Surgical Services

Video for Surgical Patients at Shore Medical Center
Shore Medical Center has prepared a short instructional video for patients to help them know what to expect before, during and after surgery.

For privacy and comfort, you and your family are provided with your own private patient area before and after surgery. A friendly personal escort guides you and your family to and from the Surgical Reception area. 

Types of procedures performed on a same-day basis include:

• Biopsies
• Carpal tunnel releases
• Cataracts
• Hernia repairs
• Hysteroscopies and D&Cs
• Myringotomy
• Oral surgery
• Endoscopic procedures
• Laparoscopic procedures 
• Robotic procedures including gall bladder surgery and hysterectomies 
• Cystoscopies 
• Microsurgical surgery
• Arthroscopic surgery

Prepare for Same Day Surgery - the day of your surgery:

• Leave all valuables at home.
• Bring your insurance cards, co-pays and your driver's license or another valid form of identification.
• Arrive at the hospital at your predetermined time. You will receive a call the day prior to your surgery to inform you of your arrival time. 
• You will enter through the main lobby of the hospital and then be directed to the 3rd floor of the Surgical Tower. 
• Once registered on the 3rd floor, you will be escorted to the Pre-Operative area where you will be prepped for surgery. You will also meet with your surgeon and anesthesiologist in this area. 
• Your family may stay with you until you are taken to the operating room.
• During your surgery, your family will wait for the surgeon in the waiting room where our volunteers will keep them informed and comfortable.
• Once in the recovery room, the nurses will monitor your vital signs, give you pain medications as needed to keep you comfortable and review your instructions before discharge to home.

When returning home:

• Once you are ready to be discharged you will be brought to the lobby via wheelchair.
• Please ensure you have a responsible individual to drive you home and stay with you for the first 24 hours
• A member of of team will call you the next day to check on you. If you have any questions before that please call your surgeons office directly. 

Shore Medical Center is proud to have one of the leading robotic surgery programs in South Jersey equipped with the latest surgical technology, da Vinci Xi robotic-assisted surgical system. 

Our highly specialized surgeons have the expertise to perform a wide spectrum of procedures with greater precision and increased vision.

Benefits of minimally invasive and robotic surgery include smaller incisions, less scarring, and faster recovery times to help you return to normal activities. TRUST in Shore Medical Center for the most advanced robotic surgical care.

Shore Medical Center's integrated approach to patient care allows surgeons and interventional radiologists to provide you with the latest and most advanced techniques for the prevention, diagnosis and treatment of vascular diseases including:

• Abdominal Aortic Aneurysms
• Carotid Artery Disease
• Deep Vein Thrombosis
• Peripheral Arterial Disease
• Pulmonary Embolism
• Varicose Veins

What Is Transcarotid Artery Revascularization (TCAR)?
TCAR is a minimally invasive procedure that can clear blockages and open a narrowed carotid artery. The surgeon makes an incision over the common carotid artery to perform the repair.

During the TCAR procedure, the surgical team reverses blood flow in the area of the blockage. This reversal decreases the risk of stroke as your surgeon uses a surgical balloon and stents to reopen the narrowed artery. Blood still reaches your brain through other blood vessels.

TCAR Procedure Eligibility
TCAR is a good option for people who have a higher risk of complications from surgery due to age or other health issues. Your doctor will discuss whether you a good candidate for TCAR.

