Liv Hospital’s standards of excellence and the use of the latest technology is fully reflected in our Breast Surgery Center, where women over the age of 40 are strongly advised to get regular mammographic scan tests even if they do not show any symptoms of the disease.

It is known that breast cancer fatality rates have declined by 19-64% (and an average of 30%) in countries where regular scanning is conducted. Younger women should also benefit from self-examination, physical examination and ultrasonography.

Women who notice the development of any hardness, lumps or similar issues should immediately seek medical advice even if their previous mammography tests have been normal. A family history of breast cancer in first and second degree relatives is an indication of a risk of hereditary breast cancer.

In addition, hereditary breast cancer can be associated with ovarian cancer in young women between the ages of 20 and 30. A mother or sister with breast cancer is a high risk indication.

The first treatment option for breast cancer that has been caught early is surgery. Either the tumor is excised leaving unaffected tissue in place, or the whole breast is removed. The lymph glands under the armpits are also removed in order to establish whether metastasis (the spread of the cancer) has occurred.

Surgical intervention allows determination of the stage that the cancer has reached and what supplementary treatments may be required (radiation, hormones, chemotherapy). Recent advances in breast cancer surgery and supplementary treatment allow excellent results.

Breast Surgery at Liv Hospital: minimal intervention for maximum results

Whereas in the past there was no other option than to remove the entire breast and lymph glands, nowadays, early diagnosed cases are much more rarely treated in this way. In half of cases it is possible to treat the cancer by removing the tumor alone, with subsequent breast-conserving radiotherapy.

This is because there is no real difference in the effectiveness of conserving treatment when compared to the removal of the entire breast. We can now examine approaches to surgical treatments, the breasts and lymph nodes in more detail.

What is breast-conserving surgery?

Rather than removing the entire breast, excision of the tumor alone in suitable single-tumor cases is preferred because breast cancer case fatalities are caused not by systemic recurrence but by metastasis.

Brest-conserving surgery involves the removal of the tumor tissue together with about 1-2 cm of surrounding normal breast tissue (wide excision, tumorectomy or lumpectomy.) Other techniques involving the removal of tissue from a wider area are called “quadrantectomy” or “partial mastectomy.”

After the removal by Radionuclide-Guided Occult Lesion Localization (ROLL) technique of mass that mammography or ultrasound-guided wire testing has indicated may be malign or palpable, X-rays is taken to establish whether it has been successfully removed.

Who is a candidate?

Breast-conserving surgery is most applicable in early stage (stage I – II) cases where the tumor is small and unifocal, and in patients who are suitable candidates for post-surgical radiotherapy. Post-surgical recurrence rates vary according to the exact nature of the tumor but there is a general 0.5 – 1% rate of recurrence in the same breast.

It is important to establish that the patient has been fully informed about the surgery before the surgery, and to be sure that the patient will be able to attend subsequent radiotherapy and follow-up examinations and tests.

This is because it will be necessary to monitor the patient very carefully for a prolonged period of time.  If the patient requires post-surgery chemotherapy, this is completed before radiotherapy is administered.

The treatment plan at the Liv Hospital is multi-disciplinary. Specialists in the fields of general surgery, radiology, pathology, medical oncology and radiation oncology all work together in order to provide the exact treatment plan that suits the patient’s disease and condition.

Generally the first specialist to evaluate the patient is the surgeon. Importance is also attached to psychological and psychiatric evaluation both before and after surgery.

Breast PET (Positive Emission Mammography / PEM) at Liv Hospital

Breast cancer is the most commonly occurring cancer in women throughout the world. The early diagnosis of cancer and correct staging are critical factors in determining the course of the disease and patient survival.

Other more commonly used methods such as ultrasound, mammography and MRI scans can sometimes be inadequate in the evaluation of suspicious lesions in the breast, and in establishing the correct staging of malign disease.

PEM technology has only emerged in recent years. It has the capacity to detect very small lesions in the breast that have not yet reached anatomic visibility. This equipment only exists in a few centers around the world and is one of just two in Europe.

Just as with other nuclear medicine examinations and PET scans, after waiting for about 60-90 minutes for the intravenously administered radioactive material to infiltrate the body, abnormal breast tissue involvement is precisely determined with high resolution PEM imaging up to a sensitivity of 1.6 mms.

