Surgical Approaches

Robotic Surgery

Minimally invasive robotic surgery enables surgeons to operate through a few tiny incisions instead of the long incision used for traditional open surgery. The da Vinci Surgical System provides enhanced vision, precision, dexterity and control.

How it works

During the procedure a surgeon sits at a console viewing 3D high-definition video and images, using controls below the display to move robotic arms with attached surgical instruments. The surgeon controls the procedure the entire time, with more flexibility than the human hand allows.

Conditions we treat robotically

There are a wide range of conditions affecting abdominal organs and tissues that general surgeons treat using robotic surgery. Among these are colon and rectal cancer, morbid obesity, stomach cancer, pancreatic disease and achalasia — a swallowing disorder. Collectively, these conditions affect millions of people.

Potential benefits compared with traditional surgery

• Excellent outcomes for cancer control
• Quick return of bowel function
• Fast return to oral nutrition
• Low blood loss and minimal surgical trauma
• Low risk of complications
• Short hospital stay and fast recovery

Single-Incision Robotic Surgery

Rather than the traditional four to five small incisions, a single small incision can be used as the entry point for certain operations.

Our practice performs single-incision robotic gallbladder surgery at Hackensack University Medical Center in Hackensack and at Hackensack UMC at Pascack Valley in Westwood. Unlike traditional robotic surgery, single-incision robotic cholecystectomy allows for one incision at the belly button, through which the diseased gallbladder is removed.

Potential benefits

Benefits of single-incision surgery can include minimal scarring, less pain, less bleeding, faster recovery and a shorter hospital stay — enhancing quality and safety, and improving the patient's experience of surgery.

Our practice was the first in New Jersey and the New York metropolitan area to perform robotic single-incision surgery.

Laparoscopic Surgery

Laparoscopic surgery is a minimally invasive way to do many procedures that were once only possible using invasive, open surgery. It is often preferred because it results in shorter recoveries and hospital stays and a faster return to everyday life.

How it works

During a laparoscopic procedure your surgeon uses a laparoscope — a slender tube affixed with a small camera. The camera fits through tiny incisions to project an image of the surgical area onto a screen in the operating room. Using that magnified view, the surgeon works through the tiny incisions with fine instruments to complete the procedure.

Advantages over open surgery

• Smaller incisions and minimal scarring
• Shorter recovery times
• Less pain
• Lower risk of complications
• Less bleeding
• Shorter hospital stays

Not all procedures can be done using laparoscopic techniques. Your surgeon carefully evaluates your case to determine which surgical approach is best for you.

Why you might need it

Your surgeon might recommend laparoscopic surgery for GERD surgery and reinforcement of your esophageal sphincter, colon resection, pancreatic or spleen surgery, bariatric surgery, hernia repair, gallbladder removal, or stomach surgery. It can also be done as a diagnostic procedure if you have unusual abdominal pain, an abdominal mass, or fluid present in the abdominal cavity.

Recovery

After laparoscopic surgery you are monitored to ensure your vital signs are normal as you come out of the anesthetic. Depending on how invasive your procedure was, you could spend one to two nights in the hospital or go home the same day. Follow the post-surgical instructions our staff provides, and avoid all strenuous activity, including heavy lifting, until your doctor has cleared you.

Minimally Invasive vs. Open Surgery

Minimally invasive surgery refers to a surgical approach that aims to minimize trauma to the patient, resulting in a lower amount of pain and discomfort.

We specialize in both traditional open surgery and minimally invasive procedures, commonly referred to as laparoscopic surgery. We work with each patient to determine the best procedure on a case-by-case basis. A small subset of our patients are not candidates for minimally invasive surgery — open surgery may be required for emergency procedures, complex anatomy or reconstructions. We strive to determine the safest, least invasive procedure with the best recovery possible.

The four approaches, briefly

Open surgery

The surgeon makes a large incision using a scalpel to reach your organs, then inserts full-sized instruments and conducts the surgery.

Laparoscopy

Surgery is done through a few small incisions using long, thin instruments and a tiny camera. In general, minimally invasive surgery is associated with less pain, a shorter hospital stay and fewer complications.

