patients. Only 4.1% of our patients require implantation of permanent pacemakers after the procedure, which is much lower than the implantation rates from other countries around the world (10%–26.3%).Table1
  5. By reducing procedural complications to a minimum, the Taipei Veterans General Hospital’s TAVI team has lower post-procedural mortality rate for our patients: Our 30-day mortality rate (5.4%) is lower than the rate of other countries (4.5% – 8.4%) and our one-year mortality rate (14.0%) is far lower than the rates in U.S, and Europe (18.4%- 24.3%).Table1

    The outstanding results of the Taipei Veterans General Hospital’s TAVI team were published in high-impact factor magazines including the European Heart Journal (SCI IF= 15.064). The team was invited to perform live demonstrations for the Annual Convention and Scientific Session of the Taiwan Society of Cardiology in 2014 and for the live course of Taiwan Society of Cardiovascular Interventions in 2017. TAVI has been selected as one of the four top specialties of Taipei Veterans General Hospital and media reports on the team have appeared in Business Weekly magazine, TVBS, and other media.

    At present, under the leadership of Dr. Chen, Ying-Hua and Dr. Zhang, Xiao-Huang, our TAVI team has sixteen cardiac surgeons and physicians who meet the requirements of the Bureau of Central Health Insurance, Department of Ministry of Health and Welfare. Not only are Dr. Chen and Dr. Zhang the few qualified proctors for Metronic devices in our country, but Dr. Zhang is also the only cardiovascular surgeon proctor for Metronic in Asia. Both of them are also qualified proctor free doctors for Edward devices. Looking forward to the future, our TAVI team will be able to provide more and more high-quality services.

 

Table1. The outstanding results of the Taipei Veterans General Hospital’s TAVI team 

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Feature Summary

To maintain the patient’s appearance and chewing function. Speech, esthetic, mastication are rarely compromised, and nutrition can be maintained. With the experience of wearing immediate denture, the patient is likely to adapt more easily to the new denture.

 

Overview

Though prevalence of periodontal disease and dental caries decreased due to the effort on public health and the improving knowledge in material, technique, and etiology; there are still lots of people not able to eat food efficiently because of mobile, or even missing tooth. Their appearance is also compromised, and disturb their normal life.

 

Features

An immediate denture is “a complete denture or removable partial denture fabricated for placement immediately after the removal of natural teeth”. The dentist use the current intraoral condition, old photos, and anatomy landmark, try to reconstruct missing dentition in a proper occlusal relationship and an esthetic way, in order to decrease the interference of tooth extraction.

 

Procedure

At the first appointment, the dentist will take impression and photo to record the intraoral/extra oral condition, and in the following appointment, the dentist will transfer anatomy landmark to the stone cast and discussed with the patient about expectation of the appearance of the new denture. The denture will deliver in the same day as remaining teeth extracted. Post operation follow up will arranged, and change the lining material to accommodate the soft tissue change during healing procedure.

 

Notification

Risks & complications

  • Because a try-in procedure is not possible beforehand, the patient may not be completely comfortable with the resulting appearance and fit on the day the immediate denture is inserted.
  • There may be some sore spot beneath the denture, and need adjustment after delivery.

 

Estimated Cost

The procedure cost 20,000NTD at the first time, and cost 1’000-7’000NTD when change lining material. Prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

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Overview

An occlusal bite is a removal device, usually made of hard acrylic, that fits over the occlusal and incisal surfaces of the teeth in one arch, creating precise occlusal contact with the teeth of the opposing arch.

Occlusal appliances have several uses, one of which is to temporarily provide an occlusal condition that allows the temporomandibular joints to assume the most orthopedically stable joint position.

 

Features

To make the temporomandibular joint to assume the most orthopedically stable joint position, and relief pain induced by temporomandibular disorder.

 

Procedure

No operation needed. Just to take impression to record current dentition, and a bite record, the occlusal bite plate would be delivered in weeks. Follow up for joint condition and occlusal condition would be arranged for adjustmne tof bite plate. Major TMJ related discomfort within weeks.

 

Notification

No major risk and complications.

 

Estimated Cost

The procedure cost is about 9,200 NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [2]=> array(8) { ["sn"]=> string(2) "64" ["classify"]=> string(2) "13" ["cover"]=> string(0) "" ["title"]=> string(44) "Comprehensive dental treatment for pediatric" ["content"]=> string(1487) "

Overview

Under general anesthesia, all dental treatment as needed is performed well, such as pulpectomy, dental restoration or extraction. When pediatric patients’ behavior cannot cooperate or deal with the treatment safely at out-patient-department, this treatment option might be a more appropriate treatment option.

 

Features

Restore tooth structure, remove odontogenic infectious source and avoid odontogenic infection.

 

Procedure

Inhalation induction. Disinfection with betadine. Remove caries with high speed and low speed. Pulpectomy with endodontic files and irrigation. Cavity restoration. Tooth extraction with elevator and forceps. Stainless steel crown coverage or space maintainer placement.

 

Notification

Risks & complications

  • Bliiding
  • Loosening of nearby teeth.
  • Difficult for wound healing.
  • Angular cheilitis.

 

Estimated Cost

The procedure cost is about 80,000~120,000 NTD, depends on different condition. Prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

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Overview

A supernumerary tooth is one that is additional to the normal series and can be found in almost any region of the dental arch. And most supernumerary teeth are located in the anterior maxillary region.

 

Features

Avoid disturbance of permanent dentition eruption and alignment.

 

Procedure

  • Inhalation induction.
  • Disinfection with betadine.
  • Under local anesthesia and flap elevation, remove extra bone and supernumerary tooth. Wound closed with stitches and compressed with surgical stent.

 

Notification

Risks & complications

  • Loosening of nearby teeth.
  • Difficult for wound healing.
  • Angular cheilitis.

 

Estimated Cost

The procedure cost is about 20,000~30,000NTD, depends on different condition. Prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.


 

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Feature Summary

Dental implants offer an alternative to replaced missing teeth with dentures or bridges.

 

Overview

Teeth missing are due to different reasons as deep caries, tooth fracture, severe periodontitis. Missing teeth replacement might be indicated and return to function and esthetics.

 

Features

Dental implants enable a single missing tooth to be replaced without restoring adjacent teeth. In addition, implants allow fixed restorations to be fabricated in patients who are fully or partially edentulous. Dental implants placement are performed under local anesthesia.

 

Procedure

Dental implants are usually placed after soft tissue flap elevation. These implants are inserted into the jaw bones to support dental prostheses after 4 to 6 months healing periods. For atrophic ridge with inadequate bone width or height, additional osseous grafting or soft tissue augmentation would be indicated.

 

Notification

Risks & complications

  • Implant supporting bone destruction or surrounding soft tissue inflammation owing to biofilm retention, overloading or inadequate implant position.
  • Vital organ injury (ex. inferior alveolar nerve injury, maxillary sinus membrane perforation…) during dental implant placement.
  • Prosthetic-related dental implant complications: mechanical, phonetic, esthetic, biologic problems.
  • Complications occur during or after implant related surgery as soft tissue augmentation, guided bone regeneration, etc.

Estimated Cost

The procedure cost is about 90,000~100,000 NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.


Missing tooth of upper right 1st premolar due to tooth fracture


Restore missing tooth with dental implant placement


Prosthesis restoring after implant placement

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Feature Summary

Root coverage procedure can cover exposing root surface, reaching esthetic outcomes and minimize the risk of root caries.

 

Overview

Gingival recession may be associated with one or more surfaces, resulting in attachment loss and root exposure, which can lead to clinical problems such as root surface hypersensitivity, root caries, cervical root abrasions, difficult plaque control, and diminished cosmetic appeal and aesthetic concern.

 

Features

Root coverage procedure is predictable in case of deep recession and lack of attached gingiva. This surgical procedure can be performed with either pedicle flap or free gingival graft, and aim to achieve harmonious gingival margin which is located at cementum-enamel junction of the tooth with no inflammation.

 

Procedure

Following administration of local anesthesia, preparation of the recipient bed was done and soft tissue graft was harvested and then placed over recipient site. Flap and graft tissue can be secured with suture.

 

Notification

Risks & complications

  • Teeth hypersensitivity might occur if complete root coverage wasn’t achieve.
  • Post-operation pain and bleeding are also common to experienced after surgery.

 

Estimated Cost

The procedure cost is about 15,000~20,000 NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.


A case with gingival recession from lower left canine to lower left premolars


Subepithelial connective tissue graft was harvested from palate and then inserted into lower left canine to lower left premolars buccal pouch


Teeth hypersensitivity and gingiva inflammation was improved due to complete root coverage of lower left premolars

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Feature Summary

The computer-assisted surgery is to increase surgical precision, reduce operation time, facilitate minimally invasive approach, and ultimately, to improve overall surgical outcomes.

 

Overview

Craniofacial deformities are a diverse group of deformities in the craniofacial region, which may be resulted from congenital anomalies, oncological resection, and traumatic injuries. Depending on the region of deformity involved, the patients may manifest with unbalanced facial appearance (short or long jaw), poor oral function, abnormal eyeball position, loss of facial part...etc. The patients usually need a comprehensive surgical planning to correct the disharmony of face and to restore the missing parts of facial structures.

 

Features

The complex nature of the craniomaxillofacial structures challenges the surgeon’s knowledge to anatomy, experience, and the perception toward surgical outcome. Computer-assisted surgery combined different techniques on virtual surgical planning, three-dimensional printing, and surgical navigation to correct the deformities in a more efficient and predictable way. This computer-assisted approach can widely apply in the following clinical scenario: orthognathic surgery, oral tumor resection and reconstruction, oral implantology, facial traumatic injuries and post-traumatic facial deformity.

 

Procedure

Several digital information is acquired for computer-assisted surgical planning. The digital image datasets are consisted of computed tomography (CT), cone-beam computed tomography (CBCT) magnetic resonance images (MRI), positron emission tomography (PET), 3D face scanning, and digital dental impression. Surgeons will plan the appropriate operation virtually based on that information. Then the plan will transfer to the operating theatre by generating customized surgical guides or patient specific implants via 3D printing technique. It could be also transferred by intra-operative real-time navigation.

 

Notification

Risk and complications

Same as the conventional procedures related to different disease entities. However, less complication rate may anticipate by precisely planning the approach and guiding by navigation and cutting jig during operation.

 

Estimated Cost

The procedure cost is about 106,000~1,006,500 USD, depends on the techniques and surgical procedures involved, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

 

Case 1. Mandibular deformity after tumor resection. Virtual planning followed by customized surgical guide fabrication precisely restore the mandible contour and maintain the condyle position.

Case 2. A case with left side orbital floor fracture from traumatic injury. Patient manifest with diplopia and enophthalmos. The orbital floor was reconstructed with Titanium mesh plate by 3D modeling technique and intra-operative navigation.

Case 3. A case with obstructive sleep apnea and skeletal class II malocclusion. Using computer assisted approach to correct the airway volume and facial profile.

Case 4. A case with ameloblastoma of mandible. The mandible was resection and reconstruction with free fibular flap. Oral rehabilitation was finished with computer-assisted implant surgical guide fabrication.

" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } } } [13]=> array(2) { ["name"]=> array(6) { ["id"]=> string(2) "14" ["zh-TW"]=> string(9) "感染科" ["english"]=> string(18) "Infectious Disease" ["jp"]=> string(0) "" ["zh-CN"]=> string(9) "感染科" ["classOrder"]=> string(1) "0" } ["items"]=> array(1) { [0]=> array(8) { ["sn"]=> string(2) "69" ["classify"]=> string(2) "14" ["cover"]=> string(0) "" ["title"]=> string(28) "Fever of unknown origin, FUO" ["content"]=> string(2274) "

Overview

FUO is defined as Fever >38.3°C (101°F) on at least two occasions, illness duration of ≥3 weeks, and the diagnosis that remains uncertain after a thorough history-taking, physical examination, and the basic investigations. It usually bothers patients a lot. Patients seek medical help frequently and usually take antibiotics to ease their anxieties.

Infection, neoplasms and noninfectious inflammatory diseases are the main etiologies of FUO. Noninfectious inflammatory diseases includes collagen or rheumatic diseases, vasculitis syndromes, and granulomatous disorders. Miscellaneous causes and unknown etiology can also be diagnosed finally.

 

Features

It is essential to get the correct diagnosis of FUO. Patients can be treated precisely after the exact diagnosis of FUO. The exact diagnosis can prevent the unnecessary use of antibiotics that are usually prescribed by the physicians. The good outcome in patients without a diagnosis confirms that potentially lethal occult diseases are very unusual and that empirical therapy is rarely required in stable patients.

 

Procedure

The diagnostic workup includes the search for potentially diagnostic clues through complete and repeated history-taking and physical examination and the obligatory investigations from blood samples. Extensive microbiology studies from blood or body fluid are necessary. Other studies include computed tomography of chest, abdomen and pelvis, echocardiography and 18F-fluorodeoxyglu­cose (FDG) positron emission tomography. Biopies of bone marrow, lymph nodes, liver biopsy, and the possible involved organs are sometimes needed.

 

Notification

There are minimal risks and complications during the diagnostic process. The risks and complications, including bleeding and the formation of hematoma, come from the biopsy of the suspicious lesion identified by the image study. They can be managed immediately and do not result in disabilities.

 

Estimated Cost

Around 200,000 NTD and the cost for the treatment is depend on the final diagnosis.

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Feature Summary

The aim of surgery is to improve the patient’s body image and correct the complications of persistent hypercortisolemia.

 

Overview

Cushing’s syndrome is caused by persistently elevated cortisol level in the body. Patients may experience moon face, buffalo hump, central obesity, muscle weakness, back pain, elevated blood pressure, elevated glucose levels, easy bruising, purplish striae, irregular menstruation and excessive hair in women.

 

Features

Endogenous Cushing’s syndrome may be caused by an adrenal tumor that secretes excessive cortisol; it may also be related to a pituitary tumor or ectopic Cushing’s syndrome that produces excessive adrenocorticotropic hormone (ACTH). Tumor removal is the treatment of choice for many cases.

 

Procedure

To treat an adrenal tumor, the urologist can perform an unilateral adrenalectomy; to treat a pituitary tumor, transphenoidal surgery should be performed by an experienced neurosurgeon. If the patient is not cured by surgery, a combination of radiotherapy and medication can be used. For ectopic Cushing’s syndrome, surgery, chemotherapy and medication may be chosen based upon different patient situation.

 

Notification

Risks & complications

  • Hypoadrenalism after surgery will warrants a period of cortisol replacement.
  • Other pituitary hormones may be influenced by transphenoidal surgery and should be carefully monitored.
  • Infection and wound healing are other problems related to surgery.

 

Estimated Cost

Prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

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Feature Summary

The use of Robot assister surgery has the benefit of less invasive, less blood loss, best result of ureteral repair due to meticulous suture and manipulation, smaller and cosmetic wound, short postoperative recovery period and hospital stay.

 

Overview

Ureteral stricture usually caused by congenital uretero-pelvic junction stenosis, iatrogenic injury, inflammation, urolithiasis, or previous endoscopic surgery, pelvic surgery, or retroperitoneal surgery. The common symptoms are flank pain, frequent UTI and hematuria. This disease causes hydronephrosis and subsequent impairment of renal function and atrophy of the kidney.

 

Features

Robot assisted laparoscopic repair of ureteral stricture: We use Da Vinci Robot assisted laparoscopic surgery to reconstruct the stricture site of the ureter to relieve the obstruction and hydronephrosis.

The purpose of the treatment is:

  • To relieve the ureteral obstruction and hydronephrosis so that the renal function could be preserved.
  • To relieve the symptoms of flank pain, hematuria and frequent UTI.
  • To avoid the need of long-term placement of Double J stent in the diseased ureter which causes flank pain, hematuria, and frequent UTI.
  • To avoid the patient’s suffer from frequent changes of double J stent.

 

Procedure

Under general anesthesia, segmental resection of the stricture area of the ureter and then one of the following operations is done:

  1. End-to end anastomosis of the proximal and distal ends of the ureters
  2. Reimplantation of the ureter into the urinary bladder
  3. Reimplantation of the ureter with Boari flap or Psoas hitch
  4. End to side anastomosis of the ureters

 

Notification

The following risk and complications are low:

  • Risk of General Anesthesia
  • Infection
  • Hemorrhage
  • Leakage

 

Estimated Cost

The procedure cost is about 188,000~244,000 NTD, prices are subject to change without prior notice, and need to pay in accordance with the actual medical expenses.

Da Vinci Robot machine

" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [1]=> array(8) { ["sn"]=> string(2) "72" ["classify"]=> string(2) "16" ["cover"]=> string(0) "" ["title"]=> string(54) "Thulium laser therapy for benign prostatic hyperplasia" ["content"]=> string(2078) "

Overview

Benign prostatic hyperplasia: Benign prostatic hyperplasia usually causes lower urinary tract symptoms such as frequency, urgency, nocturia, weak stream, intermittency, and terminal dribbling which bothers the men much.

 

Features

Thulium laser therapy is done through urethrocystoscopy using thulium laser instead of traditional cutting electro-cauterization loop.

The use of thulium laser has the benefit of less invasive, minimal blood loss, shorter catheterization period and hospital stay. It also has the benefit of better preservation of erectile function and less complications such as hyponatremia, TUR syndrome.

The purpose of the treatment is to relieve the bladder outlet obstruction and relieve the lower urinary tract symptoms such as frequency, urgency, nocturia, weak stream, intermittency, and terminal dribbling.

 

Procedure

Under spinal or epidural anesthesia, Thulium laser is introduced through an urethrocystoscopy into the prostatic urethra and deliver vaporesection or vapoenucleation of the adenoma which make the bladder outlet obstruction.

 

Notification

The following risk and complications are low:

  • Risk of Anesthesia
  • Infection
  • Hemorrhage
  • Incontinence
  • Retrograde ejaculation

 

Estimated Cost

The procedure cost is about 137,250~140,300 NTD, prices are subject to change without prior notice, and need to pay in accordance with the actual medical expenses.

Pre-operative endoscopic picture showed the adenoma of the prostate which causes bladder outlet obstruction.

Post-operative endoscopic picture showed the adenoma of the prostate was removed by thulium laser and there is no bladder outlet obstruction.

" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } } } [16]=> array(2) { ["name"]=> array(6) { ["id"]=> string(2) "17" ["zh-TW"]=> string(9) "血液科" ["english"]=> string(10) "Hematology" ["jp"]=> string(0) "" ["zh-CN"]=> string(9) "血液科" ["classOrder"]=> string(1) "0" } ["items"]=> array(1) { [0]=> array(8) { ["sn"]=> string(2) "73" ["classify"]=> string(2) "17" ["cover"]=> string(0) "" ["title"]=> string(39) "Hematopoietic stem cell transplantation" ["content"]=> string(3855) "

Feature Summary

To improve the outcome of patients with hematological malignancies and some solid tumors, including those with high risks of relapse or those relapsed patients.

To rescue the outcome of patients with marrow failure.

 

Overview

Hematological malignancies, solid tumors and marrow failure

Patients with hematological malignancies including non-Hodgkin lymphoma, Hodgkin lymphoma, acute myeloid and lymphoid leukemia, and myelodysplastic syndrome; and marrow failure (e.g. severe aplastic anemia) may need high dose therapy followed by autologous or allogeneic hematopoietic stem cell transplantation to control and even cure their diseases. In addition, patients with some solid tumors including brain tumors and germ cell tumor may need high-dose therapy followed by autologous hematopoietic stem cell transplantation to rescue their diseases.

 

Features

Since 1984, hematopoietic stem cell transplantation has been used to treat patients at Taipei Veterans General Hospital (Taipei VGH) and more than 1600 patients have undergone the procedure. In addition to autologous setting, allogeneic grafts are mainly gifted from family members and unrelated donors, including human leukocyte antigen (HLA) – matched and mismatched (e.g. haploidentical). The types of hematopoietic stem cells included bone marrow, peripheral blood stem cells and cord blood.

 

Procedure

Pre-transplant evaluations include patient’s disease (previous treatments and disease status) and comorbidities including cardiac and pulmonary function tests, the amount and storage condition of hematopoietic stem cells in the autologous setting, the availability and HLA matching status of allogeneic transplant donors, and the choice of preparative (conditioning) regimen (reduced intensity or myeloablative) and hematopoietic stem cell types. Except for patients with immunodeficiency, patients should receive preparative or conditioning therapy (usually high dose chemotherapy and/or total body irradiation) before transplantation, medications for prophylaxis of acute graft-versus-host-disease (GvHD) during the peri-transplant period of allogeneic transplantation. The infusion of hematopoietic stem cells is usually performed in laminar air flow rooms. After transplantation, patients receive transfusion support and supportive care including the use of granulocyte-colony stimulating factor (G-CSF), antibiotics, and peripheral parenteral nutrition.

 

Notification

Risks & complications

  • Early complications: within the first 30–60 days after hematopoietic stem cell transplantation a.
  1. Hemorrhagic cystitis
  2. Endothelial injury:
  • venoocclusive disease of the liver
  • capillary leakage syndrome
  • engraftment syndrome;
  • diffuse alveolar hemorrhage
  • hematopoietic stem cell transplantation-associated thrombotic microangiopathy
  • Idiopathic pneumonia syndrome
  • Infections
  1. Bacterial infection
  2. fungal infection
  • viral infection
  • Graft-versus-host-disease (GvHD)
  1. Acute GvHD
  2. Chronic GvHD
  • Late effects including fertility and gonadal dysfunction

 

Estimated Cost

The procedure cost is about 3,000,000NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

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Feature Summary

To relive pain, treat arthritis, and avoid disability.

 

Overview

Rheumatoid arthritis (RA) is caused by multiple genetic and environmental factors resulting in autoimmune-mediated polyarthritis and systemic inflammation. In order to avoid joint destruction and functional impairment, aggressive treatment is often required. The treatment starts from using conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). Biologic therapy or target-synthetic DMARDs (tsDMARDs) are options for patients who have inadequate response to csDMARDs. The aims for RA management are treat-to-target (T2T) approach while minimizing risk at the same time.

 

Features

For patients already using csDMARDs, biologic therapy or tsDMARDs but having several physically apparent inflamed joints, sono-guided aspiration with local injection provides a safe and an effective way to control the inflammation. This approach facilitates T2T without the risk of immunosuppression-related infections such as tuberculosis, viral hepatitis, herpes, intestinal perforations, or other opportunistic infections.

 

Procedure

Under the guidance of a high-resolution musculoskeletal ultrasound, the doctor utilize a fine needle to aspirate the joint fluid and inject local-active glucocorticoid subsequently. If multiple joints are required for treatment, the doctor will design a safe and effective personalized treatment. In general, the injected joint is able to maintain stable for up to 3 months. Sono-guided joint aspiration and local injection is helpful for social function recovery.

