Dr. Gregory Bearden and
Dr. Stanley Hewlett offer expert and compassionate care covering a broad range of general surgery including- but not limited to:
- Breast Surgery
- Intestinal Surgery
- Colorectal Sugery
- Hernia Repair
- Gallbladder Surgery
- Wound Care
The surgeons of Princeton Surgical Specialists care for patients with a wide variety of problems and issues, but some may not be highlighted here- so please contact the office if you have questions about a service or procedure that isn’t listed below.
Robotic & Minimally Invasive Surgery
If you have gallbladder problems, your doctor may recommend a surgery consultation. The gallbladder is an organ you can live without, especially if it is causing problems. Gallbladder removal is known as a cholecystectomy. It can be performed through multiple small incisions (minimally invasive surgery using laparoscopy) which has advantages over ‘old fashioned’ open surgery. In 2012, the FDA approved the use of the Robotic Single-Site Surgery platform for cholecystectomy. This offers the same operation, but with only one small incision hidden in the natural scar of the navel (belly button), with a superior cosmetic result.
A Whipple procedure is a common treatment for pancreatic cancer. This complex procedure, known as a pancreaticoduodenectomy, at a minimum involves the removal of the head of the pancreas, the surrounding duodenum (first portion of the small intestine) as well the lower end of the bile duct. The bile duct, remaining pancreas and stomach are all carefully connected to the intestines. Traditionally this surgery requires a large Laparotomy incision. However, since 2009 Dr. Hewlett has matured the totally robotic technique that is not offered anywhere else in the region. Patients undergoing this procedure hope to achieve the goal of successful treatment of cancer while experiencing less pain and a quicker return to a normal life.
Surgery to remove all or part of the colon is known as a colectomy. We utilize robotics in surgery of the colon & rectum.
- Colon Cancer
- Rectal Cancer
Inflammatory Bowel Disease
(Ulcerative Colitis and Crohn’s)
Instead of a large abdominal incision used in open surgery, we can make a few small incisions – similar to traditional laparoscopy. The daVinci® robotic System features a magnified 3D high-definition vision system and special wristed instruments that bend and rotate far greater than the human wrist. As a result, robotics enable Dr. Hewlett to operate with enhanced vision, precision, dexterity and control.
Robotic Colectomy offers the following potential benefits:
- Precise removal of cancerous tissue
- Low blood loss
- Quick return of bowel function
- Quick return to a normal diet
- Low rate of complications
- Low conversion rate to open surgery
- Short hospital stay
- Better cosmetic result compared to open surgery
Laparoscopic gallbladder surgery (cholecystectomy) removes the gallbladder and gallstones through several small cuts (incisions) in the abdomen. The surgeon inflates your abdomen with air or carbon dioxide in order to see clearly.
The surgeon inserts a lighted scope attached to a video camera (laparoscope) into one incision near the belly button. The surgeon then uses a video monitor as a guide while inserting surgical instruments into the other incisions to remove your gallbladder.
Laparoscopic hernia repair is similar to other laparoscopic procedures. General anesthesia is given, and a small cut (incision) is made in or just below the navel. The abdomen is inflated with air so that the surgeon can see the abdominal organs.
A thin, lighted scope called a laparoscope is inserted through the incision. The instruments to repair the hernia are inserted through other small incisions in the lower abdomen. Mesh is then placed over the defect to reinforce the abdominal wall.
Minimally invasive or laparoscopic surgery involves using multiple trocars (thin tubes) placed through 3 to 5 small incisions. These incisions are usually less than 0.5 cm (less than ¼ inch). Carbon dioxide gas is then used to slowly inflate the abdomen. A thin telescope is placed through one of the trocars. This allows the surgical team to view the inside of the abdomen on a TV monitor.
Specialized instruments are placed through the other trocars to perform the operation. For colon surgery, one of the incisions is enlarged to remove the piece of colon. This larger incision can also be made initially, allowing one hand to be placed within the abdomen along with the camera and long instruments to assist with the operation. The procedure is performed under general anesthesia.
The patient will be completely asleep with the use of general anesthesia. A cannula (hollow tube) is placed into the abdomen by the surgeon, which is used to inflate the abdomen with carbon dioxide gas to create a space to operate. A laparoscope (a tiny telescope connected to a video camera) is put through one of the cannulas which projects a video picture of the internal organs and spleen on a television monitor.
