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PATIENT INFORMATION

The surgeons at University Surgeons Associates are committed to providing minimally invasive solutions to your surgical problems.

We have been leaders in minimally invasive surgery in East Tennessee for decades. The first laparoscopic gall bladder surgery in the area was done by our surgeons. Since then the laparoscopic surgeries for gastroesophageal reflux, hernias, solid organ removal and now bariatric procedures have been introduced and are common place. The physicians of University Surgeons Associates have sponsored and directed courses for practicing surgeons in:

• Laparoscopic Biliary Surgery
• Thoracoscopic Surgery
• Advanced General Laparoscopic Surgery
• Advanced Upper Gastrointestinal Laparoscopic Surgery
• Laparoscopic Anti-Reflux Surgery with Vagotomy
• Laparoscopic Nissen Fundoplication
• Laparoscopic Solid Organ Surgery

WHAT ARE THE ADVANTAGES OF LAPAROSCOPIC SURGERY?

In the past, making incisions in the abdomen, flank, or back was necessary for open surgical procedures. Today, with the technique known as minimally invasive surgery, many previously open surgical procedures can be performed laparoscopically through small 1/4-1/2 inch incisions or now even through a single incision site. Patients may leave the hospital sooner and return to work more quickly than patients recovering from open surgery.

Results of surgery may vary depending on the type of procedure and the patients’ overall condition. Common advantages are:

• Less postoperative pain
• Shorter hospital stay
• Quicker return to normal activity
• Improved cosmetic result
• Reduced risk of herniation or wound separation

IS MINIMALLY INVASIVE SURGERY RIGHT FOR YOU?

Although minimally invasive surgery has many benefits, it may not be appropriate for some patients. Obtain a thorough medical evaluation by one of our surgeons and in consultation with your primary care physician find out if the technique is appropriate for you.

Da Vinci® robotic assisted surgery is a new technique that allows for more precision in minimally invasive procedures. Regular minimally invasive procedures are done laparoscopically, where a surgeon makes one or a few small incisions and inserts miniature instruments as well as a video camera through the incisions. The camera will transmit an image of the internal organs, and the surgeon will use the images to perform the surgery manually. With Da Vinci® robotic assisted surgery, a surgeon will sit at a console in the operating room and use controls to move tiny instruments attached to robotic arms. A camera is inserted at the sight of the incision and transmits a 3D image of the site. The surgeon operates based on the 3D imagery, and the robot translates the surgeon's movements with exact precision. The robot has extensive checks so that it is completely unable to be programmed to perform a certain task or operate in any way on its own. Robotic assisted surgical technology allows surgeons to perform increasingly advanced procedures in a minimally invasive fashion. Without this technology, most advanced operations are often done open, which results in more scarring, a longer hospital stay, increased risk of infection, and a longer recovery for the patient. As this technology improves it enables more efficiency in the medical field, and benefits both the patients and their providers.

The breast surgeons at University Surgeons Associates provide surgical expertise to women with breast problems, including breast cancer. They participate weekly in a multidisciplinary breast conference that reviews breast imaging and biopsies with the radiologists and pathologists. In situations when a breast cancer is found, a treatment plan is developed in conjunction with medical and radiation oncologists. This reassures the patient that they are receiving expert advice and opinions that are tailored to their needs. The breast surgeons at University Surgeons Associates have frequent experience with sentinel node biopsy, partial mastectomy and other less invasive techniques to reduce pain and get patients back to their regular activities sooner.

BREAST CANCER SYMPTOMS AND WARNING SIGNS

• Breast lump or mass
• Enlarged lymph nodes (lumps) in the armpit(s)
• Nipple symptoms: bleeding, discharge, retraction, elevation, eczema
• Skin symptoms: dimpling, redness, edema (swelling), ulceration

RISK FACTORS FOR BREAST CANCER

• Age over 60
• Personal history of breast cancer in one breast
• Family history of breast cancer (mother, sister, daughter and/or any male relative)
• Certain genome changes such as BRCA1 or BRCA2
• Radiation therapy to the chest before age 30
• Women who have never had children
• Women who had their first child after age 30
• Women who have never breast fed
• Women whose first menstruation came at an early age (12 years old or younger)
• Women who reached menopause late
• Race: white women greater risk than in Black, Hispanic, Asian or American Indian
• Increased breast density
• History of taking DES
• Women more than 40 percent of their ideal weight
• Lack of physical activity
• Drinking alcohol

Endocrine Surgery Overview

Our surgeons are experienced in minimally invasive radioguideed parathyroidectomy (MIRP), endoscopic assisted thyroid surgery, intraoperative PTH monitoring and vocal cord nerve monitoring during endocrine surgery.  We have expertise in all thyroid diseases including thyroid cancer.  

