Turnquest Surgical Solutions specializes in general surgery, laparoscopic oncology and weight loss surgical procedures, as well as revisions of weight loss surgery. Our robotic procedures reduce pain and recovery time for our patients.
Turnquest Surgical Solutions offers patients robotic surgery to treat uterine tumors and fibroids, prostate and other cancers, as well as obesity and many common conditions.
Our specially trained physicians and medical staff offer this advanced, minimally invasive option to improve surgical outcomes, reduce recovery time and improve overall standard of care.
We take pride to be among the first in northwest Houston to offer robotic surgery and provide patients with a less invasive surgical option.
Robotic technology provides our surgeon with a magnified, three-dimensional view, which permits optimal viewing of delicate organs and tissue and precise maneuvering in the operating filed. Fine instruments controlled by physicians from the state–of–the–art robotic platform provide pinpoint accuracy and create much smaller incisions and less obtrusive presence for some of the most complex and delicate procedures.
General Surgery Procedures
- Access for hemodialysis or peritoneal dialysis
- Adrenalectomy (removal of adrenal glands)
What are adrenal glands?
The adrenal glands are small, darkly colored organs found in the area near the top of each kidney. These glands are hormone machines, which affects many other systems in the body. This includes body fluid and salt regulation, adrenalin (or epinephrine), blood pressure, muscle development, sexual drive, and sugar metabolism.
Diagnosis of adrenalectomy
The diagnostic testing required for adrenal conditions is complex, and is dependent on the type of tumor. Often a complete endocrine work-up will help determine whether the adrenal gland is acting alone, or indicate if a pituitary tumor is driving the adrenal gland to produce more hormones. A CT of the pituitary, blood hormone levels, and an appropriate consultation with specialists are required.
Treatment of adrenalectomy
Usually only one adrenal gland is absolutely necessary to sustain a normal life. Taking out an adrenal gland, called adrenalectomy, is performed for both malignant and benign health conditions. Conditions that benefit from adrenalectomy include: pheochromocytoma, benign tumors as evidenced by CT findings, cysts, or tumors which secrete hormones. The laparoscopic technique offers excellent visualization of the adrenal structure and also gives the surgeon the ability to look at both left and right adrenals without the long incisions once required. Removal of one adrenal gland can adequately be done by laparoscopic methods. It is very rare that both adrenal glands are malfunctioning, but if both are removed (and sometimes with one gland removed) hormone replacement therapy may be necessary. Close postoperative follow up with a physician specializing in endocrinology is mandatory.
- Antireflux surgery
What is an appendix?
The appendix is a narrow, finger-shaped pouch that extends from the proximal colon. It has no function in life that we know of.
What is appendicitis?
Appendicitis is the inflammation of the appendix. The appendix can become inflamed when the pouch becomes plugged at its opening. This allows bacteria to divide and cause swelling of the appendix, eventually leading to ruptures (burst).
• Tenderness or pain in the right lower quadrant of the abdomen
• Feeling of tiredness, almost flu-like symptoms
• Can cause nausea and vomiting
• Temperature of 100º or higher.
What if I need surgery?
Removal of the appendix is a very common procedure and is done routinely laparoscopically via 3 small incisions. The operation typically last 30-45 minutes and most patients can be discharged home the same day of surgery. If the appendix is ruptured a hospital stay of 2-3 days is usually required.
- Bowel obstruction
• Axillary node dissection including sentinal (or directed) biopsy
• Breast conservation (lumpectomy)
- Cholecystectomy (removal of gallbladder)
What is the gallbladder?
The gallbladder is a small storage organ located below the edge of the liver. It stores bile, which is actively concentrated there, until it is needed to assist in the digestion of fats. When food enters the small bowel, the gallbladder is stimulated to contract excreting bile into the intestine via a tube connecting the liver and intestine called the common bile duct. There it mingles with the food and helps with the digestion of fat.
What causes gallstones?
Most gallstones are made up of cholesterol. Cholesterol is normally found in bile. It is insoluble in water and requires a combination of a fat and bile salts (break down products of blood cells) to stay in solution. If either of these become out of balance, the cholesterol will fall out and form stones. The size and number of stones varies for each person.
Symptoms of gallbladder disease
Most people with gallstones are unaware of their presence and they may go undetected for years. However, once symptoms occur, the gallbladder should be removed to avoid serious complications. Symptoms include pain or an ache in the right upper quadrant of the abdomen that may radiate toward the right flank and shoulder after meals (especially fatty meals). The ache typically last for about 2 hours and will usually resolve (biliary colic). If a stone becomes lodged in the neck of the gallbladder, the pain may persist and will cause a more serious problem (acute cholecystitis). If a stone passes from the gallbladder it will typically become lodged in the common bile duct (tube from the liver to the intestine), causing a backup of bile into the liver and blood stream. This is clinically evident by a yellow hue to the skin, whites of the eye, and
darkening of the urine. This is an emergent condition as it may lead to more serious conditions, such as pancreatitis.
