Weight loss helps address health issues like the risk of congenital conditions and can boost self-esteem due to body contouring. The loss, however, can result in loose and sagging skin that does not respond to exercise, and may require removal through surgery to enhance the contouring further. Two primary surgical options exist - panniculectomy and tummy tuck. The choice between the two may be confusing. Though the end goal remains the same, there are differences in the process, candidates, cost, and risks. A panniculectomy involves removing the panniculus, the excess loose skin that forms a flap below the waistline and over the thighs. The panniculus does not emanate from pregnancy, excess weight, or regular weight loss. It emanates from losing excess body weight, typically over 100 pounds, mostly from extensive weight loss procedures like gastric bypass. The extent of a panniculectomy, considered a medical procedure, depends on how much skin is removed. A tummy tuck, on the other hand, is considered a cosmetic procedure that involves removing excess stomach skin and tightening the abdominal muscles. Sometimes surgeons add an abdominal mesh to reinforce muscle repair. This woven mesh surgically temporarily or permanently supports organs after surgery or damaged tissue during healing. The second difference between a panniculectomy and a tummy tuck is eligibility. The former is best for patients with life-impacting sagging skin, which follows heavy weight loss, especially gastric bypass. Other candidates include individuals experiencing hygiene issues under the skin such as ulcers and infections, especially below the pubic region. The excess skin flap can also affect the individual's mobility. On the other hand, a tummy tuck addresses sagging skin that does not affect the individual's health and is mainly for cosmetic purposes, especially contouring the body for a more hourglass shape. Other good fits include individuals with sagging skin following a pregnancy who cannot get rid of the excess skin despite exercise and diet changes. In conjunction with liposuction, a tummy tuck can help resolve body-related self-esteem issues and those seeking to get rid of more skin after a panniculectomy. The third difference is the recovery time after each procedure. Recovery from any mild to major surgery involves surgical drains, skin glue, steri-strips, and the dressing. The surgeon provides instructions on how to care for each over the recovery period. A panniculectomy typically takes eight weeks to heal. However, the time may vary depending on the surgery's extent and the patient's attendance to the wound after the surgery, especially daily tasks and nutrition. Even weeks after the healing has taken place, however, the patient should refrain from strenuous activities like heavy lifting. Tummy tucks take less time to recover from due to less surgery complexity - usually four to six weeks. With proper care, especially hygiene of the surgical area, the patient should resume regular activity, including strenuous tasks, in the first few weeks following the procedure. Due to the extent of the surgery, panniculectomies are more costly than tummy tucks. A procedure typically costs between $8,000 and $15,000, plus additional fees like anesthesia, compared to an average of $6,000 for a tummy tuck. However, as a medical procedure, insurance companies may cover part or all of a panniculectomy. There is also the cost of taking time off work, especially for self-employed individuals - patients should set aside a minimum of eight weeks for recovery, compared to four to six weeks for a tummy tuck. Finally, the risks and side effects differ. Although both procedures cause discomfort and pain, the side effects tend to be more severe for panniculectomy. These can include pain post-surgery, fluid retention, and numbness. Other effects, though rare, include chest pain, heart palpitations, shortness of breath, and infections. Conversely, tummy tuck patients may experience bruising, numbness, deep vein thrombosis, and bleeding around the surgical area.Karim Sarhane, MD

