General Surgery

Front row: Laura Foote, Robin Engelking, Jennifer Laube, Julie Martin, Krystle Roberts

Back row: Joyce Schimmels, Paula Yount, Carmen Mundt, ARNP, Brian Gerrelts, MD, FACS, Paul Burgett, MD, FACS, Scott Houghton, MD, Jayson Gesme, MD, FACS, Debbie Schoephoerster

In today’s world of constantly changing technology and specialization, the need for general surgeons is still very important.

Drs. Brian Gerrelts, Paul Burgett, Jayson Gesme and Scott Houghton are Cedar Valley Medical Specialists (CVMS)’ four general surgeons in the General Surgery Department. They recently have been joined by Carmen Mundt, an experienced surgical nurse who is now an ARNP and who will assist with daily tasks.

In the past 10 years, statistics show that of the roughly 1,050 surgeons who finish their training every year in the United States, more than one-half of them enter into subspecialties. Combining this with the retirements of older surgeons and a growing U.S. population means that every year, there are more patients for each general surgeon to cover.

The field of general surgery has changed over the years. General surgeons once performed almost every kind of surgery, with the exception of specialties such as heart or brain surgery. Over the past 40 to 50 years, with increasing subspecialization and advancing technology, general surgery has slowly evolved into a specialty itself.

Although general surgeons still operate on a wide variety of body ailments and diseases, U.S. general surgeons now concentrate on a few main areas — abdominal surgery, hernia repair, trauma surgery, skin and soft tissue problems and endoscopy. Management of surgical diseases of the breast used to be done only by general surgeons, but it is becoming a specialty of its own. Two of CVMS’ surgeons maintain training and certification in breast surgery — Dr. Gesme and Dr. Douglas Duven, whose practice is entirely devoted to breast care.

The biggest change in surgery recently is the trend toward making incisions smaller, or “minimally invasive surgery.” This revolution can be traced back to the development of the laparoscopic cholecystectomy (removal of the gallbladder) in the 1980s.

The benefits of minimally invasive surgery include less pain, shorter- or-no hospital stays, reduced risk of complications, earlier return to functional status, and better outcomes. Many operations now are routinely done laparoscopically, including cholecystectomy, appendectomy, hernia repairs, weight-loss surgery and many bowel resections. All of CVMS’ general surgeons perform routine and advanced laparoscopic surgery.

The newest development in general surgery is robotic surgery. Just as with laparoscopic surgery, several “ports”, or small plastic tubes, are placed by the surgeon into the abdominal cavity through which a camera and instruments are placed. Then, instead of the surgeon manipulating the instruments with his hands as in traditional laparoscopy, the instruments and camera are connected to arms on the robot. The surgeon then sits at a console and is able to control the camera and the instruments with his hands and feet.

The advantages of this include better visualization and better control of the instruments. The view at the console is in 3D, as opposed to two-dimensional (like your TV) with traditional laparoscopy. The control of the instruments also is multidimensional, as the surgeon is able to perform “wristed,” or articulated, movements inside the abdominal cavity.

Robotic surgery has proven applications such as in prostatectomy and some gynecologic surgery and is now proving itself more useful in other procedures such as colon resections and some hernia repairs. It is likely that robotic surgery will become more of a routine part of general surgery in the future. Robotic surgery is offered by Drs. Gerrelts and Gesme in the appropriate situations.

While minimally invasive surgery offers many advantages, and new applications are always being developed, there still are times when surgery has to be or is best done with a traditional incision. This is often because of the urgent nature of some surgeries, anatomical constraints, or when laparoscopies cannot be performed safely. Fortunately, all of CVMS’ general surgeons are well-trained, experienced with minimally invasive surgery, and also have years of experience, making them comfortable with open surgeries when necessary.

Why do doctors become general surgeons? Drs. Gerrelts, Burgett, Gesme and Houghton echo the answer you might get from most of their colleagues.

“The beauty of our job is the spectrum of surgery that we perform, from removal of a little skin cancer in the office, to the straightforward cholecystectomy or appendectomy, to the six-hour-long repair of a complex abdominal wall hernia,” says one. “We get to correct a problem, small or large, and get the patient back on the path to wellness.”

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