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Advanced Laparoscopic General Surgery

There is a wide variety of surgeries under the umbrella of General Surgery. The most common operations performed are Laparoscopic Cholecystectomies (Gallbladder Surgery), Laparoscopic Hernia repairs, and Laparoscopic Appendectomies for acute appendicitis. To learn more about the surgery team and techniques visit the                                 page. For elective procedures, the patient must see Dr. Mimms for a consult. Dr. Mimms welcomes referrals from other physicians. Often, however, patients will present to the emergency room with complaints that must be addressed immediately or within 24 hours. Dr. Mimms enjoys caring for patients in this setting. Moreover, there has been advancement in the field of General  Surgery, particularly with respect to how the Gallbladder is removed. Single Site Da Vinci Cholecystectomy and Da Vinci Nissen Fundoplication are the features of this page, but a list of common operations are also described below.

Single Site Da Vinci Cholecystectomy

Most people will not require surgery to remove the gallbladder (cholecystectomy); however, some people may develop abdominal pain under the rib cage on the right side or nausea after meals. These symptoms could represent gallbladder disease which may require surgery. If not cared for, the symptoms can progress to persistent abdominal pain, nausea, vomiting, and fevers, which may require urgent surgical intervention. Twenty years ago, the most common way to remove the gallbladder was through an incision under the rib cage on the right side. The advent of laparoscopic surgery revolutionized patient care and outcomes for gallbladder disease.  Having been trained in minimally invasive surgery, Dr. Mimms has experienced the wows of performing complicated laparoscopic surgeries on very difficult patients. A few of the principal limitations to laparoscopy are the 2D vision, loss of the wrist motion, and the torque on the abdominal wall. 

Dr. Mimms uses the da Vinci for its 3D HD vision and intuitive wristed instrumentation.  In addition to using a better technique,  we are now at the beginning of the next phase of improvement where we will use fewer incisions. Single incision laparoscopic surgery can be very cumbersome for the surgical team, but with the use of the da Vinci there is better triangulation of tissues, making dissection much easier and safer. As one of the first surgeons to perform this operation in Indiana, Dr. Mimms has advocated for other surgeons to join the wave of advanced technology and improved outcomes. Watch the YouTube video by da Vinci Surgery to gain a better understanding of this operation.

Da Vinci Nissen Fundoplication

The most common operation to fix GERD is called a a gastric fundoplication. To fix the hiatal hernia, the surgeon does a hiatal hernia repair. Since GERD is often associated with a hiatal hernia, both procedures are performed at the same time, and this is called a Nissen Fundoplication. To learn more about GERD, reflux, heartburn, and hiatal hernias, go to                   . This operation used to be performed with a long midline incision, but now it is commonly done laparoscopically. Dr. Mimms uses the da Vinci for its 3D HD visualization and intuitive wristed instrumentation. The operation remains the same as shown in the picture, but the da Vinci makes is better, safer, and easier for the surgeon. 
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Laparoscopic Appendectomy

This is one of the most common operations performed by a general surgeon. Patients may present at any time of the day with acute onset of abdominal pain in the right lower side, fever, and anorexia. Some patients have vague symptoms. The diagnosis may be confirmed with blood tests and a CT scan that takes images of the contents within the abdomen. Most patients will require antibiotics and urgent surgery, which is performed laparoscopically. Once the inflammed appendix is removed, the patient usually improves quickly. Some patients will present after the appendix has already bursted; and the treatment for this varies from intravenous antibiotics alone, intravenous antibiotics with placement of a drain, intravenous antibiotics and delayed surgery, or a more challenging laparoscopic appendectomy.

Laparoscopic Ventral Hernia  Repair
with Mesh

Ventral hernias are most commonly found at the midline either at the umbilicus (belly button) or along an old scar (previous incision). Symptoms may include a bulge or mass at the site of the hernia, pain or discomfort near the hernia, or pain on the inside of the abdomen. The mass may get larger, and the pain may become worse upon exertion. Lifting heavy objects, a chronic cough, or constipation could make the hernia worse. If untreated, the contents in the abdomen (i.e. small intestine, fat, and colon) could herniate through the defect on the abdominal wall, which could result in emergency surgery. The best method for repairing the hernia is laparoscopically with mesh.

Laparoscopic Lysis of Adhesions

All patients develop scar tissue after surgery. The organs initially become very sticky after surgery; so, they stick to adjacent structures. After the body heals, the organs either return to the normal smooth slippery surfaces or a film of tissue is created between the organs and the adjacent structures. This scar tissue is called an adhesion. Over time, adhesions may become less dense and may even dissipate. However, some patients create more adhesions than others; and, they may cause pain or blockage of the intestines (bowel obstruction). This may require urgent surgery to lyse (cut) the adhesion and free (unblock) the intestines. This may be done as an open operation, but it is commonly performed laparoscopically. 

Laparoscopic Inguinal Hernia Repair
with Mesh

Inguinal (groin) hernias are most common in men, but women can get them too. The symptoms may include a bulge or mass in the groin that may be associated with pain or discomfort. The mass may get larger, and the pain may become worse upon exertion. Lifting heavy objects, a chronic cough, or constipation could make the hernia worse. If untreated, the contents in the abdomen (i.e. small intestine, fat, and colon) could herniate through the defect in the groin, which could result in emergency surgery. The best method for repairing the hernia is laparoscopically with mesh. 

Laparoscopic Partial Colectomy

Colon cancer is one of the most common cancers among men and women, and it is one of the leading causes of death from cancer. It is imperative that all patients comply with screening tests for colon cancer because if it is caught early, it can be cured with surgery. The type of surgery that is required for colon cancer depends upon the location of the mass along the colon. Often, the cancer can be removed by removing a portion of the colon. This can be done laparoscopically or even with the da Vinci.

Diagnostic Laparoscopy

This operation is reserved for patients who present with severe abdominal pain or evidence of air that has escaped from within the stomach or intestine to the space outside of the organs, which usually does not have free air. At times, the site of injury can be identified with imaging studies like a CT scan, but sometimes the cause of the free air is unknown. This requires a surgery where the surgeon uses laparoscopy to explore the entire abdominal cavity for injuries. Once the injury has been identified it can be repaired. 

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