 

Notification

Risks & complications

  • Local injection might result in bleeding and ecchymosis. Before the procedure, the doctor will check the platelet count and coagulation functions, and avoid vascular structure during the procedure. This approach will decrease the risk of bleeding and ecchymosis.
  • Local glucocorticoid injection is much safer than systemic glucocorticoid therapy. Although the risk of infection is extremely low, the risk of infection is still present. The doctor are always abided by the guideline of aseptic technique.

 

Estimated Cost

Prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } } } [18]=> array(2) { ["name"]=> array(6) { ["id"]=> string(2) "19" ["zh-TW"]=> string(15) "輸血醫學科" ["english"]=> string(20) "Transfusion Medicine" ["jp"]=> string(0) "" ["zh-CN"]=> string(15) "輸血醫學科" ["classOrder"]=> string(1) "0" } ["items"]=> array(2) { [0]=> array(8) { ["sn"]=> string(2) "75" ["classify"]=> string(2) "19" ["cover"]=> string(0) "" ["title"]=> string(18) "DNA Parentage Test" ["content"]=> string(1936) "

Overview

  • In our DNA parentage test, autosomal short tandem repeats (STRs) typing was used to study the 18 loci in addition to analysis of X- or Y-chromosome STR and mitochondria sequence analysis.
  • Determination of blood relationships, e.g., parent-child, siblings, half siblings, grandparent-child, uncle –niece, etc.

 

Features

According to the regulations of the Immigration Department, our DNA paternity test with a greater than 99.99 percent of certainty fulfills the requirement for applying dependent visa.

 

Procedure

  • Please inform us: name, birth date, identity card or passport number, address, telephone. Consultation time: 08:00~11:30/13:30 ~ 17:00. Phone: (02) 2871-2121 ext 3824, FAX: (02) 2875-7695
  • Sampling: Usually blood sample or oral mucosa sample will be used. Three mL in adult and 0.5-1 mL in child will be drawn. If the client received allogeneic hematopoietic stem cell transplantation, hair roots will be collected.

 

Estimated Cost

  • Parentage test for the relationship between parents and child: 8,500 NTD per person.
  • Additional test needed for the relationship of siblings, the relationship of aunt/uncle to niece/nephew.

X- or Y-chromosome STR: 2,000 NTD per person.

Mitochondria DNA analysis: 2,500 NTD per person.

  • Prices are subject to change without prior notice, and need to pay in accordance with the actual medical expenses.

 

" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [1]=> array(8) { ["sn"]=> string(2) "76" ["classify"]=> string(2) "19" ["cover"]=> string(0) "" ["title"]=> string(65) "Peripheral blood stem cell (PBSC) Collection and Cryopreservation" ["content"]=> string(1678) "

Features

Peripheral blood stem cell (PBSC) Collection and Cryopreservation

  • PBSCs are collected by leukapheresis from autologous or allogeneic donors.
  • PBSCs are frozen by computer-controlled cryopreservation for long-term storage with minimal damage to the cells.
  • PBSCs are used for autologous or allogeneic PBSC transplantation.

 

Procedure

The donors are administered drugs to stimulate the migration of progenitor cells from the bone marrow into the peripheral blood. Procurement of these cells is achieved by leukapheresis. These harvested cells are processed and cryopreserved in liquid nitrogen for future use.

 

Notification

  • In general, apheresis is a relatively safe procedure.
  • The most common complication caused by citrate-induced hypocalcemia is easily prevented or relieved by calcium supplementation.

 

Estimated Cost

  • The procedure cost:

PBSC Collection:63,882 NTD per person (3 collection cycles) .

PBSC Cryopreservation:67,908 NTD per person (Storage 1-3 month)

  • Prices are subject to change without prior notice, and need to pay in accordance with the actual medical expenses.

 

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Feature Summary

The Argus II is a prosthesis that stimulate retina when the light-sensing cells are no longer work. The camera reacts to light and sends a signal to the array which is surgically implanted on the retina.

 

Overview

Retinitis pigmentosa is an inherited, degenerative eye disease that causes severe vision impairment due to the progressive degeneration of the rod photoreceptor cells in the retina. Affected individuals may experience poor vision, defective light-dark adaptations, night blindness. The progressive rod degeneration is later followed by deterioration in the retinal pigment epithelium and cone photoreceptor cells. As peripheral vision becomes increasingly compromised, patients experience progressive "tunnel vision" and eventual blindness.

 

Features

Argus II prosthesis

The Argus retinal prosthesis became the first approved treatment for the disease in February 2011. The device may help adults with RP who have lost the ability to perceive shapes and movement to be more mobile and to perform day-to-day activities.

The system works from the camera on the glasses to captures a scene then the signal is sent wirelessly to the receiver in the implant. The signals are then sent to the electrode array, which stimulates the retina optic nerve brain, resulting in the perception of light.

 

Procedure

The surgery aims to implant the Argus II retinal prosthesis in and around the eyeball. The implant consists of four parts: (1) the electronics case (2) the implant coil, (3) electrode array, and (4) the scleral band. The implant is made of metal, plastic and silicone. The case, coil, and scleral band are fixated around the eyeball. Then the electrode array is surgically implanted into the eye and tacked on the retina.(Figure 1)

 

Notification

The probable but uncommon complications and risks are as following:

  • Hypotony
  • Retinal tear or detachment
  • Conjunctival erosion
  • Endophthalmitis
  • Dislodged tack

 

Estimated Cost

The procedure cost is about 2,000,000 NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [1]=> array(8) { ["sn"]=> string(2) "78" ["classify"]=> string(2) "20" ["cover"]=> string(0) "" ["title"]=> string(55) "Femtosecond Laser Cataract Surgery and Intraocular Lens" ["content"]=> string(2584) "

Feature Summary

FLACS provides precise and reproducible key steps in cataract surgery, including corneal incisions, capsulotomy and lens fragmentation. Besides, laser pretreatment could reduce phacoemulsification ultrasound energy.

 

Overview

Cataract

According to the World Health Organization (WHO), cataract is the leading cause of blindness and visual impairment throughout the world. A cataract is opacity of the lens in the eye which causes vision impairment. It probably also leads to altered contrast sensitivity, glare, myopic shift or monocular diplopia.

 

Features

Cataract surgery

Cataract removal is the standard surgical treatment to improve one’s vision. The conventional cataract surgery is phacoemulsification cataract surgery. In recent years, femtosecond laser-assisted cataract surgery (FLACS) is developed to assist cataract surgery. After cataract is removal, an intraocular lens will be implanted to provide optical power of an eye.

 

Procedure

Patients will be sent to a laser room. After proper docking, spectral-domain optical coherence tomography is used to image and map the treatment plan. Laser is applied to perform wound incision (optional), capsulotomy and lens fragmentation. Then, patients will be sent to another operative room for phacoemulsification cataract surgery. Under the operative microscope, the primary incision will be created or opened, and an ophthalmic viscosurgical devise (OVD) should be injected as usual into anterior chamber. Anterior capsulorhexis will be checked and the anterior capsule will be removed. After hydrodissection, phacoemulsification, an intraocular lens will be implanted. At the end of surgery, the corneal wounds will be sealed by stromal hydration or sutures.

 

Notification

Risks and complications

  • Incomplete capsulotomy
  • Anterior capsulotomy tag
  • Anterior capsule tear
  • Posterior capsule tear
  • Corneal haze
  • Corneal epithelial defect
  • Descemet’s membrane trauma
  • Zonular dialysis

 

Estimated Cost

The procedure cost is about 125,000 NTD, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

 

" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [2]=> array(8) { ["sn"]=> string(2) "79" ["classify"]=> string(2) "20" ["cover"]=> string(0) "" ["title"]=> string(41) "Blepharoplaty for Upper Eyelid Retraction" ["content"]=> string(1790) "

Overview

Upper eyelid retraction is the abnormal elevation of the upper eyelid margin. Most common cause of upper eyelid retraction is thyroid eye disease. It may be unilateral or bilateral, and may lead to dry eyes, secondary epiphora, irritation, lagophthalmos, exposure keratopathy, and cosmetic deformity.

 

Features

To reduce the symptoms of upper lid retraction (dry eyes, secondary epiphora, irritation, lagophthalmos, exposure keratopathy…) and improve the cosmetic deformity.

 

Procedure

Graded full-thickness blepharotomy: After local anaesthesia, a lid crease incision is created, followed by dissection through orbicularis muscle and septum. Levator aponeurosis, muller muscle (both responsible for lifting the upper eyelid) and conjunctiva are incised just superior to the tarsal plate. The incision is extended in a full-thickness fashion, nasally and temporally, with preserving a central pedicle, to produce the desired lid height and contour.

 

Notification

Risks & complications

Under or over over-correction, higher lid crease, recurrence, etc.

At times, orbital decompression may be necessary as an initial step (prior to this oculoplastic surgery) if big eyeballs or bulging eyes (marked proptosis) are present.

 

Estimated Cost

The procedure cost is about 26,400 NTD per eye, prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.

Before

After

" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [3]=> array(8) { ["sn"]=> string(2) "80" ["classify"]=> string(2) "20" ["cover"]=> string(0) "" ["title"]=> string(27) "Trabeculectomy for Glaucoma" ["content"]=> string(3355) "

Feature Summary

The purpose of trabeculectomy is to make a bypass so that fluid can come out of the anterior chamber and hence the eye pressure can be lowered. Studies have shown that a suitably low pressure can stabilize the optic nerve function and prevent further damage to the visual field.

 

Overview

Glaucoma is a disease that damages the optic nerve. It is the second leading cause of blindness worldwide. Glaucoma is usually caused by an increased pressure inside the eye (an imbalance between fluid production and outflow). The increased pressure can directly cause mechanical compression or impede the vascular supply to the optic nerve. It can lead to visual field loss and if left untreated may cause blindness.

 

Features

Trabeculectomy is a surgery that creates a new route to drain fluid from the front part of eye. As stated above, glaucoma is usually due to an imbalance between fluid production and outflow inside the eye. Most cases are caused by an impaired outflow system. The aim of trabeculectomy is create a bypass so that fluid can come out of the eye by another pathway and hence would not accumulate inside the eye and cause an increase in eye pressure.

 

Procedure

Trabeculectomy is created by punching a "hole" at the white-black interface of the eye. Fluid can hence come out from the anterior chamber through this hole (Figure 1). The hole is then covered by a partial thickness flap created by the whitish part of the eye (Figure 2). The flap is usually tied by sutures which can be used to adjust the pressure of the eye to avoid too much or too little fluid draining out. It is usually done at the superior part of the eye and a little bubble (bleb) is formed (Figure 3) which is usually covered by the upper eyelid.

 

Notification

  • Early complications of trabeculectomy are:

Bleeding inside the eye (hyphema, suprachoroidal hemorrhage)

A too low eye pressure (hypotony, corneal decompensation)

A too high eye pressure (trap door obstruction, malignant glaucoma)

Infection (endophthalmitis)

 

  • Long term complications of trabeculectomy are:

Cataract

A too low eye pressure (hypotony, hypotonic maculopathy, cornea decompensation)

A too high eye pressure (bleb scarring)

Infection (blebitis, endophthalmitis)

 

Estimated Cost

Prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.


