"General Surgery" was the first surgical specialty, having become separate from the general practice of medicine more than one hundred years ago. It is based upon a central core of knowledge that embraces anatomy, physiology, metabolism, immunology, nutrition, pathology, wound healing, shock and resuscitation, intensive care and neoplasia (cancer).

General Surgeons certified by the American Board of Surgery have, through their training, acquired knowledge and experience related to the diagnosis; preoperative, operative, and postoperative management; and management of complications involving surgical patients.

SurgOne physicians specialize in one or more of the following specialties:

• General Surgery
• Breast Surgery
• Bariatric Surgery
• Colon and Rectal Surgery
• Endocrine Surgery
• Hepatobiliary Surgery
• Hernia Surgery
• Laparoscopic or Minimally Invasive Surgery
• Robotic Surgery
• Surgical Oncology
• Transplant Surgery
• Trauma Surgery
• Vein Surgery

General Surgery today has evolved into a field that encompasses surgical treatment of the abdominal organs and intestines including the esophagus, stomach, colon, liver, gallbladder, pancreas, adrenal glands and appendix. General surgery also entails surgical treatment of breast disease, thyroid and parathyroid disease, skin and soft tissue ailments, and hernias.

Surgery of the breast involves a wide variety of breast diseases, which can be divided into two groups: benign and malignant breast disease.

Benign breast disease includes evaluation of a variety of breast maladies such as breast pain, breast lumps, nipple discharge, breast infections and abscess, fibrocystic disease, and inflammatory lesions. Though a majority of breast lumps may be benign, the surgeon’s role is to evaluate and rule out the possibility of breast cancer or a pre malignant disease.

Breast cancer is a leading cause for death in women of all ages. The surgeon’s role in breast cancer diagnosis and treatment has become more prominent. Breast cancer screening tools, including mammography, ultrasound, MRI, and breast examination and biopsy, are all mastered by the adept breast surgeon. Specific surgical skills utilized by the surgeon include excisional biopsies, lumpectomies, mastectomies, lymph node dissections, and sentinel lymph node biopsies.

In early diagnosis of breast cancer the surgeon’s role is central in a multidisciplinary approach including primary care physicians, oncologists, and radiologists.

SurgOne physicians specializing in breast surgery are qualified in all aspects of benign and malignant diseases of the breast. These surgeons maintain excellent standing in the medical community to facilitate multidisciplinary and comprehensive care of the breast cancer patient.

Bariatric Surgery involves surgical treatment of the morbidly obese patient. Obesity is a serious problem that can contribute to medical conditions including diabetes, hypertension, coronary artery disease, congestive heart failure, arthritis, restrictive lung disease, sleep apnea, gastroesophageal reflux disease, depression, and infertility.

There are two main surgical options for the obese patient. The first is the adjustable gastric band. This procedure is commonly performed laparoscopicaly through small incisions.

The second surgical procedure is referred to as the Roux-en-y gastric bypass surgery. This is also commonly performed laparoscopically unless mitigating circumstances (i.e. previous surgeries, scar tissue, or abnormal anatomy) require an open, traditional incision.

The procedure involves dividing the stomach so that food travels into a small pouch of remnant stomach. A limb of small intestine is then connected to this pouch in order to bypass the main calorie absorption section of the bowel. The small pouch leads to a sensation of feeling full faster and the bypass leads to less calorie absorption; both contributing to weight loss. SurgOne physicians trained in bariatric surgery, skillfully carry out these surgical procedures, as well as other surgical options. These surgeons are trained also in the thorough evaluation of appropriate candidates, which entails nutrition management, mental health assessment, and evaluation of comorbid medical issues. As such, all bariatric surgeons in SurgOne, have been designated with Bariatric Centers of Excellence by the American Society of Bariatric Surgery. This designation recognizes surgical programs with a demonstrated track record of favorable outcomes in bariatric surgery.

Colon & Rectal Surgeons provide comprehensive surgical management of abdominal, rectal, anal and pelvic floor conditions. These services also include colonoscopy screening for colon and rectal polyps and cancer. The Colon and Rectal Surgeons of SurgOne collectively perform over three thousand of these examinations each year.

Surgical management of abdominal and rectal conditions include cancer of the colon and rectum, inflammatory bowel disease including ulcerative colitis and Crohn’s disease, diverticulitis, intestinal blockages, strictures, and colostomy related problems.

We provide comprehensive surgical and nonsurgical care of common anal conditions such as hemorrhoids, fissures, fistulas and infection. Our treatment options often provide for a painless experience. We incorporate both office treatment and modern surgical options including the PPH procedure, minimizing time away from work and normal activities.

Surgical approaches include advanced laparoscopic and robotic techniques. Colon & Rectal surgical expertise in the management of rectal cancer often results in preservation of normal bowel function without the need for a permanent colostomy. CRS management of ulcerative colitis includes reconstruction of the digestive tract to permit continued normal anorectal bowel function, through the use of the “J-pouch”.

In addition, transanal techniques often eliminate the need for more invasive abdominal approaches, resulting in superior function, less post-operative pain and quicker return to normal life. These approaches include the latest, advanced techniques including Transanal Endoscopic Microsurgery.

