OUR SPECIALTIES

Our Specialties

GVS offers a wide variety of services and an extensive array of the latest surgical techniques, including minimally invasive surgery to provide care for the many facets of general and vascular surgery. Our doctors will discuss with you the best options available for your care.

General Surgery

General Surgery is the branch of medicine that deals primarily with the diagnosis and surgical treatment of the abdominal organs. General Surgery also involves breast surgery, parathyroid and thyroid surgery. Following are some of the many types of procedures our physician perform.

Appendectomy

Appendectomy is the removal of the appendix. The appendix may become swollen and inflamed causing symptoms of abdominal pain, fever, nausea, and/or vomiting. In severe cases, the appendix may rupture. The appendix can be removed with an endoscope (also called laparoscopic) through a series of small incisions or through a small incision in a traditional or “open” method.

Breast Surgery

Breast surgery is a large category and encompasses many techniques to surgically treat benign (noncancerous) and malignant (cancerous) breast tissue. Available options include:

• Excisional biopsy: Another type of open biopsy, the entire lump is removed. This is usually performed on a smaller lump.
• Lumpectomy: Removes a lump with a small margin of healthy tissue surrounding it. Lumpectomy is often recommended in place of mastectomy for women whose cancers are small or localized. Lumpectomy may be performed with a sentinel node biopsy to determine whether cancer has spread to nearby lymph nodes.
• Axillary lymph node dissection: Examination of the lymph nodes in the axilla (arm pits) can determine whether cancer has spread beyond the breast to other parts of the body. This procedure may be performed at the same time as a breast biopsy or sentinel node biopsy, if the previous biopsy revealed positive results. It may also be performed during a mastectomy.
• Modified Radical Mastectomy: Involves the surgical removal of the breast, nipple, lining of the chest muscles, and some or all of the Axillary lymph nodes. Part of the chest wall muscle may also be removed.

Gallbladder Removal or Cholecystectomy

The gallbladder is a small organ that sits just below the liver and aids digestion. It also stores bile produced by the liver. Removal of the gallbladder may be recommended when you have symptoms such as nausea and vomiting (especially after eating fatty foods) and/or abdominal pain.

Laparoscopic cholecystectomy, most frequently performed, involves a series of small incisions that allow your surgeon to insert a laparoscope (a tiny camera) to visualize your internal anatomy. Instruments are inserted through the openings and the gallbladder is freed and removed through one of the incisions. Occasionally, for reasons related to patient care, an open procedure may be performed.

Hernia Repair

A hernia occurs when the lining of a cavity that normally contains body organs weakens, and a protrusion will occur. A bulge is often seen or felt in the area, most commonly in the abdominal wall, navel area (umbilical hernia) or groin (inguinal hernia or femoral hernia.) Hernias can also occur at previous surgical sites (incisional hernia.) Common symptoms include pain in the abdomen or groin, especially with heavy lifting, coughing, sneezing, or bowel movements.

Hernia repair places the protruding tissue back into place and repairs the weakened area, usually with mesh. Hernia repair can be performed either laparoscopically or in an open manner. Our doctors will discuss with the best treatment available to you.

Colon Resection

Colon resection (colectomy or partial colectomy) is performed to remove diseased or damaged portions of the colon, mostly commonly due to bowel obstruction, diverticultis, and colon cancer. Often, the healthy ends of the colon resection are rejoined directly (anastamosis) at the time of surgery. However, some patients need time for the colon to heal before the ends can be sewn together. In those cases, a colostomy is made, an opening of the colon through the skin. This is usually temporary.

Small Bowel Resection

Small bowel resection is performed to remove diseased or damaged portions of the small intestine, mostly commonly due to cancer, intestinal blockage, bleeding, infection, ulcers, or Crohn’s disease. Often, the healthy ends of the bowel are rejoined directly (anastamosis) at the time of surgery. However, some patients require additional time for the bowel to heal before the ends be sewn together. In those cases, an ostomy is created by forming a hole in the abdominal wall and attaching the healthy end of the intestine to it. A drainage bag is fitted around the opening to collect waste. The ostomy is usually temporary.