At Penn, many of our patients are eligible for TCAR. We often can offer TCAR to people who are at high risk for complications from surgery, have appropriate anatomy and have carotid artery stenosis:

• Greater than 50 percent with symptoms
• More than 70 percent without symptoms

You may also be a candidate for TCAR instead of carotid endarterectomy if you have:

• Age of 75 or older
• Congestive heart failure or unstable angina
• Heart attack (myocardial infarction) within the past six weeks
• History of head or neck surgery or irradiation
• Other problems with your larynx (voice box) or neck
• Restenosis (carotid stenosis that returns after surgery) or stenosis in both carotid arteries
• Uncontrolled diabetes or severe pulmonary (lung) disease

The TCAR Procedure: What to Expect
You undergo TCAR in an operating room at the hospital. Your team includes a vascular surgeon, nurses, technicians and an anesthesiologist. During the TCAR procedure:

• You receive anesthesia to keep you calm and comfortable. 
• Your surgeon makes a small incision above your collarbone (clavicle) or a vertical incision over your common carotid artery.
• The surgeon inserts a tube into your carotid artery and connects it to an advanced system that temporarily reverses blood flow. By directing blood flow away from the brain, we can catch and remove any loose fragments of plaque before they cause a problem.
• The filtered blood returns to your body through a tube (catheter) inserted into a vein in your groin.
• The surgeon places a stent (a small wire mesh tube) in your carotid artery. The stent stays in place to hold open the carotid artery.
• Your surgeon removes the surgical tube, restores the direction of blood flow and closes the incision with stitches.

TCAR recovery
Most people go home the day after a TCAR procedure. You should expect to take it easy for at least a week before returning to your usual activities. Your doctor will likely recommend taking aspirin and another drug to prevent blood clots, as well as a statin. These medicines help reduce long-term complications like stroke and heart attack.

At some point after your TCAR recovery, your doctor will order a carotid duplex ultrasound to check for carotid artery stenosis or narrowing. This test uses sound waves to show how blood is flowing through the artery. 

TCAR versus Carotid Angioplasty and Stenting
TCAR and transfemoral carotid angioplasty and stenting are both minimally invasive alternatives to carotid endarterectomy. The major difference between the two is that TCAR uses advanced technology to reverse blood flow away from your brain during the ballooning and stenting procedure. It can be a safer alternative to transfemoral carotid artery stenting.

The da Vinci® surgical system is the most innovative technology available for minimally invasive surgery. With the da Vinci system, surgeons can perform surgeries that are both complex and minimally invasive. Using sophisticated computer and robotic-aided technology, the da Vinci system simulates the open surgical environment required for complex surgeries, but without the need for large incisions. Currently, surgeons perform urological procedures such as:

• Cystectomy to removal parts or all of the bladder
• Nephrectomy to remove part or all of the kidney
• Prostatectomy to remove the prostate
• Pyeloplasty/ureteroplasty to remove and reconstruct part of the urinary tract

What is robotic prostatectomy?
Robotic prostatectomy is a minimally invasive surgical procedure for removing cancerous prostates in men. Utilizing the da Vinci advanced robotic-assisted surgical system, urologists specially trained in robotic surgeries perform small-incision prostate surgeries that deliver outstanding results.

Robotic prostatectomy minimizes the risks of incontinence and impotence and offers qualified candidates many potential benefits over traditional prostatectomy surgery, including:

• Shorter hospital stays
• Less pain and scarring
• Faster recovery
• Virtually bloodless procedure

• DePuy BrainLab Spine Navigation is a state-of-the-art technology designed to enhance precision and safety during spinal surgeries. This advanced system combines 3D imaging and computer-assisted guidance, allowing surgeons to navigate complex spinal structures with unparalleled accuracy. By providing real-time, high-definition visuals of the patient’s spine, BrainLab technology helps surgeons perform intricate procedures more efficiently, reducing the likelihood of errors and minimizing the risk of complications.
• For patients, this means a more personalized and targeted approach to spinal surgery, often resulting in smaller incisions, less tissue damage, and faster recovery times. Whether addressing conditions like spinal stenosis, herniated discs, or spinal deformities, DePuy BrainLab Spine Navigation ensures that surgeons have the most accurate information at their fingertips, allowing for better outcomes and fewer post-operative issues.
• This technology is particularly beneficial for complex surgeries that require precise placement of screws, rods, or other implants. With BrainLab’s advanced imaging and tracking capabilities, surgeons can visualize and adjust their approach in real time, leading to safer and more effective treatments. For patients, it represents the cutting edge of spinal care, offering a path to a quicker, safer recovery.