Several cannulas are placed in different locations in the abdomen which allow the surgeon to place instruments inside the belly to work and remove the spleen. Since nearly 15% of all people have small, extra spleens, a thorough search will be done for any accessory (additional) spleens so that they may be removed as well.
After the spleen is surgically released from all that it is connected to, it is placed inside a special bag and removed from the abdomen. In special cases it may be desirable for the spleen to be broken up into small pieces (morcelated) within the special bag to limit the size of the extraction site incision.
Dr. Hewlett may recommend this nonsurgical treatment for tumors. This is a type of focused radiation therapy using special software and precise robotic technology to deliver therapeutic doses of radiation while sparing surrounding tissue as much as possible. This is typically used for patients who are not candidates for any form of surgery, and have very limited options.
It is estimated that over 200,000 Alabamians have this condition that is thought to be related to gastroesophageal reflux disease (GERD). Benign irritation and inflammation of the lining of the esophagus from acid and bile reflux can change to this precancerous problem. This is called ‘metaplasia’.
Further pre-cancerous changes that are identified on a biopsy are called ‘dysplasia’. But, up to 25% of people over age 50 who do not have heartburn can have this abnormal condition. Cancer of the esophagus is becoming more common, it’s prevalence has increased six-fold over the last four decades, while other cancers have a steady ratio of frequency.
Addressing Barrett’s esophagus before it becomes a cancer can have a major impact in preventing esophageal cancer. While most physicians caring for these patients are educated about Barrett’s, few do more than perform surveillance EGDs, and wait for progression to cancer.
Dr. Hewlett performs ablation therapy of Barrett’s esophagus, combined with directed medical and surgical therapy to stop the reflux injury. While continued surviellance is still necessary, this is the strategy that has the best chance of preventing cancer.
At Princeton Surgical Specialists Dr. Gregory Bearden specializes in providing women with comprehensive breast care. Women seek medical attention for a variety of breast complaints, including painful cysts, masses, abnormalities on a mammogram, and worries about risk of developing breast cancer. Using the latest technology and following the most appropriate guidelines, Dr. Bearden empowers patients to make informed decisions about their care.
Breast pain and most lumps represent benign conditions, but the fear of malignancy is always present. A quick and definitive diagnosis can usually be made during the initial office visit using a careful examination, ultrasound, and ultrasound guided intervention such as cyst aspiration and biopsy. Many, if not most, benign conditions can be managed non-operatively.
For women with a strong family history of breast cancer or other risk factors, the possibility of developing the disease can be very worrisome. Dr. Bearden offers a thorough Risk Assessment evaluation to all women seen in consultation for breast issues. Often women are simply provided with reassurance that they are actually not at increased risk. For others, risk reduction strategies including screening with a Breast MRI, chemoprevention with Tamoxifen, or Risk Reduction Billateral Mastectomy are discussed.
As part of a thorough history and physical exam, Dr. Bearden routinely performs a diagnostic breast ultrasound in the office at the time of the inital consultation. This allows further characterization of the lesion as either malignant or benign, and often an Ultrasound Guided Needle Biopsy can be performed at that time. After injecting a small amount of local anesthesia into the skin, a tiny incision is made and the ultrasound is used to watch the needle as it enters the questionable area. The entire procedure takes about five to ten minutes. Women whose lesions are clearly seen on ultrasound leave the office with sampled tissue sent to the pathologist for a definitive diagnosis.
Dr. Bearden often utilizes a Stereotactic Breast Biopsy technique for women who need a biopsy of a lesion not clearly seen on ultrasound. This procedure is performed in the breast care center. The lesion is localized with the mammogram, and after the lesion is visualized a small amount of local anesthesia is injected and the biopsy is performed through a small incision.
It takes several days for the results of a biopsy to be available. It is our practice to notify patients of the results by phone as soon as we receive the report. Regardless of the technique, there are three possible results after a needle biopsy of a breast lesion.
One possibility is that the area is clearly benign, or non-cancerous. If this is the outcome, a follow up mammogram is ordered for six months later, and then the patient can return to normal screening.
Another possibility is that the biopsy is equivocal. This may happen if the lesion is small, or if the appearance under the microscope isn’t entirely clear. In this case a second biopsy, operating through a larger incision and performed as an outpatient surgical procedure, may be required to make a definitive diagnosis.
Lastly, there is a possibility that the biopsied area is a breast cancer. In this case, the patient is notified and a follow up appointment is made with Dr. Bearden to discuss options for further treatment.