In addition, the procedure is far more comfortable for the patient since it is designed to operate without squeezing or compressing the breast, in a motionless state.

PEM’s sensitivity in showing breast lesions has been reported as being above 90%; it therefore facilitates more accurate staging and surgical planning without unnecessary biopsies and re-excisions, and allows preventive and protective breast surgery.

It is also more accurate and specific than anatomic imaging methods in terms of assessing patients’ responses to treatment, and detecting local recurrences.

Breast PET (PEM) Indications

• Diagnosis of patients with mammographic or MRI results that identify suspicious breast lesions
• Planning and staging prior to breast cancer surgery
• Investigating contralateral malignancy in multicentric / multifocal tumors
• Axillary lymph node metastasis investigation
• Re-staging of locoregional recurrence

Evaluation of response to treatment

• Colorectal Surgery
• Digestive System Surgery
• Hepatobiliary Surgery (diseases of the Liver)
• Endocrinal Surgery
• Obesity and Metabolic Diseases Surgery
• Peripheral Vascular Surgery

Colorectal surgery is the field of medicine dealing with disorders of the rectum, anus, and colon. We believe that our Center offers you and your family the best option in the region for the following principle reasons:

• Liv Hospital’s Colorectal Surgery Center is here to give our international patients the highest level of care, comfort and hope.
• We offer the very latest surgeries for colorectal disease, some of which are not available at many other centers in the region.
• We provide true multidisciplinary care, bringing together a team of specialists who meet regularly to discuss each patient’s case.
• We realize you may come from far away for your care, so we organize your appointments in the most convenient way possible, liaising with your medical specialists in your home country to the required degree through the dedicated Recovery Specialist.

The Endocrine Surgery Center at Liv Hospital consists of a multidisciplinary team of specialists dedicated to providing quality, innovative and comprehensive treatment of benign and malignant diseases of the endocrine system (thyroid gland, parathyroid glands, adrenal glands and pancreas).

At Liv Hospital we personalize care for our international patients through:

► Quality patient care

► Specialized surgical expertise

► Advanced medical education

► Innovative clinical research

Our specialists are experts in their fields and provide the experience, knowledge, skills and enthusiasm that our international patients deserve. Under Liv Hospital’s famous interdisciplinary philosophy, we combine the diagnostic and treatment strengths of leading medical experts, including, endocrine surgeons, transplant surgeons, endocrinologists, geneticists, radiologists, radiation oncologists, pathologists and oncologists, to unify state-of-the-art treatment options into personalized care. Partnering with the referring physician, we can provide the highest quality and greatest continuity of care for our patients.

The Endocrine Surgery Center is one of the few in the region that is solely dedicated to the diagnosis and treatment of endocrine diseases, including complex, advanced and recurrent disease

Liv Hospital’s Center for Hepatobiliary Surgery brings together the extensive resources of Liv Hospital, to focus on providing well-coordinated, multidisciplinary, international patient- and family-centered care for adults with malignant and benign conditions that affect the liver, the biliary system, and the pancreas.

Hepatobiliary cancers include those of the liver, gallbladder, bile ducts, and pancreas. Our research team also develops treatments for metastatic cancers that arise elsewhere in the body and spread to these organs.

Our team implements techniques that spare healthy tissue during surgery and result in reduced blood loss as well as nonsurgical approaches such as tumor embolization, radiofrequency ablation, and cryosurgery, when appropriate. We have also pioneered innovative chemotherapy approaches for these cancers, including new methods of delivering anticancer agents directly to the liver. Research by our pathologists and radiologists has led to advances in diagnostic and prognostic approaches.

Our highly experienced team of physicians and surgeons offers state-of-the-art diagnosis and treatment, such as the latest minimally invasive procedures (including robot-assisted operations), that scientific evidence shows produces the best possible outcomes.

We provide comprehensive, multidisciplinary evaluation, diagnosis, and the latest, most effective treatments to patients with the conditions listed below. We also provide second opinions. When clinically appropriate, we offer patients the latest minimally invasive approaches to surgical treatment, including robot-assisted surgery, and access to investigational therapies through clinical trials.

