5 top weird ops

Advancements in computer imaging, fibre optic endoscopes, and the development of more and more advanced surgical tools, means that things are changing fast at the cutting edge of surgery. Yet, even though new surgical techniques are constantly being developed, some of the most successful have been around for years. We picked our top five amazing ops:

Angioplasty and stenting

Angioplasty is a procedure performed to open up blocked coronary arteries and is sometimes done as an alternative to coronary bypass surgery. In this procedure a wire is inserted into the patient's body at the groin, hand or arm. This thin wire is threaded all the way to the aorta and up to the blocked coronary artery. A small amount of dye is released and tracked using x-rays.

The x-rays help pinpoint the exact position at which the blockage is situated. The blocked artery is then forced open by inflating a special kind of balloon. Once opened, it is kept open by a stent (a cylindrical wire mesh), allowing blood to once again flow freely. Angioplasty made our list because of the simple physical principles that it is based on. A stent, for example, is basically a pipe, much like those that bring water to our houses.

Face transplantation
French surgeons have recently completed the first partial face transplant. In most skin transplant cases, the patient's own skin is used. In this case, however, skin from a brain-dead donor was used. Tissue, muscles, arteries and veins from the donor was attached to the lower part of the recipient's face. Getting the muscles and nerves to work is very tricky and it is still too early to judge whether the procedure was a success.

The surgeons stressed that the new face will look like a hybrid of that of the donor and the recipient. Since the face is such a central part of a person's personality, the possibility of getting a new face raises some interesting questions concerning identity.

Fetoscopic foetal surgery
Foetal surgery involves operating on the foetus before birth. It is done to correct, or limit the damage from congenital abnormalities that cannot be equally well treated after birth. In fetoscopic surgery the foetus is operated on while still inside the womb. Fibre optic telescopes and specially designed instruments are inserted through a small incision in the uterus.

The tools used in such surgery are extremely small and highly specialised. In addition, fetoscopic surgery requires immense precision from the surgeon. Fetoscopic surgery can be used to treat spina bifida, congenital diaphragmatic hernia, and twin-twin transfusion syndrome, among others.

Awake brain surgery
In awake brain mapping surgery the patient is awake during part of the brain surgery. This procedure is usually done to remove brain tumours. The patient is anaesthetised and part of his scull is cut open, exposing the brain. MRI scans help the surgeons locate the exact location of the tumour.

During the surgery the patient is given a cocktail of drugs to wake him or her up. Once awake, the patient is asked to count, read, talk, or to identify a number of pictures. Pulses are also sent through certain brain regions and the patient is asked about sensations in different parts of the body. The information gathered, combined with advanced computer modelling allows the brain to be very accurately mapped. As a result, surgeons can remove more of the tumour, and the risk of damage to areas of the brain related to motor and speech function is decreased.

Heart transplantation
First performed in 1967 by the South African heart surgeon Christiaan Barnard, heart transplantation remains one of man's most incredible achievements in the field of medical science. A donor heart is taken from a brain-dead individual and placed in a special solution. The recipient's breastbone is cut open and before the heart is removed the patient is connected to a bypass machine that keeps the body going while there is no heart.

The new heart is inserted, stitched in place, the necessary connections made, and if all goes well, it will start beating. If it doesn't start beating by itself, an electric shock may be used to jolt it into action. Thousands of heart transplants are carried out each year and survival after a transplant has been significantly improved by the use of anti-rejection drugs.

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