General Surgery

Fisher-Titus General Surgery performs surgery for cancer or benign disease in the colon or gastrointestinal system.

A common colon issue that can be treated by our general surgeons is colon polyps. These are small clumps of cells that form on the lining of the colon. Most are harmless, but over time they can develop into colon cancer which can be fatal when found in later states. Since colon polyps often do not cause symptoms, it is important to have regular screenings such as a colonoscopy so they can be found early and removed safely. Other related procedures include colectomies or removal of part of the colon due to colon cancer or diverticular disease

Colon prep instructions

General Surgery providers, Dr. Michael Nill and Dr. Eric Schmidt both perform robotic-assisted hernia repairs using The da Vinci Surgical System.

da Vinci surgical technology provides the ability to perform complex surgical procedures with incredible precision and very tiny incisions. This minimally invasive approach allows us to deliver advanced surgical care to our patients with fewer side effects, faster recoveries, and shorter hospital stays.

The da Vinci Surgical System is designed to provide surgeons with enhanced capabilities, including high-definition 3D vision and a magnified view. Though it is often called a “robot,” da Vinci cannot act on its own. The surgery is performed entirely by your doctor. He or she controls the da Vinci System, which translates all hand movements into smaller, more precise movements of tiny instruments inside your body. Together, da Vinci technology allows your doctor to perform complex procedures through just a few tiny openings. As a result, you can get back to your life without the usual recovery following major surgery.

Patient benefits

• Minimal scarring
• Minimal pain
• Low blood loss
• Fast recovery
• Short hospital stay
• High patient satisfaction

A hernia is caused by a weakness in the abdominal wall that progress to a full-thickness hole. This weakness may be present at birth or can be cause by the wear and tear of daily living. Areas such as the belly button or a healed surgical incision are even more prone to weakness.  Other risk factors for hernias include obesity, smoking, and diabetes.

Hernia symptoms depend on the size, location, and contents of the hernia, such as fatty tissue verses intestine.  Common symptoms include:

• A bulge in the groin, abdomen, thigh, or genitals—the bulge may get bigger when you stand and go away when you lie down
• Discomfort or pain may be worse at the end of the day or after standing for long periods
• Pain during heavy lifting, coughing, sneezing, or physical activities
• A feeling of weakness or pressure in the groin

The types of hernias include:

• Inguinal hernias: These occur in the groin and are the most common type of hernia, more common in men. These hernias occur when fatty tissue or intestines push through a weak spot in the lower abdominal wall, often in the inguinal canal found in your groin.
• Umbilical hernias: A normal weak spot can enlarge with heavy lifting, weight gain, and sometimes pregnancy causing fatty tissue or intestine to push out the belly button. These may be small and asymptomatic but can continue to enlarge and cause significant problems.
• Incisional hernias: These occur after abdominal surgery when your intestines push through the scar or the weakened tissue surrounding the incision.

Hernias can also appear on both sides of the body (bilateral hernias) and recur in the same spot (recurrent hernias). In some cases, more than one type of hernia can occur at the same time.

While there are several treatment options for hernias your doctor may suggest, surgery is usually necessary to repair the defect in the abdominal wall. Many hernia repairs can be performed with robotic-assisted techniques using the da Vinci surgical system. General Surgeons Dr. Nill and Dr. Schmidt both perform robotic-assisted hernia repairs at Fisher-Titus.

Hernia Patient Education Book

Regular mammograms and self-breast exams are an important component of women’s health. Knowing how your breasts normally look and feel helps you and your doctor recognize early when something has changed and may indicate a problem.

The most common symptom of breast cancer is a new lump or mass. Usually, a painless, hard mass with irregular edges is more likely to be cancer but breast cancers can be tender, soft, or round and even painful. Because breast cancer can present differently from person to person, it is important to call your doctor so they can examine any new breast mass, lump, or change.