Robotic surgery

Similar to laparoscopy, but using a 3D high-definition vision system and special instruments for enhanced precision and dexterity, allowing many complex procedures to be performed with more precision, flexibility and control.

Single incision

Robotic surgery performed through a single entry point for reduced scarring and faster recovery.

Advantages of laparoscopic over open surgery

• Smaller incisions, which reduce pain and shorten recovery time, with less postoperative scarring
• Less pain, leading to less pain medication needed
• Shorter hospital stay, often with same-day discharge and a quicker return to work
• Reduced complications, including a decreased risk of acquiring infections
• Reduced hemorrhaging, which reduces the chance of needing a blood transfusion

Diagnostic Laparoscopy

A laparoscope is a telescope designed for medical use, connected to a high-intensity light and a high-resolution television camera so the surgeon can see what is happening inside you. It enters the abdominal cavity through a hollow tube, and the image of the inside of your abdomen is seen on a monitor. In most cases this procedure will help us diagnose your particular abdominal problem.

Why it's performed

Abdominal pain

Laparoscopy has a role in the diagnosis of both acute and chronic abdominal pain. Causes include appendicitis, adhesions or intra-abdominal scar tissue, pelvic infections, endometriosis, abdominal bleeding and, less frequently, cancer. It is often used in patients with irritable bowel disease to rule out other causes. We can often diagnose the cause and, during the same procedure, correct the problem.

Abdominal mass

A patient may have a lump that can be felt or seen on an x-ray. Most masses require a definitive diagnosis before appropriate treatment can be recommended. Laparoscopy is one of the techniques available to look directly at a mass and obtain tissue to help the diagnosis.

Ascites

The presence of fluid in the abdominal cavity is called ascites. Sometimes its cause cannot be found without looking into the abdominal cavity, which laparoscopy can accomplish.

Liver disease

Imaging such as a sonogram, CT scan or MRI may discover a mass inside or on the surface of the liver. If imaging cannot give your physician enough information, a liver biopsy may be needed. Diagnostic laparoscopy is one of the safest and most accurate ways to obtain tissue for diagnosis, without actually opening the abdomen.

“Second look” or cancer staging

Your doctor may need information about the status of a previously treated disease, such as cancer — after some forms of chemotherapy, or before more is started. Laparoscopy can also provide information before planning a formal exploration of the abdomen, chemotherapy or radiation therapy.

What to expect during the procedure

Diagnostic laparoscopy is usually performed under general anesthesia; in selected cases a regional anesthesia such as spinal or epidural anesthesia can occasionally be used. A cannula is placed into the abdominal cavity in the upper abdomen or flank just below the ribs, and a laparoscope connected to a special camera is inserted through it. Other cannulas allow us to see the internal organs and make a decision on the proper diagnosis or treatment. Upon completion the small incisions are closed with absorbable sutures or surgical tape.

Recovery

Following the procedure you will be transferred to the recovery room and monitored carefully until the sedatives and anesthetics have worn off. Even though you may feel fully awake, the effects may persist for several hours — so someone must accompany you and drive you home. Once you are able to walk and get out of bed unassisted you may be discharged.

You can expect some soreness around any incision site; this is normal, and your pain should improve daily even though you may need a pain reliever. Most patients are able to shower the day after surgery and begin all normal activities within a week. Schedule a follow-up appointment within two weeks after your procedure.

General Surgery

General surgery involves the performance of operations and procedures that affect your internal organs, including the abdomen and digestive tract. Our surgeons have the experience to diagnose your condition, perform the appropriate surgery, help you with recovery, and manage your health afterward.

General surgery takes in many procedures, some more involved than others. We carefully evaluate your case, your health and the outcome you need in order to decide which surgical approach is right for you.

Procedures included in our general surgery practice

• Anti-reflux surgery
• Appendix removal
• Bariatric surgeries
• Biopsies and dissections
• Colon resection
• Diagnostic laparoscopic procedures
• Gallbladder removal
• Hernia repair
• Robotic cholecystectomy
• Robotic gastrectomy
• Robotic Heller myotomy
• Pancreatic surgery
• Spleen removal
• Stomach surgery

We analyze your symptoms and screenings to recommend the most appropriate surgery to improve your health and quality of life.