Gastric Resection

Gastric resection (gastrectomy or partial gastrectomy) is performed to remove a part of the stomach for cancer, benign tumors, perforations or ulcers. The stomach connects the esophagus to the small intestine. Depending on the reason for the operation, your surgeon may remove all (total gastrectomy) or part of the stomach (partial gastrectomy. If a total gastrectomy is performed, the esophagus will be connected directly to the small intestine. Dietary consultation may be necessary to understand changes necessary to help your body adapt to changes in the digestive process. Our doctors will discuss with the best treatment available to you.

Gastric Pacemaker

Some people suffer from chronic nausea and vomiting which may be a result of diabetes, gastroparesis, or other difficult to treat gastrointestinal disorders. A gastric pacemaker electrically stimulates the lower stomach nerves, encouraging the stomach to contract and can help to relieve nausea and vomiting. Our physicians are among a select few in the state of Arizona performing this procedure.

Hemorrhoid Surgery

Hemorrhoid surgery (or hemorrhoidectomy) is performed to surgically remove hemorrhoids. The incision(s) may be closed with sutures or left partially open to allow fluid to drain and help the healing process.

Pancreatic Resection

Pancreatic resection is performed to remove part or all of the pancreas, a gland located behind the stomach that helps digest food and regulate blood sugar. Pancreatic resection may be indicated for treatment of pancreatic cancer, chronic pancreatitis, pancreatic pseudocysts, or injury due to trauma. In the case of pancreatic cancer, the goal is to remove all traces of cancer while preserving as much of the pancreas as possible. In some cases, all of the pancreas must be removed as well as bile duct, the upper part of the small intestine, and part of the stomach. This is frequently referred to as a Whipple procedure.

Splenectomy

The spleen helps the body filter blood and fight infection. Removal of the spleen (splenectomy) may be necessary if there has been injury to the spleen, an abscess has formed on the spleen, enlargement of the spleen (splenomegaly), or for treatment of Idiopathic Thrombocytopenia (ITP, a disorder where platelets are destroyed by the spleen)

Thyroidectomy

The thyroid is a small gland located in the front of the neck and is responsible for regulating metabolism. When the thyroid function becomes abnormal due to thyroid cancer, a goiter, or hyperthyroidism, it may become necessary to remove the thyroid. The extent removal depends on the patient’s condition.

The thyroid is butterfly-shaped, consisting of two lobes connected by the isthmus. Partial thyroid lobectomy removes a part of a lobe. Thyroid lobectomy removes an entire lobe. Thyroid lobectomy with isthmusectomy removes an entire lobe as well as the isthmus. Subtotal thyroidectomy remove a lobe, the isthmus, and part of the other lobe. Total thyroidectomy removes both lobes as well as the isthmus.

Parathyroidectomy

Parathyroid glands are located in the neck, behind the thyroid gland. There are four glands which can vary from the size of a grain of rice to the size of a pea. The parathyroid glands are responsible for production of parathyroid hormone which control calcium levels in the blood. When the glands increase in size or activity, hyperparathyroidism occurs. Parathyroidectomy, removal or the abnormal gland(s), is the accepted treatment.

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Vascular Surgery

Vascular Surgery is the branch of medicine that addresses problems associated with the circulatory system. The circulatory system consists of the arterial system (Delivers oxygenated blood to the organs) and the venous system (carries blood away from the organs.) Common disorders include blocked arteries in the extremities, abdomen, and neck, aneurysms, endstage renal disease, and varicose veins.

Abdominal Aortic Aneurysm

An aneurysm is a portion of a blood vessel wall that is enlarged and weakened. The commonly form in the aorta, the body’s largest artery that runs from the heart down into the abdomen. Most people do not feel any symptoms while others may feel a pulsating feeling in the abdomen, deep pain in the abdomen or low back.

Your surgeon may recommend surgical repair of the aneurysm to prevent rupture of the aneurysm. Surgical repair of an abdominal aortic aneurysm is major procedure. It can be performed in a traditional manner. This involves opening the abdomen and replacing the weakened area with a fabric tube.

An alternative approach is the Endovascular Graft Repair and is performed by Dr. Hillmann. The endovascular stent graft repair allows a physician to implant a synthetic tube supported by metal into the aorta. The tube is threaded into the aorta using a catheter inserted through a small incision in the groin. The stent graft allows blood to flow through the aorta without putting pressure on the damaged wall of the aneurysm.