Laparoscopic surgery is a revolutionary surgical technique that utilizes innovative methods to deliver improved surgical outcomes. Through the insertion of short, narrow tubes known as trochars into the abdomen via small incisions, this procedure paves the way for transformative medical possibilities. Surgeons skillfully employ long and narrow instruments within these trochars to manipulate, cut, and suture tissue, granting them great precision. In stark contrast to traditional open abdominal surgery, which necessitates substantial incisions ranging from 6 to 12 inches, laparoscopic surgery embraces a more precise approach. With a mere two to four small incisions measuring half an inch or less, the benefits can be substantial. This technique allows for enhanced visualization and optimal surgical maneuvers. These incisions serve distinct purposes: one acts as an entry point for a camera, while the others accommodate the surgical instruments. A vast array of common surgeries can now be accomplished through laparoscopy, heralding a new era of medical advancement. The procedure entails using a laparoscope, a slender tube equipped with high-intensity light, and a high-resolution camera at its forefront, granting doctors a clear view of the abdominal organs. Guided by these live images projected onto a video monitor, physicians gain invaluable information without resorting to extensive incisions. Moreover, they can extract biopsy samples and perform surgical interventions, all during the same procedure. Eligibility for laparoscopic surgery hinges upon the complexity of an individual's condition. This technique is rapidly emerging as the preferred choice for an expanding range of common operations, driven by its cost-effective nature and improved patient outcomes. Doctors now recommend laparoscopy to examine various organs, including the liver, appendix, stomach, gallbladder, pancreas, spleen, small and large intestines, and reproductive organs. Exceptional advantages associated with laparoscopic surgery include reduced bleeding, accelerated healing, and diminished pain and scarring. Unlike standard open surgery, recovery time after laparoscopic surgery can be remarkably reduced from several weeks to a few days. A vital aspect contributing to these favorable outcomes is the minimal manipulation of abdominal contents during laparoscopic procedures. Before undergoing most laparoscopic surgeries, patients typically receive general anesthesia. Adequate preparation is vital, and doctors typically advise patients to abstain from eating or drinking for approximately eight hours before the procedure to minimize the risk of anesthesia-induced nausea. In addition, it’s essential to arrange for a reliable means of transportation home considering the potential disorientation resulting from the anesthesia's effects. Specific instructions regarding medications may also be provided by the attending physician. While laparoscopy generally carries a low-risk profile, it is important to remain vigilant for any potential complications. Although rare, instances of bleeding, infection, or organ damage may occur. If symptoms such as fevers or chills, escalating abdominal pain, redness or discoloration, bleeding, and shortness of breath persist, consult the doctor. Other signs that might warrant a doctor’s attention include swelling, bleeding, continuous nausea or vomiting, inability to urinate, or lightheadedness. There is a minor threat of organ injury during a laparoscopy, which might result in the leakage of blood or other fluids into the body if an organ is accidentally pierced. In such circumstances, additional surgical intervention is required to repair the damage and restore function. Less prevalent risks of laparoscopic surgery include issues from general anesthesia, inflammation of the abdominal wall, and the formation of blood clots that could spread to the pelvis, legs, or lungs. While these dangers are rare, it is critical to be aware of them and get proper medical assistance if any of these symptoms occur.

Surgical robots have transformed how surgeons deliver medical solutions. Robot-assisted surgery allows doctors to perform complex surgical procedures faster and with more precision and control than was previously possible with conventional surgical techniques. Today, many surgeons frequently use robot-assisted surgery for various medical procedures. Among others, robotic surgery is used by general surgeons, urologists, gynecologic surgeons, colorectal surgeons, and cardiothoracic surgeons. Also known as robotic surgery, robot-assisted surgery comes with numerous benefits for both the patient and the surgeon. Doctors, through robotic technology, make tiny incisions that allow complex surgical procedures. Surgical robots are computer-controlled, self-powered devices programmed to aid surgeons in the positioning and manipulation of surgical instruments. During the procedure, three to four tiny robotic arms are inserted through a small incision on the patient’s body. One robotic arm holds a small camera while two arms assume the role of a surgeon’s hands. A fourth arm may help move tissue out of the way. Through a small console, the physician controls the robotic arms with a standby surgical team nearby for any needed assistance during the procedure. Because the robot’s “hands” are very dexterous, surgeons can operate in very tight body spaces that they would normally find very challenging to access through open surgery. The robotic arm’s reach is also greater than that of a human hand. In addition, robotic arms can rotate and maneuver the small surgical instruments in tight spaces in ways human hands cannot. A sophisticated high-definition camera provides enlarged 3D views of the surgical area that a human eye couldn’t possibly generate. Robot-assisted surgery is a great option when the surgeon needs to access hard to reach parts of the body. The tiny surgical instruments help avoid the necessity of the large incisions made when using conventional surgical tools. Since robotic surgery involves the use of smaller instruments, it becomes much easier to navigate around healthy tissue or organs. This reduces the potential impact the surgery can have on the patient’s body, as less tissue is touched or damaged. It also contributes to less pain and a more comfortable recovery journey. Robotic surgery is considered minimally invasive, and compared to conventional surgery tends to have a shorter recovery period. However, because people are very different, the healing times will of course vary for the same procedure. Also, patients can save on the cost of hospital stays, since most robot-assisted surgeries can be performed on an outpatient basis, which also saves time. Because of the greater precision and smaller incisions, the chances of surgical site infection are also reduced. Smaller incisions may also mean less bleeding and swelling after surgery. This can translate to requiring less pain-relieving medication that is typically associated with conventional surgery. Compared to conventional surgery, incidences of a patient requiring a blood transfusion or experiencing major complications after robot-assisted surgery are generally much fewer. However, it’s important to point out that robot-assisted surgery may not be an option for every procedure or patient. The suitability of the procedure will depend on the particular medical case. Therefore, patients should talk with their healthcare providers about the benefits, risks, and how robot-assisted surgery compares with conventional open surgery and other minimally invasive surgery options.

