CMC Surgery Overview

Surgery:  Patient-focused and Progressive


At Cayuga Medical Center, we want your surgical experience to be as safe, comfortable, and stress-free as possible. From your pre-admission testing to the time of your discharge, we will do our utmost to meet your individual needs and honor your preferences.


We perform all inpatient surgery at the medical center. Same-day surgery and outpatient procedures take place at two locations: at the main campus in the medical center’s Same-day Surgery Center, Schuyler Hospital and at Surgicare, on the Convenient Care Campus at Ithaca, located on Arrowwood Drive off Warren Road.


Our surgical teams perform thousands of procedures a year and help our patients through recovery. We understand, however, that for most of our patients surgery is an unfamiliar experience. Our goal is to take excellent care of you, to educate you and your family about your surgery and what to expect during recovery, and above all, to help you get better.


If at any time during your stay you have questions, please ask us. You are the reason we’re here.


          Surgical Specialties





Surgical Specialties


Cayuga Medical Center offers a broad range of inpatient and outpatient surgery. We do this so that you can stay close to home when you require surgery. Having family and friends nearby for love and support is important to your recovery.


General Surgery

Bariatric (weight-loss) Surgery

Ear-Nose-Throat (Otorhinolaryngology)

Hand Surgery

Head and Neck Surgery


Maxillofacial, Oral, and Facial Plastic Surgery

Cleft Palate and Facial Deformities Team


Obstetrics and Gynecology

Ophthalmologic (Eye) Surgery

Oral Surgery

Orthopedic Surgery and Joint Solutions

Plastic Surgery


Urologic Surgery

Vascular Surgery

Pre-Admissions: Before Your Hospital Visit


Whether you are having same-day surgery or are staying overnight at the medical center, you need to go through pre-admission. We do this to ensure that you are ready for surgery before the day of your operation.


Making your appointment

·  Your doctor’s office will call the medical center for you to set up your pre-admission appointment. We schedule pre-admission appointments Monday-Friday, between 8 a.m. and 4 p.m.

·  Your pre-admission appointment and testing should be completed within seven days of your surgery.


Pre-admission testing

·  Your doctor will perform a health history and physical examination during an office visit prior to your pre-admission appointment. Then, depending on the procedure you’re having, your doctor will order one or all of the following tests to be performed during your pre-admission appointment at the medical center:          -blood tests (which require a needle stick)

o    EKG

o    chest x-ray.


During the pre-admission interview

During your pre-admission appointment, the nurse will discuss with you

·  instructions for the day and evening prior to your surgery

·  how and when you will be discharged

·  planning for home-care services if you need them following surgery

Your pre-admission nurse will also review a pre-surgery checklist with you and make sure that you have arranged for transportation to and from your surgery.


What you should bring to your pre-admission appointment

·  a list of your current medications and the dosage

·  the anesthesia questionnaire from your physician’s office

·  your health insurance cards

·  a list of your prior surgeries

·  a copy of your living will, health care proxy, or power of attorney for your medical record



Anesthesiology: Operating at the Highest Standard of Care


At Cayuga Medical Center and Surgicare, only board-certified anesthesiologists administer anesthesia. By way of contrast, many hospitals have systems whereby a single anesthesiologist may supervise a number of nurse anesthetists in different rooms who are administering patient anesthesia.

·  To ensure maximum control and patient safety, we only recruit anesthesiologists who perform their own anesthesia. We have ten anesthesiologists on staff.

·  One anesthesiologist will take care of you from beginning to end, which increases safety and provides continuity for each patient.

·  There are many choices regarding the specific anesthesia to be used. This decision is made jointly by you and your anesthesiologist with input from your surgeon, so that the anesthesia choice is appropriate for you and the anesthetic plan addresses your individual concerns.

More about Anesthesia

Patients typically have lots of questions for their anesthesiologists. Here, anesthesiologist Dr. Mattison Burt answers some of the most frequently asked questions.

What is anesthesia?