How trabeculectomy is done? (downloaded from Nick Strouthidis)


Trabeculectomy is done at the white-black interface of the eye. A flap is created to cover the punched hole and then sutured with stitches to adjust eye pressure. (downloaded from the Southeast Texas Ophthalmology)


A bleb is formed and usually covered by the superior eyelid. (downloaded from Glaucoma Consultant of Texas)

" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [4]=> array(8) { ["sn"]=> string(2) "81" ["classify"]=> string(2) "20" ["cover"]=> string(0) "" ["title"]=> string(25) "Glaucoma Drainage Implant" ["content"]=> string(3019) "

Overview

Glaucoma drainage implant is a medical device that divert fluid from the front part of the eye (anterior chamber) to the external posterior whitish portion (subconjunctival space) of the eye. Theoretically, an implant can avoid healing scar tissue and is especially useful in patients who have already undergone trabeculectomy or conjunctival manipulation.

 

Features

The purpose of glaucoma drainage device is to divert fluid from the anterior chamber to the external reservoir created by the surgery and hence can relieve the high pressure caused by the accumulated fluid inside the eye.

 

Procedure

With Ahmed implant (Figure 1), a conjunctival flap is created in the upper outer quadrant of the eye, usually between two eye muscles. The body of the implant is positioned 8-10 mm behind the white-black interface of the eye. The tube of the implant is inserted about 1-3 mm posterior to the white-black interface into the anterior chamber of the eye. The drainage tube is covered with a piece of preserved donor sclera (Figure 2). The conjunctival flap is then closed and sutured.

The procedure of implanting an Express shunt (Figure 3) is very similar to trabeculectomy described above except that instead of a hole being punched at the white-black interface, a stainless steel spur like device 3 mm long is inserted into the anterior chamber under a whitish sclera like flap (Figure 4).

 

Notification

  • Early complications of glaucoma drainage implants are:

Bleeding inside the eye (hyphema, suprachoroidal hemorrhage)

A too low eye pressure (hypotony)

A too high eye pressure (blockage of the tube)

Infection (endophthalimitis)

 

  • Late complications of glaucoma drainage implants are:

A too low eye pressure (hypotony, hypotonic maculopathy)

A too high eye pressure and excessive capsule fibrosis

Tube exposure and conjunctival erosion

Corneal decompensation and edema

Infection (endophthalmitis)

 

Estimated Cost

Prices are subject to change without prior notice, need to pay in accordance with the actual medical expenses.


The Ahmed valve implant (downloaded from Ophthalmology Management)


The implant is usually put on the upper-outer quadrant of the eye. (downloaded from the New World Medical)


The Express shunt (downloaded from Lakewood, Long Beach CA of glaucoma)


The Express shunt is inserted into the anterior chamber under a whitish sclera like flap. (downloaded from M.D./Alert)

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Overview

Abdominoplasty, sometimes known as a 'tummy tuck', is designed to help improve the shape and tone of the abdominal region. The procedure involves the removal of excess sagging fat and skin to improve the shape and tone of the underlying tissue that supports the fat and skin. This procedure can be cosmetic or reconstructive in nature.

 

Features

While abdominoplasty can be a cosmetic procedure, it may also be partly a reconstructive procedure that is necessary to:

  • Correct abdominal abnormalities caused by pregnancy, obesity, extensive weight loss, trauma, tumours or other disease
  • Correct or relieve structural defects of the abdomen
  • Improve function of abdominal muscles
  • Create a more normal appearance of the abdomen
  • Repair an abdominal hernia that has followed previous abdominal surgery
  • Remove a large and distressing apron of fat, also called a “pannus”, that can cause chronic dermatitis, skin infection, difficulty in walking and difficulties with hygiene. The surgical removal of a pannus is called an “apronectomy”

 

Notification

Some risks and complications associated with abdominoplasty may include:

  • Wound infection (treatment with antibiotics may be needed)
  • Pain and discomfort around the incisions
  • Haematoma (an accumulation of blood around the surgical site that may require drainage)
  • Visible and prominent scars including keloid and hypertrophic scars. These are raised, red and thickened scars that may form over the healed incisions. They may be itchy, annoying and unsightly but are not a threat to health
  • Numbness around operated sites. In most cases this is temporary and will improve over many months
  • Areas of skin that do not heal and may require a skin graft
  • Difficulty in bending forward due to the tightened skin. Other movements may also feel constrained
  • Excess fluid accumulation under the skin (known as a seroma) around an operated site that may require one or more drainage procedures with a needle
  • In the unlikely event that blood loss during surgery has been large, a transfusion may be needed
  • A blood clot in a leg or the chest (deep venous thrombosis) that will require further treatment. It is rare that a clot can move to the lungs and become life threatening
  • Nausea (typically from the anaesthetics which usually settles down quickly)

 

Estimated Cost

Cost is always a consideration in elective surgery. Prices for a tummy tuck can vary widely between Specialist Plastic Surgeons. Some factors that may influence the cost include the surgeon’s experience, the type of procedure used and the geographic location of the office.

Costs associated with the procedure may include:

  • Surgeon’s fee
  • Hospital or surgical facility costs
  • Anaesthesia fees
  • Prescriptions for medication
  • Post-surgery garments
  • Medical tests

Your surgeon should welcome any questions you may have regarding fees.

" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [1]=> array(8) { ["sn"]=> string(2) "83" ["classify"]=> string(2) "21" ["cover"]=> string(0) "" ["title"]=> string(14) "Blepharoplasty" ["content"]=> string(2334) "

Overview

Eyelid surgery, also known as a blepharoplasty, is a procedure that removes excess fatty tissue and/or loose skin surrounding the eyes to give the area a more rejuvenated appearance.

 

Procedure

The aim of eyelid surgery is to improve facial appearance and reduce the signs of ageing by treating:

  • Loose or sagging skin that creates folds or disturbs the natural contour of the upper eyelid, sometimes impairing vision
  • Excess fatty deposits that appear as puffiness in the upper eyelids
  • Bags under the eyes
  • Droopiness of the lower eyelids, showing white below the iris (coloured portion of the eye)
  • Excess skin and fine wrinkles of the lower eyelid

 

Notification

Specific risks and complications associated with eyelid surgery include:

  • Bruising and swelling
  • Pain and discomfort
  • Removal of too much skin, possibly exposing the cornea to injury
  • Asymmetry of the eyelids
  • Noticeable scarring of the incisions
  • Itchiness, watering or dryness of the eyes
  • Drooping of the lower eyelid which will usually recover but occasionally requires further surgery
  • Temporary changes in vision. In rare cases, changes in vision may be long lasting or permanent
  • In extremely rare cases, eyelid surgery can lead to blindness. Smoking, pre-existing eye disease, straining, lifting and coughing can add to this risk

 

Estimated Cost

Cost is always a consideration in elective surgery. Prices for a tummy tuck can vary widely between Specialist Plastic Surgeons. Some factors that may influence the cost include the surgeon’s experience, the type of procedure used and the geographic location of the office.

Costs associated with the procedure may include:

  • Surgeon’s fee
  • Hospital or surgical facility costs
  • Anaesthesia fees
  • Prescriptions for medication
  • Post-surgery garments
  • Medical tests

Your surgeon should welcome any questions you may have regarding fees.

" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [2]=> array(8) { ["sn"]=> string(2) "84" ["classify"]=> string(2) "21" ["cover"]=> string(0) "" ["title"]=> string(19) "Breast Augmentation" ["content"]=> string(4147) "

Overview

Breast augmentation, also known as augmentation mammoplasty, can be a cosmetic procedure or a reconstructive procedure in the case of breast reconstruction surgery. The procedure involves implants being inserted beneath the breasts to enlarge them. The implant type and size depends on factors such as how much bigger you want your breasts to be, your breast anatomy, skin thickness and elasticity, and body type.

 

Features

Breast implants can be used to:

  • Enlarge small breasts
  • Restore breast volume after weight reduction or pregnancy and breastfeeding
  • Even up asymmetric breasts
  • Reconstruct a breast after mastectomy or injury

 

Procedure

The two main types of breast implant used in Australia are:

Saline implants – a silicone envelope filled with varying amounts of sterile salt water (saline). This can affect the shape, firmness and feel of the breast. If the implant shell leaks, a saline implant will collapse and the saline will be absorbed and naturally expelled by the body

Silicone implants – a silicone envelope filled with an elastic gel that feels much like natural breast tissue. If the implant leaks, the gel may remain within the implant shell or it may escape into the scar capsule (area around the implant) or even into the breast tissue. A leaking implant filled with silicone gel may not collapse

Implants are placed behind the breast, not within the breast tissue. Implants can be inserted either:

  • Between the breast tissue and the chest muscle, or
  • Behind the large chest muscle called the pectoralis major

Each position has its advantages and disadvantages. Your Specialist Plastic Surgeon can provide further details and will recommend which position is likely to be most suitable for you.

 

Notification

Some possible complications and risks associated with breast augmentation may include:

  • Surgical risks such as bleeding or infection
  • Fluid accumulation around the implant after surgery
  • Allergic reaction to suture materials, tape adhesive or other medical materials and lotions
  • Changes in breast and nipple sensation
  • Temporary or permanent areas of numbness
  • Wrinkling of the skin over the implant
  • Keloid, or lumpy scar tissue, which is pink, raised and irregularly shaped. These scars may be inflamed and itchy. There are several possible sites for the incision. Discuss this with your surgeon
  • Capsular contracture, where firm scar tissue forms around the implant causing it to lose shape and softness
  • Inappropriate implant size
  • Implant rupture or deflation
  • Asymmetry (unevenness) of the breasts
  • Calcium deposits in the scar capsule around the implant
  • Granulomas, or lumps in local lymph node tissue formed by leaking silicone
  • Breastfeeding difficulties, including reduced milk supply
  • Reduced effectiveness of breast cancer screening, since an implant may hide breast tissue (and tumors) during a mammogram
  • Movement of the implants from their original position
  • Further surgery to treat complications
  • Risks of anesthesia including allergic reaction or potentially fatal cardiovascular complications such as heart attack
  • A blood clot in the deep veins of the legs (deep vein thrombosis), which can move to the lungs (pulmonary embolus) or to the brain and may be life threatening

 

Estimated Cost

Costs associated with the procedure may include:

  • Surgeon’s fee
  • Hospital or surgical facility costs
  • Anaesthesia fees
  • Prescriptions for medication
  • Post-surgery garments
  • Medical tests
" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [3]=> array(8) { ["sn"]=> string(2) "85" ["classify"]=> string(2) "21" ["cover"]=> string(0) "" ["title"]=> string(11) "Breast Lift" ["content"]=> string(2501) "

Overview

Breast lift surgery, also known as mastopexy, is a procedure that raises and firms the breasts. Excess skin is removed to tighten the surrounding tissue and to reshape and support the new breast contour. The internal breast tissue is usually reshaped as well.

Breast lift surgery is designed to reshape and tighten the breast contour by removing excess skin. This gives the breasts a more firm and raised appearance. A breast lift can also reduce the size of the areola, which can become enlarged over time.

 

Notification

Breast lift surgery is a highly individualised procedure and may not be suitable for everyone. Always talk to your Specialist Plastic Surgeon before making a decision. Your Specialist Plastic Surgeon will assess your condition and general health, and plan the treatment that is best suited to you.