University Surgeons Associates work closely with patients and their endocrinologist to provide the most advantageous care to those with endocrine disorders.    With surgeons who specialize in endocrine surgery, we are leaders in implementing the newer technologies in endocrine surgery.  

WHAT IS THE ENDOCRINE SYSTEM?

The endocrine system is made up of glands throughout the body that regulate the function, growth and development of almost every cell, tissue and organ in the body.  It does this through the secretion of hormones directly into the bloodstream.

The Thyroid gland is a small, butterfly-shaped gland located at the base of your neck which regulates the body’s metabolism.   Thyroid dysfunction happens when the thyroid gland produces too much or too little thyroid hormone. 

• Hypothyroidism, or under activity of the thyroid gland, occurs when the thyroid gland produces too little thyroid hormone. 
• Hyperthyroidism occurs when too much thyroid hormone is produced.  

The Parathyroid glands, located behind the thyroid secrete parathyroid hormone.  These glands control calcium levels throughout the body.     

The Adrenal glands are located above of each kidney.  Their functions include:  maintaining salt levels in the blood, maintaining blood pressure, controlling kidney function, and controlling fluid concentrations in the body. 

If you've struggled with obesity
most of your life...

...you know it is more than just a weight problem. It is a lifestyle problem. It is a self-esteem problem. Above all, it is a major health problem. In fact, clinically severe obesity—at least 100 pounds over ideal body weight—is classified as a serious disease.

University Surgeons Associates works with the The University Bariatric Center at the University of Tennessee Medical Center to provide a comprehensive approach to the bariatric surgery process. Its multidisciplinary team of consultants made up of surgeons, dietitians, exercise specialists and administrative staff will partner with you to provide a weight-loss program that addresses your individual needs and helps you maintain your weight loss.

WHAT MAKES A HERNIA CENTER?

A Hernia Center is a special surgery unit focused on the innovative treatment of the broad spectrum of hernia disease.  Most people think of a hernia as a small medical inconvenience, but hernia disease ranges from small and simple to very complex, difficult, and even recurrent. Hernias can happen from physical wear and tear, related to a prior abdominal surgery, and even return after a prior hernia repair. Also there can be life altering complications when a hernia surgery does not go well.  Our Hernia Center is designed to provide the most innovative hernia care in the world by focusing on four core principles:

• Create a partnership with the patient through education and preoperative optimization
• Provide world class surgical expertise by our fellowship trained hernia surgeons
   
• Utilized the safest and most innovated hernia mesh materials for patients
   
• Ensure the highest quality of care by tracking patient outcomes

The Hernia Center focuses on solving patient problems from hernia or hernia related complications.  We provide unique hernia care services not available elsewhere, that further demonstrate our commitment out patients and community. This includes:

• Abdominal Wall Reconstruction for large complex abdominal hernia
   
• Sports Hernia evaluation and management
   
• Chronic groin pain management after inguinal hernia surgery
   
• Mesh complication treatment after prior hernia repair

The surgeons at University Surgeons Associates perform surgical procedures through endoscopic and combined laparoendoscopic techniques.  This includes removal of tumors, foreign bodies and stones as well as treating sites of bleeding, obstruction and infection.  These types of procedures can be the definitive treatment for some patients and therefore avoid a more invasive procedure.  For others these procedures may be diagnostic or used in preparation for a later procedure.  There are some situations where the patient may be so ill that such surgical interventions may be palliative or used to allow the patient to stabilize or gain strength before undergoing more invasive surgery.  University Surgeons Associates are committed to developing and implementing the latest techniques and technologies as they become proven and available.

General Surgery Overview

The surgeons at University Surgeons Associates are all fully trained and board certified by the American Board of Surgery in the management of all aspects of General Surgery.  As full time faculty members of the Department of Surgery and Division of General Surgery at the University of Tennessee Medical Center at Knoxville we are constantly enhancing and maintaining our medical knowledge and surgical skills.  We are involved daily in teaching students, residents, nurses and practicing physicians the most up to date information and techniques.

The University of Tennessee Medical Center is the regions’ premier medical teaching institution and tertiary referral center and as such treats a wide variety of routine as well as complicated and unusual surgical conditions.  It has the largest selection of comprehensive services at any location in the East Tennessee region.  There are numerous medical and surgical specialist and subspecialist available to us when needed to help with your care.  We have access to research programs that provide our patients with the latest advances in treatments and diagnostics.  

