The Operation offers viewers a unique opportunity--to enter the surgical arena and witness the wonders of today's most innovative surgical procedures. It takes viewers into the lives, minds and hearts of patients and surgeons.

Each episode follows one case from pre-op through surgery to post-operative recovery. We first meet the patient and learn of the processes involved in his or her decision to undergo the procedure. Next, the surgeon explains the specific details of the surgery and how it can significantly improve the quality of the patient's life. The actual surgery is then recorded and each program concludes with a visit to the patient during the recovery process.

Each procedure is explained in clear, uncomplicated medical language to accommodate the average viewer. However, each program is also in-depth and comprehensive enough to appeal to medical professionals who use the program for study or review. Artistically rendered computer graphics help illustrate the procedures and enhance understanding for viewers.

The Operation cover such topics as Laparoscopic Hernia Repair, Arthroscopic Knee Surgery, Breast Reduction, Cesarean Section, Back Microsurgery, Cornea Repair, Prostate Surgery, Kidney Transplant, Cleft Palate Repair, Coronary Bypass Surgery, Tubal Ligation and Vasectomy. The operations are performed throughout North America at prominent hospitals and medical center, such as Duke University, Johns Hopkins, Cleveland Clinic, Columbia Presbyterian, Vanderbilt, Emory, UCSF, and Toronto Western.

The Operation
Season 1

BRAIN SURGERY
More than 2 million Americans suffer from epilepsy, an abnormal electrical activity in the brain. Medication is the first line of defense but sometime surgery may be an option. Such is the case with Lynn Venuto. Neurologist Dr. Rodney Radke has identified the source of Lynn's seizures, a tiny cluster of blood vessels behind her left temple. Because the site is close to her brain's language center, Lynn must stay awake and answer questions during the operation. The doctors need to know that her vocal abilities are not being disturbed. In a moment, neurosurgeon Dr. Alan Freedman will remove the lesion in Lynn's brain. Join us as doctor and patient prepare for the operation.

CAESARIAN SECTION
This program witnesses the miracle of birth combined with the technology of modern medicine. Because childbirth can sometimes pose a threat to both mother and baby, a Caesarian section can be a safe alternative. Named after Julius Caesar who according to legend entered the world this way, a Caesarian is the delivery of a baby through an incision in the mother's lower abdomen. Joan and Tim Barber's baby is in breech position and if delivered naturally would travel down the birth canal feet first. To prevent the baby from getting stuck, Dr. Nancy Cheshire will perform a C-section. Join us as the doctor and the family prepare for the operation.

CORNEAL TRANSPLANT
More than 40,000 corneal transplants will be performed in the United States this year alone. It is the most common of all tissue transplant operations. The cornea, the outer lens of the eye, performs the first step in the eye's focusing system. But injury or disease can cloud this lens, causing impaired vision.
To restore clear sight, a corneal transplant may be needed. With any eye surgery, a one millimeter mistake could mean instant blindness so doctors perform the surgery through the lens of a microscope. In a moment, Dr. Linda Burke will replace Margaret Hurr's right cornea. Join us as doctor and patient prepare for the operation.

LAPROSCOPIC GALLBLADDER REMOVAL
In the science fiction film "Fantastic Voyage," a miniature medical team travels inside a human body. Doctors today can repeat that journey, using tiny cameras instead of tiny people. That's what they do in gallbladder surgery. The lens of a microscopic camera is placed inside the patient through a tiny slit about the size of a dime. This gives the surgeon a bloodless view of the entire abdominal area. Long, delicate tools are used to remove the diseased organ leaving a scar small enough for a bandaid. Join us as Dr. James C. Rosser and patient Candice Windhan take us on a fantastic voyage on the operation.

LEG STRAIGHTENING
The patient, 12 year old Richard Nichols, fractured his leg when he was four. The bone healed improperly, leaving his shin bone in his ankle twisted. The treatment he needs was developed in Siberia almost 40 years ago, when Dr. Gabriele Elizara, a Soviety physician, learned how to manipulate bone growth.
Much like an orthodontist straightens teeth, orthopaedists can lengthen and straighten limbs with this procedure. In a moment, orthopaedic surgeon Richard Davis begins the process of correcting a young boy's twisted leg. Join us as doctor and patient prepare for the operation.

