THE DIAGNOSIS AND MANAGEMENT OF LYMPHOEDEMA

Swelling that persists can be difficult to diagnose. However, lymphoedema is often not considered and the diagnosis of primary lymphoedema usually presenting in the foot is often delayed for years. For patients presenting after cancer surgery and lymph node excision, the diagnosis may be relatively easy, yet early referral for treatment remains crucial. Reversal of limb volume increase and maintenance is only possible before the permanent lymphoedema-induced tissue changes of fibrosis and fat accumulation have occured. There have been recent changes in the risk and management recommendation for lymphoedema in recent times, as anaecdotal (often quite reasonable) advice has been challenged by research. 

The taking of blood pressure recordings or blood from the lymphoedema arm has not been proven to exacerbate lymphoedema. However, the use of the non-affected limb is preferred. Maintaining normal use of the affected limb, exercise including repetitive or isometric (weights) and permission to undertake activities in the heat (except saunas) or the cold are now key self-management strategy recommendations. One in six patients with lymphoedema will experience cellulitis in the affected limb usually due to Streplococcus Pyogenes, which remains sensitive to penicillin. Rapid diagnosis, early treatment and continuing a second course of antibiotics are imperative in avoiding hospitalisation. 

Complex lymphoedema therapy of skin care, decongestive massage, multilayer bandaging, exercise and ultimately compression garmenting remain the mainstay of lymphoedma management. However, providing this care in the current health environment remains a difficult task. 

Surgeries, such as liposuction, lymph node transfers and lympho-venous anastomoses are (re)emerging as complementary therapy for selected patients. The Macquarie Advanced Assessment Clinic is the only multidisciplinary Clinic available in Australia to select and provide these services embedded in a research environment. 

To find out more on the Advanced Lymphoedema Assessment Clinic please click here 

Dr Helen Mackie, Lymphoedema and Rehabilitation Specialist, 66 Rosamond Street, Hornsby, NSW 2077. Phone 02 9847 5085.

Guest Bloggers – from time to time MUH invites our specialists to provide content on our MUH Blog. Please note that with all guest bloggers the views and opinions expressed in these articles are those of the individual and are not necessarily the views of Macquarie University Hospital.


Thursday, January 15, 2015/Author: SuperUser Account/Number of views (384)/Comments (0)/
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UROLOGY: GETTING SMARTER WITH ROBOTIC TECHNOLOGY

Macquarie University Hospital has recently invested in the da Vinci surgical system, an advanced robotic surgical tool to boost the hospital’s oncology, urology and gynaecological capabilities. Our doctors will initially use this system for urological cases, with a focus on prostate surgery. However the technology will eventually be utilised by a number of specialities. Around 20,000 new cases of prostate cancer are diagnosed in Australia every year and one in five Australian men will develop prostate cancer by age 85. It is the most common form of cancer and the second most common cause of cancer deaths in Australian males.

We’re very excited about this new technology to equip our talented surgical team. The new da Vinci surgical system is a minimally invasive technique. The acquisition makes Macquarie University Hospital one of only two hospitals in Sydney to offer this unique and intuitive technology.  

Urology is one of Macquarie University Hospital’s core areas of treatment. The da Vinci Surgical System is a robotic technology that facilitates complex laparoscopic procedures. The da Vinci system provides surgeons with all the clinical and technical capabilities of traditional surgery while enabling them to operate through a few tiny incisions, smaller than a centimetre. Delicate tissue can be handled and dissected even in the most confined spaces such as the chest, abdomen and pelvis.

The da Vinci has an ergonomically designed console positioned alongside the patient, where the surgeon sits while operating. Surgeons have an immersive view of the surgical field with extremely high-definition 3D vision, allowing for precision and control. Four interactive robotic arms, which are precisely calibrated, are positioned above the patient. This technology also allows each individual surgeon’s hand movements to be scaled, filtered and translated into precise movements of the instruments that are working inside the patient’s body.  The latest da Vinci Robot also has a greater range of hand movement and visual acuity than a human hand. The high-definition 3D image provides the surgeon with unprecedented vision that enables surgical precision around vital structures. This becomes important when performing nerve sparing prostate cancer surgery.

The benefits to patients are immense. It has been well documented that patients experience a faster recovery with a reduced stay in hospital. There is significantly less post-operative pain and a lower risk of infection. Longer term results see reduced scarring and fewer post-operative complications. The Macquarie University Hospital system will be used across several areas of urological surgery. While prostate cancer will be the most common condition to be addressed, the da Vinci system will also be used to treat bladder and kidney cancer. The acquisition of the da Vinci system further enhances Macquarie University Hospital’s reputation as a major centre for minimally invasive urological surgery – with one of the key treatments of urological services being cancer. Cancer services is one of the hospital’s core areas of clinical emphasis. For further details click here

Guest Bloggers – from time to time MUH invites our specialists to provide content on our MUH Blog. Please note that with all guest bloggers the views and opinions expressed in these articles are those of the individual and are not necessarily the views of Macquarie University Hospital.