The myriad of treatment options for women with breast cancer can be confusing. Often women will have preconceived notions that they’ve picked up from friends or the media that may or may not be accurate. Dr. Bearden offers patients a rational approach to working through these options based on the National Comprehensive Cancer Network guidelines, current literature, recommendations from the American Society of Breast Surgeons, and a career’s worth of personal experience.
Women are given guidance when choosing between a Partial Mastectomy or a Complete Mastectomy. Partial Mastectomy, also known as Lumpectomy, involves removing the tumor and a surrounding rim of normal breast tissue while leaving the rest of the breast intact. For the right patients, this treatment- along with the addition of radiation therapy, can offer long term results similar to mastectomy, but with less surgery and superior cosmesis. Dr. Bearden also works closely with area plastic surgeons to offer Oncoplastic Partial Mastectomy in an effort to improve cosmesis without sacrificing the principles of cancer resection.
For women who undergo mastectomy, often a Nipple Sparing Mastectomy is a good option. This procedure involves removal of all the breast tissue through an incision, either on the side of or under the breast, while leaving all the skin and the nipple intact. A plastic surgeon provides immediate reconstruction, usually with an implant, and the cosmetic outcome can be excellent. Even women who are not candidates for a Nipple Sparing Mastectomy can usually be offered immediate reconstruction by a plastic surgeon at the time of their initial surgery.
All patients undergoing surgery for breast cancer routinely need a Sentinel Node Biopsy as part of their initial surgery. At the time of removal of the breast cancer, a small amount of dye is injected into the breast, and several lymph nodes are removed through a small incision under the arm. Only rarely do women need to have all the lymph nodes removed, a procedure traditionally referred to as axillary dissection. The Sentinel Node Biopsy provides important prognostic information and can be used to guide additional therapy.
As part of his commitment to providing comprehensive, high-quality care, Dr. Bearden meets weekly with medical oncologists, radiation oncologists, and other medical personnel at the Multidisciplinary Breast Cancer Conference to develop a coherent plan of treatment for each patient. At this conference, the whole range of treatment options, including surgery, radiation therapy, hormonal therapy, and chemotherapy are discussed, and a specific plan is tailor made for each woman diagnosed with breast cancer- based on her needs and desires.
Hyperparathyroidism is an excess of parathyroid hormone causing high levels of calcium in the blood. The great majority of time patients with this disorder have no symptoms and the disease is discovered on routine blood work. Enlargement of one the parathyroid glands in the neck is the usual cause and surgery is the most common treatment for primary hyperparathyroidism. Both Dr. Hewlett and Dr. Bearden are skilled at localizing and removing these over functioning glands through a small incision, usually resulting in a complete cure.
When needed, Dr. Hewlett and Dr. Bearden routinely use colonoscopy to directly examine the inner lining of a patient’s large intestine (rectum and colon). Using a thin, flexible tube called a colonoscope to look at the colon, colonoscopy helps find ulcers, colon polyps, tumors, and areas of inflammation or bleeding. During a colonoscopy, tissue samples can be collected (biopsy) and abnormal growths (polyps) can be removed. This procedure is usually performed safely and easily on an outpatient basis.
Colonoscopy is the best screening test to check for cancer or precancerous growths (polyps) in the colon. Generally, all individuals are advised to start routine screening at the age of 50. Specific recommendations for colonoscopy are based on a patient’s age, family history, and symptoms.
Esophagogastroduodenoscopy (EGD) is a test to examine the lining of the esophagus (the tube that connects your throat to your stomach), stomach, and first part of the small intestine. It is done with a small camera (flexible endoscope) that is inserted down the throat. Possible indications for an EGD include abdominal pain, reflux, heartburn and bleeding. The surgeons of Princeton Surgical Specialists often utilize an EGD as part of their complete and comprehensive evaluation of a patient’s symptoms.
Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that combines the use of endoscopy and fluoroscopy (X-Rays) to diagnose and treat certain problems of the biliary or pancreatic ductal systems. Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject radiographic contrast into the ducts in the biliary tree and pancreas so they can be seen on X-rays.
ERCP is used primarily to diagnose and treat conditions of the bile ducts and main pancreatic duct, including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer. ERCP can be performed for diagnostic and therapeutic reasons, although the development of safer and relatively non-invasive investigations such as magnetic resonance cholangiopancreatography (MRI/MRCP) and endoscopic ultrasound (EUS) has meant that ERCP is now typically performed with a therapeutic intent.
Questions about a procedure you didn’t see listed?