The physicians and staff of University Surgeons Associates. are committed to working with all patients, institutions and communities in east Tennessee for the purpose of providing the highest quality surgical care, with the sole intent of improving the health status and well being of all served.

Our surgeons will work with you to diagnose, manage and if necessary operate on your general surgical condition.  We will co-ordinate with your primary care professional and specialty consultants in determining the need for and timing of surgical intervention.  If your condition requires surgery the following are general guidelines.

WHAT PREPARATION IS REQUIRED?

• Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on your age and medical condition.
• After your surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.
• Blood transfusion and/or blood products may be needed depending on your condition.
• It is recommended that you shower with an antibacterial soap the night before or morning of the operation.
• After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon and/or anesthesiologist tells you to take with a sip of water the morning of surgery.
• Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and large doses of Vitamin E will need to be stopped temporarily for several days to a week prior to surgery.
• Diet medication or St. John’s Wort should not be used for the two weeks prior to surgery.
• Quit smoking and arrange for any help you may need at home.

HOW IS SURGERY PERFORMED?

For elective surgery, you will most likely be asked to check into the hospital the morning of your surgery.

• Surgery may be performed under a general or local anesthesia.  The length of time it takes varies depending on the procedure and your condition.
• Most procedures require one or more incisions to allow access for the surgeon to accomplish the procedure.
• After the surgeon accomplishes the procedure, the incision or incisions are closed.

WHAT SHOULD I EXPECT AFTER SURGERY?

Our goal is for your surgery and recovery to be as comfortable and convenient as possible.  You may experience temporary pain and swelling at the excision site.

• Most Patients are able to engage in light activity while at home after surgery. Check with your surgeon to see when you can remove any dressings and shower.
• Post-operative pain is usually generally mild and patients may require a pain pill or pain medication.
• Most patients can resume normal activities shortly after surgery, including driving, walking up stairs, light lifting, and work.  Do not drive if you are taking narcotic pain medications. 
• You should call and schedule a follow-up appointment within 2 weeks after your operation.

WHAT COMPLICATIONS CAN OCCUR?

Surgery is generally considered extremely safe.  The degree of risk is dependant on the procedure and your condition.  As with any operation, there is a risk of a complication. Complications during the operation may include:

• Bleeding or hematoma
• Rarely infection of the wound
• Skin wound separation
• Infection or sepsis
• Adverse reaction to general anesthesia

WHEN TO CALL YOUR DOCTOR

Be sure to call your physician or surgeon if you develop any of the following symptoms after surgery:

• Persistent fever over 101 degrees F (39 C)
• Chills
• Bleeding
• Pain that is not relieved by your medications
• Persistent nausea or vomiting
• You are unable to eat or drink liquids
• Persistent cough or shortness of breath
• Purulent drainage (pus) from the incision
• Redness surrounding the incision that is worsening or getting bigger

 Check with your surgeon regarding any special information and/or instructions for your particular procedure and/or conditions.

The Surgical Health Optimization Center was developed to help patients properly prepare for their upcoming surgery. Our goal is to improve each patient’s health in order to decrease their risk of complications during and after surgery. The best results for your surgery may require you to address health issues that increase your risk of complications. Smoking, nutrition, obesity and diabetes are some conditions that increase those risks.

Patients identified as “high risk” based on their underlying physical status and co-existing medical conditions account for more than 30% of ICU admissions, 70% of post-operative deaths and 90% of the care provided during hospitalization. Health optimization prior to surgery has been shown to help reduce hospital length of stay, hospital acquired conditions, and readmission rates; translating into better quality care and higher patient satisfaction.

PATIENT PARTNERSHIP FOR SURGERY

Our health optimization team of Advanced Practice Providers and Health Educators develop a preoperative risk assessment that customizes the care plan for each patient. In some cases, medications may be used to optimize your health and reduce your risk prior to your upcoming surgery. Education and individualized coaching are provided at each visit. Support groups may also be effective to assist you in reaching your health goals.

COMMUNICATION WITH YOUR PHYSICIAN

Your health optimization team will be in communication with your referring physician after each visit. Updates about your progress towards health improvement will he shared and celebrated. The health optimization program will be tailored for your specific surgery, preoperative goals and current health status.

LONG-TERM FOLLOW-UP

We provide long term follow up care for those patients who need continued accountability, lifestyle intervention and behavior modification. We are committed to helping our patients achieve long term success to help prevent future health problems. We may follow our patients for years to ensure adequate support. Each treatment plan is tailored to meet our patients’ unique needs.