Anesthesia is the loss of sensation using medication and is a crucial part of the surgical experience. The anesthetized patient is not physically aware of the surgical procedure. Anesthesia can be administered in a number of ways. Under general anesthesia, the patient is completely unconscious. Regional and local anesthesias target specific areas of the body affected by the surgery; the patient is awake but typically sedated.

How do you determine the appropriate type of anesthesia?

The type of anesthesia depends largely on the surgical procedure being performed. General anesthesia is typically used for surgery of the chest, abdomen, brain, and spine, as well as for major breast surgery and laparoscopic removal of the gallbladder or appendix. Regional anesthesia, which allows us to anesthetize or "block" specific nerves, is used for a wide variety of surgeries ranging from joint repair and replacement to hernia repair and cesarean section.

Will the anesthesia make me sick?

Studies show that the primary fear people have about receiving anesthesia is that it will make them nauseous and want to vomit. (The fear of pain is secondary, interestingly.) However, there have been significant advances in anti-nausea medications we use to prevent and treat nausea following surgery and anesthesia. We are also better at identifying risk factors that may indicate a higher incidence of nausea and vomiting. Among these are patients undergoing abdominal laparoscopic surgery and people having procedures that require a high amount of narcotic for pain control.

What are some of the important advances in anesthesia?

By far the most important are those that have increased the safety of administering anesthesia. The risk of death or significant injury from anesthesia is extremely low with technology such as pulse oxymetry, which continually measures the level of oxygen in the patient's blood, and capnography, which measures the patient's exhaled carbon dioxide. This helps confirm the proper placement of breathing devices that secure the patient's airway. Automation in the operating room, such as automated blood pressure, electrocardiograms, and other technologies, provide continuous updated information about the patient.

Another important advance is the expanded use of regional anesthesia (nerve blocks), which minimizes the undesirable effects of general anesthesia. Nerve blocks can last for several hours after surgery, giving the patient significant pain relief after the procedure. The result is that patients need less pain medication and their regimen of pain medication is shorter. A considerable amount of surgery performed at Cayuga Medical Center and Surgicare is done with regional anesthesia.

What is the role of sedation in regional anesthesia?

The medications used to sedate patients who receive regional anesthesia are easily tolerated, short acting, and they clear from the body quickly, usually with minor after-affects. Most patients are sedated with nerve blocks. Sedation makes the patient comfortable and relaxed while the surgeon is working. These medicines have a calming effect and they also allow the patient to lie in what might otherwise be an uncomfortable position without feeling discomfort. Some of these sedatives also have amnesic properties; the patient can be awake during the procedure but may not remember it. A small number of patients choose to observe their surgery, typically shoulder or knee arthroscopy, and they ask not to be sedated. This allows them to watch the procedure on the video monitor.

In summary, the new anesthesia and sedation medications are more focused and their properties are intended to work in very specific ways with fewer side affects. I believe regional anesthesia is under utilized in many medical centers. We use regional anesthesia whenever possible at Cayuga Medical Center and Surgicare, which I think has a genuine benefit for our patients.


Surgicare Gets Rave Reviews


Surgicare, our outpatient satellite surgery center, consistently garners high patient satisfaction ratings for its patient-friendly approach and convenience, especially for people with restricted mobility. Located on the Convenient Care Campus on Warren Road in Ithaca, Surgicare makes it easier for many people in Tompkins County and the region to have routine outpatient surgery nearer to where they live and work.


Surgeon specialists and gastroenterologists perform a number of procedures at Surgicare:

·  leading-edge eye surgery

·  orthopedic procedures

·  minimally invasive varicose vein surgery

·  ear, nose, and throat surgery

·  plastic and cosmetic procedures

·  minor general surgery

·  endoscopy (including colonoscopy and other diagnostic and minor surgical procedures)

·  minimally invasive laparoscopic surgery.


General Surgery


Our general surgery specialists take care of patients requiring:

- Treatment for injuries from traumatic accidents

- Surgery for all types of cancer (breast, colon, lung, etc.)

