These Are Just Some Of The Operations We Perform:

Partial or Total Thyroidectomy
Removal of all or part of the thyroid gland through a neck incision.

Fine Needle Aspirate of the Thyroid
An in-office diagnostic biopsy of thyroid lumps.

Parathyroidectomy
This is most commonly performed for hyperparathyoidism, a condition that causes a dangerously high calcium level. This is almost always a benign condition.

Removal of Lumps and Bumps of the Head and Neck
These are most often such things as skin cysts, thyroglossal duct cysts, and enlarged lymph glands.

Tracheotomy
The creation of a temporary or permanent opening directly into the trachea.

Tube Thoracostomy
The insertion of a tube into the thoracic cavity to drain fluid of expand the lung.

Breast Biopsy
Sometimes this is an open excisional breast biopsy. Sometimes this is a needle biopsy, which is usually a diagnostic procedure.

Lumpectomy
The process whereby a cancerous lump is removed from the breast. Usually this is coupled with a sampling of the lymph nodes from the axilla (arm pit) on the same side as the breast cancer (called staging axillary lymphadenectomy). More and more of these cases are being addressed using the new staging technique of sentinel lymph node biopsy. All of these procedures are performed by the General Surgeons of Valley Surgical Clinics.

Mastectomy
Some cases of breast cancer still require treatment via modified radical mastectomy, or sometimes via a simple mastectomy, also called total mastectomy.

Gastric and Esophageal Resections
These are done for either benign conditions, such gastric or duodenal ulcer disease, or malignant conditions, such as stomach cancer. Operations include partial gastrectomy, esophago-gastrectomy, and subtotal or total gastrectomy.

GERD
Gastroesophageal reflux disease (GERD) is a condition in which the esophagus becomes irritated or inflamed because of acid backing up from the stomach. More than 60 million adults suffer daily from heartburn. Twenty-five percent of pregnant women experience daily heartburn, and more than 50 percent have occasional distress. The esophagus or food pipe is the tube stretching from the throat to the stomach. When food is swallowed, it travels down the esophagus. Surgery is never the first option for treating GERD. Changes in lifestyle and habits, nonprescription antacids, and prescription medications all must be tried before resorting to surgery. Only if all else fails is surgery recommended. Because lifestyle changes and medications work well in most people, surgery is done on only a small number of people.

The operation used most often for GERD is called fundoplication. Fundoplication works by increasing pressure in the lower esophagus to keep acid from backing up. The surgeon wraps part of your stomach around your esophagus like a collar and tacks it down to provide more of a one-way valve effect. This procedure now can be done laparoscopically, without a large incision in your abdomen.

Hiatal Hernia
There are two main types of Hiatal hernias: sliding and paraesophageal (next to the esophagus).

In a sliding hiatal hernia, the stomach and the section of the esophagus that joins the stomach slide up into the chest through the hiatus. This is the more common type of hernia.

The paraesophageal hernia is less common, but is more cause for concern. The esophagus and stomach stay in their normal locations, but part of the stomach squeezes through the hiatus, landing it next to the esophagus. Although you can have this type of hernia without any symptoms, the danger is that the stomach can become "strangled," or have its blood supply shut off.





Achalasia
is a rare disease of the muscle of the esophagus (swallowing tube). The term achalasia means "failure to relax" and refers to the inability of the lower esophageal sphincter (a ring of muscle between the lower esophagus and the stomach) to open and let food pass into the stomach. As a result, patients with achalasia have difficulty swallowing food. Surgery can be performed where the sphincter is cut surgically, a procedure called esophagomyotomy. The surgery can be done using a large abdominal incision or laparoscopically through small punctures in the abdomen. In general, the laparoscopic approach or the Robotic Assisted surgery is used with uncomplicated achalasia.

Heller Myotomy
is used to treat achalasia, a condition in which the cardia is unable to relax properly and the sufferer is unable to swallow liquids or food. Heller myotomy is performed by cutting the muscles of the cardia, the lower esophageal sphincter. This allows food and liquids to pass through to the stomach. Post Laparoscopic Myotomy patients are discharged on a full liquid diet for the first two weeks.

Esophageal Cancer
Cancer that begins in the esophagus (also called esophageal cancer) is divided into two major types, squamous cell carcinoma and adenocarcinoma, depending on the type of cells that are malignant. Squamous cell carcinomas arise in squamous cells that line the esophagus. These cancers usually occur in the upper and middle part of the esophagus. Adenocarcinomas usually develop in the glandular tissue in the lower part of the esophagus. The treatment is similar for both types of esophageal cancer.