Before you decide on breast lift surgery, there are some important issues to keep in mind:

  • Breast lift surgery does not significantly change the size of your breasts or round out the upper part of your breast. If you want your breasts to look fuller or smaller, you might want to consider either breast augmentation or breast reduction surgery
  • Surgeons generally recommend waiting until breast development, child birth and breastfeeding have stopped before undertaking breast lift surgery
  • Although breasts of any size can be lifted, the results may not be as long-lasting in women with heavier breasts

A breast lift may be a good option for you if:

  • You are physically healthy
  • You have realistic expectations
  • Your breasts are fully developed
  • Your breasts are sagging and have lost their shape and firmness
  • Your breasts have a flatter, elongated shape or are pendulous
  • When unsupported, your nipples fall below the breast crease
  • Your nipples and areolas point downward
  • You have stretched skin and enlarged areolas
  • One breast is lower than the other

 

Estimated Cost

Costs associated with the procedure may include:

  • Surgeon’s fee
  • Hospital or surgical facility costs
  • Anaesthesia fees
  • Prescriptions for medication
  • Post-surgery garments
  • Medical tests
" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [4]=> array(8) { ["sn"]=> string(2) "86" ["classify"]=> string(2) "21" ["cover"]=> string(0) "" ["title"]=> string(21) "Breast Reconstruction" ["content"]=> string(3865) "

Overview

Breast reconstruction is an increasingly common surgical procedure for women who have had a mastectomy. The procedure can create a breast that resembles a natural breast in appearance and form. Breast reconstruction is a physically and emotionally rewarding procedure for a woman who has lost a breast due to cancer or other condition

 

Features

Breast reconstruction is a surgical procedure that rebuilds a new breast or breasts to resemble a natural breast in appearance and form. Breast reconstruction is usually performed immediately after, or sometime after a mastectomy.

 

Procedure

There are two main types of breast reconstruction: implant reconstruction and flap reconstruction. In implant reconstruction, an implant is placed under the skin and muscle to recreate the shape of the breast. In flap reconstruction, skin, fat and muscle are taken from elsewhere on the body to make the new breast. The procedure best for you will depend on your age, general health, size and shape of the other breast, and available body tissue.

 

Notification

Some general complications and risks associated with surgery may include:

  • Heavy bleeding from an operated site
  • Fluid accumulation around the operation site(s)
  • Infection that may require treatment with antibiotics or further surgery in some cases
  • Allergic reaction to sutures, dressings or antiseptic solutions
  • The formation of a large blood clot (haematoma) beneath an incision site may require further surgery
  • Complications such as heart attack, pulmonary embolism or stroke may be caused by a blood clot, which can be life threatening
  • Pain, bruising and swelling around the operated site(s)
  • Slow healing, often related to smoking or diabetes
  • Short-term nausea following general anaesthesia and other risks related to anaesthesia

Some possible complications and risks associated with breast reconstruction surgery using implants may include:

  • Infection around the implant
  • Capsular contracture, where firm scar tissue forms around the implant causing it to lose shape and softness
  • Implant rupture or deflation
  • Leakage of the implant’s contents (silicone gel or saline)
  • Asymmetry (unevenness) of the breasts
  • Calcium deposits in the scar capsule around the implant
  • Granulomas, or lumps in local lymph node tissue formed by leaking silicone
  • Movement of the implants from their original position
  • Further surgery to treat complications

Some possible complications and risks associated with breast reconstruction surgery using flap reconstruction may include:

  • Loss of blood circulation to the reconstructed breast due to clotting in the rejoined blood vessels. This can result in flap tissue dying (necrosis)
  • Small areas of hardness (fat necrosis) may develop in the new breast
  • Fluid collection (seroma) at the flap site
  • Weakened abdominal muscle, which can result in a hernia
  • Difference in size and shape (asymmetry) between the natural and reconstructed breasts
  • Temporary loss of full movement of the arm on the side of the reconstructed breast

 

Estimated Cost

Costs associated with the procedure may include:

  • Surgeon’s fee
  • Hospital or surgical facility costs
  • Anaesthesia fees
  • Prescriptions for medication
  • Post-surgery garments
  • Medical tests
" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [5]=> array(8) { ["sn"]=> string(2) "87" ["classify"]=> string(2) "21" ["cover"]=> string(0) "" ["title"]=> string(16) "Breast Reduction" ["content"]=> string(2910) "

Overview

Breast reduction, also known as reduction mammoplasty, is a surgical procedure that reduces the size of overly large breasts. Overly large breasts can cause health issues and emotional problems for some women. In addition to self image issues, it can also cause physical pain and discomfort. Breast reduction surgery removes excess breast fat, glandular tissue and skin to achieve a breast size in proportion with your body. The procedure is designed to alleviate the discomfort associated with overly large breasts.

 

Notification

Breast reduction is a highly individualized procedure and may not be suitable for everyone. Always talk to your Specialist Plastic Surgeon before making a decision. Your Specialist Plastic Surgeon will assess your condition and general health, and plan the treatment that is best suited to you.

Before you decide on breast reduction surgery, there are some important issues to keep in mind:

  • Surgeons generally recommend waiting until breast development, child birth and breastfeeding have stopped before undertaking breast reduction surgery
  • Breast reduction surgery can interfere with some diagnostic procedures
  • Ability to breastfeed following breast reduction surgery may be affected. Talk to your surgeon if you are planning to breastfeed a baby in the future
  • Changes in the breasts during pregnancy, or significant weight loss or gain can alter the outcomes of previous breast reduction surgery
  • Breast and nipple piercings can cause an infection
  • Smokers are at increased risk of complications. If you are serious about undergoing surgery, you should quit smoking

Breast reduction may be a good option for you if:

  • You are physically healthy
  • You have realistic expectations
  • Your breasts are fully developed
  • You are bothered by the feeling that your breasts are too large
  • Your breasts limit your physical activity
  • You experience back, neck and shoulder pain caused by the weight of your breasts
  • You have regular indentations from bra straps that support heavy, pendulous breasts
  • You have skin irritation beneath the breast crease
  • Your breasts hang low and have stretched skin
  • Your nipples rest below the breast crease when your breasts are unsupported
  • You have enlarged areolas caused by stretched skin

 

Estimated Cost

Costs associated with the procedure may include:

  • Surgeon’s fee
  • Hospital or surgical facility costs
  • Anaesthesia fees
  • Prescriptions for medication
  • Post-surgery garments
  • Medical tests
" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [6]=> array(8) { ["sn"]=> string(2) "88" ["classify"]=> string(2) "21" ["cover"]=> string(0) "" ["title"]=> string(17) "Chin Augmentation" ["content"]=> string(2705) "

Overview

Chin surgery, also known as mentoplasty, is designed to reshape the chin. It is performed to either enhance the chin with an implant, or reduce its size with surgery on the bone. Occasionally, surgery to the chin bone is used to enlarge the area instead of using an implant. Sometimes, a Specialist Plastic Surgeon will recommend chin surgery to a patient having nose surgery in order to achieve facial proportion, as the size of the chin may magnify or minimise the perceived size of the nose. Chin surgery helps provide a harmonious balance to facial features by enhancing facial contours. For patients who feel that their chin is too small, an implant is inserted to enhance the size and shape of the chin. Implants may be made of human tissue or synthetic materials such as silicone or polythene. For patients who feel their chin is too large, surgery is performed on the bone to reshape and resize the chin.

 

Notification

Chin surgery is a highly individualized procedure and may not be suitable for everyone. Always talk to your Specialist Plastic Surgeon before making a decision. Your surgeon will assess your condition and general health, and plan the treatment that is best suited to you.

Before you decide on chin surgery, there are some important issues to keep in mind:

  • Some chin implants are made from silicone. While currently there is no clear scientific evidence that silicone is a harmful substance, concerns have been raised about the safety of silicone implants
  • Smokers are at increased risk of complications. If you are serious about undergoing cosmetic surgery, you should quit smoking

Chin surgery may not be a good option for you if you are:

  • Not able to have an anaesthetic
  • Prone to bleeding tendencies or have poor healing ability
  • Too high risk of having surgical complications

Chin surgery may be a good option for you if:

  • You are physically healthy and you do not have medical conditions that can impair healing or increase risk of surgery
  • You have realistic expectations of what chin surgery can accomplish
  • You are a non-smoker or have stopped smoking

 

Estimated Cost

Costs associated with the procedure may include:

  • Surgeon’s fee
  • Hospital or surgical facility costs
  • Anaesthesia fees
  • Prescriptions for medication
  • Post-surgery garments
  • Medical tests
" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [7]=> array(8) { ["sn"]=> string(2) "89" ["classify"]=> string(2) "21" ["cover"]=> string(0) "" ["title"]=> string(9) "Face lift" ["content"]=> string(4119) "

Overview

Facelift, also known as meloplasty or rhytidectomy, is a surgical procedure that tightens and removes sagging skin on the face and neck. Facial muscles may be surgically tightened to improve their tone. Excess fat may also be removed or repositioned as part of the surgery. Most facelifts are performed for people aged between 40 and 65, but older people can also have facelifts.

 

Features

The aim of a face lift is to reduce the signs of ageing by improving the contours of the face and neck. A facelift can help to make the face and skin appear younger and smoother. A facelift may also be combined with other surgical procedures such as a brow lift, eyelid surgery or nose reconstruction. The bone structure of the face will not be changed during facelift surgery.

Non-surgical treatments, such as chemical skin peel, dermabrasion or skin resurfacing of the face, may be undertaken at the same time as the facelift. The aim of these treatments is to treat sun-damaged skin and crow’s feet around the eyes, and fine lines around the mouth, which are not removed by facelift surgery.

 

Notification

Facelift surgery is a highly individualized procedure and may not be suitable for everyone. Always talk to your Specialist Plastic Surgeon before making a decision. Your surgeon will assess your condition and general health, and plan the treatment that is best suited to you.

Before you decide on facelift surgery, there are some important issues to keep in mind:

  • While a facelift should make you look younger, it will not raise sagging eyebrows, remove deep frown lines in the forehead, change your upper or lower eyelids, or get rid of wrinkles around the mouth. Other forms of treatment may be more appropriate for you
  • Suture facelift, or thread lifting, is best suited for younger and middle-aged patients whose tissues have sagged with time or sun damage. It is not recommended for people with very thin or dry skin. Your surgeon will need to assess your individual suitability for this type of treatment
  • The results of a facelift usually last between five and twelve years. Most people can have two to three facelifts in a lifetime, depending on the extent of each procedure and the amount of scarring that occurs with each facelift
  • Facelift surgery does not “stop the clock” of ageing. The normal ageing process will continue after the surgery
  • Smokers are at increased risk of complications. If you are serious about undergoing surgery, you should quit smoking

Facelift surgery may not be a good option for you if you are:

  • Not able to have an anaesthetic
  • Prone to bleeding tendencies or have poor healing ability
  • Too high risk of having surgical complications

Facelift surgery may be a good option for you if:

  • You have sagging in the mid-face
  • You have deep creases below the lower eyelids
  • You have deep creases along the nose extending to the corner of the mouth
  • You have fat that has fallen or is displaced
  • You have loss of muscle tone in the lower face which may create jowls
  • You have loose skin and excess fatty deposits under the chin and jaw, creating the appearance of a double chin
  • You are physically healthy and you do not have medical conditions that can impair healing or increase risk of surgery
  • You have realistic expectations of what face lift surgery can accomplish
  • You are a non-smoker or have stopped smoking

 

Estimated Cost

Costs associated with the procedure may include:

  • Surgeon’s fee
  • Hospital or surgical facility costs
  • Anaesthesia fees
  • Prescriptions for medication
  • Post-surgery garments
  • Medical tests
" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [8]=> array(8) { ["sn"]=> string(2) "90" ["classify"]=> string(2) "21" ["cover"]=> string(0) "" ["title"]=> string(26) "Facial Bone Reconstruction" ["content"]=> string(1069) "

Overview

There are a wide variety of plastic surgery procedures, such as Skull/Facial Bone Reconstruction, that our practice performs. Please contact us if you are interested in receiving more information on this particular procedure.Plastic surgery encompasses both cosmetic and reconstructive surgery.Cosmetic surgery is performed to reshape normal structures of the body in order to improve the patient's appearance and self-esteem. Cosmetic surgery is usually not covered by health insurance because it is elective.

