Joshua S. Tierny, MD | Robotic Surgeon
Are you looking for the best Robotic Surgeon in Scottsbluff, NE? Schedule an appointment with Dr. Joshua Tierney today!
Dr. Joshua S. Tierney
Hepatopancreatobiliary (HPB) Surgery, Robotic Surgery, and Interventional Endoscopy/ERCP
Dr. Joshua Tierney is a published, award-winning, and fellowship-trained surgeon who treats patients from the Northern Front Range and Eastern Plains of Colorado, Wyoming, and Western Nebraska. He is board-certified in General Surgery and Fellowship-trained in Hepatopancreatobiliary (HPB) Surgery and ERCP.
The pancreas balances the body’s blood sugar by producing insulin, which is the enzyme that controls blood sugar levels. The pancreas is vital for the digestive system since it produces enzymes that help break down food and insulin which regulates blood sugar levels. Many types of pancreatic issues can develop, ranging from diabetes to cancer.
Pancreatic cancer develops when a tumor grows in the pancreas. Pancreatic cancer, like any other cancer, starts from one or a few cells that divide uncontrollably and form a tumor. The tumor cells stay localized to the pancreas initially but can spread to lymph nodes or other organs (liver, abdominal cavity, lungs) as cancer becomes more advanced. The exact reasons for DNA damage of pancreatic cells are not known, but several factors have been established to raise the risk of a person developing pancreatic cancer such as obesity, smoking, environmental exposures, and genetics.
Pancreatic cancer can be very aggressive, progressing from stage I (localized disease) to stage IV (metastatic disease) in one year or less. It also is very difficult to diagnose early due to the lack of screening tests.
The symptoms of pancreatic cancer are often vague and non-specific. How to diagnose pancreatic cancer early in Scottsbluff, NE is very challenging. For this reason, only 20% of pancreas patients with pancreatic cancer are diagnosed at an early stage.
Symptoms of pancreatic cancer in Scottsbluff, NE include: jaundice, itching, weight loss, loss of appetite, diarrhea, new-onset diabetes, and vague abdominal pain. These symptoms are discussed in more details:
Pain – The growing tumor presses against the surrounding tissues and nerves, causing discomfort as it becomes more significant. The pain becomes severe when cancer develops beyond Stage III. In the early stages, the pain is relieved by strong prescription painkillers, which block the celiac plexus block nerves from sending pain signals to the nervous system.
Weight loss - The discomfort in the stomach area, nausea, and vomiting contribute to making it difficult to eat and retain nourishment. The production of digestive fluids and enzymes which is needed for digestion and absorption of nutrients hampers, leading to rapid weight loss.
Jaundice – In some cases, the tumor blocks the bile duct, preventing the stomach's normal release of bile. The high levels of bile in the liver cause jaundice, which shows in the yellowing of skin, eyes, and nails.
Poor bowel movement – The pancreatic tumor can press into the small intestines (duodenum), making it obstructed. It slows down the normal flow of food in the digestive tract, adding to stomach discomfort, loss of appetite, and constipation.
How to diagnose pancreatic cancer early? Pancreatic cancer is usually diagnosed after a physician suspects the diagnosis and orders a CT scan to evaluate conditions of the pancreas or discovered incidentally on a CT scan obtained for other reasons. When a pancreatic mass is discovered on imaging a thorough workup is performed to establish the diagnosis, stage the disease, and determine if the tumor is resectable surgically. The additional tests employed include: blood tests, endoscopic ultrasound, endoscopic retrograde cholangiopancreatography (ERCP), and sometimes MRI or additional CT scan in hospital. After the workup is complete the case is discussed in a multidisciplinary tumor board where pancreatic surgeons in Scottsbluff, NE, discuss each case and determine the proper treatment strategy.
When pancreatic cancer is detected early, and if the disease is localized, it can be treated with curative intent. Treatment involves a combination of surgery, chemotherapy, and sometimes radiation therapy. Due to the aggressive biology of pancreatic cancer, treatment with surgery or chemotherapy alone is inadequate and a combination of the two is always necessary. It is of utmost importance to select the best pancreatic surgeon in Scottsbluff, NE who has specialized training in pancreatic surgery when embarking on treatment for pancreatic cancer. Pancreatic cancer is treated by complex surgery and difficult in patients. Multiple studies have shown that outcomes in pancreatic surgery are better when performed by surgeons with specialized training in Scottsbluff, NE who also perform a high volume of cases. Dr. Tierney is a fellowship-trained hepatopancreatobilairy (HPB)surgeon who performs a high volume of pancreatic surgery and has a reputation for success. Dr. Tierney is also the best robotic surgeon in Scottsbluff, NE, who performs complex minimally invasive pancreatic surgery using new robotic technologies as dictated by the extent of the disease.
