SOFHA Surgical Group

Breast Cancer has become increasingly more frequent. What once occurred in 1 in 11 women now occurs in less than 1 in 9 women. Attention to risk factors and early detection has become more important. This is best accomplished with monthly self-examinations, yearly mammography (initial at 35, yearly after 40), and yearly physical examinations.

Breast Cancer surgery itself has undergone a minimally invasive approach. The vast majority of cancers can now be treated by lumpectomy or partial mastectomy. It is now the rare occasion that a complete mastectomy is necessary. It has become more of the patient’s choice as to which procedure is performed as overall survival is the same with either choice.

Most importantly, it is the treatment of the lymph nodes which has underwent the most advantageous approach to minimally invasive surgery. No longer do women have to endure the potential side effects of a full lymph node dissection unless there is documented metastatic cancer. Most women with early stage breast cancer are candidates for a Sentinel Lymph Node Biopsy. This is where only 1 or 2 lymph nodes are removed at the time of surgery to test for metastatic cancer. This spares about 75% of patients from having to risk the side effects of a complete lymph node dissection. Our surgeons are trained and experienced in this technique.

There is a broad range of cancers which are treated by the General Surgeon. A few are listed below:

• Colon cancer
• Rectal cancer
• Breast cancer
• Pancreatic cancer
• Stomach cancer
• Thyroid cancer
• Melanoma
• Skin cancer
• Esophageal cancer

Surgery is the backbone of treatment for cancer and the general surgical oncologist is best equipped to care for these patients. Our surgeons treat all of the above malignancies. However, the best success is achieved with a combined team approach including the surgeon, oncologist and radiation therapist. It is our philosophy to treat cancer with a team approach. Our medical community offers all patients access to the best trained specialists in the region and our surgeons are highly trained and experienced in the surgical care of cancer patients. They pride themselves in staying updated in the latest technology and surgical advances.

Colonoscopy is a medical procedure involving the endoscopic examination of the large bowel and the distal portion of the small bowel. This examination is performed using either a CCD camera or a fiber optic camera, which is mounted on a flexible tube and passed through the anus.

The purpose of a colonoscopy is to provide a visual diagnosis via inspection of the internal lining of the colon wall, which may include identifying issues such as ulceration or precancerous polyps, and to enable the opportunity for biopsy or the removal of suspected colorectal cancer lesions.

Many colon and rectal problems require surgery. The most common being diverticular disease, colon polyps and cancer. The most serious of these is colorectal cancer. This malignancy is best treated by surgery and the General Surgeon is the most experienced and qualified provider. Our surgeons are knowledgeable and experienced in the latest technology for the surgical care of colorectal cancer. We have years of experience in both the laparoscopic and open approach to colon resections. Most recently, they have been trained in Da Vinci robotic resections and now offer this technique as an option. We also believe these are best cared for by a team approach and therefore work closely with the gastroenterologist, oncologist, and radiation therapist

However, there are also many benign conditions which occasionally result in surgical intervention. These include large polyps which cannot be removed with the colonoscope and recurrent diverticulitis or diverticular disease. Both of these conditions can result in the need for surgical removal of a section of the colon or rectum. Traditionally, this has been done with a large incision resulting in a prolonged recovery time and significant discomfort. Our surgeons have done many of these procedures through the laparoscope resulting in a shorter hospital stay, less pain and discomfort and a faster return to unrestricted activity with excellent results. This has become our preferred approach to colorectal surgery and has been met with increased patient satisfaction. . Most recently, they have been trained in the Da Vinci robotic resections and now offer this technique as an option.

Our doctors use the DaVinci Robot to accomplish many of their minimally invasive surgical procedures. This includes both the simple and more complex operations which allows the surgeons to care for their patients using the latest state of the art technology. In certain situations this allows for a faster recovery with less pain and a shorter length of hospital stay thus providing a more timely transition to normal activity

Some of the operations that can be accomplished with the robot include:

• Cholecystectomy
• Inguinal Hernia Repair
• Ventral/Incisional Hernia Repair
• Colon Resection for cancer and diverticulitis
• Nissan Fundoplication
• Sleeve Gastrectomy
• Splenectomy

Most of the procedures that can be accomplished with the laparoscope can also be performed using the DaVinci Robot.

Esophagogastroduodenoscopy (EGD) is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract down to the duodenum. It is considered a minimally invasive procedure since it does not require an incision into one of the major body cavities and does not require any significant recovery after the procedure unless sedation or anesthesia has been used. However, a sore throat is common.