Surgeons utilize two distinct methods for diverse surgical interventions: laparoscopic and open surgery. It is important for preoperative patients to understand these treatment alternatives, including the surgical processes, benefits and drawbacks, and ensuing discomfort after operation. While clinicians are the ideal experts to determine the preferred surgical approach, patients' comprehension of the two techniques enables meaningful treatment decisions. Laparoscopic or keyhole surgery involves a small abdominal incision of less than one centimeter. Through this opening, a laparoscope (a slender instrument equipped with a high-resolution camera) is introduced to enable visualization of the body's internal structures without the need for open surgery. Surgeons then use a magnified view on a video monitor to perform the procedure. Various surgeries can be performed laparoscopically, including abdominal procedures to treat Crohn's disease or inflammation of the colon, rectal prolapse (where а part of the rectum sticks out), chronic constipation, and duodenal perforation (holes in the intestine). Other surgeries that can be performed laparoscopically include gallbladder procedures, gynecological surgeries, and hernia surgeries to repair weak tissues in the abdomen. Laparoscopic surgeries are characterized by their minimally invasive nature, resulting in decreased pain, blood loss, and surgical trauma. The approach also reduces postoperative complications, promotes faster wound healing, and minimizes the duration of hospital stays. Less exposure to internal organs also reduces risks for external contaminants. That being said, trocar or instrument insertion, a key process in laparoscopic surgery, may lead to abdominal wall hematoma or bleeding, as well as umbilical hernia characterized by bulging tissue around the navel region. In some cases, doctors may recommend against laparoscopic surgery due to factors such as prior surgery in the area or excessive weight, which can impede surgical access and visibility. Emergency open access may be necessary in cases of significant bleeding or infection. Additionally, individuals with certain cardiopulmonary conditions may be at a higher risk of negative reactions to compounds like carbon dioxide used during laparoscopic procedures. Open surgery may be a safer alternative in these scenarios. Open surgery, a time-honored approach to surgical procedures, involves using a scalpel to make а large incision up to 10 inches in length on the skin to reach the intended surgical area. This technique provides surgeons with access to sizeable organs and facilitates the performance of intricate procedures like heart surgery, organ transplantation, and the elimination of kidney stones. Compared to laparoscopic surgery, open surgery is good for treating conditions like large tumors, complex fractures, and spinal tumors or severe scoliosis, which minimally invasive approaches cannot address. Open surgery also affords surgeons a clearer view of the operative site, facilitating more efficient tissue and organ manipulation. That being said, due to the need for extensive incisions, this type of surgery mаy cause increased post-operative discomfort, complications, and prolonged healing periods. Medical costs depend on several variables, such as the type of procedure, the patient's medical history, and the health care facility. Typically, laparoscopic surgery incurs а higher cost due to additional equipment expenses. However, the quick recuperation and shorter hospital stay associated with laparoscopic surgery can offset costs. In the same vein, open surgery may seem cheaper at first glance, but а prolonged hospital stay and greater likelihood of complications may ultimately increase expenses. Patients should carefully weigh various factors when choosing between laparoscopy and open surgery. Consulting a medical professional is crucial to understand the nuances of one's unique medical situation, rather than simply relying on personal judgment or non-expert opinions. A skilled surgeon will evaluate each patient before making recommendations, empowering them to make well-informed decisions.

