Category Archives: General Surgery

Different types of Hernias

Our new team member at Surgical Artistry, Hannah, did some studying regarding hernias, and this is what she wrote:

Dr. Lee and Dr. Wu operating together on a hernia.

Different Types of Hernias

Inguinal Hernias– The most common type of hernia. They occur in the inguinal canal. Inguinal hernias develop when abdominal tissue such as intestine or omentum, protrudes through a weak spot in the abdominal muscles and fascia. They do not improve on their own and can lead to life threatening complications.

Ventral Hernias– This is a hernia that appears at the site of a previous surgery incision. These can appear weeks, months, or even years after surgery and can be very small or very large and complex. If this hernia widens, it can be very difficult to repair. These have a high recurrence rate.

Femoral Hernias– Like the inguinal hernia, femoral hernias also appear in the groin area. These are common in women, but can also appear in men. These are usually the result of a pregnancy, or childbirth. A weakness in the lower groin allows the intestinal sac to drop into the femoral canal. Early repair is strongly advised for this type of hernia, as severe complications such as incarceration and strangulation are common.

Umbilical Hernias– Occur near or on the bellybutton or naval, which has a natural weakness from the blood vessels of the umbilical cord. In adults, umbilical hernias often do not resolve and will progressively worsen over time. This type of hernia is often caused by abdominal pressure due to being overweight, excessive coughing, or pregnancy.

Epigastric Hernia– These occur due to a weakness, gap, or opening in the muscles or tendons of the upper abdominal wall, on a line between the breast bone and the naval or umbilicus.

Hiatal Hernias– These are slightly different from other hernias because they are a weakness or opening in the diaphragm, which is the muscle that separates the chest cavity from the abdominal cavity. These hernias cause reflux of acid from the stomach into the esophagus, which can lead to heartburn, pain, and erosion of the esophagus.

Spigelian Hernia– A rare type of hernia in the spigelian fascia, lateral to the rectus abdominis muscles.

Obturator Hernia– A rare type of hernia that occurs in the pelvic floor. Much more common in women, especially elderly women. It is said that obturator hernias can be caused by pregnancy, which leads to lax pelvis muscles.

Other Hernia Terms

Strangulated – Squeezing the blood supply

Incarcerated- The hernia is not reducible

Reducible- The hernia can be pushed back without surgery

YouTube vs. FaceBook Video Sound Quality

Piano as surgical dexterity practice

As part of my daily surgical dexterity practice, I play the piano.  But I also need feedback by self-assessing my technique by making videos.  Most importantly the sound created with my fingers, arms, and body is important.  I do load the videos up onto the internet at times to get feedback from others.  I would say that there are plenty of experts out there on the internet who know a lot more about piano playing than I do.  But part of my goals is to have my dexterity improve for my cosmetic surgical practice where I inject Botox, Fillers, Veins and I perform Acupuncture too.

Two social sharing platforms are FaceBook and YouTube.  I had to compare to see which one had better sound quality.  In the end I think the sound quality goes with the video quality.  YouTube won out in my opinion.  But both platforms do change the volume and degrade the quality of the original file which was taken as a quicktime move with a Canon 60D camera which I got from Costco about a year ago.

Head to head comparison: YouTube vs. FaceBook

My initial conclusions are that YouTube’s sound quality degrades less than FaceBook’s. YouTube has a tendency to lower my volume and FaceBook does the opposite – it raises the volume (when compared to the original quicktime file sitting on my hard-drive). Here’s the YouTube Video:

I don’t know if I can share the video from FaceBook, but this would be the link:

I guess you can decide for yourself.

I did the listening through a new beyerdynamic professional headphone.  It’s the Beyerdynamic DT 770 Pro 80 Ohms.

beyerdynamic professional headphone dt770 pro

The box got crushed in the delivery to me, but I think the headphones are fine.  This is how it arrived (there was an outside box that got beat up too).  The box was torn in several places, but I think miraculously the headphones were flexible enough to take some of the squishing that happened.

Beyerdynamic Headphone specs for the DT 770 Pro, 80 Ohms:

  • Transducer type: dynamic
  • Operating principle: closed
  • Nominal frequency response 5-30,000 Hz
  • Nominal impedance 80 Ohms/system
  • Nominal SPL:  96 db SPL
  • Nominal THD:  <0.2%
  • Ambient noise isolation:  approx. 18 dBA
  • Weight without cable: 270g
  • Cable: 3m/stright cable
  • Connection: gold plated mini jack 1/8″ and 1/4″ adapter

How long does it take to become a Surgeon?