General Anesthesia involves making the patient unconscious using intravenous drugs and inhalational agents such as nitrous oxide, oxygen, and anesthetic gases. This may involve the use of a breathing tube, which is inserted into the windpipe to ensure proper breathing while the patient is under anesthesia.

Regional Anesthesia produces numbness in the area of surgery and is performed by the anesthesia clinician.

Methods of administration include:

• Nerve Block - Local anesthesia is injected near the major nerves surrounding the area of surgery.
• Intravenous regional - Local anesthesia is injected into a vein in the arm or leg and then retained in the area through constriction from a tourniquet.
• Local - Local anesthesia is injected into and around the area of surgery.
• Spinal - Local anesthesia is injected into the fluid surrounding the spinal cord in the back.
• Epidural/Caudal - Local anesthesia is injected in the epidural space directly outside the spinal canal.

Monitored Anesthesia Care (MAC) involves local anesthesia verve blocks administered by the surgeon while the anesthesia clinician monitors sedatives. Unlike general anesthesia, the patient maintains their heart/lung functions without the direct support of the anesthesia provider.

Questions to ask your anesthesia clinician

• Who will provide my anesthesia during the procedure, and what are their qualifications?
• How will I be monitored?
• How will I be made comfortable during and after the procedure?
• Will I have an IV?
• What happens if there is an emergency?
• When can I go home?
• Who can I call with questions after the procedure?:

What to expect before surgery
Prior to your surgical procedure, you  will undergo a preoperative evaluation. This evaluation focuses on your health and choosing an anesthetic plan that is right for you and your procedure. This can include the following:

• A review of your medical history, including medications you are taking and allergies to medications.
• A physical examination
• Blood and lab tests
• EKGs or X-rays

Please note that you will not be able to eat or drink for some period of time prior to your procedure.

What to expect during surgery
During surgery, you will be provided with comprehensive anesthesia care, as it relates to both the anesthetic plan defined before the surgery and the type of procedure, This can include the following:

• Administration and regulation of the anesthetic to ensure you are comfortable and sedated until the procedure is complete.
• Management of your body functions during the procedure, such as heart rate and blood pressure.
• Management of your medical and chronic conditions as they relate to anesthesia care during the procedure.

Depending on the type of procedure, you may be in an unconscious state during the procedure, as in the case of general anesthesia, have a sedative administered or remain awake. It is the responsibility of the anesthesia clinician to keep you comfortable and to control pain no matter what kind of procedure you are having.

What to expect after surgery
After your procedure, and anesthesia clinician will reverse the effects of the anesthetic medications you received and the return you to a conscious state. You will then be taken to a recovery room for monitoring. The anesthesia clinician will check your activity level, breathing, circulation, and level of consciousness. They will also assist to control any post-operative pain you may be experiencing.

Anesthesia Clinicians
Anesthesiologist - An anesthesiologist is a Medical Doctor (MD) or a Doctor of Osteopathic Medicine (DO) who specializes in the field of anesthesiology. It is the responsibility of the anesthesiologist to provide the anesthetic for the patient during a surgical or clinical procedure.

CRNA - A certified registered nurse anesthetist is an anesthesia professional who provides anesthesia care before, during and after a surgical or clinical procedure. CRNA responsibilities may include the following, depending on expertise and practice location:

• Performing an assessment and evaluation or the patient before the procedure.
• Developing the anesthetic plan for the patient
• Initiating the anesthetic used for the procedure
• Monitoring the patient's life functions during the procedure
• Facilitating the patient's emergence and recovery from anesthesia and providing post-anesthesia care

Anesthesiologist Assistant - An anesthesiologist assistant works under the medical direction of an anesthesiologist to provide anesthesia care before, during and after a surgical or clinical procedure. Their responsibilities include supporting the anesthesiologist in the areas of:

• Pre-anesthetic health history
• Pre-operative physical exams
• Monitoring life functions during the procedure
• Administering medications
• Executing anesthetics as delegated by the anesthesia clinician

Pain Management
"Pain is whatever the patient says it is and exists whenever the patient says it does."