Thyroid cancer affects endocrine glands that regulate crucial bodily processes via hormone production. Tumor growth in the neck region, which characterizes thyroid cancer, can result in discomfort, difficulty swallowing, and inflamed lymph nodes. Previously, radiation was the go-to treatment option. However, recent advancements have enabled the medical community to understand the disease better, leading to more advanced diagnoses and treatments. Overdiagnosis, which refers to detecting small, slow-growing nodules or tumors that may not be cancerous, is а significant issue when diagnosing thyroid cancer. Studies from the National Cancer Institute (NCI) reveal that in one-third of instances where а questionable nodule (tumor) is removed from the thyroid, it is not cancerous. Researchers backed by the NCI have devised novel genomic tests to identify if these dubious nodules are cancerous, reducing unwarranted surgeries and enabling the selection of the most suitable treatment alternatives. Optical diagnostic imaging (OI) is a new technology that utilizes light to observe cellular, tissue, or organ structure and function, assisting in diagnosis. Compared to traditional imaging methods like x-ray, OI provides molecular specificity, flexibility, and safety, potentially mitigating issues of overdiagnosis and enhancing diagnostic efficacy. Additionally, it supports precise and non-invasive treatments for thyroid cancer. Fluorescence imaging (FI) is another promising modality for cancer diagnosis. It involves intravenous injection of a fluorescent dye before the operation. Upon exposure to а specific light wavelength, the dye emits fluorescence that helps highlight the parathyroid glands and other cancerous tissues. This technique offers several advantages over conventional imaging methods, including reduced invasiveness, cost-effectiveness, and superior spatial and temporal resolution. FI has demonstrated clinical potential in various applications, such as image-guided surgery. Doctors typically recommend radioactive iodine therapy (RIT) to treat differentiated thyroid cancers, such as papillary cancer originating from follicular cells in thyroid glands. RIT involves the patient taking a pill or liquid containing high doses of radioactive iodine, which collects in the thyroid gland and targets cancerous cells. Before treatment, doctors may conduct tests to determine if the cancer will likely respond to RIT. Targeted therapy is another thyroid cancer treatment involving drugs that specifically attack certain targets on cancer cells. Kinase inhibitors and anti-angiogenesis drugs are examples of drugs used in targeted therapy. Kinase inhibitors help treat thyroid cancer cells with mutations in specific genes, while anti-angiogenesis drugs disrupt the formation of new blood vessels supplying tumors with nutrients and enabling them to grow. An alternative treatment for thyroid cancer is ethanol ablation, whereby a doctor injects alcohol into the targeted nodule to shrink or kill tumor cells by changing the structure of their proteins. The procedure involves inserting a thin needle, guided by ultrasound, into the nodule to inject alcohol. It is one of the safest therapeutic profiles and has successfully been used to treat toxic and benign cystic nodules. Alcohol ablation is a good alternative for patients unwilling or unable to undergo surgery. RNA therapy is another innovative approach to treating thyroid cancer. It involves using small interfering RNA (siRNA) to target and silence genes associated with cancer cells. Anaplastic thyroid cancer (ATC), a difficult-to-treat form of thyroid cancer, can now be targeted with novel nanotechnology that allows for the precise delivery of RNA therapy to ATC cells. Animal testing has demonstrated RNA therapy's effectiveness in halting tumor growth and preventing cancer from spreading to other body parts.

Dr. Karim Sarhane is an MD MSc graduate from the American University of Beirut. Following graduation, he completed a research fellowship at Johns Hopkins University (Maryland, USA) in peripheral nerve surgery. He then completed a residency in general surgery at the University of Toledo (Ohio, USA), followed by a year of additional training in plastic surgery. He then joined Burjeel Royal Hospital in September 2022 (after spending a total of 10 years in the USA). He is a Diplomate of the American Board of Surgery. Dr. Sarhane is a Surgeon-Scientist who combines clinical care with scientific research to deliver the best possible outcomes to his patients. He is published in top-ranked bioengineering, neuroscience, and surgery journals. He holds a patent for a novel Nanofiber Nerve Wrap that he developed with his colleagues at the Johns Hopkins Institute for NanoBioTechnology and the Johns Hopkins Department of Neuroscience (US Patent # 10500305, December 2019). He is the recipient of many research grants and research awards, including the best basic science paper at the Johns Hopkins Surgery Research Symposium, the basic science research grant prize from the American Foundation for Surgery of the Hand, the Research Pilot Grant Prize from the Plastic Surgery Foundation, and a Scholarship Award from the American College of Surgeons. He has authored to date 49 peer-reviewed articles, 11 book chapters, and 48 peer-reviewed abstracts, and has 29 national presentations. Dr. Sarhane is recognized by colleagues for his commitment to medicine, his superior surgical skills, his compassionate care, and his innovative mindset. He strives to advance surgical care through excellence in research, education, clinical care, and service. He is proud to offer the patients of the UAE the entire gamut of general and laparoscopic/robotic surgery. He is also one of the pioneer surgeons to perform migraine surgery (a new and highly effective therapeutic modality for patients suffering from intractable migraines). His areas of expertise include,

Karim Sarhane MD

Karim SARHANE MD