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Laparoscopic Anti-Reflux Surgery

is a surgical procedure commonly performed to treat severe acid reflux, also known as gastroesophageal reflux disease (G.E.R.D) or heartburn. Many adults suffer from heartburn, but in some cases can cause severe pain and a decline in quality of life. GERD happens when the lower esophageal sphincter, a circular muscle that acts as a valve, does not close sufficiently and the acid from the stomach flows back into the esophagus. This causes a burning sensation in the chest, throat and neck. GERD is often treated with medications and lifestyle changes, but at times those treatment options are not successful in treating severe symptoms. Your surgeon may diagnosis severe reflux by performing diagnostic studies such as high-resolution manometry, barium swallow study and pH Bravo testing. Following diagnosis and unsuccessful non-surgical treatment options, your surgeon may recommend anti-reflux surgery.

For more information regarding G.E.R.D and it’s treatment options, please visit Anti-Reflux (GERD) Surgery Patient Information from SAGES – Society of American Gastrointestinal and Endoscopic Surgeons.

Colon resection

A colectomy is a surgical procedure that is done by either laparoscopic or open approach, depending on the severity of disease. There are conditions that may result in requiring a colon resection, such as colon cancer, inflammatory bowel disease, diverticulitis and abnormal growth in the lining of the rectum or colon. A colectomy is defined as removing a part of or the entire colon. At East Hawaii Health General Surgery, our surgeons offer a variety of techniques to treat colon conditions. With minimum invasive techniques, patients experience less pain, quicker healing time and shorter hospitalizations.

For more information regarding laparoscopic and open colon resections, please visit Colectomy (facs.org)

Video-assisted thoracoscopic surgery (VATS)

is a minimally invasive technique used to diagnose and treat chest and lung problems. A small camera and surgical instruments are inserted into your chest through small incisions. Your surgeon can then perform a variety of procedures such as biopsies of the lung, remove a diseased portion of the lung or lung space, or remove excess fluid from the space around the lung. This minimally invasive technique may result in less pain, shortened recovery time and fewer complications.

For more information regarding VATS procedure, please visit https://patient.info/treatment-medication/video-assisted-thoracoscopic-surgery.

Thyroid surgery

is performed for a variety of thyroid conditions, including thyroid cancer and benign (non-cancerous) nodules. Our general surgeons at East Hawaii Health General Surgery can assist you in determining if surgery is recommended for your thyroid condition. For more information regarding thyroid surgery, please visit Thyroid Surgery.

Breast Cancer

A cancer diagnosis is a stressful time for patients and their families. Our surgeons at East Hawaii Health provide compassionate care and timely coordination for our patient’s cancer needs. They will discuss surgical and non-surgical options and will assist you in developing a personalized plan to meet your needs.

Surgery for Breast Cancer | Breast Cancer Treatment

Robotic Surgery

Robotic assisted cholecystectomy

Robotic assisted gallbladder surgery is commonly performed to remove a gallbladder that is inflamed or develops gallstones that cause pain and discomfort. Da Vinci technology allows the surgeon to remove the gallbladder through smaller incisions, allowing for a quicker recovery with minimal pain. For more information about the Da Vinci robotic system or robotic assisted cholecystectomy, please visit Da Vinci Surgery | Cholecystectomy Robotic Assisted Surgery.

Robotic assisted hernia repair

Robotic assisted hernia repair allows for your surgeon to repair weakened areas of the abdominal muscle that can cause part of your intestine to bulge through the muscle. This minimum invasive technique can lower the chances of post-operative complications and allow for quicker recovery with minimal pain. For more information about robotic assisted hernia surgery, please visit Da Vinci Surgery | Inguinal Hernia Repair Robotic Assisted Surgery for robotic inguinal hernia repair and Da Vinci Surgery | Ventral Hernia Repair Robotic Assisted Surgery for ventral hernia repair.

NOTES (Natural Orifice transluminal endoscopic surgery) – Incisionless procedures

Scarless surgery performed on internal organs, also known as Natural Orifice Transluminal Endoscopic Surgery (NOTES), is a form of minimally invasive surgery combining endoscopic and laparoscopic approaches with entry through a natural orifice, such as the mouth, anus, vagina, etc. NOTES has gained a great interests of surgeons and public after a revolutionary success of laparoscopic surgery a decade ago. Although, this novel and promising approach has been trialed for many abdominal operations, only few procedures emerged to today’s practice. Below is a table comparing surgical approaches.

 

Open   Surgery Laparoscopic Surgery Robotic Surgery Single-Port  laparoscopic  Surgery NOTES
Length of Incision (cm) 5-20 0.5-1.5

3-5 sites

 1

3-4 sites

 2-3

one site in the umbilicus

No incisions
Pain Significant Minimal Minimal  Minimal Least or none
Hospital stay 4-7 days 2-3 days  2 days  2 days 0-1 day
Scar tissue risk (adhesions) High Low  Low  Low Extremely Low to none
Risk of incision infection Present Low  Low  Low None
Risk of hernia Present Very Low  Low  Present Non-existent

 

Some of the NOTES procedures are used in combination with traditional laparoscopic approach, the others are true incisionless operations. Because of inhereted technical complexity, they are mainly performed in large speciality centers. As a community hospital ,Hilo Medical Center stands out in this regard as we are capable of performing all existing type of NOTES accepted in surgical practice to date. For over eight years we have been offering peroral surgical treatment of esophageal diverticulum, known as Zenker’s diverticulum, and TAMIS (transanal minimally invasive surgery). The later procedure allows for removal of large and precancerous intestinal polyps that could not be removed via traditional endoscopy without incisons or removal of part of intestine. The first transanal mesorectal excision operation (or TaTME – a form of NOTES) ever performed at a communitiy hospital was first successfully conducted at HMC in 2017. A series of first successful peroral endoscopic myotomy (POEM) in the state of Hawaii was also performed at HMC. Below is a table with NOTES and advanced endoscopic procedures we offer at HMC today:

Peroral endoscopic myotomy (POEM) Performed with flexible scope, just like upper endoscopy. It used for esophageal motility disorders and esophageal diverticula.
G-POEM (endoscopic pyloromyotomy) Used for treatment of gastroparesis (“lazy stomach”) and alleviates food passage into intestine.
Endoscopic submucosal dissecation (ESD) Pure endoscopic procedure allowing for removal of large or precancerous gastric and intestinal lesions.
Endoscopic suturing Using a suturing device attached to the end of conventional flexible endoscope allows for full thickness intestinal defects or fistula closure without operation or fixation of stents to prevent their migration.
Peroral endoscopic stapling esophago-diverticulostomy Incisionless surgery for Zenker’s diverticulum in upper esophagus
Transanal minimally invasive surgery (TAMIS) Surgical excision of larger intestinal polyps and lesions, which could not be removed endoscopically
Transanal mesorectal excision (TaTME) A spincter preserving removal of rectum for rectal cancer; combined with laparoscopic approach.
Stretta (radiofrequency treatment of acid reflux) Endoscopic procedure to augment lower esophageal sphincter to improve it’s function against gastro-esophageal reflux.

 

Despite the obvious benefits of minimally invasive approach, not all patients could be candidates for some of these complex procedures. For best results we consider patient’s individual patterns, anatomy and physiology with the help of intensive work up and detailed discussion. The role of pioneers of endoscopic surgery in the state of Hawaii obligates us to maintain up to date knowladge and skils via CME (continued medical education) courses with world experts oin the area. We dedicated to provide the best possible surgical care available to our community.