OPEN HEART SURGERY
The patient Rod Dirkson has a timebomb in his chest; he has Mar fan Syndrome, a disease marked by unusual height, loose jointedness, and a dangerously weakened aorta. Mar fan's can bring both genius and tragedy. It may have blessed Paganini with his dexterity on the violin. It struck down Olympic volleyball player Flo Heinman in 1986. Some say that Abe Lincoln had it and would have died prematurely with or without an assasin's bullet.
In a remarkable open heart procedure, Dr. Vince Gaudiani will now attempt to defuse the bomb in Rod Dirkson's chest on the operation ion.

RECONSTRUCTIVE HAND SURGERY
Maria was born with amniotic band syndrome. She was missing part of the ring finger, the middle finger and the pointer finger was cut all the way down and half of her thumb. Dr. Chou did surgery on Maria in June and her ring finger was like a little bit attached to the middle finger. So what he did was he made an opening to make the finger go more freely. He like unwebbed it. And then the last operation that she had, they built her up a thumb. So this extra bone that was left over from the pointer, they transferred it over and built up her thumb.
The next operation, Dr. Chou will be taking a toe, O.K. attaching it to her hand, and making a finger out of it. They're taking the second toe, O.K., on each foot. And that should have no effect on her walking.

The Operation
Season 2

BACK SURGERY - MICRODISCECTOMY
The surgery that is going to be performed on Rick is called a "Microdiscectomy." This is a relatively new technique of removing a slipped disc. The other way of doing it is called a Lamenectomy - or "open procedure." Microdiscectomy is exactly what it sounds like. I'm going to use microscopic techniques to remove the disc. The benefits of doing the surgery this way is that it is "minimally evasive," meaning that it causes less trauma to the patient. Using this technique, only about a one inch incision in the skin has to be made and from there one can reach the position needed to remove the disc. In the open procedure, you need to make about a eight inch opening in the skin. The recovery time for an open procedure is much greater than a Microdiscectomy. Rick will be operated on in the morning, and later that same day he'll be standing and walking around. It would be days and even weeks if this operation were to be done as an open procedure.

CORONARY BYPASS
Though our patient, Grant Roberts, is only 47 years old, he has already suffered one heart attack and is in danger of another. Doctors have located blockages in three of his coronary arteries. The coronary arteries encircle the heart and supply it with the blood it needs to function. Any kind of blockage in these arteries can be life threatening. To increase the blood flow to Grant's heart and reduce the risk of heart failure, Dr. James Douglas, Jr., of the Duke University Medical Center needs to create detours around the blocked arteries. This is a serious procedure which involves stopping the heart in order to save it.

ENDOMETRIOSIS SURGERY
The womb of the uterus is lined with endometrium tissue. It provides the incubation for fertilized eggs. It is every babies first chance for life. Ironically when this tissue spreads into a woman's ovaries or abdomen it can cause infertility as well as severe pain. This condition is called endometriosis and it affects 10 million women in the United States alone. In this episode, Dr. Ana Murphy at the Emory Clinic in Atlanta will use a slender microscopic viewing device to locate our patient's excess endometrial tissue and remove it on the operation.

FACE LIFT
We are about to watch a procedure commonly known as a face lift. It is sought by men and women in search of a more youthful appearance. While gossip columns have made cosmetic surgery a popular topic, in reality the choice to have a face lift is made every day by hundreds of people who have never been in the headlines. In this program, our patient is Beverly Strong, a 51 year old, single working mother who wants to restore her face to a younger more vibrant look. Beverly's decision was the result of careful thought about the serious nature of this delicate operation. Her plastic surgeon is Dr. Neal Handel who will perform facial liposuction and eyelid surgery in addition to the face lift procedure. Join us now as Dr. Handel and Beverly prepare for the operation.

HERNIA OPERATION
We're about to witness one of the most significant advances in modern medicine — laparoscopic surgery. Using a tiny video camera, surgeons can now enter the body's inner world through an incision of only half an inch in length. Once inside, the laparoscope serves as the surgeon's eyes while he performs a range of complex medical procedures. In this program, you will meet Dr. Carlos Gracia and his patient, 37 year old Charles Garrison. A policeman and father of three small children, Charles' physically demanding life style has been interrupted by a tear in the muscle wall of his abdomen, commonly known as a hernia. This condition used to require extensive recovery time following surgery. The use of the laparoscope will allow Charles to return more quickly to his family and his job. Join us as Dr. Gracia and Charles prepare for the operation.

