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Division of Minimally Invasive Surgery

Minimally invasive laparoscopic surgery is an approach to surgery that enables doctors to operate on patients without having to make large incisions. Doctors are able to accomplish traditional surgical goals while delivering less pain and blood loss, fewer complications and a faster recovery, which means happier patients. Patients typically spend less time in the hospital; and for many patients with chronic medical conditions and the elderly, this kind of surgery decreases their risk of developing complications. Minimally invasive surgery can also be used as a diagnostic tool for emergent causes of abdominal pain of unknown causes.

Ventral hernias often develop at the site of a previous surgical incision in the abdomen and are caused by the thinning or stretching of the abdominal wall, resulting in a bulge or tear of the muscle. One in three large incisions in the abdominal will result in a hernia during the lifetime of a patient. Left untreated, these hernias can cause inflammation, obstruction or strangulation of the intestine. The belly button is another common place for ventral hernias to develop.

Using a minimally invasive surgery approach to repairing these hernias eliminates the need for another large incision, reducing the chances of the condition reappearing. Additionally, patients often have less post-operative pain, a shortened hospital stay (most patients are discharged on the day of surgery), and a faster return to a regular diet and normal activity.

Inguinal, Femoral and Umbilical Hernias

Inguinal hernias are the most common type of hernia and occur when soft tissue—usually part of the intestine—protrudes through a weak point or tear in the lower abdominal wall and almost always occur spontaneously. The resulting bulge of this common condition can be painful, especially when coughing, bending over or lifting a heavy object. Although far more men than women have inguinal hernias, no one is immune—including infants, pregnant women and older adults.

In many people, the abdominal wall weakness can be present from birth; however, many inguinal hernias develop later in life when muscles weaken or deteriorate due to factors such as aging, strenuous physical activity or coughing that accompanies smoking. In women, inguinal hernias may be associated with pregnancy.

Not necessarily dangerous in themselves, inguinal hernias can lead to life-threatening complications—including incarceration and strangulation of the intestine—and surgery may be required to repair a hernia that's painful or becoming larger.

Femoral hernias are more common in women, usually in the elderly and frail (although they can happen in children). In a femoral hernia, a bulge is usually present in the upper part of the thigh, just below the groin and may or may not be painful.

An umbilical hernia, another spontaneous hernia, occurs when part of the intestine protrudes through a weak spot in the abdominal muscles. Umbilical hernias are most common in infants, but they can affect adults as well. Most umbilical hernias close on their own by age 2. To prevent complications, umbilical hernias that don't disappear by age 4 or 5 or those that appear during adulthood should usually be repaired surgically.

The good news is that the operations to repair these hernias no longer require a large abdominal incision, a lengthy hospital stay or weeks of immobility. Instead, many inguinal, femoral and umbilical hernias now can be successfully repaired with minimally invasive surgery techniques that use several small incisions, leading to a faster, less painful recovery.

Flank Hernias:

Hiatal and Paraesophageal Hernias
Giant hiatal and paraesophageal hernias are where the stomach bulges up into the chest through an opening in the diaphragm and are increasingly becoming a common diagnosis in the elderly population.

Depending on the size of theses types of hernias, complications can occur including incarceration, where the hernia gets stuck and twists, resulting in an inability to swallow solid foods, regurgitation of food into the mouth, and even chest pain. The worst result of the twsiting is strangulation of the stomach, causing a lack of blood supply that leads to tissue death in the stomach and poses a life-threatening emergency.

With the use of a minimally invasive laparoscopic surgical approach, surgeons are able to repair the hernia through several small holes in the patient’s abdomen. The advantage of this surgical option is small incisions, which in turn means less risk of infection, less pain and scarring, resulting in a faster recovery time. The safety provided by minimally invasive laparoscopic surgery also allows surgeons to recommend surgery to the aging baby boomer generation and to those who are in their 80s and 90s prior to the disease resulting in an emergency.

Other hernia repair procedures include those for diaphragmatic, bilateral, giant and recurrent hernias.

Colon Resection
Each year more than 600,000 surgical procedures for colon diseases are performed in the United States. Today, many colon surgeries can be done using a laparoscopic surgery approach. The vast majority of surgeries performed are for cancer, diverticulitis, Crohn’s disease and colitis.

Dr. Geis was one of the first surgeons to perform a colon resection using a minimally invasive laparoscopic surgical approach in the United States in 1990.

In most laparoscopic colon resections, surgeons repair and/or remove portions of a patient’s colon through small openings in the abdomen while watching an enlarged image of the patient's internal organs on a television monitor. Depending on the length and complexity of the procedure, patients most often leave the hospital in a few days and return to normal activities more quickly than patients recovering from open surgery.