- Thoracic (chest) surgery, major and minor abdominal procedures,               including digestive tract, biliary tract (liver, gallbladder, pancreas) and      hernias

- Vascular surgery on the circulatory system (arteries and veins)

- Endocrine system procedures (thyroid and parathyroid glands that      produce the   body’s hormones

- Skin and soft tissue surgery


All of our general surgeons subspecialize within their field, advancing their skills in areas such as:


·  Laparoscopic (minimally invasive) abdominal surgery and hernia repair

·  Thyroid and parathyroid procedures

·  Tissue-conserving breast-cancer surgery

·  Vascular  surgery (to open up blockages in the carotid and aortic arteries, bypass surgery for arterial obstructions in the legs, and for repair of abdominal aortic aneurysms)

·  Phlebology (including minimally-invasive varicose vein surgery)

·  Nissen fundoplication (for heartburn)

·  Bariatric surgery (to treat morbid obesity)

·  Fast-track colorectal and intestinal surgery

·  Please read Health Visions Magazine Spring 2008, article entitled Surgery on the Fast Track


Ear-Nose-Throat (Otorhinolaryngology) and Head and Neck Surgery


Our ENT and Head and Neck surgeons treat a wide range of acute and chronic problems, involving both illness and congenital conditions, such as:

·  Severe snoring and obstructive sleep apnea

·  Functional endoscopic sinus surgery or FESS (to treat chronic sinus infections)

·  Microlaryngoscopic surgery (to repair damaged vocal cords)

·  Removal of tonsils and adenoids

·  Myringotomy and tubes (to drain fluid from the ear)

·  Septoplasty (to improve breathing)

·  Tympanoplasty (to repair eardrum injuries)

·  Bronchoscopy (to diagnose congenital malformations of the trachea and larynx, and to remove foreign bodies)

·  Parathyroid surgery


Hand Surgery


Fellowship-trained reconstructive and orthopedic surgeons perform hand surgery at Cayuga Medical Center and Surgicare. Powerful surgical microscopes enable them to repair the delicate bones, tendons, ligaments, and nerves located in the hands and wrists:


Hand injuries resulting from traumatic accident

Sports-related injuries

Wrist joint arthroscopy for injuries due to trauma or repetitive motion

Endoscopic carpal tunnel surgery to relieve nerve compression

Reconstruction and replacement of painful arthritic joints




Head and Neck Surgery


In addition to ENT surgery, these surgeons perform cleft lip and palate repair and delicate phonosurgical and laryngeal framework surgery for diseases of the larynx.

·  Using a multidisciplinary approach and the newest surgical technology, we treat patients at Cayuga Medical Center with advanced cancers of the nose, mouth, throat, and esophagus.

·  Our ability to offer conservation surgery and functional reconstruction helps to preserve the swallowing, vocal, and breathing functions while eradicating the cancer and leaving patients cosmetically intact.

Head and Neck Surgery for Cancer


Gastroenterology and Endoscopy


The gastroenterologists at Cayuga Medical Center are at the leading edge of their field of specialty. They diagnose and treat digestive tract problems including swallowing difficulties, stomach ailments, liver disease, and problems affecting the intestines and colon. In their work, gastroenterologists use a narrow, flexible tube with a light source and a tiny video camera at its tip. This is inserted into the body, giving a detailed look inside the digestive tract.


We offer comprehensive video-endoscopy services at both the medical center and at Surgicare, on the Convenient Care Campus at Ithaca, including both EGD (esophagogastroduodenoscopy) and colonoscopy.


Additional diagnostic modalities include:

·  esophageal manometry

·  24-hour wireless esophageal pH testing for diagnosing gastroesophageal reflux disease (known as GERD or heartburn)

·  capsule endoscopy to identify diseases of the small intestine, which are typically difficult to diagnose using radiologic or endoscope technologies

·  biliary endoscopy

·  liver biopsy.