• Pancreatic cancer
• Pancreatic masses
• Pancreatitis Liver cancer
• Liver masses

The occurrence of obesity is on a continuous upward trend and has become a very significant public health issue. Turkey is amongst the top European countries in terms of obesity frequency, with the condition affecting some 40% of women and 20% of men. With high success rates, obesity and metabolic surgery has gained in importance and is being used more frequently to treat diseases associated with obesity such as diabetes and high blood pressure. Gastric bypass surgery is regarded as the gold standard in this kind of surgery.

The frequent use of laparoscopic (keyhole) surgical techniques has made life considerably easier both for doctors and patients.  However, even these techniques have their limitations; the devices have limited mobility and only have 2D imaging capacity. Robotic surgery has been developed in order to address these limitations. This system uses remote control high mobility robotic arms instead of hand devices directly controlled by the doctor. These robotic arms are able to mimic the actions of the human wrist, with the capacity for a far higher degree of precision and movement.

3D imaging

As well as providing clearer images, the robotic surgery system provides the surgeon with depth of vision and the sensation of depth of movement by providing a 3D image of the field of operation. Since the camera is under the surgeon’s control, it also allows the surgeon to operate easily in confined and narrow spaces that are inaccessible by regular keyhole techniques. This serves to minimize the extent of surgical injury.

High mobility

Like the human wrist, the devices at the ends of the robotic arms have the capacity for 180 degree movement in every direction. This eases the surgeon’s access and ability to function in confined or inaccessible spaces, gives the surgeon greater freedom of movement and greatly facilitates stitching. The robotic arms’ sensitivity removes issues associated with the normal shaking of the human hand.

Greater comfort for the surgeon

The doctor remains seated at the console during robotic surgery operations; the surgery is conducted under 3D imaging. This reduces the stress and fatigue experienced by the surgeon and extends the surgeon’s period and power of concentration.

What are the benefits of robotic surgery to the patient?

Robotic surgery is conducted with very small surgical incisions with far better esthetic results. Furthermore, side effects that can extend the patient’s period of hospitalization such as bleeding or leakage are reduced.

DaVinci® robotic surgery system

The Da Vinci robotic system is more and more widely used in obesity surgery.

1. Console: the area where the surgeon sits, the 3D images are obtained and from where the robotic device and arms are controlled.
2. Control tower: The part of the device where the monitor, light sources and robotic arms are attached.
3. Patient side: 4 robotic arms are located in this section: one for the camera, the other three to control the DaVinci® devices.

Robotic surgical techniques are especially applicable in obesity operations that present challenges even for laparoscopic techniques and cases in which potential side effects could be life threatening. Robotic surgery presents enormous benefits for both patient and surgeon especially in surgery like bypass operations that require a very high degree of skill and experience.

Benefits:

• Surgery is carried out with 3D imaging
• Patients with high BMI are easier to treat in comfort in a single operation
• More precise control and facility for the surgeon’s skills to be fully implemented
• Greater ease and precision in stitching
• Greater precision and quality of dissection
• Greater ergonomic capacity that reduces surgeon fatigue
• Reduced occurrence of post-op complications such as bleeding and leakage
• Early return to patient’s daily activities
• Reduced hospitalization period

The gold standard in obesity surgery: the gastric bypass operation

Gastric bypass surgery has been carried out in the United States for the past 30 years. At the beginning these operations where conducted using open surgery; over time keyhole surgical techniques became more widely used. Today, the era of robotic surgery has begun, with higher success rates and effectiveness.

With its long term results and success rates, robotic surgery is regarded as the gold standard in obesity surgery. Its weight loss credentials are superior to other techniques. Under this technique, patients lose 80% of their excess weight and continue to lose weight for a period of 18-24 months. It also enjoys greater success rates than conventional methods in terms of its effectiveness in correcting obesity-related conditions such as diabetes, high blood pressure and lipid disorders (cholesterol etc.). Patients’ food intake and absorption levels are effectively reduced.

Unlike in other operations, correction of type 2 diabetic conditions begins not with weight loss but at a much earlier stage, even before weight loss has occurred. 80% of diabetic patients experience total correction, 10% partial correction.