Colon and Rectal Surgeons provide comprehensive evaluation and treatment of a variety of pelvic floor problems including fecal incontinence and defecation difficulties. Integrated management includes surgical therapy, medical therapy, physical therapy, and dietary counseling.

Endocrine glands produce hormones that affect the function of other body organs or systems. While many organs in the body secrete hormones, the endocrine glands that frequently require surgery include the adrenal, pancreas, thyroid and parathyroid glands.

Endocrine surgery involves treatment of benign and malignant diseases of these organs. Endocrine surgeons are also trained in the evaluation and diagnosis of these varying diseases. This includes thyroid cancer, thyroid nodules and cysts, Grave’s disease, hyperparathyroidism, parathyroid cancer, benign and malignant adrenal masses, benign and malignant pancreatic masses, and pancreatitis along with its potential complications. Evaluation of these endocrine disorders involves a close working relationship with endocrinologists, radiologists, gastroenterologists, and oncologists in determining surgical candidates and maximizing successful patient care.

Surgical options are varied based on the organ involved but they often involve newer minimally invasive techniques. This allows for faster recovery, reduced postoperative pain, and better cosmetic outcomes.

Hepatobiliary surgery encompasses surgery of the liver, bile ducts, gallbladder, and pancreas. Hepatobiliary surgeons work in close conjunction with gastroenterologists, radiologists, and oncologists in evaluation and treatment of surgical maladies within this field. Surgical diseases of the gallbladder include gallstones (cholelithiasis), inflammation (cholecystitis), or gallbladder cancer. Pancreatic masses, benign or malignant, as well as chronic inflammation of the pancreas (pancreatitis) along with its varying complications all require surgical treatment. Bile duct surgery is required for cancer, injury, or strictures and often mandates resection or bypass of the affected segment. Liver surgery is performed for benign symptomatic or premalignant lesions as well as malignant tumors, which are either primary or metastatic in origin.

Hepatobiliary surgeonsare adept in varying techniques of treatment for the above-described diseases. Laparoscopy or minimally invasive surgery is commonly used for gallbladder surgery and has been more recently used in treatment of liver lesions. Previously, cancerous lesions of the liver were slated for resection of a portion of the liver. Newer techniques including chemoembolization and radiofrequency ablation have diversified the arsenal in treating such lesions allowing for sparing of liver function and tissue. Laparoscopy has played a significant role in advancing these newer modalities in liver surgery. Comprehensive care with radiologists ensures successful treatment plans and outcomes in these patients.

Hernia surgery involves repair of an abdominal wall muscle defect, or hole, through which tissues inside the abdomen may protrude. Hernias may occur because of a congenital weakness in this area or because of an induced injury to the abdominal wall musculature (i.e. lifting, straining, or previous surgical incision). They are most commonly seen in the groin and abdomen, presenting as a noticeable lump with associated discomfort. Less commonly, internal hernias can occur when congenital scar tissue or postoperative scar tissue leads to entrapment of internal organs or intestines.

The majority of hernia surgery is performed on an elective outpatient basis, allowing for rapid recovery and return to work. Occasionally hernia surgery can become urgent and life threatening if tissue trapped in the hernia becomes strangulated and gangrenous (dead). In these cases, surgical treatment is carried out on an emergent basis.

Laparoscopy or minimally invasive surgery allows general surgeons to provide surgical treatment of many intra-abdominal conditions through small incisions. This inturn minimizes pain and discomfort allowing for more rapid recovery and return to normal activities. The benefits of laparoscopy have been proven in many controlled studies since its inception. Laparoscopy first began gaining favor with treatment of gallbladder disease and general exploration of the abdomen. Soon after laparoscopic cholecystectomy (removal of the gallbladder) became standard of care; laparoscopy became favorable in other surgical situations. These include appendectomy, hiatal hernia repair, gastroesophageal reflux disease, inguinal hernia repair, incisional hernia repair, and bowel obstruction. Large organ operations can also be performed laparoscopically. This includes surgery of the colon, liver, spleen, adrenal glands, and kidneys. Laparoscopic surgery has demonstrated benefits in patient recovery across the board. Although it is not always possible in every situation, it has now become the first line of surgical treatment in the majority of surgical disease processes. SurgOne physicians are all trained in laparoscopy and its feasibility in the management of the surgical patient.

The daVinci robotic system has been around for 10 years in this country, but only in the last several years has utilization of this technology in complex surgeries seen a rapid increase. This device allows the surgeon to sit at a console and maneuver 4 robotic arms that hold various instruments or a 3D vision scope. This platform provides the surgeon much better vision and technical skill than standard laparoscopic technology, allowing for safer surgery and the ability to perform more complex cases laparoscopically.

Various general surgical cases can be done with the robot. The following list is representative, but not exhaustive.

Laparoscopic Cases: Nissen fundoplication, repair of paraesophageal hernia, esophageal and gastric resections, pancreatic and biliary cases, adrenalectomy, living donor kidney removal for kidney transplant, splenectomy, and several different kinds of colon operations. In addition, the daVinci platform has been used to perform thyroid and parathyroid surgeries through an armpit incision rather than a neck incision to provide superior cosmetic results.