 

Features

Reconstructive surgery is performed on abnormal structures of the body, caused by congenital defects, developmental abnormalities, trauma, infection, tumors or disease. It is generally performed to improve functions, but may also be done to approximate a normal appearance.

 

Estimated Cost

For more information on plastic surgery and the procedures we offer, please schedule a consultation and visit our practice.

" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [9]=> array(8) { ["sn"]=> string(2) "91" ["classify"]=> string(2) "21" ["cover"]=> string(0) "" ["title"]=> string(15) "Facial implants" ["content"]=> string(2682) "

Overview

Facial implants are a form of cosmetic surgery designed to improve and enhance facial contours. Implants are inserted in areas of the face to provide a more harmonious balance to facial features and its overall appearance. Implants may be made of human tissue or synthetic materials such as silicone or polythene. Facial implants are used to enhance facial contours. Some common areas where implants are inserted include the cheeks, chin and lower jaw. For example, cheek implants can make the cheeks look larger, higher or fuller. Chin implants are usually chosen for people who think their chin looks too small. A patient undergoing nose surgery may also elect to undergo chin surgery at the same time to achieve a more harmonious facial balance. Jaw implants are commonly inserted to give the jaw line a more defined appearance.

 

Notification

Facial implant surgery is a highly individualized procedure and may not be suitable for everyone. Always talk to your Specialist Plastic Surgeon before making a decision. Your surgeon will assess your condition and general health, and plan the treatment that is best suited to you.

Before you decide on surgery with facial implants, there are some important issues to keep in mind:

  • Some facial implants are made from silicone. While currently there is no clear scientific evidence that silicone is a harmful substance, concerns have been raised about the safety of silicone implants
  • Smokers are at increased risk of complications. If you are serious about undergoing cosmetic surgery, you should try to quit smoking

Facial implant surgery may not be a good option for you if you are:

  • Not able to have an anaesthetic
  • Prone to bleeding tendencies or have poor healing ability
  • Too high risk of having surgical complications

Facial implants may be a good option for you if:

  • You are physically healthy and you do not have medical conditions that can impair healing or increase risk of surgery
  • You have realistic expectations of what facial implant surgery can accomplish
  • You are a non-smoker or have stopped smoking

 

Estimated Cost

Costs associated with the procedure may include:

  • Surgeon’s fee
  • Hospital or surgical facility costs
  • Anaesthesia fees
  • Prescriptions for medication
  • Post-surgery garments
  • Medical tests
" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [10]=> array(8) { ["sn"]=> string(2) "92" ["classify"]=> string(2) "21" ["cover"]=> string(0) "" ["title"]=> string(25) "Forehead lift (brow lift)" ["content"]=> string(2987) "

Overview

A surgical procedure that corrects a sagging or deeply furrowed brow. The procedure is often performed to reduce the creases, or ‘frown lines’, that develop across the forehead and on the bridge of the nose. It can also raise the eyebrows to a more alert and youthful position.

 

Features

The aim of a brow lift is to improve facial appearance and reduce the signs of ageing by:

  • Elevating the brow into a preferred position
  • Smoothing out forehead wrinkles
  • Lessening frown lines that develop between the eyes near the nose

Other surgical rejuvenation treatments often performed along with a brow lift are facelift surgery and eyelid surgery.

 

Notification

Brow lift surgery is a highly individualised procedure and may not be suitable for everyone. Always talk to your Specialist Plastic Surgeon before making a decision. Your surgeon will assess your condition and general health, and plan the treatment that is best suited to you.

Before you decide on a brow lift, there are some important issues to keep in mind:

  • If you are most concerned about the area around your eyes, eyelid surgery may be more appropriate than a brow lift or may be combined with a brow lift. Discuss your options with your surgeon
  • Brow lift surgery does not “stop the clock” of ageing. The normal ageing process will continue after the surgery. Any major changes in lifestyle, including your weight, after surgery could affect how you look
  • Smokers are at increased risk of complications from any surgery. If you are serious about undergoing cosmetic surgery, you should quit smoking

Brow lift surgery may not be a good option for you if you are:

  • Not able to have an anaesthetic
  • Prone to bleeding tendencies or have poor healing ability
  • Too high risk of having surgical complications

Brow lift surgery may be a good option for you if:

  • You have sagging of your eyebrows
  • You have deep creases in your forehead
  • You have crows feet or deep frown lines at the root of your nose
  • You are physically healthy and you do not have medical conditions that can impair healing or increase risk of surgery
  • You have realistic expectations of what brow lift surgery can accomplish
  • You are a non-smoker or have stopped smoking

 

Estimated Cost

Costs associated with the procedure may include:

  • Surgeon’s fee
  • Hospital or surgical facility costs
  • Anaesthesia fees
  • Prescriptions for medication
  • Post-surgery garments
  • Medical tests
" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [11]=> array(8) { ["sn"]=> string(2) "93" ["classify"]=> string(2) "21" ["cover"]=> string(0) "" ["title"]=> string(13) "Gynaecomastia" ["content"]=> string(2631) "

Features

Gynaecomastia is an excessive enlargement of the male breast and may be present in one breast (unilaterally) or in both breasts (bilaterally).Gynaecomastia is common in men of any age and may develop as a result of:

  • Hormonal changes
  • Weight gain
  • Hereditary conditions
  • Disease, such as liver disease
  • Certain medication
  • Use of non-prescription or recreational drugs, including anabolic steroids and marijuana

Gynaecomastia can cause emotional discomfort and may affect a man’s self-confidence. Excess breast tissue can also cause a man’s breasts to sag and stretch the areola (the dark skin surrounding the nipple).

 

Notification

Surgery for gynaecomastia is a highly individualised procedure and may not be suitable for everyone. Always talk to your Specialist Plastic Surgeon before making a decision. Your Specialist Plastic Surgeon will assess your condition and general health, and plan the treatment that is best suited to you.

Before you decide on breast reduction surgery, there are some important issues to keep in mind:

  • Any surgical treatment to correct gynaecomastia will require incisions. While most incisions are hidden in natural contours or in the areolae of the breasts, some scars may be visible and an unavoidable result of any breast reduction surgery
  • Surgeons generally recommend waiting until breasts are fully developed. Younger men or adolescent boys may be advised to wait a number of years after the onset of gynaecomastia before surgery
  • Breast reduction surgery is not recommended for overweight men who have not tried proven weight-loss techniques such as diet and exercise
  • If gynaecomastia has resulted from the use of alcohol, certain prescription medications or drugs including steroids, you must be fully free of these substances before undergoing surgery
  • You must remain at a stable weight in order to maintain the results of your surgery
  • Smokers are at increased risk of complications. If you are serious about undergoing surgery, you should try to quit smoking

 

Estimated Cost

Costs associated with the procedure may include:

  • Surgeon’s fee
  • Hospital or surgical facility costs
  • Anaesthesia fees
  • Prescriptions for medication
  • Post-surgery garments
  • Medical tests
" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [12]=> array(8) { ["sn"]=> string(2) "94" ["classify"]=> string(2) "21" ["cover"]=> string(0) "" ["title"]=> string(20) "Hair Transplantation" ["content"]=> string(2324) "

Features

Hair Transplantation surgery incorporates a range of transplant techniques to restore hair fullness. Transplant techniques, such as punch grafts, mini-grafts, micro-grafts, slit grafts, and strip grafts are generally performed on patients who desire a more modest change in hair fullness. Flaps, tissue-expansion and scalp-reduction are procedures that are usually more appropriate for patients who desire a more dramatic change. Sometimes, two or more techniques are used to achieve the best results.All hair replacement techniques use existing hair to achieve the optimal outcome. Grafts and flaps with healthy hair growth are taken from a donor area and relocated to a bald or thinning area. The result is hair growth in a previously affected area.

 

Notification

Hair Transplantation surgery is an individualized procedure and may not be suitable for everyone. Always talk to your Specialist Plastic Surgeon before making a decision. Your surgeon will assess your condition and general health, and plan the treatment that is best suited to you.

Before you decide to undergo hair replacement surgery, there are a few things you should keep in mind:

  • Hair Transplantation surgery candidates must have healthy hair growth at the back and sides of the head to serve as donor areas
  • Hair colour, texture and waviness or curliness may affect the cosmetic result
  • It is important to understand that you will never have the coverage you had prior to your hair loss, but surgery may camouflage the thin areas and give you more fullness

Hair Transplantation surgery may be a good option for you if:

  • You are physically healthy and you do not have medical conditions that can impair healing or increase risk of surgery
  • You have healthy hair growth at the back and sides of the head to serve as donor areas
  • You have realistic expectations of what surgery can accomplish
  • You are a non-smoker or have stopped smoking

 

Estimated Cost

For more information on plastic surgery and the procedures we offer, please schedule a consultation and visit our practice.

" ["lang"]=> string(7) "english" ["itemOrder"]=> string(1) "0" ["valid"]=> string(1) "1" } [13]=> array(8) { ["sn"]=> string(2) "95" ["classify"]=> string(2) "21" ["cover"]=> string(0) "" ["title"]=> string(11) "Liposuction" ["content"]=> string(3409) "

Overview

Liposuction, also known as lipectomy or lipoplasty, is a procedure that improves the body’s contours and proportion by removing excess fat deposits to slim and reshape specific areas of the body. Common areas targeted include thighs, buttocks, abdomen, arms, neck and under the chin.

 

Features

Liposuction is invasive surgery that aims to improve the body’s contours and proportion by removing localised and disproportional deposits of fat. Liposuction can remove up to 5 litres of fat with relative safety during one session. Depending on the number of areas that require treatment, repeated treatments may be necessary.

Specific techniques of liposuction include:

  • Suction Assisted Lipectomy (SAL) where fat is removed from the body using a vacuum suction. SAL may be dry, wet or tumescent depending on the volume of saline (salt solution) which is injected into the operation site before the procedure begins
  • Ultrasonic Assisted Lipoplastry (UAL) uses ultrasonic energy to liquefy the fat cells before SAL is used to remove the liquefied fat and to smooth the edges of the treated areas
  • Mechanical Assisted Lipoplasty (MAL) uses an oscillating shaver driven by a motor to shave the fat which is vacuumed away as used in the SAL and UAL methods

 

Notification

Liposuction is an individualised procedure and may not be suitable for everyone. Always talk to your Specialist Plastic Surgeon before making a decision. Your Specialist Plastic Surgeon will assess your condition and general health, and plan the treatment that is best suited to you.

Liposuction may be suitable for you if:

  • You are physically healthy and at a stable weight
  • You have realistic expectations
  • You are a non-smoker or have stopped smoking
  • You have bulges that persist despite a healthy diet and exercise

Liposuction is most likely to be successful for healthy weight people with firm, elastic skin who have pockets of excess fat in certain areas. Although age is not a significant concern, older people may have less skin elasticity and may not achieve the same results as a younger person with tighter skin.