There are many different ways to measure this length of time for surgery training and surgery education.  I was just wondering these same things as I reflect on my surgical experience.  I was also wondering how long it might take me to become a pianist.  Perhaps my musings might help others.  First I should say that I am very grateful to all my teachers.

I currently practice in a Modesto Plastic Surgery setting with my wife, Dr. Tammy Wu, Modesto Plastic Surgeon.

I had posted this comment on my Modesto FaceBook page, but I thought I’d share these educational duration thoughts here:

It took me 10 years of diligent study to become a semi-proficient VIOLINIST. It took me 17 years to become a competent full fledged SURGEON. I wonder how long it would be if I attempted to tackle piano.

1) Violin years determined by age started (7) and age with performance-readiness of the Tchaikovsky violin concerto.  My Tchaikovsky violin concerto – see below.
2) Surgery years determined by starting with the first year of acceptance into Brown University’s Medical Education program and the year where I became a full fledged board certified surgeon. This duration of time is 17 years after high school.
3) I learned piano briefly when I was little, but then switched to violin, dropping all piano lessons. I had to focus. Just like these days I have to choose between Acupuncture vs. Surgery – there isn’t enough time/energy to focus on all things.

Here’s a violin recording/video of my Tchaikovsky violin concerto:

Tchaikovsky Violin Concerto, Calvin Lee

My uses for Hypertonic Saline

Normal Saline was invented in 1896 by Mr. Hartog Hamburger in Holland. Yes, this was at one point called Hamburger’s solution. Normal saline is a close approximation to the osmolarity of blood – thus there are tons of uses for normal saline. So how about HYPERTONIC Saline? What are the uses of something that has a higher osmolarity of blood? There are multiple uses but in my career it has been used for reducing brain swelling in trauma patients (more specifically to lower intracranial pressure, where maintenance of cerebral perfusion is key as it relies on blood pressure being high enough above intracranial pressure.)

The other use of HYPERTONIC Saline is in the COSMETIC treatment of spider veins. Now it’s less popular for this indication because POLIDOCANOL has been shown to be a superior product for spider vein treatment (and more expensive), but safety and superiority trumps cost for the most part. We use Polidocanol at Surgical Artistry, in Modesto, CA.

Facial Plastic Surgery – Head, Neck, Facial Cancer Notes


Triangles of the neck – anatomy

Most of this is probably of interest to folks that work with facial anatomy: such as ENT’s – Ear Nose Throat surgeons, facial plastic surgeons, cosmetic surgeons, and those who work around the face all the time such as dermatologists, and cosmetic injectors who perform Botox and dermal fillers.  These are notes that I took for myself while reviewing some head and neck cancer issues.  Keeping up to date and reviewing medical knowledge is important for my – Calvin Lee, MD – surgical practice in Modesto, CA.

Sistrunk Procedure for Thyroid Glossal Duct Cysts with papillary carcinoma

Surgical Review: Sistrunk Procedure (of which I’ve done a few in my career) and some with assistance from my expert Modesto surgeon friend Dr. Suntra (ENT/facial plastic surgeon) is used for the removal of thyroid glossal duct cysts and involves the cyst removal in continuity with the tract, central portion of the hyoid bone, and tissue above the hyoid bone to the base of the tongue. This procedure is usually considered adequate for a finding of a well differentiated papillary carcinoma of the thyroid.

Fine Needle Aspiration for diagnosing neck lymph nodes

Surgical Review: FNA (fine needle aspiration) is considered first line for tissue diagnosis for a solitary neck mass suspicious for metastatic squamous cell carcinoma.

Tonsils – the great sequester of cancer in the head and neck

Surgical Review: Consider tonsils when finding a non-obvious source of metastatic squamous cell carcinoma in the upper neck.

Metachronous and Synchronous – definition

Surgical Review head and neck cancers: Metachronous means occurring at different times, as opposed to synchronous (at the same time).

Lateral Aberrant Thyroid = papillary thyroid carcinoma

My personal Surgical Review: Lateral Aberrant Thyroid is a lymph node metastasis from papillary thyroid carcinoma. Consider the surgery of: total thyroidectomy with a neck dissection ie. central compartment.


Wartin’s Tumor – treat with parotidectomy superficial or total

My personal Surgery Review: Papillary Cystadenoma Lymphomatosum (Warthin’s Tumor) is a benign salivary tumor (like pleomorphic adenoma), which is usually in the Partoid gland. Treatment is excision with superficial (lateral) parotidectomy or total parotidectomy (which preserves the facial nerve) depending on location of the benign tumor. Enucleation is contraindicated due to recurrence.


Facial nerve, parotid gland



Just some personal notes for Calvin Lee, MD Modesto, CA.  No medical advice here.