Maxillofacial and Oral Surgery for the Face and Facial Bones


This field of surgery involves the face and facial bones, nasal surgery, orthognathic surgery (jawbone realignment), cleft lip and palate surgery, cheek bone and chin surgery, arthroscopic temporomandibular (TMJ) surgery, extractions and jaw implants (permanent replacement of missing teeth and jaw reconstruction).


Cleft Palate and Deformities Team


Under the leadership of Dr. Jeffrey Lewis, a surgeon specializing in facial plastics and maxillofacial surgery, our Cleft Facial and Deformities Team provides needed support for cleft palate patients and their families. Since our program started, we have evaluated more than 100 children and a number of adults with cleft lip, cleft palate, and other deformities. Our team is eager to provide services to children of all ages, and adults as well.

·  The team includes approximately 20 area specialists in oral and maxillofacial surgery, pediatric medicine, plastic surgery, ear-nose-throat, maternal-child care, audiology, speech and occupational therapy, social work, developmental psychology, dentistry, orthodontics, genetics, early intervention program, and parent support group.

·  These specialists work together to provide comprehensive care and to facilitate a smooth transition into the care network for infants and their families.




A team of neurosurgeons with more than thirty years of collective experience performs neurosurgery at Cayuga Medical Center. They work with a highly trained group of operating-room and intensive-care-unit professionals to treat a wide variety of neurosurgical problems affecting the spine, neck, and brain, including:

·  Herniated disks, spinal fusions, and lumbar stenosis (impinged nerve functioning due to narrowing of the spinal canal)

·  Benign and malignant tumors of the brain and spine

·  Aneurysms and other hemorrhages in the brain, brain injury from trauma or stroke

·  Hydrocephalus (accumulated fluid in the brain)

·  Fractures of the neck and spine


Obstetric and Gynecological Surgery Includes VBAC


Although vaginal birth after a previous c-section (VBAC) is now considered to be a safe childbirth choice for many mothers, not many hospitals offer this option to expectant mothers. At Cayuga Medical Center, VBAC is available as part of our commitment to provide a variety of birthing options to our community.


Our Ob-Gyn surgeons also perform extensive specialty surgeries:

·  Operative hysteroscopy to correct causes of uterine internal bleeding

·  Endometrial ablation for menorrhagia (heavy menstrual bleeding)

·  Laparoscopically-assisted hysterectomy

·  Myomectomy to remove uterine fibroids

·  Tubal ligation to prevent pregnancy

·  Cesarean section

·  Surgery for prolapse of the female genital organs, including bladder prolapse and urinary incontinence


Ophthalmologic (Eye) Surgeons at Leading Edge


Due to the ongoing involvement of our eye surgeons in the clinical testing and development of surgical instruments, phacoemulsification (lens extraction) equipment, and lens implantation devices, people in our region have access to the very newest technology, making cataract surgery safer for our patients. Our medical staff includes specialists in both adult and pediatric ophthalmology.


Eye surgeons on staff at Cayuga Medical Center routinely perform:

·  Eye trauma surgery

·  Advanced surgery for cataract removal and lens replacement

·  Infant eye exams and pediatric surgery for amblyopia and strabismus

·  Glaucoma surgery

·  Eyelid and eye muscle surgery

·  Repair of detached retina and retina surgery for those with eye damage from diabetes

·  Refractive surgery (to correct nearsightedness and astigmatism)


Orthopedic Surgery and Joint Solutions


Our board-certified orthopedic surgeons operate at both Cayuga Medical Center and Surgicare. They offer the latest, minimally invasive approaches for joint replacement and revision, operating through small incisions. They routinely introduce new surgical procedures, such as the use of custom-made models for minimally invasive knee-replacement surgery, Copeland shoulder resurfacing for painful arthritis, and elbow arthroscopy to treat joint derangement. Our orthopedists treat:

·  Fracture surgery for accident victims

·  All types of sports-related injuries

·  Specialized arthroscopic shoulder, knee, wrist, and hand surgery, including endoscopic carpal tunnel surgery

·  Arthroscopically-assisted ligament reconstruction

·  Tendon repair and fracture reduction

·  Total joint replacements of the hip, elbow, shoulder and other joints, including both total and unicondylar knee replacement

·  Minimally invasive joint revision, for repair and replacement of existing joint replacements


Joint Solutions: State-of-the-art Joint Replacement at CMC


Joint pain can be caused by injury or inflammation to the joint. The most common cause of joint inflammation is osteoarthritis. This occurs when the cartilage covering the ends of the bones wears away, resulting in pain and stiffness.