Carotid Endarterectomy

The carotid arteries carry oxygenated blood from the heart to the brain. Over time, plaque can build up in the arteries causing the arteries to become stiff and narrow. This blockage can prevent sufficient blood flow to the brain. If blood flow is blocked long enough, a stroke can occur.

Carotid endarterectomy is usually only done when the amount of partial blockage is severe enough to threaten stroke. No surgery is performed on a completely blocked artery.

Dialysis Access

Dialysis access is critical for patients whose kidneys have failed and must undergo hemodialysis. Dialysis access creates a portal into the bloodstream so the blood can be cleansed by dialysis. This access is generally created in the arm or neck, but may be created in the thigh.

A common type of access is a fistula, whereby your surgeon joins and an artery and a vein, typically in the forearm The vein must be large enough or the procedure will fail. Some patients are not good candidates for fistulas due to small vein size. Vein size may be determined pre-operatively with vein mapping.

If a fistula is not feasible or has failed, a dialysis graft may be offered. A graft connects an artery to a vein via synthetic conduit.

Peritoneal Dialysis Catheters (PD Catheters) are implanted in the abdomen and allow dialysis solutions to flow in and out of the body without the need for a new injection site before each session. PD Catheters also allow patients greater flexibility with dialysis sessions but come with unique needs.

Temporary dialysis may be performed using a catheter inserted into a large vein in the patient’s neck, chest, or groin.

Our doctors and your dialysis doctors will discuss with the best treatment available to you.

Chemotherapy Catheters

Patients requiring chemotherapy treatment often request a catheter or port to allow easier delivery of chemotherapy agents in to the blood stream. Chemotherapy catheters allow direct venous access and are inserted directly into a vein in a patient’s arm, neck or chest. Your oncology physician will discuss which style of access will best suit your needs.

Vascular Bypass

Vascular bypass is performed to improve blood flow in the legs by rerouting blood around the portion of an artery that is blocked or narrowed by plaque. Common terms for vascular disease are peripheral vascular disease (PVD), peripheral arterial disease (PAD), and atherosclerosis. These disease processes can result in claudication (pain with exercise), rest pain, and ulcerations on the legs and feet. These conditions are a result of plaque build-up in the arteries causing decreased circulation to the legs.

During vascular bypass, doctors make a new connection between arteries using a synthetic conduit (graft) or vein. Alternatives may also include angioplasty and/or stent. This allows blood to bypass the existing blockage, thus restoring circulation to tissue. Depending on testing results, your surgeons will discuss treatment options available. A cornerstone longterm success is lifestyle changes such as smoking cessation, regular exercise, and changes in diet.

Varicose Vein Treatment

Varicose veins are a result of venous insufficiency. Veins, unlike arteries, have one-way valves that channel oxygen- depleted blood back to the heart. If the valves don’t work properly, blood will not travel back toward the heart in a normal manner. The veins will be under pressure and become congested with blood.

There are several terms used to describe this condition: Varicose veins, venous insufficiency, valvular insufficiency, and reflux. Unlike spider veins which appear on the surface of the skin, varicose veins are located deeper. Valvular insufficiency is often hereditary and is more common in women than men. Hormonal fluctuations and pregnancy can exacerbate the condition, as can occupations or lifestyles that involve prolonged periods of standing. Once the valves no longer function properly, they cannot be fixed. However the symptoms caused by venous insufficiency are treatable.

Treatment options may include:

• Leg Elevation
• Compression Hose
• Endovenous Ablation: This procedure involves a thin catheter inserted into a small incision. The catheter is heated causing the vein wall to collapse and seal shut. This method eliminates pressure on the smaller surface veins, thus reducing recurrent varicose veins. It can be done as a supplemental procedure to a ligation and stripping. Only one leg can be treated at a time.
• Ligation and Stripping: This procedure involves the large veins and their branches (tributaries) being removed through small incisions. While this is a highly effective means of treating varicose veins, scarring may occur due to the number of required incisions.
• Sclerotherapy: This procedure is performed in our office. Your physician injects a chemical substance into the affected veins, causing the veins to harden (sclerose) from the inside out. The veins are no longer able to fill with blood and form a hardened cord. This procedure is most commonly performed for treatment of spider veins.

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