If the cancer spreads outside the esophagus, it often goes to the lymph nodes first. (Lymph nodes are small, bean-shaped structures that are part of the body's immune system.) Esophageal cancer can also spread to almost any other part of the body, including the liver, lungs, brain, and bones.



Hepatic Resections
Via such procedures as partial hepatectomy, hepatic lobectomy, or segmentectomy, are performed for benign or malignant tumors of the liver. Liver drainage procedures are often done for abscess of the liver.

Whipple Procedure
Also called a pancreaticoduodenectomy, the Whipple procedure is performed to address chronic pancreatitis and cancer of the pancreas, ampulla of Vater, duodenum, and the distal bile duct. The Whipple procedure involves removing the cancerous parts of the pancreas, duodenum, common bile duct, and if required, part of the stomach.

The pancreas is examined by an open incision or by laparoscopic instruments. If the cancer has not spread to surrounding tissues, your surgeon will continue to perform the Whipple procedure.

The overall goal of the Whipple procedure is to remove the head of the pancreas and the attached section of the small intestine. First, the end of the stomach is divided off and detached. This part the stomach leads to the small intestine, where the pancreas and bile duct both attach. In the next step, the cancerous head of the pancreas is cut, leaving it attached to the small intestine. Farther down from the pancreas attachment site, the small intestine is divided to free the section of the intestine that is connected to the pancreatic head. The bile duct is the last connection to be cut. This leaves the gallbladder and common bile duct attached to the removed section.

The next steps reconnect the intestinal tract. The stomach is connected to the small intestine, and the bile duct and remaining portion of the pancreas are reattached.

Several tubes may be implanted for postoperative care. To prevent tissue fluid from accumulating in the operated site, a temporary drain leading out of the body will be implanted. Also, a G-tube leading out of the stomach will be inserted to help prevent nausea and vomiting, and a J-tube inserted into the small intestine will serve as a channel for supplementary feeding.

Pancreatico-jejunostomy
Also sometimes called the Puestow procedure. This is where the duct of the pancreas is connected to the intestinal tract, usually to bypass an obstruction in the pancreatic duct from chronic pancreatitis.

Distal pancreatectomy
Removal of a part of the pancreas. Done for benign or malignant conditions.

Laparoscopic cholecsytectomy


Laparoscopy has become the preferred surgical technique for some conditions, such as gallbladder disease.

Laparoscopic cholecystectomy: Removal of the gallbladder with laparoscopy is one of the most common operations in the United States. About 800,000 people undergo laparoscopic gallbladder removal each year. Today almost all gallbladder surgery is performed by laparoscopic surgery. Laparoscopic gallbladder surgery is associated with a shorter hospital stay, less pain and discomfort after the surgery and a rapid recovery allowing many patients to go back to work within a short period of time after the surgery. In many cases, laparoscopic cholecystectomy is performed as an outpatient surgery, with patients spending only a matter of hours at the surgery center. It may be hard for some younger generation patients to appreciate the fact that an operation which, just a generation ago, meant about a week in the hospital and a month off of work, has now been transformed into an outpatient procedure that allows patients to return to work in a week or less.

In this procedure, 5-10mm diameter instruments (graspers, scissors, clip applier) can be introduced by the surgeon into the abdomen through trocars (hollow tubes with a seal to keep the CO2 from leaking). Rather than a minimum 20cm incision as in traditional cholecystectomy, four incisions of 0.5-1.0cm will be sufficient to perform a laparoscopic removal of a gallbladder. Since the gall bladder is similar to a small balloon that stores and releases bile, it can usually be removed from the abdomen by suctioning out the bile and then removing the deflated gallbladder through the 1cm incision at the patient's navel. Conceptually, the laparoscopic approach is intended to minimize post-operative pain and speed up recovery times, while maintaining an enhanced visual field for surgeons. Today this procedure can also be offered as a Laparoscopic Robotic Assisted Surgery.

Bile Duct Surgery
These are usually performed open, but sometimes can be done via the laparoscope. They include common bile duct exploration, and transduodenal sphincteroplasty, as well as connections made between the bile duct and intestinal tract for bypass purposes.

Intestinal resections
This is the removal of a part of the large or small intestine, with a reconnection of the remaining intestinal tract (called anastomosis). Besides small bowel resection, these operations include hemi-colectomy, low anterior resection of the rectum, and abdomino-perineal resection of the rectum. The latter operation requires the creation of a permanent colostomy. But not all colon (large intestinal) resections require a colostomy. Sometimes it is necessary to create a temporary colostomy, as, for example, with a perforated diverticulitis.