Advantages of robotic surgery

• Fewer complications / side effects
• Fewer surgical wound infection rates
• Lower probability of having to change over to open surgery
• Shorter hospitalization periods

Advantages of robotic gastric bypass surgery

• Lower leakage rates
• Lower rates of repeat operation
• Lower probability of having to change over to open surgery

Less surgeon fatigue and greater concentration capacity.

One of the modern world’s most severe health issues, obesity is not only an esthetic issue but also affects the overall health and quality of life of millions of people.

The Liv Hospital Obesity Clinic caters for international patients and their accompanying persons, offering the latest techniques, advice, programs and surgery in liaison with international patients’ medical professionals in their home countries.

Operating as a sub-unit of the General Surgery Center, the Liv Hospital Obesity Clinic uses laparoscopic and robot technology to perform bariatric surgery that is known as the “Permanent Weight Loss Method” as a result of significant body weight loss. This method begins to show significant results after 6 months, and takes up to 18 months in total.

With the additional support and consultation of psychologists and dieticians, this can give our international weight loss surgery patients a whole new life of good health and activity.

Patients who seek information on obesity from public sources are exposed to information overload and sometimes misinformation.

Accurate and updated information can only really be obtained from fully equipped centers such as the Liv Obesity Center that specialize in obesity surgery.

Successful obesity surgery cannot only be defined as a certain degree of weight loss over a short period of time. It must also be medically acceptable and proven, and maintain the weight loss in the long term with minimum side effects or complications.

The Liv Hospital Obesity Clinic caters for international patients, their families and accompanying persons, offering the latest techniques, advice, programs and surgery in liaison with international patients’ healthcare providers and professionals in their home countries.

Liv Hospital’s Multidisciplinary Approach

LİV Hospital brings together a wide array of surgical branches as part of our multidisciplinary approach to all health and obesity issues. Thus, our Obesity Surgery Unit is fully integrated into other fields of specialization including the Anesthesiology and Reanimation, Endocrinology, Psychiatry, Exercise and Nutritional Physiology, Dietetics and Plastic and Reconstructive Surgery.International patients are offered the services of other Centers as and when required.

At the Liv Hospital Center of Obesity and Weight Loss Surgery we offer international patients a comprehensive program designed to help them lose significant weight, keep it off, and improve their health and well-being over the long term.

International patients are provided with a dedicated Recovery Specialist throughout their stay at the Liv Hospital, who will assist the patent and their accompanying persons in all aspects of their treatment, including liaison with healthcare professionals in their home country.

The Liv Hospital program includes:

• Extensive pre-operative evaluation and preparation
• Psychological evaluation
• Pre and post-op behavior modification program run by our psychologist, dietician, in weekly support groups
• Personal trainer diet counseling with our registered dietician
• Lifelong follow up and liaison with the patient’s healthcare providers in their home countries

Is weight-loss surgery right for you?

In general, gastric bypass and other weight-loss surgery could be an option for you if:

• Efforts to lose weight with diet and exercise have been unsuccessful
• Your body mass index (BMI) is 40 or higher (extreme obesity)
• Your BMI is 35 to 39.9 (obesity), and you have a serious weight-related health problem, such as type 2 diabetes, high blood pressure or severe sleep apnea
• In some cases, you may qualify for certain types of weight-loss surgery if your BMI is 30 to 34 and you have serious weight-related health problems

When noninvasive methods of clearing blocked arteries are no longer an option, or if multiple vessels are blocked, a vascular care physician at Liv Hospital may recommend peripheral vascular surgery as the best course for treatment.

Peripheral vascular surgery can be performed as an endarterectomy procedure, a technique used to remove the plaque buildup inside of the blocked artery.

If an artery or arteries are significantly blocked, a bypass procedure can be performed. A bypass surgery allows blood to bypass or flow around clogged arteries. A healthy blood vessel (arteries or veins) segment from the leg may be taken as a source for a new blood vessel. An artificial blood vessel may also be used. The new blood vessel is grafted to one end of the artery, beneath the blocked area. The other end of the blood vessel is grafted above the blocked area. The new vessel bypasses around the clogged artery allowing blood to flow freely through the arteries and reach the heart.

Vascular Conditions Treated with Peripheral Vascular Surgery at Liv Hospital:

• Peripheral Artery Disease
• Peripheral Vascular Disease