How is gallbladder disease diagnosed?
A physical exam often reveals tenderness in the right upper area of the abdomen, acute cholecystitis, and sometimes in biliary colic. There is usually no tenderness in chronic cholecystitis. Diagnostic tests are commonly used to document gallstones. Gallbladder disease is diagnosed by having an ultrasound and possibly a HIDA scan (nuclear medicine test).
What if I need surgery?
Surgical removal of the gallbladder is the only acceptable definitive treatment for gallbladder disease. The gallbladder is typically removed via 3 small incisions and lasts 45 minutes. Most patients are discharged home the day of surgery and return to work in 1 week. The risk of complication is low, however the risks include but are not limited to infection, bleeding, and injury to the common bile duct, intestine, and surrounding organs.
- Colon surgery – benign or malignant disease
- Common bile duct exploration
- Gastric Neurostimulator for severe gastroparesis
- Hiatal hernia repair
What is a Hiatal Hernia?
Your chest is separated from your abdomen by a domed sheet of muscle called the diaphragm. To reach your stomach, your esophagus has to pass through an opening, or hiatus, in the diaphragm. When the tissue around the hiatus weakens, part of the stomach may protrude through the opening into the chest cavity. This abnormality at the diaphragm hiatus is termed hiatal hernia. A hiatal hernia is caused by a weakening of the anchoring tissues of the gastroesophageal junction to the diaphragm, perhaps due to increased pressure within the abdomen such as sometimes results from obesity or trauma. While some people are born with a hernia, factors such as heavy lifting, aging, and even some medications can cause the sphincter to weaken, allowing the stomach to push into the chest.
• Substernal fullness or ache
• Difficulty swallowing
• Shortness of breath
• Bloating or hiccups after meals
Your evaluation will include having a physical exam and a complete medical history. The doctor will want to know how severe the problem is and how it is limiting or affecting your lifestyle. You will be asked to have diagnostic testing, which will include: Esophageal Motility, 24 hour pH study, and occasionally an upper endoscopy.
What if I need surgery?
Surgery for a hiatal hernia is indicated once the symptoms of the hernia become severe enough to alter your quality of life and is refractory to medical management. The surgery is done through a laparoscopic approach. During the procedure, 4-5 small holes are made and the operation is completed in about 60-90 minutes. A 24 hour stay is usually all that is required and most people return to work in 1 week.
- Inguinal hernia repair
What is an Inguinal Hernia?
An inguinal hernia is a protrusion of soft tissue, such as a portion of the intestine, through a weak spot in a muscle, usually in the abdominal wall. Inguinal hernias occur where the abdomen meets the thigh, the area known as the groin. Anyone can have an inguinal hernia. Men, women and even children of all ages experience hernias. They typically occur two ways: first, by wear and tear over time (acquired hernias) and secondly from a weakness in the abdominal wall that is present at birth (congenital hernias). Although many people “live” with hernias for years before they even know it or it becomes a problem, over time they often get worse due to physical stress or aging. Typically men are 10 times more likely to get an inguinal hernia than women.
Signs and Symptoms
• Lump in groin area when standing/straining and disappears when reclining
• Pain at the site of the lump, especially when lifting a heavy object
• Swelling of the scrotum
• Excruciating abdominal pain (caused by the intestine twisting and getting caught in the muscle tear)
• Nausea, vomiting, loss of appetite & pain (if intestinal obstruction occurs) associated with constipation or a change in bowel habits
Hernias produce different symptoms or feelings. Sometimes you will notice a protrusion or lump in your groin area between the pubis and the top of the leg, feel pain when you strain during urination or a bowel movement, or when you lift a heavy object. The pain can be sharp and immediate. Other times you will feel a dull aching sensation, a vague feeling of fullness, nausea, or constipation; these feelings typically get worse toward the end of the day or after standing for long periods of time and may disappear when you lie down. Whilepeople can live for years with hernias, without treatment, they will not disappear.
Your evaluation will include completing a medical history form or questionnaire and talking with Dr. Turnquest about the problem. A physical exam is performed in which the actual defect and protrusion are felt by the physician. This is not painful, but you may feel uncomfortable from the pressure applied as Dr. Turnquest evaluates how large the opening (defect) actually is. It is important that the patient notify the doctor of changes in bowel or bladder functions during this exam. Other complications that are resulting from your condition will also be evaluated. Should surgery be recommended, you would be asked to have a medical work done including blood tests, chest x-ray, or EKG as needed. If you have had them recently, these will not be repeated.
How Is An Inguinal Hernia Treated?