Initially, osteoarthritis can be treated conservatively with medication, weight loss, exercise to increase range of motion and gain strength, and the use of an assistive device (such as a cane) to relieve stress on the joint.


The goal in treating inflammation is to relieve pain and improve joint function. However, when conservative measures are unsuccessful and the pain you experience diminishes your quality of life, your doctor may recommend total joint replacement surgery.


Let us tell you about Joint Solutions.


The name Joint Solutions reflects the goal of our program:  To assist patients in working toward a solution to joint pain and deteriorating function.


We know from patient satisfaction surveys that our patients are satisfied with the education we provide throughout the program, the quality of care they receive, and the favorable outcomes from joint replacement surgery. Knowledge is the power that motivates joint replacement patients to strive for and gain optimal function. As a result, they can resume their lives without the pain they lived with prior to surgery.


The Joint Solutions program has three components to help you through joint replacement surgery.


1)  Before Surgery: Getting Ready


Once you and your surgeon have decided on joint replacement, the surgery is scheduled. At this time, you enroll in a pre-operative education class led by the Joint Solutions program director and an experienced orthopedic nurse.


In class you learn what to expect and how to prepare for the surgery. The class also gives you an opportunity to ask questions and interact with other people preparing for surgery. You’ll learn about the importance of pre-operative exercises in preparation for the surgery and you’ll receive a journal outlining what to expect before, during, and after the operation.


2)  Your Stay at Cayuga Medical Center


Day One

The surgical day includes completion of the surgery and optimal post-operative pain control. Our staff will monitor your vital signs and pain level, and will prepare you to begin moving around the next morning. Experienced orthopedic nurses and physical therapists will teach you about total hip precautions and total knee care, depending on the surgery you’ve undergone. This important education and awareness component continues throughout your hospital stay.


Day Two

Group physical therapy begins in our Joint Solutions gym and continues twice a day, every day, in preparation for discharge. Therapy works on improving strength, range of motion, and mobility. The family member or friend who is acting as your coach is invited to attend these classes to observe and to assist you.


Day Three

Group physical therapy sessions continue twice a day. As the exercises become more advanced, walking and distances increase, and you will become more independent. You’ll also progress to stair climbing and learn more about total hip precautions and self total knee stretches. Our occupational therapist will assist you with activities of daily living and make recommendations regarding assistive devices (such as reachers, sock aids, or long-handled shoehorns).


Day Four

Group physical therapy classes continue. Your coach should plan to attend, to help you maximize your gains in independence and function. We wrap up the stay with a gourmet meal for lunch or dinner so that you and your coach can celebrate your success.


3) After Surgery


Prior to discharge, our discharge-planning nurse will assist you in obtaining necessary equipment and setting up home-care services for physical therapy and nursing. You and your home-care therapist will continue to work for two to four weeks on gaining strength, improving range of motion, and walking without the use of a cane or walker.


After home-care therapy has ended, your surgeon may recommend continued outpatient physical therapy. Outpatient physical therapy is available in our Department of Physical Therapy and Sports Medicine, located both at the Island Health Center and Cayuga Medical Center’s Convenient Care Center. We offer aquatic therapy at Island Health and Fitness.


Frequently Asked Questions


How long does the joint last?


The components of the artificial joint last an average of fifteen years, depending on the activity level of the patient. Our surgeons specialize in selecting the optimal components for the activity level and age of each individual patient. Our surgeons also specialize in total joint replacement revision surgery, if necessary.


What are the components made of?


Total joint replacement components may be made of plastic, metal (including cobalt chrome and titanium), or ceramic materials.


