Breast

Surgeons are often called upon to treat both benign and malignant conditions of the breast, both in women and men. Patients come to our office with many problems: pain, discharge, mammographic abnormalities, lumps, and infections. All of these various conditions are evaluated and treated. Many can be dealt with simply in the office. Others require surgical biopsies or other procedures. The treatment of breast cancer has changed radically since the mid 1970's. Breast conserving surgery is now the norm in most cases. Each patient is evaluated and a plan of diagnosis and treatment tailored to the individual. We are fortunate to have nearby expertise in radiation therapy and medical oncology, so our patients can be treated fully “under one roof.” We offer the newest developments in breast cancer diagnosis and treatment. 1. In-office ultrasound guided core needle biopsy (Vacora System) for rapid accurate diagnosis of breast lumps. 2. Sentinel lymph node biopsy, pioneered at Virtua by Dr. Butler, allows accurate evaluation of lymph node status with minimal incisions, thus sparing our patients needless extensive surgeries. 3. Partial breast irradiation (Mammosite balloon catheter) allows for more rapid completion of post-lumpectomy radiation therapy and spares normal breast tissue.

Vascular

Vascular surgery involves the care of patients with a broad spectrum of diseases of arteries and veins, focusing on the circulation to the brain, kidneys, gastrointestinal tract, and arms and legs. Athersclerosis (hardening of the arteries) commonly cause arteries to narrow and block, causing lack of circulation to the effected organs. This may lead to stroke, kidney failure, trouble walking, or even gangrene of a limb. The arteries can also enlarge into aneurysms, which are vulnerable to rupture. Sometimes the treatment is surgical and at other times medicine can be helpful. A thorough discussion with and examination of the patient will usually give the vascular surgeon a strong clue as to what the problem is. On occasion, further tests are necessary. Our Vascular Laboratory on site is often very helpful in establishing the diagnosis. Early recognition of vascular disease is always beneficial. The cutting edge of vascular surgery today involves the application of minimally invasive techniques to the treatment of aneurysms and varicose vein disorders. Our Regional Vein Center offers the latest endovenous laser treatments (EVLT) in our office without hospitalization.

Pacemakers

The need for a pacemaker is determined by a cardiologist. The pacemaker is a sophisticated device that monitors the function of the heart. If the heart beats too slowly the pacemaker will cause the heart to beat at a faster and more normal rate. Today's pacemakers will adjust their rates to adapt to various levels of activitiy. Pacemakers are inserted in the operating room under light sedation through minimal incisions.  Most people will be able to resume all normal activities in a short time. The pacemaker’s function is monitored at home monthly over the telephone. The pacemaker’s battery will last at least five years and can be replaced in a small out-patient procedure.

Thoracic Surgery

Thoracic Surgery involves the structures of the chest: the heart, lungs, pleura (coverings of the lungs), esophagus, and great vessels. Thomas A. Grabiak, MD, our Thoracic surgeon is often called upon to perform many different procedures, from open biopsy to laparoscopic assisted biopsies, to the resection of tumors, drainage of infections of the chest, and esophageal surgery.

All of the surgeons in Regional Surgical Associates are capable of placing chest tubes to remove fluid or to treat a collapsed lung (pneumothorax). Insertion of a chest tube is done at the bedside with sedation and is often the only treatment needed for some common thoracic problems.

Laparoscopic Surgery

Laparoscopic surgery is an expanding area of general surgery. Laparoscopic techniques were first developed and used by gynecologists for the diagnosis of pelvic problems and for tubal ligations. As the technology expanded and better cameras and instrumentation were developed, laparoscopic surgery blossomed.

The basic technique calls for the patient to undergo general anesthesia. The patient's abdomen is then insufflated with carbon dioxide to enhance visibility. Multiple small punctures are then made and small ports are placed through the abdominal wall that allow instruments to be placed into the abdominal cavity so that the appropriate procedure may be done.

Many laparoscopic procedures are done on an out-patient basis. This technique has increased our ability to treat patients in a very comfortable expedient manner and has simultaneously reduced the risks more often associated with open surgical procedures, specifically wound infection, incisional hernias, and intra-abdominal scar formation that may cause intestinal obstruction. Patients can return to daily living in a much more rapid fashion since their postoperative pain is reduced. Smaller incisions also result in less immunological stress on the body.

Regional Surgical Associates is proud to be able to offer their patients the option of using minimally invasive techniques to address many surgical problems. These include: Hernias of all types, ranging from hiatal to inguinal to ventral/incisional hernias; Gastroesophageal reflux disease (GERD); Gallbladder disease; Appendicitis; Splenic disorders; Colon disease; Small intestinal disorders, and many more.

Colon & Rectal Surgery

This branch of surgery involves disorders of the colon, rectum, and anus. Colon surgery often involves removal of portions of the colon for either benign or malignant diseases. We are specialists in these procedures and have made them more comfortable through the routine use of post-operative epidural catheters (similar to epidurals for childbirth). In addition, many of these operations can now be performed laparoscopically with minimal incisions.

Dr. Winter also specializes in proctology, that branch of surgery dealing with the rectum and anus. Rectal surgeries for common problems such as hemorrhoids, fissures, fistulas, or abscesses can usually be performed comfortably in the office or in our surgicenters under light sedation with supplemental local anesthesia. Return to full activity is swift. Dr. Winter also specializes in painless, non-operative treatments for bothersome or bleeding hemorrhoids. If surgery is necessary Dr. Winter is trained in the latest minimally invasive hemorrhoid stapling techniques (PPH Procedure), designed to speed healing in a comfortable manner.

We offer colonoscopy for cancer screening, diagnosis and removal of polyps, and the investigation of colon symptoms under comfortable intravenous anesthesia at Centennial Surgical Center in Voorhees. Dr. Winter has been safely performing these procedures for over 30 years.