VASECTOMY
One out of four couples in the United States choose a vasectomy or tubal ligation as a way to plan their families. Their next important and intimate decision is which partner will undergo the surgery. Fortunately, both surgical procedures are equally safe and reliable. Lets join the doctors and their patients for the operation.

VASECTOMY REVERSAL
Because many men are hesitant to lose the option of having children later in life, the decision to have a vasectomy is significant. However, thanks to the latest microsurgery techniques that choice is now reversible. While a vasectomy blocks the tube that carries the sperm, the reversal removes that blockage and reconnects the tube allowing the sperm to pass freely. Lets join Dr. and patient as they begin the operation.

VOCAL CHORD OPERATION
Tammy Lee Hart is a 33 year old aspiring singer and mother of two. In her quest for the spotlight, she has developed most of her adult life to building a successful career. And in the competitive town of Nashville, Tammy Lee knows that her voice must always be at its best. Yet recently her future has been threatened by the formation of cysts on her vocal chords. To correct this problem, Dr. Robert Osof, the medical director of the Vanderbilt Voice Center, will remove these cysts, allowing her vocal chords to once again function effectively. For Tammy Lee, the surgery is a necessity if she is to ultimately fulfill her dream. Join us now as Dr. Osof and Tammy prepare for the operation.

The Operation
Season 3

ANATOMICAL RADICAL RETRPUBIC PROSTATECTOMY
Joe Rascoff is 49 years old and is the father of a college-age son and two 20-month-old twins. He and his wife are in the process of moving to New York City from California. Through the use of a PSA test, Joe was diagnosed as being within an early stage of prostate cancer. Traditionally, removal of the prostate would leave a patient impotent. Dr. Patrick C. Walsh developed this technique that allows post-op sexual functional in a high percentage of cases. Due to the early detection, Joe can reasonably expect that this surgery will cure him of his cancer.

BUNIONECTOMY
A bunion is an arthritic bump that forms as a result of malalignment of the big toe. Bunions are genetic. Wearing tight shoes can aggravate an existing condition. Most bunion surgeries fail to correctly realign the joint. 30% of bunions return after a year of surgery. The Tri-Correctional Bunionectomy usually gets the patient back in shoes in 2-3 weeks as opposed to 6-8 weeks with other procedures. The Tri-Correctional Bunionectomy is a three dimensional realignment of the big toe joint done in an attempt to eliminate the forces that caused the bunion. In this program we will watch as Dr. Allen J. Selner removes his patient's extra bone growth and realigns the joint of his big toe.

CERVICAL FUSION
Mary injured her neck during gymnastics. One of her vertebra moved out of place and then popped back into place moments later. Unfortunately, the surrounding ligaments have been stretched, leaving her neck unstable and susceptible to further and more serious injury. The goal of surgery is to stabilize the vertebrae which are currently pushing against her spinal cord and causing shooting pains in her arms. Without this surgery, Mary could be paralyzed if she were to have another accident. Dr. John A. Jane will make a 3-inch incision in Mary's neck. Using a high-powered microscope, he'll clear away the surrounding tissue to access the damaged vertebrae, C5 and C6. He will then drill holes into the vertebrae and place pins in the holes. He'll then lasso these pins with cable, pulling the separated vertebrae together. This procedure will stabilize the vertebrae to prevent against further injury to her spinal cord.

CONGENITAL HEART
Ashley Fridley was born with a deformed heart. She does not get enough oxygenated blood into her bloodstream. Her illness is commonly referred to as "Blue Baby Syndrome" because her skin actually takes on a grayish-blue skin tone. She also tends to be lethargic and tires easily. Dr. Ross Ungerleider of Duke University Medical Center will perform a procedure called a Fontan. Ashley has had two previous surgeries, and the Fontan will be the third and final in the series. Dr. Ungerleider will reroute the plumbing in her heart by hooking up her atrium to her pulmonary arteries. This will deliver more oxygenated blood into her bloodstream. After a successful surgery, Ashley's skin tone will become more pink, and she will be less lethargic. Ashley needs this surgery to live. Without it, her life span will be shortened significantly.

KIDNEY FAILURE
Clifford Stahl is a 54-year-old high school math teacher who has been diagnosed with failing kidneys and requires a transplant. All of Clifford's five brothers and sisters had close genetic matching with Clifford, but there was one problem. Clifford has an unusual blood type which his brothers and sisters did not. His son Jeff became his only hope because they have similar blood types. Doctors Robert and Rafael Mendez are identical twin brothers. The two work together to complete the kidney transplant. As Dr. Rafael Mendez works on removing the donor kidney, Dr. Robert Mendez prepares the recipient for surgery in a neighboring operating room. Clifford Stahl's original diseased kidneys will remain intact. One of his son's kidneys — a healthy kidney — will be removed and then implanted in an area just below Clifford's abdomen. It will then be attached to the iliac artery and the bladder.