Wednesday, May 29, 2013/Author: SuperUser Account/Number of views (528)/Comments (0)/
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Macquarie University Hospital Performs It’s First Hysterectomy Robotically

With twenty years of experience treating gynaecological cancers laparoscopically, Dr Felix Chan has begun to offer the same procedure using the da Vinci robotic system. Trained in the US to use the da Vinci System, Dr Felix Chan says that even though he is performing the same operations robotically, as he did laparoscopically, the new approach represents a major medical advance. “Robotic surgery is a ‘quantum leap’ ahead”, said Dr Chan, a gynaecological surgeon at Macquarie University Hospital. “The precision of the instruments, the clarity of vision, the definition of tissue and the access to the small vessels and nerves means that, from a surgeon’s point of view, one can perform complex surgeries with great accuracy.”

While Dr Chan will use the da Vinci primarily to treat gynaecological cancers, the system can also be used for other complex gynaecological operations such as complex gynaecological surgery in pelvic floor reconstruction, uro-gynaecology and pelvic endometriosis. “The system also has broad application,” said Dr Chan. “In the US, utilising this technology is standard when performing hysterectomies and fibroid removals. Indications are that Australia is heading in the same direction.” In his opinion patients having had a hysterectomy robotically seem to recover faster, require a shorter stay in hospital due to less bleeding and less damage to nerves and tissue.

“At Macquarie University Hospital, it is not just about performing the operation,” said Dr Chan. “A patient at this hospital also has access to a remarkable set of other important services, including oncological services, research programs and unique imaging services. It’s all in one place. In addition, wards are aesthetically pleasant and administrative services are electronically advanced.”

To make an appointment with Dr Felix Chan at Macquarie University Hospital please call 9812 3860.

Dr Felix Chan

Guest Bloggers – from time to time MUH invites our specialists to provide content on our MUH Blog. Please note that with all guest bloggers the views and opinions expressed in these articles are those of the individual and are not necessarily the views of Macquarie University Hospital.

 

Tuesday, May 21, 2013/Author: SuperUser Account/Number of views (645)/Comments (0)/
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Tuberous/Constricted Breast Deformity: A common but often unrecognised breast condition

A relatively common, but often unrecognised, breast condition in young women is “tuberous” or “constricted” breast deformity, a congenital condition in which the breast fails to develop fully during puberty; the breasts may develop unusual shapes as well as develop differently to each other.

Although the cause is not understood, plastic surgeons believe tuberous/constricted breast is caused by an underlying restriction of the normal growth of the breast during puberty, particularly the lower half. As the breast continues to grow, it is restricted in the lower half, pushing excess breast forward beneath the areolar region. This causes a “tuberous” (an elongated shape), where the breast is often narrow and long, with a puffy and wide areolar shape. Because the lower breast doesn’t develop properly, the upper breast collapses down, giving a droopy breast. The two breasts are often affected to different degrees, so major asymmetries may also exist.

Having breasts develop like this can cause significant embarrassment and social problems, however surgery can usually offer major improvements.

The surgical treatment for tuberous/constricted breast deformity is to release the constricted breast tissue, either through an incision around the areola or from below the breast, to allow the breast to splay out naturally. To improve the breast volume, or to correct asymmetries, a breast implant is often placed beneath the breast to enhance its shape. Often, the areolar circle is made smaller at the same time, and the fold under the breast lowered. If the breast is drooped, a breast lift is done at the same time. In severe cases, more complex reconstructive plastic surgery is required to stretch the skin and existing breast tissue prior to insertion of the final implant.

As a fully qualified plastic surgeon, Dr Merten is experienced in these complex breast conditions. To see some of Dr Merten’s work with tuberous/constricted breast deformity and breast asymmetries, please click here


For more information about this or any other plastic and cosmetic surgery procedure, please contact Dr Merten at Macquarie Cosmetic & Plastic Surgery at:

www.mcps.com.au, Email: info@mcps.com.au, or call for an appointment on 02 9812 3890

Dr Steve Merten

Guest Bloggers – from time to time MUH invites our specialists to provide content on our MUH Blog. Please note that with all guest bloggers the views and opinions expressed in these articles are those of the individual and are not necessarily the views of Macquarie University Hospital.

 


Tuesday, May 21, 2013/Author: SuperUser Account/Number of views (255)/Comments (0)/
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