Many patients’ lives are disrupted by the dysfunction of the gallbladder. This can result from the presence or absence of gallstones. Common symptoms include right upper quadrant pain, nausea, vomiting, substernal chest discomfort, fatty or greasy food intolerance and pancreatitis. The diagnosis is usually made by the finding of gallstones on ultrasound. However, the gallbladder can be dysfunctional without gallstones. This is usually diagnosed by a test called HIDA scan with CCK injection. A decreased ejection fraction or reproduction of the symptoms is suggestive of a dysfunctional gallbladder.

The gallbladder can be removed minimally invasive or laparoscopically. This is done with 4 small incisions as an outpatient procedure. This is done in an ambulatory surgery center with minimal discomfort and limitations. Most patients can eat a regular diet the evening of surgery and return to work with no restrictions in about a week. There is minimal discomfort and scarring associated with the procedure. Most patients can be scheduled for their procedure shortly after the office visit.

New Technique for Hemorrhoidectomy

Hemorrhoids have been an unwelcome problem for centuries. It has also been a misunderstood problem. Hemorrhoids are actually the veins which drain our lower rectum and anus. They can develop varicosities like the veins in our legs. With time and persistent pressure they will eventually prolapse and become inflamed. This will lead to multiple complaints such as bleeding, pain, itching, prolapse and thrombosis.

Hemorrhoids are classified by grades. Grade I is mild disease. Grade II will prolapse but spontaneously reduce. Grade III will prolapse but will require manual reduction. Grade IV are prolapsed and cannot be reduced.

Most hemorrhoidal symptoms can be treated without surgical intervention. This includes fiber supplementation, stool softeners, increased water consumption, exercise, sitz baths and steroid ointments. However, when conservative measures fail there are several options. Most grade II and some grade III hemorrhoids can be successfully treated by hemorrhoidal banding techniques. The majority of grade III and all grade IV disease must be treated surgically.

Historically, traditional hemorrhoid surgery has been feared because of the significant postoperative pain. This no longer is the case. A device called the PPH hemorrhoid stapler has been developed which has revolutionized this procedure. This is a simple outpatient procedure which produces excellent results with significantly less pain. The patient can usually return to regular unrestricted activity in about 5 days. Thus far, our patients have raved about their results. They have experienced far less discomfort than traditional hemorrhoid surgery and returned to their everyday activities much quicker.

Every patient with rectal prolapse or symptomatic prolapsing hemorrhoids should consider being evaluated to see if they are a candidate for this new procedure. Appointments can usually be made expeditiously with one of our surgeons credentialed in this technique.

Hernias are openings in the abdominal wall or groin which can occur at birth or be acquired as a result of abnormally increased intrabdominal pressure. They can also occur as the result of previous surgery. This could potentially allow the intestines to become trapped in the opening resulting in a potential life threatening situation. This could result in emergency surgery. It is for this reason, all hernias should be repaired. The most common sites of hernias are inguinal, umbilical, and the abdominal wall. Our surgeons have been thought leaders in the region in minimally invasive hernia surgery and have taught and shared their experience with many other surgeons.

Inguinal Hernia

These are commonly referred to as groin hernias. They have been traditionally treated as an open procedure without the placement of mesh. This has been an uncomfortable procedure and resulted in a high recurrence rate. These hernias are now routinely repaired with mesh which has resulted in a less painful operation with a recurrence rate of 0.2%. Patients can expect to return to work in about 14 days.

Even better is the laparoscopic approach which can be done as an outpatient procedure as well. This is less painful and the recurrence rate is the same. However, one can expect to return to work with unrestricted activity much quicker (typically in 3-5 days). This requires only 3 small puncture sites and no sutures in the muscle. Results have been excellent

All of our surgeons perform laparoscopic inguinal hernia repairs.

Incisional/Ventral Hernia

Incisional hernias are common after previous abdominal surgery. They can be very uncomfortable and unsightly with a considerable bulge in the abdomen. They can also be dangerous if the intestines were to become stuck in the defect. Therefore, all of these hernias need to be repaired.

The recurrence rate approaches 25% so these are usually repaired with mesh. These also can be repaired with an open or laparoscopic approach.