Before opting for liposuction, you must keep in mind that:

  • Liposuction is not a substitute for weight loss
  • If your skin is dimpled before the liposuction, it will probably still be dimpled afterward the procedure has been done
  • If the ‘extra’ skin doesn’t contract (tighten) after liposuction, you may need a further procedure to remove excess skin
  • You may not be able to undergo the procedure if you are unable to have an anaesthetic, if you are prone to bleeding tendencies or have poor healing ability or are too high risk of having surgical complications

 

Estimated Cost

Costs associated with the procedure may include:

  • Surgeon’s fee
  • Hospital or surgical facility costs
  • Anaesthesia fees
  • Prescriptions for medication
  • Post-surgery garments
  • Medical tests

 

 

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Overview

Ear surgery, also known as otoplasty, is a procedure that changes the angle and shape of protruding or uneven ears in children and adults.

 

Features

Ear surgery reshapes part of the cartilage in the ears, allowing them to lie closer to the side of the head. For the most part, the operation is done on children between the ages of four and fourteen. This is because a child’s ear cartilage is soft and easy to mould. In teenagers and adults, the firmer cartilage of fully formed ears does not allow the same degree of moulding. However, ear surgery can still be effective in teenagers and adults.

Ear surgery is a highly individualised procedure and may not be suitable for everyone. Always talk to your Specialist Plastic Surgeon before making a decision. Your surgeon will assess your condition and general health, and plan the treatment that is best suited to you.

Some children and adults are unhappy with the shape of their ears because they are too big, stick out too much or are uneven in shape (asymmetrical). Some may have experienced teasing and taunting as a result of their appearance Ear surgery may be able to assist in making the ear appear more normal and restore self-confidence.

 

Notification

Before you decide on ear surgery, there are some important issues to keep in mind:

  • Even when only one ear appears to stick out (protrude), surgery is usually performed on both ears for a better balance
  • Exact evenness (symmetry) isn’t likely. Similar to natural ears, the position of the ears after otoplasty will not match perfectly
  • Smokers are at increased risk of complications. If you are serious about undergoing surgery, you should quit smoking.

Ear surgery may be a good option for you if:

  • You are physically healthy and you do not have medical conditions that can impair healing or increase risk of surgery
  • You have realistic expectations of what ear surgery can accomplish
  • You are a non-smoker or have stopped smoking

 

Estimated Cost

Costs associated with the procedure may include:

  • Surgeon’s fee
  • Hospital or surgical facility costs
  • Anaesthesia fees
  • Prescriptions for medication
  • Post-surgery garme

 

 

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Overview

Nose surgery, also known as rhinoplasty, is designed to reshape or repair the nose by improving the appearance and/or function of the nose. Another procedure associated with rhinoplasty and often performed at the same time is septoplasty, a procedure that opens up nasal passages blocked by a bent septum.

 

Features

Rhinoplasty may be performed for cosmetic reasons or for reconstructive purposes, such as correcting breathing problems. Nose surgery can change the size of the nose as well as its width and profile. The nose tip, shape of the nostrils and balance of the nose (nasal symmetry) can also be altered.

Nose surgery aims to achieve the following results:

  • Straighten a crooked nose
  • Make the nose look more symmetrical (keeping in mind that perfect symmetry is not always possible)
  • Make the nose a little smaller or larger
  • Restore the height of a flattened area
  • Alter the appearance of the nasal tip
  • Reduce the size of large nasal openings
  • Correct a hump deformity Improve the look of the nose in relation to the upper lip
  • Correct birth defects
  • Repair damage caused by injury
  • Repair damage caused by disease, such as infection or cancer
  • Open up nasal passages and improve breathing often by performing a septoplasty (surgery on the nasal septum as well as rhinoplasty)

 

Notification

Rhinoplasty is a highly individualised procedure and may not be suitable for everyone. Always talk to your Specialist Plastic Surgeon before making a decision. Your surgeon will assess your condition and general health, and plan the treatment that is best suited to you.

Before you decide on nose surgery, there are some important issues to keep in mind:

  • Your surgeon can only work with the existing bone and cartilage structure, so there are limits to how far you can alter the shape of your nose
  • If you need surgery to repair a broken nose, it is best to seek medical attention straight away. Otherwise, the swelling of the tissues can delay surgery for around five days
  • Your surgeon will need to carefully evaluate your nasal structure to ensure that surgery does not interfere with breathing. This may prevent you from having certain procedures
  • The final results may take up to 12 months to emerge, at which point your surgeon will assess the need for further surgery
  • The bones of the face and nose need to fully mature before nose surgery can be performed. For boys, the nose will have taken its final shape by about 17 years, and a girl’s nose by about 16 years. Nose surgery performed while the nose is still growing can interfere with its normal growth and give unpredictable results
  • Smokers are at increased risk of complications. If you are serious about undergoing surgery, you should quit smoking.

Nose surgery may not be a good option for you if you are:

  • Not able to have an anaesthetic
  • Prone to bleeding tendencies or have poor healing ability
  • Too high risk of having surgical complications

Nose surgery may be a good option for you if:

  • Your facial growth is complete
  • You experience breathing problems
  • You are self-conscious about the appearance of your nose
  • You are physically healthy and you do not have medical conditions that can impair healing or increase risk of surgery
  • You have realistic expectations of what nose surgery can accomplish
  • You are a non-smoker or have stopped smoking

 

Estimated Cost

Costs associated with the procedure may include:

  • Surgeon’s fee
  • Hospital or surgical facility costs
  • Anaesthesia fees
  • Prescriptions for medication
  • Post-surgery garments
  • Medical tests
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Feature Summary

Young, active patients with early osteoarthritic change over knee joints can benefit from high tibial osteotomy surgery, including a significant pain relief and to delay or eliminate the need of total knee replacement surgery.

 

Overview

In young, active patients with early osteoarthritic change over knee joints, total knee arthroplasty may not be the best choice of treatment because of increased risk of implant failures because of extremely high level of functional demand. Therefore, high tibial osteotomy plays an important role in such a population.

Varus alignment is often seen in patients with an osteoarthritic knee joint, which might be related to medial side cartilage wear, increased tibial or femoral varus alignment. This varus alignment would lead to increased load and cartilage wear on the medial side and thus make the alignment more varus, which is a vicious cycle.

The aim of high tibial osteotomy is to make the alignment more valgus and shift the load toward lateral side of knee joint. This surgery can effectively relieve pain symptoms and to slow down the progression of osteoarthritis.

 

Procedure Summary

The surgery takes approximately 50 minutes with three major steps.

Wound size is about less than 10 cm, on the medial side of the leg.

Step 1. Tibial osteotomy

Step 2. Correction toward the designated angle (more valgus)

Step 3. Fixation with plate

After surgery, no splint or cast is required. There is no limitations on range of motion exercises or any position of the operated knee joints. Patients is allowed partial weight-bearing with crutches for 6 weeks. Weight-bearing without restriction is allowed after 6 weeks.

 

  • Pre-operative planning

        Long film x-rays and CT scan of lower extremity can provide accurate and useful information about the cause of varus alignment.

  • Bone bank

        We have one of the largest and best bone bank in Taiwan, which provided structured bone graft to augment the site of correction. This can eliminate the need to harvest autograft from patients’ pelvic bones, which is often pretty painful.

  • Custom-made 3D cutting jig

        Custom-made 3D cutting jig based on pre-operative CT scan can optimize the accuracy of correction and effective shorten the procedure time.

In addition, for patients with valgus alignment with lateral side cartilage wear, we can perform distal femur osteotomy (DFO) in a pretty similar and simple fashion.

 

Estimated cost

The procedure cost is around 300,000 NTD, depends on the actual medical expenses.

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Feature Summary

        The advantages of minimally invasive total knee arthroplasty include a smaller wound size with better cosmesis, less damage of thigh muscle (quadriceps, vastus medialis) to facilitate early recovery without the need of walking aids.

 

Overview

        Advanced stage of arthritis including osteoarthritis, rheumatoid arthritis, gouty arthritis, traumatic osteoarthritis and spontaneous osteonecrosis of the knee can lead to severe functional impairment because of pain, joint effusion, deformity and limited range of motion. Total knee arthroplasty surgery can bring to a new, smooth articulating surface(resurfacing) as well as to straighten the affected leg (realignment), which is one of the most satisfying surgery in the field of Orthopedics.

 

Procedures and Features

  • Minimally invasive surgery

        Mean operation time of minimally invasive total knee arthroplasty would be around 30 minutes only or less; simultaneous bilateral total knee arthroplasty would take around 70 minutes or less. Wound size would be approximately 8 to 10 centimeters. More importantly, we do less damage to quadriceps muscle during the surgery, compared with traditional surgical approaches. Therefore, walking aids after surgery are usually not required.

 

  • Multimodal patient blood management

        We have standard protocol including intra-articular medication to reduce blood loss as well as post-operative blood transfusion, which makes patients safe and comfortable even undergoing simultaneous bilateral total knee arthroplasty.

 

  • Multimodal pain control management

        Combined oral, intra-venous or patient-controlled analgesia devices greatly facilitate early rehabilitation and patient satisfaction. Almost all patients can walk well on post-operative day 1 with our pain management.

 

  • Venous thromboembolism prevention protocol

        VTE (venous thromboembolism) is one of the common complications following total knee arthroplasty, but can be well prevented. Combination of intravenous low molecular weight heparin, low dose aspirin, factor Xa inhibitor in our protocol can effectively protect against this complication.

 

  • Professional rehabilitation program

        Our team, composed of experienced orthopedic doctors, rehabilitation doctors, physical therapists, special nurses can help patients with their post-operative rehabilitation protocol, including continuous passive range of motion exercises with machines, ice-packing, walking independently with or without walking aids, walking up- or downstairs and to deal with common questions after surgery.

 

Estimated cost

        The procedure cost is around 400,000 NTD, depends on the actual medical expenses.

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Feature Summary

        We have highly experienced surgeons to deal with common but challenging problems during a revision total knee arthroplasty surgery, including infection, torn ligaments, massive bone loss, poor alignment or poor implant position. The goal of a revision total knee arthroplasty surgery would be to make the affected knee joint stable, painless, with correct alignment and functioning well.

 

Overview

        Recurrent pain, swelling and disability of the knee joint after a total knee arthroplasty surgery is problematic. Common causes are listed as below:

  • Infection

        Clinical presentations of an infected knee joint include pain, swelling, erythematous skin, purulent discharge and local heat. Proper assessment, diagnosis, and management of periprosthetic joint infection (PJI) is the key to eradicate infection.

  • Instability

        Patients may present with recurrent knee effusion, weakness, especially from sitting to standing, or refractory tendinitis around the knee joint. Revision of partial or all components may be necessary to regain stability.

  • Wear or implant loosening

        Longevity of the prosthesis depends largely on patients’ age and activity level. Wear or implant loosening may happen many years after primary total knee arthroplasty surgery, with presentation of painful sensation over a previously well-functioning, painless joint. X-ray is the main diagnostic image modality of this condition.

  • Implant malposition

        Patients may present with persistent pain, especially during walking or bending his/her knee following primary total knee arthroplasty surgery.

        Above all, a knee operated with total knee arthroplasty should be painless, able to bear weight and to do range of motion without difficulty. Potential problems or complications following total knee arthroplasty surgery should be well assessed by experienced surgeons in our team.