LAPAROSCOPIC COLON SURGERY
Kevlin Morgan has Chrone's disease, a chronic inflammation of the digestive tract. Chrone's disease causes cramping, bleeding, diarrhea, fever and depression. Fortunately, the inflammation is in an area (ileum and colon) that can be easily removed and has a lesser risk of reoccurrence of inflammation.
Using laparoscopic surgery, Dr. Joseph Uddo will attempt to remove the inflamed section of colon and reconnect the two ends not affected by the inflammation.

RETINAL SURGERY
Our patient, Mike Larkin, is diabetic. Recently the vision in his left eye has become completely blurred due to diabetic retinopathy, a condition that weakens blood vessels in the eye and causes them to leak and impair vision. A decade ago doctors could offer little hope for Mike's sight. Today, however, using tiny surgical tools and high-powered microscopes, they can reach inside the eye and repair the damage. Dr. Julia Haller of the Johns Hopkins Hospital will perform this vision restoring, called a vitrectomy.

The Operation
Season 4

ACID REFLUX DISEASE
10% of the adult population suffer from heartburn on a daily basis and 10% of these (some 1.5 million individuals) have severe reflux requiring intensive medial management for the disease. Gastric Esophageal Reflux Disease (GERD) is the number one reason for referrals to Gastroenterologists in the U.S. and accounts for the largest pharmaceutical expenditure for diseases of the gastrointestinal tract. GERD is a life-long disease which doesn't "burn out" like ulcer disease and can result in a condition associated with esophageal cancer, an essentially incurable disease. Using five tiny incisions, Dr. Tom A. Paluch manipulates a camera and laparoscopic tools in order to "wrap" part of the stomach around the esophagus. The esophagus will accept this wrap to increase the "area of pressure" which keeps food and stomach acid from refluxing back up the esophagus and into the mouth -- causing heartburn, burping, painful swallowing and reflux.

BREAST RECONSTRUCTION
Diagnosed with breast cancer in 1992, Jean Dubravoc was forced to part with her breast after an unsuccessful Lumpectomy in 1993 gave way to a Mastectomy in 1994. Today she looks forward to her breast reconstruction. Dr. Susan Downey will take tissue from Jean's abdomen and tunnel beneath the skin to the breast to form a new breast mound.

CLEFT PALATE REPAIR
A cleft palate is among the most common of birth defects among caucasian Americans, affecting nearly 1 out of every 700 individuals. Dr. Steven R. Buchman will repair 9-month-old Jackson Lamb's cleft palate prior to his first birthday.

FREE VASCULARIZED FIBULAR GRAFT
A Free Vascularized Fibular Graft consists of removing dead bone that has poor blood supply from the hip, and replacing it with a healthy segment of vascularized (blood rich) bone from the fibula, which serves as a graft. The surgery is done by two teams of specialized doctors. One team works on the h ip area, and the other team works on the lower leg. During the surgery, an incision is made along the hip so that the dead bone may be removed and the remaining bone may be prepared to receive the graft. An incision is made in the lower leg to remove a segment of the fibula and its attached blood vessels. The fibular segment of bone is then inserted into the hip bone, and the vessels (artery and vein) in the hip region are connected to the vessels of the fibular graft using microsurgical thenique by either sutured connection or 3M vascular coupler. The circulation is carefully checked to insure blood flow into the h ip, and the incisions are closed. A splint is applied to the lower leg to immobilize it for comfort, which is usually removed after five days.

HYSTERECTOMY SURGERY
Although Hysterectomy surgery has probably been over-utilized in the past, there are many situations where removal of the uterus is the best or only solution to a woman's health problems. Today, women seek alternative therapy before resorting to a hysterectomy. A vaginal hysterectomy is a much less invasive operation that the traditional open procedure and is much better tolerated by the patient with a faster recovery and less hospitalization. Certain situations preclude vaginal hysterectomy, but by using laparoscopic instruments for part of the surgery, many open hysterectomies may be turned into vaginal ones instead.