The laparoscopic incisional hernia repair is done with only 3 or 4 puncture sites. Occasionally, this can be done on an outpatient basis. This results in a less painful procedure with a faster recovery time. Mesh is used for the repair and recurrence rates are similar to the open repair. Most patients can return to work with unrestricted activity in about 2 weeks instead of the 6 weeks typically required by open repairs.

Larger abdominal wall defects will require abdominal wall reconstruction. This is a more complex operation which requires releasing muscle attachments laterally in order to bring the abdominal muscles together in the midline to recreate the natural position and function of the abdominal wall. These also are reinforced with mesh and having excellent functional and long term results. Our surgeons have extensive training and experience in repairing these most difficult hernias.

Our surgeons perform laparoscopic incisional hernia repairs.

Umbilical Hernia

Umbilical hernias can be acquired as an adult or as a result of birth. While in children 85% of umbilical hernias resolve without surgical intervention, in adults these need to be repaired. They have a high incidence of entrapping the intestines and smaller ones carry a higher risk than larger ones. These are repaired on a outpatient basis with low recurrence rates. The incision is hidden in the navel and return to work usually occurs in about 2 weeks.

Hiatal/ Paraesophageal/ Diaphragmatic Hernia

Gastroesophageal reflux disease is common. 90% of it can be treated medically but the rest will remain symptomatic and require surgical intervention. Most patients have a hiatal hernia which can be repaired with minimally invasive techniques either laparoscopically or with the Da Vinci robot. Likewise, all paraesophageal and diaphragmatic hernias need repair and can also be done with minimally invasive techniques.

There are now many surgical procedures that can be successfully performed with minimally invasive techniques. This is most commonly referred to as Laparoscopic Surgery. Our doctors are accomplished laparoscopic surgeons and have been the leaders in advancing laparoscopic techniques in the Tri-Cities. 

Also, the approach to breast disease, melanoma, and parathyroid surgery has been revolutionized by minimally invasive techniques. The Neoprobe has allowed surgeons to abandon axillary dissections for breast cancer and melanoma by performing a Sentinel Lymph Node Biopsy.

Likewise, no longer are surgical breast biopsies necessary for the diagnosis of breast cancer. Stereotatic Breast Biopsies can accurately diagnose breast pathology without the need for surgery. This is a simple procedure done as an outpatient outside the operating room.

Laparoscopic and Minimally Invasive Procedures offered by SOFHA Surgical Group:

• Gastric Bypass
• Cholecystectomy
• Appendectomy
• Incisional/Ventral/ Inguinal Hernias
• Colon Resections
• Splenectomy
• Nissan Fundoplication for Gastroesophageal Reflux
• Heller Myotomy for Achalasia
• Sentinel Lymph Node Biopsy
• Stereotatic Breast Biopsy
• Parathyroid Surgery
• Adrenalectomy

Thyroid Disease

Surgeons treat several disorders of the thyroid but the most common are cancer and thyroid nodules. A solid nodule of the thyroid can be an indication of underlying malignancy and should be evaluated. This is usually done with ultrasound and a fine needle aspiration. Depending on the cell type, the thyroid lobe may or may not need to be removed. One example would be the follicular cell type. The presence or absence of cancer can only be diagnosed with removal. Most thyroid lobectomies can be done as an outpatient with a 23 hour stay and return to work in less than a week.

Thyroid cancer is only treated with surgical removal. This usually results in an excellent prognosis. Most of the time, the whole gland will need to be removed and this too can be done with a 23 hour stay. Return to work is usually 7-10 days and no chemotherapy is required. Replacement hormone therapy is done daily with the ingestion of a pill.

All of our surgeons are experienced in the surgical care of thyroid disease.

Hyperparathyroidism

Hyperparathyroidism is the result of abnormally increased activity of the parathyroid glands. This is diagnosed by a high calcium level in the blood and an elevated parathyroid hormone level. This can be the result of a single hyperfunctoning gland (adenoma), or all 4 glands functioning abnormally. If left untreated this can result in severe weakening of the bones, nervousness, mental status changes, various gastrointestinal complaints and if the calcium level gets high enough, death.

Surgical treatment results in a cure. This can usually be done with a minimally invasive approach using a new technique called the Neoprobe. This allows us to identify the offending gland prior to making an incision so that the incision is much smaller and the amount of surgery is less. This results in a less painful and more cosmetic result. Results are excellent.

Our surgeons perform this new and state of the art minimally invasive approach to parathyroid surgery.