Ileostomy/Colostomy and Closure of Ileostomy/Colostomy
Minimally invasive laparoscopic surgery is also being using in fecal diversion with the creation of an ileostomy, an opening between the surface of the skin and the small intestine, and a colostomy, an opening between the surface of the skin and the colon.  Fecal diversions are often used to treat complex rectal or anal problems and poor control of bowels (incontinence). If a patient has had an ileostomy or colostomy, minimally invasive surgery may be used to easily reverse and close the ileostomy or colostomy with a very short hospitalization.

Other common gastrointestinal procedures performed using a minimally invasive surgical technique are small bowel resection, appendectomy/cecectomy and various procedures on the stomach, among many others.

Other minimally invasive laparoscopic surgery procedures include:

Laparoscopic Exploration as a Diagnostic and Therapeutic Tool

Elective or semi-elective surgeries: 
• Tumor diagnosis
• Staging of disease
• Biopsy diagnosis

Emergency Procedures

• Abscess
• Bowel obstruction
• Incarcerated hernia
• Appendicitis/perforated appendicitis
• Perforated viscus/perforated ulcer
• Peritonitis
• Bleeding from stomach, intestine or rectum

Solid Organ

• Splenectomy
• Adrenalectomy
• Nephrectomy

Special New Procedures

• Micro-incision laparoscopic cholecystectomy and hernia repair
• Combined procedures
• Removal of large polyp-tumors from the colon or stomach

Gynecologic Laparoscopic Procedures

• Total laparoscopic hysterectomy
• Supracervical laparoscopic hysterectomy
• Laparoscopic removal of ovarian cysts
• Laparoscopic paravaginal repair of cystocele
• Laparoscopic treatment of pelvic pain/endometriosis

For more information on minimally invasive hysterectomy procedures, click here .

In addition to his groundbreaking work in minimally invasive surgery, Dr. Geis is also the director of the Laparoscopic Fellowship Program, the first of its kind at Northwest Hospital. The program enables residents and experienced surgeons, unfamiliar with laparoscopic techniques, to work side by side with Dr. Geis to gain exposure and experience in the field of minimally invasive surgery.

For more information about the Division of Minimally Invasive Laparoscopic Surgery at Northwest Hospital, call 410-601-WELL.

 

 

 

 

 

 

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Division Head
W. Peter Geis, M.D. Northwest Hospital 5401 Old Court Road Randallstown, MD 21133 410-552-4202
Associate Director
David L. Zisow, M.D. 750 Reisterstown Road Clinical Associates Building Suite 301 Reisterstown, MD 21136 410-879-1139
Physicians
Robert S. Baxt, M.D. 750 Main Street Suite 301 Reisterstown, MD 21136 410-526-3051	Howard K. Berg, M.D. 25 Crossroads Drive Suite 312 Owings Mills, MD 21117 410-363-6664
Alan S. Davis, M.D.  Chief of Surgery - Northwest Hospital 21 Crossroads Drive Suite 360 Owings Mills, MD 21117 410-356-0410	Jayant B. Desai, M.D.   716 Maiden Choice Lane Suite 302 Catonsville, MD 21228 410-788-8264
Richard P. Franklin, M.D. 21 Crossroads Drive Suite 360 Owings Mills, MD 21117 410-356-0410	Gary Hamamoto, M.D. 23 Crossroads Drive Suite 240 Owings Mills, MD 21117 410-581-0700
Efem E. Imoke, M.D.   4713 Leeds Avenue Baltimore, MD 21227 410-247-4740	Brian M. Levin, M.D. 21 Crossroad Drive Suite 450 Owings Mills, MD 21117 (410) 581-1600
Eugene Meyer, M.D.   4000 Old Court Road Suite 300 Pikesville, MD 21208 (410) 517-1050	Justin C. Somerville, M.D. 25 Crossroads Drive Suite 312 Owings Mills, MD 21117 (410) 363-6664
Chanarong Suphavejkornkij, M.D. 282 E. Padonia Road Timonium, MD 21093 410-561-8333

 

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The Division of Minimally Invasive Laparoscopic Surgery at Northwest Hospital is led by Peter Geis, M.D., one of the founders of laparoscopic surgery in the United States and one of the leading laparoscopic surgeons in the country. He has conducted extensive research and written numerous articles on minimally invasive surgical techniques.

Below is a list of some of the most common procedures performed with minimally invasive surgery that Dr. Geis has helped pioneer:

Ventral/Incisional Hernias