LIVER TRANSPLANT
As of October 1995, the waiting list for liver transplants has grown to 5,149.
Helen Bennett has been on the donor waiting list for 9 months. Our patient, along with about 20% of other people waiting for a liver transplant, has liver disease of unknown origin (not related to any form of alcohol abuse or hepatitis). The surgery can be subdivided in four consecutive stages: (1) preparation of the donor liver (called back table work), (2) removal of the diseased liver, (3) implantation of the donor liver and revascularization, and (4) reconstruction of the hepatic artery and bile duct.

PARATHYROID SURGERY
I in 700 persons has hyperparathyroidism. There are 100,000 new cases reported each year. The symptoms can be diabolical in that patients may be treated for individual symptoms (e.g. depression) before the correct diagnosis is made. Dr. Orlo Clark will make an incision across the neck above the Thyroid and will carry down through muscle by sharp dissection. A dry field is maintained so that blood does not stain fat and other tissues. Staining makes it more difficult to distinguish between normal and abnormal parathyroid glands. The Thyroid Gland is retracted and held up out of the way by a silk thread. The parathyroid Tumor (adenoma) is located and excised. The remaining Parathyroids are examined on either side of the neck. In doing so great care is exercised in identifying the recurrent laryngeal nerve; If this is injured the voice will be affected.

VASCULAR NEUROSURGERY
Kelly Flanders has been suffering from extreme headaches her entire life. She was misdiagnosed for years until, when at 30 years old, she had 2 strokes. As she was waiting for the third stroke to kill her, she heard of Dr. Spetcler and his innovative technique. Dr. Robert F. Spetcler harvests an artery under the cheekbone in front of the ear; removes the artery; removes the skull; and sutures the new artery to the existing deteriorated artery… in effect building a new temporal artery.

The Operation
Season 5

ANEURSYM SURGERY
Ed is a 58 year old retiree, who loves to play golf. While undergoing tests for an upcoming ear surgery, three aneurysms were discovered. One on the left side behind the eye, one very large aneurysm on the left side near the brain stem and one on the right behind the eye. The surgery we will profile will correct the two on the left side. In the future there will be a second procedure to correct the aneurysm on the right side. The aneurysm near the brain stem is in the most inaccessible part of the body. It presents a challenge to Dr. Julian Bailes, the surgeon.

DORSAL RHIZOTOMY
Allan has cerebral palsy. Most of the children undergoing a dorsal rhizotomy have cerebral palsy, though children with traumatic brain injuries also can be helped by the surgery. Selective dorsal rhizotomy can improve the affected child's ability to sit, stand, crawl and, in Allan's case, hopefully, result in his being able to walk. Dr. Karin M. Muraszko will open up spine, locate and test nerves. Nerves that over respond (hyperactive nerves) will have a portion clipped in order to reduce spasticity. To receive the most benefit from the surgery, children must have some control over their legs. They also cannot have other movement disorder problems. Finally, they have to be able to participate cognitively in the program. The last point is crucial because the program is more than just surgery. After the four to five hour procedure, patients recover in the hospital for several weeks. That is followed by a year of therapy.

ENDOSCOPIC BROWLIFT and COSMETIC LASER SURGERY
Five to six small incisions are placed in the scalp a few inches behind the hairline. An "endoscope", which is a long tube with a video camera at one end, is inserted into one of the incisions. Into one of the other incisions the surgeon inserts special endoscopic surgical instruments. He then is able to operate through these tiny incisions by watching his movements on a video monitor. The small muscles between the eyebrows that cause frown lines are removed. The eyebrows are carefully elevated and precisely secured at a slightly higher, more youthful position.

A local anesthetic is given in the areas being treated. Since the laser light can be harmful to the eyes, the patient, physicians and nurses wear protective eyewear. The amount of laser energy being delivered are important variables which the surgeon determines prior to treating each patient The surgeon aims the laser with a handpiece and turns the laser on and off with a foot switch. The surgeon treats each area individually, and can vary the depth of the treatment from area to area, depending on how deep the wrinkles or scars are. After each "pass", the surgeon carefully inspects the treated areas to determine if the treatment is adequate. He wipes away the wrinkled or scarred upper layers of the skin that have been treated with the laser and inspects the color and texture of the remaining deeper layers to determine how much deeper the treatment needs to go.