Various lifestyle and medical treatments often can help. Since hernias are caused by obesity, a serious program of weight control is recommended, especially if your weight is centered in the abdomen. Eating more fiber often helps reduce straining of the bowels. Getting more exercise, avoid standing for long periods of time, and learning proper lifting techniques can strengthen the back areas or eliminate strain on the hernia. Since smoking often causes straining when coughing, it is also recommended that you stop. Because these approaches do not completely get rid of the hernia, most people elect to have surgery to cure a hernia defect. Surgery for repair of a hernia is usually done via a laparoscopic approach utilizing a mesh material to buttress the defect, but in some incidences may best be accomplished via a traditional open approach. The laparoscopic approach is preferred by Dr. Turnquest because of its smaller incisions, less dissection, smaller incisions, and quicker return to normal activity. The surgery is accomplished via 3 small incisions just below the belly button. It takes about 45 minutes to complete and most patients are discharged home the same day of surgery. Risks are generally low and include but are not limited to infection, bleeding, wound infection, injury to the blood vessels supplying the testicles, nerve injury, and persistent pain.
- Lymph node biopsies
- Myotomy for esophageal achalasia
- Percutaneous/open endoscopic gastrostomy
- Port-a-cath placement (for chemotherapy)
- Procedures for ulcer disease
- Skin cancers
• Basal cell carcinoma
• Melanoma w/or w/o sentinal lymphbiopsy
• Squamous cell carcinoma
- Spleenectomy (removal of the spleen)
What is the spleen?
This dark purple, bean-shaped organ is located in the upper left-hand side of the abdomen, just under the lower ribs. One of the primary functions of the spleen is filtering the blood. Each day our entire blood volume filters through the spleen as bacteria, foreign materials, and even tumor cells are sifted out and removed if needed by the guarding action of this secondary lymph gland. In addition, the spleen also functions to hold blood platelets in healthy adults.
What conditions require a splenectomy?
The spleen is not essential to normal life however it role in removing bacteria and old blood cells is significant and if possible the undamaged spleen is spared as much as possible.
Idiopathic Thrombocytopenic Purpura (ITP)
ITP is an autoimmune disease involving platelet destruction. Steroids are used to medically treat this condition, but this weakens the patient and sometimes does not affect the autoimmune response enough. Splenectomy is effective in about 70% of chronic ITP cases.
The spleen can be ruptured by blunt or penetrating injuries to the chest or abdomen. In this situation, every attempt is made to preserve a portion of the spleen.
Abscesses in the spleen
These are relatively uncommon but have a high mortality rate. An abscess can sometimes be drained using percutaneous CT (using a needle through the skin to drain the fluid assisted by advanced imaging). This less invasive technique is considered before a surgical alternative is employed.
Aneurysm (an out pouching) of the splenic artery
Again, every attempt is made to preserve some splenic functioning, if possible, by tying off the splenic artery. Some forms of leukemia, such as HCC (Hairy Cell Carcinoma) and Hypersplenism (a group of symptoms that includes an enlarged spleen, defective blood cells, and a high blood cell turnover rate) may occur. Other diseases that could occur include Mononucleosis (can cause enlargement of the spleen), Malignancy Thalassemia, and Sickle Cell Anemia.
Typically, splenic disorders, with the exception of trauma, are diagnosed by a blood test. Once diagnosed and medical treatment has failed, you may be referred to a surgeon for removal of the spleen.
What if I need Surgery?
We attempt elective removal of the spleen preferentially in all cases. This is accomplished via 4 small incisions through which long instruments and a special camera (laparoscope) are used to free the spleen. It is then placed in pouch and removed through a 3 inch incision in the left upper abdomen. The procedure generally last 90 minutes and most people are able to go home in 24 hours and return to work in 1 week.
- Surgery on pancreas for cancer
- Thyroidectomy/Parathyroiectomy (one of few surgeons utilizing video assistance to decrease incision size and reduce complication)
- Ventral hernia repair
What is a Ventral Hernia?
Abdominal hernias are called ventral hernias and can be in any part of the abdominal wall. Umbilical hernias are a type of ventral hernia at the “belly button”. If the hernia is caused by a previous operation, it is called an incisional hernia, and if the hernia comes back after a repair, it is called a recurrent hernia. Until now, the only available repair required a large incision, an extensive operation, one week in the hospital, and eight weeks to recover.
Herniations, or bulging of the intestine, can arise from defects in the abdominal muscle wall that developed after any type of abdominal incision. They may be evident soon after the surgery, or may take years to progress. Often, just having pain is the first symptom, and later a bulge may be seen or felt under the skin.
The diagnosis is typically made based upon physical examination. History of prior surgery is a strong indicator, although some abdominal wall defects can be difficult to detect and imaging studies may be required.
What if I need surgery?
Incisional hernia repair in the past required open surgery, staying in the hospital, and up to eight weeks recovery time. Now, there is a laparoscopic way Dr. Turnquest can successfully treat an incisional hernia, with no hospital stay, and put you back to normal life in just days. The surgery typically is done via 3 small incisions and takes about 60 minutes to complete.