This procedure is also known as a pancreaticoduodenectomy. It involves removing the head of the pancreas, the duodenum, the distal bile duct, and the gallbladder. This procedure is performed when the tumor is located in the head of the pancreas. The Whipple procedure is performed through both open and robotic approaches by Dr. Tierney.
Distal pancreatectomy
This procedure is done when the cancer is confined to the tail or body of the pancreas. For pancreatic cancer, the spleen is removed with the tail of the pancreas so that all of the surrounding lymph nodes are removed with the tumor. This procedure is performed both open and robotically by Dr. Tierney.
Total pancreatectomy
This procedure removes the whole pancreas together with the small intestines, gallbladder, and spleen. It is possible to live without the pancreas but one must depend on insulin shots and oral enzymes for a lifetime.
The traditional method of pancreatic surgery involves cutting open the stomach area to get to the pancreas. It enables the surgeon to see the surrounding tissue and organs. The main drawback of open surgery is trauma.
A new way of performing pancreatic surgery is by using a robot in a robotic-assisted procedure using a precise cut by a surgeon controlled robot. This type of pancreatic cancer surgery can be done with different types of pancreatic cancers, including benign masses, neuroendocrine tumors, pancreatic adenocarcinoma, cystic tumors, and chronic pancreatitis. The best pancreatic surgeons in Scottsbluff, NE are knowledgeable and skilled with these techniques.
The robot has a 3D camera attached to the robotic arm, through which the surgeon can see the pancreas and surrounding organs. The robotic arm inserts via a small incision (about half an inch) on the side of the stomach. The pancreatic surgeon then guides the robotic arm to excise the tumor and pull it out. Robotic surgery has become the preferred treatment in pancreatic surgery because there is less trauma, lower blood loss, and tissue injury. The patient takes a shorter time to recover and can move on to chemotherapy.
A hernia disease occurs when internal tissues or organs push through the wall holding them. The most common is an abdominal hernia where fatty tissue protrudes through a hole in the stomach wall, causing a bulge under the skin. Hernias are defects within the groin or abdominal walls that cause the abdomen’s contents to push out through these defects. Hernias are commonly situated at the groin and umbilicus because these areas in the abdominal wall feature congenital weakness. This may be caused by undue pressure e.g. heavy lifting, or weakness in the stomach wall e.g. from prior surgery. Hernias also form at the site of an incision from previous surgery. This type of hernia is also known as an incisional hernia. Hernias usually present as a protrusion or bulge that comes with a feeling of discomfort around the site, which may increase during physical exertion.
Simple Hernia protrusions can be reduced and manually pushed back in an outpatient facility. An urgent assessment is necessary when a hernia causes sudden pain and the protruding tissue can’t be pushed back in. This is usually a sign that the protruding tissue is trapped and tightly pinched in the hole. This is called obstruction and can lead to cutting off blood supply to these tissues (strangulation), which is a very dangerous condition. This procedure increases the risk of damaging the contents of the intestine that are within the hernia. A hernia does not heal by itself as it needs hernia surgery for the repair, an operation consisting of a mesh reinforcement, to strengthen the abdominal wall.
Robotic surgery
Robotic hernia surgery in Scottsbluff, NE is a minimally invasive procedure that involves robotic technology to address the defects on the groin or abdominal wall. Treatment is possible for simple and complicated hernia disease via small incisions to reduce the pain after surgery and speed up recovery.
Umbilical repair
This is a process that aims to repair defects next to the umbilicus. A small hernia can be repaired successfully through an open approach without using a mesh. The best method for more significant hernias is minimally invasive robotic surgery with mesh reinforcement.
Reconstructing the abdominal wall
Complex and large incisional hernias may need open hernia surgery in Scottsbluff, NE as a treatment solution to release the abdominal wall's muscular components to restore functionality.
Hernias are tears or holes in the abdominal or groin wall through which inner tissues protrude. A hernia causes pain and can lead to more complicated strangulation of the intestines. Hernia surgery is done to push back the protruding tissue and repair the hole. The weak point is reinforced with mesh.