Surgical oncology is a specialized area of oncology that engages surgeons in the cure and management of cancer. Cancer has become a medical specialty warranting its own surgical area because of advances in biology, pathophysiology, diagnostics, and staging of malignant tumors. The surgical oncologist functions within a multidisciplinary team as a coequal partner with medical oncologists and radiation oncologists. The overriding function of this team is to communally devise an optimal treatment plan for each individual patient prior to the application of therapeutic components.

The surgical oncologist is specialty trained in combining advanced surgical care with appropriate adjuncts including chemotherapy, radiotherapy, and ablative therapy, among many others. The surgical oncologist performs local tumor excision, regional lymph node removal, the handling of cancer recurrence (local or widespread), and in some cases, with surgical resection of metastases from the primary tumor.

Traumatic injury is one of the leading causes of death and disability in our country. Management of the trauma patient has become a critical specialty provided by general surgeons. Trauma surgeons are surgeons who have specific training and expertise in managing the initial evaluation and resuscitation of the trauma patient as well as the subsequent critical care management of these patients. Trauma general surgeons work in conjunction with other trauma specialists including emergency physicians, orthopedists, neurosurgeons, cardiothoracic surgeons, vascular surgeons, and plastic surgeons to evaluate and treat injuries expediently. Doing so avoids progression of injury and prevents complications while maximizing recovery and rehabilitation of the traumatized patient.

SurgOne physicians who are trained in trauma surgery maintain Advanced Trauma Life Support (ATLS)certification which designates knowledge and skill in the rapid assessment, resuscitation, and treatment of the traumatically injured patient.

SurgOne has several transplant surgeons that run the Centura Health Transplant Program, located at Porter Adventist Hospital. The program involves liver transplants, kidney transplants, and combined kidney/pancreas transplants. The program was instituted in 1986 and has grown overtime to become the premier transplant program in Colorado and the surrounding areas. Its success is based on a comprehensive care plan for all transplant patients, pre and post operatively. This includes physicians, surgeons, nurses, social workers, and financial coordinators all specialized in the care of the transplant patient.

The transplant surgeon’s role is evaluation of disease processes, which will determine eligibility of a transplant candidate. This evaluation is done in conjunction with other physicians including gastroenterologists, nephrologists, and endocrinologists. Transplant surgeons are not only trained in the intricacies of the surgeries themselves, but have thorough knowledge of systemic immunology, which allows for successful care of the post-transplant patient.

Liver transplantationis potentially applicable to any acute or chronic condition resulting in irreversible liver dysfunction, provided that the recipient does not have other conditions that will preclude a successful transplant. Most liver transplants are performed for chronic liver diseases that lead to irreversible scarring of the liver, or cirrhosis. The indication for kidney transplantation is end-stage renal disease regardless of the primary cause. Common diseases leading to ESRD include hypertension, infection, diabetes, and glomerulonephritis; genetic causes include polycystic kidney disease. Kidney/pancreas transplantation is performed for patients with ESRD secondary to Type 1 diabetes. The majority of renal transplant recipients are on some form of dialysis at the time of transplantation. In some cases, however, individuals with chronic renal failure, who have a living donor available, often elect to undergo transplantation before dialysis is needed. Kidney transplant surgery with live donors has become particularly successful with the advent of laparoscopic nephrectomy for kidney procurement. This has allowed for faster recovery of the donor patient, which consequently has increased the willingness and overall numbers of potential kidney donors. SurgOne transplant surgeons have maintained excellent outcomes through the Centura Health Transplant Program. Their multidisciplanary approach, skillful surgical technique, comprehensive care, and dedication have created a strong, successful program in the field of liver, kidney, and kidney/pancreas transplantation.

Vein surgery includes treatment of varicose veins and spider veins, which are commonly found in patients with underlying venous disorders. Often thought to be mainly cosmetic, vein surgery for venous disease is important in preventing serious health complications such as blood clots, ulceration, and spontaneous bleeding.

Minimally invasive techniques are used to treat these ailments. For varicose veins, endovenous laser ablation of the saphenous vein is performed under ultrasound guidance to collapse the damaged saphenous vein, which is the cause of the varicosities. This is often combined with ambulatory phlebectomy in which the varicose veins themselves are removed through tiny incisions under local anesthetic. Medical ultrasound-guided sclerotherapy can also be used to treat these varicose veins.

For spider veins (small, thin blood vessels visible beneath the skin), sclerotherapy or laser therapy is entertained. Sclerotherapy involves injecting a solution into the vein, which causes collapse and absorption of the vein. Laser therapy uses light energy to coagulate the blood in the abnormal vein, thereby destroying it. Patients usually require 3–5 treatments for best results. These varying treatment options are all performed in a minimally invasive, office based procedure with tremendous success and efficiency. Most insurance companies have a medical policy for the treatment of varicose veins and if the patient meets criteria, it is covered. However, the treatment of spider veins is considered cosmetic and is not covered by insurance.