General Surgery

A laparotomy is a surgical procedure involving an incision through the abdominal wall to gain access into the abdominal cavity. It is also known as coeliotomy.

• the Kocher (right subcostal) incision; appropriate for certain operations on the liver, gallbladder and biliary tract;
• the Davis or Rockey-Davis "muscle-splitting" right lower quadrant incision for appendectomy;
• the Pfannenstiel incision, a transverse incision below the umbilicus and just above the pubic symphysis. In the classic Pfannenstiel incision, the skin and subcutaneous tissue are incised transversally, but the linea alba is opened vertically. It is the incision of choice for Cesarean section and for abdominal hysterectomy for benign disease. A variation of this incision is the Maylard incision in which the rectus abdominis muscles are sectioned transversally to permit wider access to the pelvis.
• Lumbotomy consists of a lumbar incision which permits access to the kidneys (which are retroperitoneal) without entering the peritoneal cavity. It is typically used only for benign renal lesions. It has also been proposed for surgery of the upper urological tract.

A lumpectomy is a surgical procedure to remove abnormal and sometimes cancerous tissue from the breast. Some surrounding healthy tissue also is removed to increase the likelihood that all of the cancer is removed. Lumpectomy is considered a breast-conserving surgery because its goal is to remove the abnormal tissue while saving as much of the breast as possible. In a lumpectomy, lymph nodes under the arm also need to be removed and examined in either a sentinel lymph node biopsy or an axillary lymph node dissection.

Because lumpectomies leave the breast mostly intact, they are often the preferred form of surgery when treating breast cancer. However, they are usually effective only in the early stages of breast cancer, and almost always are followed by 5 to 7 weeks of radiation therapy.

Recovery from lumpectomy is significantly easier than recovery from mastectomy and most women return to normal activities within a few weeks. Patients who have lumpectomies in the early stages of breast cancer have survival rates nearly identical to patients who have more radical surgery, such as a mastectomy. A number of factors must be considered when choosing between a lumpectomy and mastectomy. Consultation with physicians is the best way for patients to determine if lumpectomy is the appropriate treatment for them.