Showing posts with label Surgical. Show all posts
Showing posts with label Surgical. Show all posts

Surgical Cure for Migraines

Western Reserve - Surgical Cure for Migraines.
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Do you know about - Surgical Cure for Migraines

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To say that surgery can cure migraines is a bold statement. Recent studies from Case Western Reserve University, Cleveland Clinic, Georgetown University, and the University of Texas Southwestern Medical Center have pointed out a mechanical reason for migraines and have shown that surgery can indeed provide a cure for the majority of migraine patients. I want to take a few moments of your time and discuss the evolution and rational for these treatments.

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How is Surgical Cure for Migraines

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Lets look at the progression of migraine treatment, starting with the discovery of Botox® as a treatment. Botox was originally used by ophthalmologists to treat blepharospasm (a problem with the eye muscles). A husband and wife team (ophthalmologist and dermatologist) found that Botox decreased frown lines in the forehead. That was the start of cosmetic Botox use. What several plastic surgeons noted was that patients treated with Botox who also happened to suffer from migraine reported a significant decrease in the frequency and duration of their headaches. Neurologists made note of this benefit and began studying Botox as a treatment. After several studies, Botox was approved by the FDA as treatment for migraines.

Shortly after this it was noted by some plastic surgeons that patients reported relief of their migraines following forehead rejuvenation, either by open or endoscopic brow lift. This lead to several studies showing four common trigger sites for migraines:

Where the nerve that gives feeling to the central forhead passes through the scowling muscles above the eyebrows Where the sensory nerve to the temples and side of the forehead / scalp passes over the temples and the chewing muscles underneath At the back of the head where the sensory nerves pass through the muscles that hold your head straight and help you look up From problems within the nose - such as a deviated septum or other deformity on the inside.

The benefit of migraine surgery was still questioned, so a remarkable study was designed. A group of about 70 people agreed to have surgery with 20 of them randomly selected to have a sham operation. That means that they had the anesthesia and the incision, but then nothing was done to the nerves. Only the surgeon and the operating team knew who had the real surgery. Things were kept simple so only a single nerve compression site was released. After a period of recovery, a different doctor examined the patients and asked them about their symptoms. He had no idea who had the real surgery and who had a sham operation since they all had the same incision.

The results were remarkable. A majority had no further migraines and most of the remainder had a significant decrease in the number and severity of headache. The examiner did not know which patients had the sham procedure and yet was able to tell who was real with certainty most of the time. Since then the surgery has been improved to include all 4 sites. Now the complete relief group is higher than 80%.

Studies are ongoing now to help figure out why there are still some non-responders. It seems likely that two other causes may explain the persistent pain and both are due to the nerves wrapping around local arteries. The temporal artery can wrap around the nerve to the temple region giving an intense pulsing migraine. The same can happen in the back of the head with the occipital artery. Treatment of these conditions may improve the surgery even further.

So how does this work? You might be referred to the plastic surgeon by your neurologist, your internist, or you can refer yourself. The plastic surgeon will probably send you a headache log where you fill out details for at least one months worth of migraines. This log will help determine what type of migraines you have and where the likely sites of nerve compression and irritation are located. You may also be asked to get a CT scan of your sinuses to see if you have any nasal problems that can cause your migraines or add to the symptoms of other trigger points. You will likely be asked to fill out an additional questionnaire to supply more information about your headaches.

The next step is often a trial of Botox injections. The purpose is to confirm the trigger(s) for the migraines and help confirm the surgical plan. Relief typically occurs within 1 to 2 weeks. Any residual symptoms are noted.

Next a surgical plan is formulated and discussed with the patient. The surgery typically takes about 2 - 2 1/2 hours, depending on the number of trigger sites. Complications are minimal and return to work usually takes about 1 week - slightly longer if nasal surgery was required.

Is migraine surgery for you? Although the criteria are not written in stone, I think that you should consider surgery if you have migraine symptoms more than 14 days out of every 28 and if you do not have a good result from standard medical treatments. I also think you should consider the surgery if your migraines affect your ability to work or affects your normal social relationships.

For more information you can ask about migraines on my website or contact my office at 770 682-3375 to schedule an appointment.

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The DaVinci Surgical Robot, Hospital Budgeting Considerations

University Hospitals - The DaVinci Surgical Robot, Hospital Budgeting Considerations

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In 2000 Intuitive Surgical released the first surgical robot, extending minimally invasive surgery into a new realm. Since its inception the company has sold over 1400 da Vinci surgical systems, and continues to grow the business through system redesigns and procedure expansions. Currently the larger volumes of procedures being done are prostatectomy, hysterectomy, and heart valves.

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The benefits of minimally invasive surgery are many; improved patient outcomes, decreased length of stay, and reduced blood utilization; and some feel the addition of a surgical robot further benefits the patient. While the clinical benefits may be debatable there exists a level of demand by both physicians and patients. Physician's market their robotic skills in an effort to build their business by attracting those patients who feel robotic surgeons are more desirable. Hospitals must have a robot to recruit the surgeons performing these state of the art procedures, which in turn brings higher surgical volumes.

For most hospitals the million investment is a sunk cost, there is no guarantee the robot will attract increased surgical volume. Surgeons can be on staff at multiple hospitals as an effort to expand their own patient base. Without a contractual agreement in place a surgeon can easily move his or her surgical volume to a new hospital, for example East Hospital purchases a robot in 2005 to attract Dr. A's business, in 2008 West Hospital purchases the newer generation robot and Dr. A moves his entire robotic business to West Hospital, now East hospital as to begin to rebuild that lost volume.

Therefore the debate begins regarding the opportunity costs of the million investment, such as investing in needed Information Technology, updating existing medical equipment, or even expanding bed capacity. Financing alone can be a challenge for some hospitals, if not a member of a larger network, or beneficiary of a trust or donation a capital expenditure of this size may need to be financed. As you will later the opportunity cost of capital must be considered in this decision as well.

It is also important to consider other fixed costs such as the service contract which starts year two and is about 0,000 per year, a hospital doing 150 robotic cases a year will automatically incur an additional 00 cost per case. Specially trained labor is also required for the surgical team. In this situation administration may have the ability to convert this from a fixed cost to a variable cost if the main operating room functions on a different budget, and staff cross coverage is expected during periods of low robotic volume. One last budgeting consideration is marketing, as discussed if the main driver for purchase is to attract market share it will be important that patients are educated you the hospital's offerings.

Other variable operating expenses include the robotic instruments, specialty drapes and other accessories that bring the total robot specific variable cost to about 00 per case, which is above and beyond the standard laparoscopic surgery requirements. It is important to note that at this time there is no additional reimbursement from insurance payers to cover this cost. Therefore there is an estimated 00 in additional cost to perform robotic surgery (not including the capital investment) to consider, for most hospitals this additional cost will not be covered resulting in a negative contribution margin. When evaluating the opportunity cost of capital it is important to note these procedures will not generate a profit for the hospital, therefore this project will have a negative net present value.

In conclusion the decision to invest in a surgical robot is based primarily on the predicted future need to recruit quality surgeons and the desire to retain or reclaim experienced robotic surgeons who will not only bring robotic cases but non-robotic cases as well. It is these non-robotic cases that some institutions predict will offset the negative investment. By partnering with surgeons in both the decision making process and program design hospitals can hope to retain existing volume as well as grow into the future.

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