Other possible symptoms of breast cancer include:

• Swelling of all or part of a breast
• Skin dimpling
• Breast or nipple pain
• Nipple retraction
• Nipple or breast skin that is red, dry, flaking, or thickened
• Nipple discharge
• Swollen lymph nodes

Fisher-Titus General Surgery offers a few procedures for the diagnosis and treatment of breast cancer including:

• Core Needle Biopsy
• Stereotactic biopsy (uses imaging to guide the procedure) using ultrasound or mammogram
• Mastectomy (including some reconstruction options)

Formally known as cholecystectomy, Fisher-Titus General Surgeons perform gallbladder removals, including laparoscopic procedures.

The gallbladder is a four-inch, pear-shaped organ positioned under your liver in the upper-right section of the abdomen. It stores bile which is a combination of fluids, fat, and cholesterol that helps break down fat from food in your intestine.

There are several symptoms that can indicate a problem with your gallbladder including:

• Pain in the mid- to upper-right section of your abdomen that can be mild and intermittent or quite severe and frequent. The pain may even radiate to other areas such as the back or chest.
• Nausea or vomiting
• Unexplained fever or chills may signal an infection.
• Chronic diarrhea defined as more than four bowel movements per day for at least three months.
• Jaundice or yellow-tinted skin as it may be a sign of a block or stone in the common bile duct—the channel that carries bile from the gallbladder to the small intestine.
• Unusual stools or urine such as lighter-colored stools or dark urine as these may also indicate a block in the common bile duct.

Problems with the gallbladder that may require surgery include, inflamed gallbladder, gallstones, and on rare occasion, cancer.

Gallstones can also cause pancreatitis. Pancreatitis is a disease that cause inflammation and pain in your pancreas, a small organ that makes fluids and enzymes to break down your food. Sometimes, gallstones can block your pancreatic duct and cause pancreatitis.

Gallbadder Patient Education Book

A neoplasm or tumor is a new and abnormal growth of tissue in the body.

There are three main types of neoplasms:

• A benign neoplasm is not cancerous. These include birthmarks, moles, skin tags, keloids, lipomas and sebaceous cysts.
• A pre-cancerous neoplasm has similar features to a malignant neoplasm but has not yet become cancer or spread.
• A malignant neoplasm is cancerous. The most common are basal cell and squamous cell which can be treated by excision of the lesion. Melanoma is the most serious type of malignant neoplasm which can spread through the body and can be life threatening.

Skin damage from sun exposure can develop and cause neoplasms. The ultraviolet radiation found in sunlight is absorbed by the skin and can damage the genetic material in skin cells whether you get a sunburn or not. Over time, this damage accumulates and can increase a person’s risk for developing skin cancer. When spending time in the sun, it’s important to take precautions to protect your skin and prevent damage.

Fisher-Titus General Surgeon, Dr. Jayne Minier, offers vein treatment for patients who suffer with the physical and/or social discomfort of spider and varicose veins. These treatments are minimally invasive and highly effective.

Vein treatment options include:

• Laser vein treatment that works without surgery or lengthy downtime. The procedure takes approximately 45 minutes to complete, leaves minimal to no scarring, requires no general anesthesia or hospitalization, and allows immediate return to your daily routine. For this procedure, medical lasers deliver highly concentrated beams of light to the targeted tissue with extreme precision and no effect to the surrounding tissue.
• Sclerotherapy involves an injection of a solution directly into the vein. The solution irritates the lining of the blood vessel, causing it to swell and stick together, and the blood to clot. Over time, the vessel turns into scar tissue that fades away.

Fisher-Titus General Surgery offers vasectomy procedures for men. A vasectomy is a minor surgery to block sperm from reaching the semen. After the procedure, the patient will still have semen but there will be no sperm in it making it an effective form of birth control for men, preventing pregnancy better than all other forms of birth control except abstinence.

There are two types of vasectomies:

• A conventional vasectomy involved one or two small cuts made in the skin of the scrotum to reach the vas deferens. The vas deferens is cut and a small piece may be removed leaving a small gap between the two ends that are then seared and tied. This is repeated on the other side and the incision may be closed with dissolvable stitches or allowed to close on its own.
• In a no-scalpel vasectomy, the doctor feels for the vas deferens under the skin of the scrotum and holds it in place with a small clamp. A tiny hole is mad in the skin and stretched open so the vas deferens can be gently lifted out and cut, tied or seared, and put back into place.

Vasectomy post-operative instructions