Understanding Pain
Pain can cause phsycial, emotional, and psychological stress on the body. It may vary from one person to the next, and it has the potential to interfere with daily life activities. This information can help you gain knowledge, encourgaement, and tools needed to help control pain while in the hopsital. 

Medication Facts
A variety of medications are available for managing and relieving pain. These may come in various forms and are received through different routes. It is important to talk to your doctor or nurse about options for your pain relief along with any questions or concerns. 

• P.R.N.  is an abbreviation meaning "when necessary." P.R.N. medications are not given unless you ask for them directly from your doctor or nurse. 
• Medications may cause side effects such as constipation, nausea, or drowsiness. It is helpful to always speak to your doctor or nurse about all medications. 
• It is encouraged to seek out pain relieving measures before the pain gets too severe. 

Patients React Differently to Pain
Pain feels different from one person to the next. You will often be asked questions about your pain. It is encouraged to report pain to your doctor and ask for pain relief when needed. You will be taught to use a pain rating scale (shown on back) so nurses can better manage your pain. Complete relief of pain may not always be possible, but it can be managed effectively to a tolerable level. 

Your Right to Pain Control
You have the right to have your pain addressed and to participate in your pain management. You have the right to refuse any drugs, treatment, or procedures. Your right to pain control is included in the "Patient Bill of Rights." You should expect the following:

• Information about your pain and pain relief measures.
• Concerned staff committed to pain prevention and management.
• Regular assessment of your pain.
• Access to pain medication as scheduled or when requested as P.R.N. protocol.
• Access to multiple pain treatments therapies. 

Integrative Medicine
Non-Drug Treatments Shore Medical Center offers:

• Aromatherapy
• Guided Imagery
• Massage Therapy
• Reiki and Healing Touch
• Slow Relaxed Breathing
• Pet Therapy
• Laughter
• Applications of Heat and Cold
• Reduction of Environmental Stimuli
• Repositioning
• Diversionary Activities
• Social Worker
• Religion/Spiritual Leaders

Relaxation Response Benefits
All of these interventions help elicit the Relaxation Response with these physical benefits:

• Reduce blood pressure
• Accelerate physical healing
• Increase endorphin levels
• Boost the immune system
• Stimulate digestion
• Augment pain management
• Help regulate body temperature
• Equalize brain wave activity
• Ease the process of childbirth
• Can induce sleep 
• Reduce body and muscke tension
• Relieve anxiety and stress
• Stimulate memories and aid mental focus
• Provide a release of emotions and grieving
• Provide time for contemplation 

Rate Your Physical Pain

• 0 - No Pain
• 1 -Very minor annoyance - occasioanl minor twinges
• 2 -Very minor annoyance-occasional strong twinges 
• 3 -Annoying enough to be distracting 
• 4 -Can be ignored, but distraction is increasing 
• 5 -Cant be ignored for more than 30 minutes 
• 6 -Pain is stready, increasingly distracting 
• 7 -Pain cant be ignored for any length of time 
• 8 -Interferes with sleep and normal function 
• 9 -Physical activity is severely limited 
• 10 -Overwhelming pain, crying, moaning 

Rate Your Emotional Pain

• 0 -No stress, calm and peaceful 
• 1 -Very minor distress, not completely calm
• 2 -Faint tension, faint distress
• 3 -Increasing mild distress
• 4 -Steadily increasing distress, mildly agitated 
• 5 -Distressed, agitated 
• 6 -Very distressed, distracted, and agitated 
• 7 -Severe emotional pain, cant be ignored 
• 8 -Interferes with sleep and normal function 
• 9 -Almost unbearable emotional pain 
• 10 -Overwhelming emotional pain