JAW RECONSTRUCTION
Orthognathic Surgery: The word "orthognathic" comes from the Greek words orthos, meaning straight, and gnathos, meaning jaws. Orthognathic surgery shapes up the face by straightening teeth with orthodontics and repositioning jaws with corrective jaw surgery. The orthognathic team consists of an orthodontist and surgeon. The orthodontist specializes in the straightening of teeth and uses braces to move the teeth into correct position for the bite expected after orthognathic surgery. The surgeon, trained in corrective jaw surgery reshapes jaws and possibly other facial bones during surgery to form a better bite and a more pleasing appearance.

MITRAL VALVE RECONSTRUCTION
The mitrovalve is a one-way valve within the heart As the blood is pumped from one chamber to the other the mitrovalve opens and then snaps shut. Mitrovalve prolapse is a condition where the valve begins to malfunction, allowing the blood that was just pumped out of the chamber to backwash back into it The heart is therefore forced to work harder to accompb'sh it's work and sometimes even begins to enlarge as a result The malfunctioning mitrovalve can be seen via a trans-esophogeal echo. By running this down the patient's throat the heart can be seen in motion much like an ultrasound. The valve's "floppiness" is fairly easy to see even for the lay person. The operation is begun with an incision being made down the sternum. The sternum is cut and spread. The patient is then placed on a heart/lung machine so the heart can be stopped for the operation. The heart is stopped. The mitrovalve is on the backside of the heart, so the heart is folded over to expose the surface above the mitrovalve. The valve itself looks like a hole with a series of bungee cord-like strands which pull the edges of the opening together. Dr. Stephen F. Boiling will assess the mitrovalve and decide how best to move the tissue around at that time. He will use stitches to re-position the tissue to make a smaller opening. A plastic ring is then used to create a tight wall for the opening. The bungee cord tissues are then reattached at the right tightness. The heart is closed and restarted.

REDUCTION MAMMOPLASTY
In 1994, over 37,000 people had breast reduction surgery. Almost half were between the ages of 19 and 34, and another third were in the 35-50 year old range. Relief of symptoms was the most common reason women gave for having surgery. Women with large breasts usually experience back, shoulder and neck pain as well as deep grooves where the bra straps pass over the shoulders. The condition also affects posture. It is not uncommon for a woman to lose more than two pounds of tissue from each breast during surgery. Using markings drawn on the patient in the standing position, a design tailored to the individual patient is measured and drawn. The nipple areolar complex is then transposed while getting its blood supply from the underlying breast tissue. Tissue (breast and fat which make up the tissue of the breast) is removed from the medial, lateral and superior aspects of the breast then measured and sent to pathology for analysis. The remaining "skin bassiere" is redraped over the remaining tissue to support the breast and to produce an esthetically pleasing new contour to the breast.

SHOULDER CAPSULAR RECONSTRUCTION
A shoulder capsular reconstruction is among the most common shoulder surgeries for young, athletic people. Dr. Peter McCann uses an arthroscope to document the pathology. We will be able to see how far the shoulder has separated with this view. While he does this, he explains the anatomy to us and discusses the benefits of being able to look at the damage before he actually makes the open incision. He also explains why he doesn't actually do the surgery through the arthroscope. (Because the ligament can't be tightened enough—he can tighten it better in the open procedure.) The field of anatomy will be seen to the sternum. McCann makes an incision in the deltoid area. He separates the subcapularious muscle and detaches the ligaments. He can then expose the dislocated socket Using a drill, he attaches two "anchors" to the glenoid. Then, he attaches the opposite end of the anchors to the stretched ligament and begins to essentially wrench it down, taking up the slack, slowing, the ligament is pulled taut across the capsule, into its normal position.

TUMOR SURGERY
The pituitary tumor surgery takes about 3 hours and the patient is under general anesthesia. Dr. Edward R. Laws makes an incision inside the nose and a small incision underneath the upper lip. The incision is made inside the nose for cosmetic reasons. Working through the nose, Dr. Laws moves the nasal septum out of the way. He then begins working under the microscope. Reaching the back of the nasal cavity, he breaks through the thin boney wall separating the sinus cavity from the pituitary gland. At this point, the tumor, a white jellylike substance will be clearly seen. Dr. Laws will carefully remove the tumor, scraping it free from the surrounding pituitary gland and the brain structures nearby. He has to take great care to avoid damaging the carotid artery and optic nerves that sit just above the tumor. Once the tumor is removed, Dr. Laws will begin to close. He will fill up the extra space in the cavity with a piece of fat from the belly, and then make a small stent, of cartilage or bone, to close the opening at the back of the sinus cavity. Finally, the incisions will be sutured and the nose packed.