Hemorrhoidectomy
Lately we have found that using the harmonic scalpel, an ultrasound driven device, lessens the post-operative pain.

Appendectomy
In some cases, it is to the patient’s benefit for us to perform a laparoscopic appendectomy.

Pilonidal Cystectomy
This entails the removal of a chronically inflamed cyst between the buttocks. It is an outpatient procedure.

Inguinal herniorraphy

Surgery repairing an inguinal hernia, which is a lump in the groin area resulting from abdominal organs pushing through the abdominal wall. Most hernias will require surgical repair. Fortunately, many patients will have the option of a minimally invasive procedure to relieve inguinal hernia, tears in the abdominal wall. There are two main options for hernia repair:

1. Open Repair: The traditional, open repair has been the gold standard for over 100 years. There are 5-10 different approaches that are performed routinely with local and intravenous sedation. Due to the larger size of the incision, open hernia repair is sometimes more painful and, in many cases, has a longer recovery period than with the minimally invasive technique.

2. Minimally Invasive (Laparoscopic) Hernia Repair and Robotic Assisted Surgery

In laparoscopic hernia surgery, a telescope attached to a camera is inserted through a small incision that is made under the patient's belly button. Two other small cuts are made (each no larger than the diameter of pencil eraser) in the lower abdomen. The hernia defect is reinforced with a 'mesh' (synthetic material made from the same material that stitches are made from) and secured in position with stitches/staples/titanium tacks or tissue glue, depending on the preference of your individual surgeon. Pain usually subsides quickly, and the patient can return to work within a few days—although lifting will be prolonged until approximately three weeks.

Femoral herniorraphy
The repair of a less common groin hernia. We follow the same techniques described above.

Splenectomy
Removal of the spleen. Depending upon the reason why we are performing the operation, we sometimes do a laparoscopic splenectomy. This results in much less pain and disability to the patient, and a more rapid return to normal activities.

Skin surgery
Anything from removal of "lumps and bumps" to drainage of boils. We sometimes need to excise a wide area of skin, as in the case of skin cancer (such as melanoma). This sometimes requires us to perform a skin graft.

Colon Surgery

Conventional (Open) Colon Surgery

Each year, more than 600,000 surgical procedures are performed in the United States to treat a number of colon diseases. Diseases of the colon and rectum that might requiring surgical intervention include diverticulitis, colonic polyps not amenable to removal by colonoscopy, tumors (benign and malignant), hemorrhage, as well as other entities.


Patients undergoing colon surgery often face a long and difficult recovery because the traditional "open" procedures are highly invasive. Most open surgeries of the colon require long incisions, and surgery results in an average hospital stay of 5-8 days and usually requires 6 weeks for recovery.

Minimally Invasive (Laparoscopic) Robotic Assisted Colon Surgery

Laparoscopic Robotic Assisted Colon Surgery is a newer technique that is rapidly gaining popularity. Advantages of Laparoscopic Robotic assisted surgery over the open method of surgery include the following:

• Colon function normalizes faster
• Faster recovery time and shorter hospitalization
• Less postoperative pain
• Quicker return to normal activities
• Smaller scar

• A Block in the intestine
• Bleeding, infection, or ulcers due to inflammation (Crohn's disease)
• Pre-cancerous polyps
• Benign tumors

• Less postoperative pain
• Shorter hospital stay
• Quicker return to normal activity
• Improved cosmetic result
• Reduced risk of herniation or wound separation

• Less postoperative pain
• Shorter hospital stay
• Faster return to a regular, solid food diet
• Quicker return to normal activities
• Better cosmetic results

• ANAL FISTULA REPAIR
• DRAINAGE OF PERI-RECTAL ABSCESS
• REPAIR OF ANAL FISSURE
• INCISIONAL HERNIA REPAIR
• ABDOMINAL WALL HERNIA REPAIR
• UMBILICAL HERNIA REPAIR
• VASECTOMY
• SENTINEL NODE PROCEDURES
• SUTURE OF LACERATIONS
• REMOVAL OF TESTICULAR HYDROCELE (CYST)
• CREATION OF GASTROSTOMY
• CREATION OF JEJUNOSTOMY
• PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG)
• PORT-A-CATH OR GROSHONG CATHETER FOR CHEMOTHERAPY
• VASCULAR ACCESS CATHETERS FOR HEMODIALYSIS
• INTRA-ARTERIAL HEPATIC INFUSION PUMP FOR CHEMOTHERAPY
• EGD
• COLONOSCOPY