How can I best prepare for joint replacement surgery?


The Joint Solutions pre-operative education class outlines how you can best prepare for the surgery and includes information on appropriate exercise, home safety, and arrangements for a post-operative support network.


What are the risk factors for total joint replacement surgery?


Most surgeries occur without any complications. However, the risk of infection and blood clots concern us the most. Antibiotics, blood thinners, and early mobilization assist in preventing these complications.


How much pain will I have?


Many patients have suffered with painful arthritis leading up to the surgery. The pain experienced after total joint replacement surgery is temporary and will diminish over the first few weeks following the surgery. It’s important to keep your post-operative pain under control to allow you to exercise and walk. The staff will work with you to keep you comfortable.


How long until I am back to normal?


The average hospital length of stay is four days, followed by home care and outpatient therapy as needed. Recovery times vary; however, most patients return to driving and work activities four to six weeks after surgery.


For more information on our Joint Solutions Program click here.



Make an appointment with an Orthopedic Specialist:


Orthopedic Services of CMA
16 Brentwood Drive, Suite A - Parkview Campus
Ithaca, NY 14850
(607) 272-7000

For more information on our Orthopedic Services click here.

Plastic, Cosmetic, and Reconstructive Surgery


Our surgical specialists are fellowship-trained and very experienced. They perform both facial plastic surgery and reconstruction following surgery for cancer and trauma. They operate at Surgicare and Cayuga Medical Center, routinely handling:

·  Facial and nasal surgery, both reconstructive and cosmetic

·  Reconstruction after the excision of tumors

·  Mammoplasty (breast reconstruction) and TRAM flap or transverse rectus abdominus myocutaneous flap (breast reconstruction with skin and fatty tissue from the patient’s abdomen)

·  Hand surgery, including the reattachment of severed fingers; endoscopic carpal tunnel surgery; nerve surgery and other forms of microsurgery

·  Liposuction to remove fat and contour the body

·  The newest techniques for chronic wound care


Podiatry­: Surgery for the Feet


Our podiatrists perform a number of surgical procedures to correct painful foot problems.

·  Realignment of toe joints deformed by bunion, joint implants, and bone fusion

·  Hammer toe correction

·  Metatarsal surgery to alleviate pain and callous formation

·  In the realm of soft tissue surgery, they treat neuromas (pinched nerves), tarsal tunnel release, soft tissue tumors (cysts and ganglions), plantar fasciotomies

·  Surgical and laser wart removal

·  Shock-wave therapy to treat heel pain


Urologic Surgery


Urologists at Cayuga Medical Center provide medical and surgical treatment for diseases of the urinary tract in women and men, and the reproductive tract in men. They offer the newest approaches for treating bladder cancer and take care of patients requiring:


·  Prostate surgery

·  Microsurgery for male infertility

·  Medical and surgical treatment for erectile dysfunction

·  Circumcision and surgery to correct undescended testicles in young boys

·  Medical and surgical treatment for incontinence in women related to childbirth

·  Minimally invasive lithotripsy to break up painful kidney stones from outside of the body using shock waves, with no cutting or incision involved (patients are able to return home the same day)


Vascular Surgery Addresses Circulatory Problems


Vascular disease affects the circulation of blood in the arteries and veins. The vascular surgeons at Cayuga Medical Center reopen blocked and narrowed blood vessels using minimally invasive endovascular techniques for much of the surgery they do.

·  Endovascular repair of abdominal aortic aneurysm (AAA) eliminates the need for a large abdominal incision and significantly reduces the time required in the hospital and for post-operative recovery

·  The entire range of blood vessel surgery, including angioplasty, stenting, and bypass surgery

·  Carotid endarterectomy (to remove plaque buildup from the inside of the carotid arteries) and other advanced vascular procedures, including renal artery angioplasty and stenting

·  Our venous-disease expert (phlebologist) treats varicose veins using a new minimally invasive approach called the Endo Laser Venous System (ELVS), which allows patients to return to normal activities the following day.

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