Hernia surgery in Scottsbluff, NE can vary in complexity depending on the size and position of the hernia. Hernia surgery is the only long term solution to treating a hernia completely. This is because a hernia will only grow larger if it is left untreated. Even small hernias require prompt surgical attention. Dr. Tierney’s surgery clinic offers hernia surgery in Scottsbluff, NE done using minimally invasive robotic surgery. This is a newer alternative to open surgery. The surgeon uses a robotic arm with a camera to perform the surgery. This method comes with several advantages for the patient, including less tissue damage, which translates into faster healing time.
Robotic hernia surgery in Scottsbluff, NE is a relatively new technique used to treat smaller hernias and rebuild the abdominal wall. Laparoscopic surgery requires a surgeon to hold the instruments, while robotic surgery features tools operated by a robot and controlled by the surgeon.
Robotic hernia surgery in Scottsbluff, NE, like other laparoscopic surgeries, consists of using a laparoscope, small incisions, a small camera, inflating the abdomen, and projection of the inside part of the abdomen to video screens. During robotic surgery, the surgeon sits at the console inside the operating room to manipulate the tiny surgical instruments. This procedure is essential for reducing pain after the operation and aids faster recovery by using small incisions. In comparison to open hernia repair, robotic hernia surgery in Scottsbluff, NE results in less pain post-surgery, fewer complications like infected wounds, shorter hospital stays, reduced recovery times, and faster return to work regular activities.
Dr. Tierney is an award-winning, published, and fellowship-trained surgeon who takes pride in patient care.
The Whipple procedure is a type of HPB Surgery & Oncology treatment that is recommended for advanced pancreatic cancer that has spread to the small intestines, gallbladder, and bile ducts. This procedure is also known as a pancreaticoduodenectomy. It involves removing the head of the pancreas, the duodenum, the distal bile duct, and the gallbladder. This procedure is performed when the tumor is located in the head of the pancreas. In the late stages of pancreatic cancer, the gallbladder, bile duct, and the first part of the small intestines become affected by the disease as well.
The Whipple procedure is done to prevent further spread of cancer by removing all of the diseased tissue. The specialized Whipple surgeon in Scottsbluff, NE removes the gallbladder, bile duct, and the head of the small intestines (duodenum) and then reconnects the remaining organs. One of the top whipple surgeon in Scottsbluff, NE, like Dr. Tierney, perform this procedure through both open and robotic approaches.
Total Pancreatectomy
This procedure removes the whole pancreas together with the small intestines, gallbladder, and spleen. It is possible to live without the pancreas but one must depend on a lifetime of insulin shots and oral enzymes.
ENDOSCOPIC RETROGRADE CHOLAGIOPANCRE-ATOGRAPH (ERCP)
This procedure is typically the first intervention for the treatment of chronic pancreatitis. Through ERCP obstructing stones in the pancreatic duct can be removed and narrowed areas in the pancreatic duct (strictures) can be stented. Some patients do not respond or only temporarily respond to ERCP, at which point they are considered for surgery.
Frey procedure
This procedure is good for patients who have severe inflammation in the head of the pancreas with associated dilation of the main pancreatic duct. It involves a top surgeon for Whipple procedure in Scottsbluff, NE coreing out the tissue in the head of the pancreas and opening the main pancreatic duct along the length of the gland then sewing a piece of intestine over the cored-out region and the duct to improve drainage.
PEUSTOW PROCEDURE
When the main pancreatic duct is dilated more than 6mm, this procedure is performed. It involves opening the pancreatic duct over the length of the gland and suturing a piece of intestine to the duct so that it drains properly. This procedure can be very successful in select patients and can be performed robotically in a minimally invasive fashion by a top Whipple surgeon in Scottsbluff, NE
DISTAL PANCREATECTOMY WITH/WITHOUT SPLENECTOMY
This procedure is performed in cases where the disease is located in the body or tail of the pancreas. It involves the removal of that portion of the gland. The decision to remove the spleen is made based on whether or not the splenic vein has a clot in it. If the splenic vein is clotted due to the chronic inflammation in that region the spleen will be removed to prevent gastrointestinal bleeding in the future. This procedure can often be performed robotically by a top surgeon for Whipple procedure in Scottsbluff, NE so the recovery is short.
Dr. Joshua Tierney is a published, award-winning, and fellowship-trained surgeon who treats patients from Northern Front Range and Eastern Plains in Colorado and in Western Nebraska. He is board-certified in General Surgery and experienced in handling Hepatobiliary and Pancreatic Surgery.
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