 

Procedures and Features

        Our team is composed of experienced orthopedic doctors, infectious disease specialist and radiologists who can make accurate diagnosis and management of a painful, malfunctioning knee joint following total knee arthroplasty surgery.

        We have set up one of the largest bonk bank in Taiwan, which makes us easy to deal with different degrees of bone loss during a difficult revision surgery.

        Operation time largely depends on surgical plan, which may vary from about 1 to 3 hours. Range-of-motion exercises and weight-bearing program will be decided by orthopedic doctors according to intra-operative findings. Most of the patients can walk without weight-bearing restrictions and start range-of-motion exercises immediately after surgery.

 

Estimated cost

        The procedure cost is around 600,000 NTD, depends on the actual medical expenses.

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Feature Summary

        The advantages of minimally invasive total hip arthroplasty include a smaller wound size with better cosmesis, less damage of hip muscle (abductors, gluteus medius and minimus) to facilitate early recovery without the need of walking aids.

 

Overview

        Advanced stage of hip diseases including osteoarthritis, traumatic osteoarthritis, osteonecrosis of the femoral head, rheumatoid arthritis, ankylosing spondylitis associated arthritis and hemophilic arthritis of the hip can lead to severe functional impairment and limping because of pain and limited range of motion. Total hip arthroplasty surgery can bring to a smooth articulating surface (resurfacing) as well as to lengthen the affected leg and minimize leg length discrepancy.

 

Procedures and Features

  • Minimally invasive surgery

        Mean operation time of minimally invasive total hip arthroplasty would be around 50 minutes only or less. Average wound size would be less than 8 to 10 centimeters. More importantly, we do less damage to abductor muscles during the surgery, compared with traditional surgical approaches, thus minimize the incidence of limping after surgery. Walking aids are usually required for only 2 weeks or less after surgery.

  • Multimodal pain control management

        Combined oral, intra-venous or patient-controlled analgesia devices greatly facilitate early rehabilitation and patient satisfaction. Almost all patients can walk well on post-operative day 1 with our pain management.

  • Venous thromboembolism prevention protocol

        VTE (venous thromboembolism) is one of the common complications following total knee arthroplasty, but can be well prevented. Combination of intravenous low molecular weight heparin, low dose aspirin, factor Xa inhibitor in our protocol can effectively protect against this complication.

  • Professional rehabilitation program

        Our team, composed of experienced orthopedic doctors, rehabilitation doctors, physical therapists, special nurses can help patients with their post-operative rehabilitation protocol, including proper body positioning, walking independently with or without walking aids, walking up- or downstairs and to deal with common questions after surgery.

 

Estimated cost

        The procedure cost is around 400,000 NTD, depends on the actual medical expenses.

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Subtrochanteric osteotomy and reconstruction with total hip arthroplasty

Feature Summary

        Developmental dysplasia of hip is characterized with a shallow hip socket, various degree of subluxation or even dislocation of the femoral head, and risks of early osteoarthritic change. For a more severe type of hip dysplasia – high-grade developmental dysplasia of hip, can lead to limping, hip pain, leg length discrepancy (if unilateral) and cosmetic concerns.

        Reconstruction with total hip arthroplasty alone might not be easy as usual cases. Special osteotomy techniques and methods to protect sciatic nerve are certainly necessary to ensure the success of this surgery.

 

Overview

    Developmental dysplasia of hip is a disease with a wide spectrum, from mild, early osteoarthritic change of hip joint to hip dislocation. For a more severe form of hip dysplasia (Crowe type III or IV, high-grade, high-riding developmental dysplasia of hip), reconstruction with total hip arthroplasty in combination with femoral osteotomy and methods to protect sciatic nerve is the mainstay of treatment.

    Patients usually complain about limping, leg length discrepancy, and hip pain because of a dislocated hip with malfunctioning abductor muscle. This surgery can effectively lengthen the affected limb, improve the performance of abductor muscle and relieve hip pain.

 

Procedure Summary

    The surgery takes approximately two hours. Wound size is about 20cm, along the lateral side of the hip and thigh.

    Usually, the affected leg is shortened more than 5-7 cm. But the sciatic nerve can only usually tolerate approximately 4cm of lengthening. Otherwise, too much increased tension might lead to sciatic nerve palsy. Therefore, we have to do femoral osteotomy (subtrochanteric osteotomy) to match the limb lengthening to 4cm. In other words, we have to cut approximately 2cm (6 - 4 =2) of femoral bone segment to match this amount of correction.

    In addition, we have to test sciatic nerve function during surgery after correction to make sure the correction is not too much. Therefore, the patient will receive general anesthesia and be “wake-up” without a sense of pain during surgery by professional anesthesiologists. They will ask the patient to extend the big toe and dorsi-flex the ankle, if ok, the patient will be put into a sleep again right away.

    Total hip arthroplasty procedure is quite similar to that of our routine methods. An additional plate is required for femoral bone fixation at osteotomy site.

    After surgery, partial weight-bearing program is allowed with the use of a cane or crutches for 3 months. After 3 months, with signs of bone union on the femoral osteotomy site, patients can walk without weight-bearing restrictions.

 

Features of Taipei Veterans General Hospital

  1. Subtrochanteric osteotomy technique

    Accurate osteotomy techniques can lengthen the affected leg to compensate excessive leg length discrepancy, improve abductor muscle performance and correct limping.

  1. Intra-operative wake-up test

    Sciatic nerve is effectively protected using this method. We have an international publication describing this method.

Estimated cost

    The procedure cost is around 600,000 NTD, depends on the actual medical expenses.

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Feature Summary

        Our team is composed of highly experienced surgeons to make correct diagnosis and deal with an unsuccessful hip arthroplasty surgery. Common problems included recurrent dislocation, infection, loosened implant, impingement or persistent hip pain with causes to be determined. The goal of a revision total hip arthroplasty surgery would be to create a stable, painless, well-functioning hip joint that is free from infection.

Overview

       Recurrent pain, swelling and disability of a hip joint after a total hip arthroplasty surgery is problematic. Common causes are listed as below:

  • Infection

        Clinical presentations of an infected hip joint include pain, swelling, erythematous skin, purulent discharge and local heat. Proper assessment, diagnosis, and management of periprosthetic joint infection (PJI) is the key to eradicate infection.

  • Instability

        Patients may have recurrent dislocation with a certain posture that makes patients unable to walk or adapt to his/her daily activity well. In most of the cases, an experienced surgeon can put the implant, including the cup and stem in a good position. Therefore, we don’t usually limit the postures of the patients following a hip arthroplasty surgery.

  • Wear or implant loosening (without signs of infection, aseptic)

        Longevity of the prosthesis depends largely on patients’ age and activity level. Wear or implant loosening may happen many years after primary total hip  arthroplasty surgery, with presentation of painful sensation over a previously well-functioning, painless joint. X-ray is the main diagnostic image modality of this condition.

  • Persistent “Painful” total hip arthroplasty with unknown causes

        A hip operated with total hip arthroplasty should be painless, able to bear weight and to do range of motion without difficulty. A “painful” total hip arthroplasty should be carefully assessed for signs of infection, instability or loosening. In addition, other possible causes including impingement, metal particles related inflammatory response or excessive leg length discrepancy should as well be considered. A thorough history taking, physical examination and image study by a highly experienced surgeon is the key to solve a “painful total hip arthroplasty”.

 

Procedures and Features

        Our team is composed of experienced orthopedic doctors, infectious disease specialist and radiologists who can make accurate diagnosis and management of a painful, malfunctioning hip joint following total hip arthroplasty surgery.

        We have set up one of the largest bonk bank in Taiwan, which makes us easy to deal with different degrees of bone loss during a difficult revision surgery.

        Operation time largely depends on surgical plan, which may vary from about 1 to 4 hours. Not all the components should be removed and replaced during a revision surgery. Instead, we would revise only the problematic components and aim to make the revision surgery effective and easy.

        Muscle training and weight-bearing program will be decided by orthopedic doctors according to intra-operative findings. In most revision surgeries, protective, partial weight-bearing program would be suggested for approximately 6 weeks for a solid bony integration onto the implant surface. Patients would be allowed to walk without weight-bearing restrictions thereafter.

 

Estimated cost

        The procedure cost is around 700,000 NTD, depends on the actual medical expenses.

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Lower limb amputation

    The cause of lower limb amputation may include diabetic foot, peripheral arterial occlusive disease (PAOD), trauma, tumor, infection, etc. the primary cause of trans-tibial/trans-femoral amputation are diabetic foot and PAOD which may easily occurred by the elderly. A many of the foregoing patients are combined with cardiovascular dysfunction, which would lead to a longer prosthesis rehabilitation process. However, a larger number of trans-tibial amputee could have satisfactory ambulation ability with their prosthesis, and the trans-femoral amputees could also achieve their live independence. Tumor is the major cause of teenage amputation, which would result in high-level amputation (hip disarticulation, hemi-pelvectomy). Nevertheless, the young patients could still have a good prognosis of prosthesis rehabilitation due to less complication.

 

What is a lower limb prosthesis?

    Nowadays, lower limb prosthesis has been modularized. The module components of prosthesis encompass artificial foot, artificial knee, artificial hip joint and socket. Custom-made Socket is the most important part of prosthesis, which needs multiple modifications due to the shape change of patients’ stump. According to patients’ expected function, body weight and future life style, our medical team would suggest the most suitable sets of prosthesis for fulfilling patients’ needs. Sometimes, high –level function patients would choose different kinds of module components for accomplishing various activities.

 

The process of lower limb prosthesis Fabrication

    Before fabrication of prosthesis, amputees must use elastic bandage to shape their stump and reduce edema of residual limb. Custom-made socket will be fabricated when the stump condition is stable. Then, the suitable module prosthesis components would be assembled for lower limb prosthesis. There are several steps for prosthesis training course. Firstly, patients (sometimes the care giver) will be taught the method of wearing prosthesis. Then, the ways of standing, weight shifting and ambulation will be instructed by the therapists. The prosthesis would be adjusted by patients’ static alignment, dynamic alignment and training performance whenever necessary. According to patients’ performance, a variety of training course and assistive devices would be provided by the therapists. Finally, we will teach patients how to clean and maintain the prosthesis and then the follow-up plan will be made for regularly prosthesis check.

 

Why is it done?

    Lower limb prosthesis may enable the user to function as well or nearly as well as before the amputation. Thus, patients could improve their independence of life and self-worth.

 

Risks & complications

    The prosthesis users may occur wound of stump skin and fall down during walking. The incidence of above-mentioned situation could be decreased by prosthesis alignment adjustment and vigorous prosthesis rehabilitation.

 

How much will it cost?

    A prosthesis can range widely in price, depending on your amputation level and the type of device you are looking for. The definitive prosthesis will be fabricated when the medical team and a patient have a good communication and reach an agreement.

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Nephrology

Musculoskeletal tumor

Pediatric Surgery

Gastroenterology and Hepatology (Digestive Disease)

Otology

Rhinology

Laryngology

Neurological Institute

Dermatology (Skin) Center

Orthopaedic

Obstetrics and Gynecology

Cardiology

Stomatology (Oral, Dental Disease)

Infectious Disease

Endocrinology and metabolism

Urology

Hematology

Allergy, Immunology, Rheumatology

Transfusion Medicine

Ophthalmology

Plastic (Cosmetic ) Surgery Center

Arthritis & Joint Replacement Center

Pathology and Laboratory Medicine

Rehabilitation and Technical Aid Center