Our surgeons have special expertise in treating cancers and injuries of the bile duct. In fact, Mount Sinai is the leading referral center for bile duct injuries in New York City. When the bile duct is injured, we create a new connection from the bile duct to the intestine. The most common treatment, called hepaticojejunostomy, bypasses the injured portion of the bile duct and pancreas.

Bile duct cancer is among the most difficult malignancies to treat. We have extensive experience in all aspects of the surgical treatment of this disease, including:

• Liver resection for tumors arising from the ducts inside the liver (intrahepatic cholangiocarcinoma)
• Combined liver and bile duct resection for tumors arising from the ducts as they enter the liver (hilar cholangiocarcinoma, Klatskin tumor)
• Resection of lower bile duct tumors, along with the pancreas and first part of the small intestine (pancreaticoduodenectomy, or Whipple procedure).

Our full-service breast health program offers state-of-the-art technology in diagnostic, treatment, and reconstruction procedures. Whenever possible, Mount Sinai surgeons use a minimally invasive approach to reduce the length of hospital stays and recovery times.

Breast diagnosis

Once doctors have detected a lump in the breast, either physically or via a mammogram, several tests can evaluate the mass for malignancy. Many of these exams occur in the physician’s office.

Axillary lymph node dissection

Surgeons remove a small pad of fat from under the arm. This sample contains 10 to 20 lymph nodes. Examination of these nodes often reveals whether cancer has spread to other parts of the body.

Core needle biopsy

This outpatient procedure allows diagnosis of a breast mass without surgery. The surgeon inserts a needle through the skin and removes a tissue sample from the suspicious area. The procedure typically involves collecting three to six separate samples.

Excisional biopsy

This procedure is used to diagnose lumps smaller than one inch in diameter. Performed in the doctor’s office, this operation removes the entire lump or suspicious area. The tissue is then tested for malignancy.

Sentinel lymph node biopsy

This procedure provides an outpatient alternative to axillary node dissection for women whose lymph nodes appear normal. Surgeons remove and study one or two sentinel nodes for traces of disease. These glands are the first to receive lymphatic drainage from a tumor. Healthy sentinel nodes can spare women from more aggressive diagnostic tests.

Breast treatment

Mount Sinai breast surgeons specialize in procedures that minimize physical trauma and avoid unnecessary surgery. If surgery is required, the size and stage of the mass determines the procedure.

Lumpectomy

This procedure is the most common form of breast surgery. The surgeon removes the tumor and a small amount of surrounding breast tissue.

Mastectomy

In a partial mastectomy, surgeons remove a wedge of the breast tissue. A total mastectomy involves removing the entire breast, which may extend to axillary lymph nodes under the arms.

Breast reconstruction

Prior to surgery, Mount Sinai plastic surgeons work closely with breast surgeons, oncologists, pathologists and radiologists to create a seamless, multidisciplinary experience for the breast cancer patient. We provide a warm, supportive environment for the breast cancer patient, while providing access to state-of-the-art care. Research has shown that breast reconstruction does not interfere with treatment or change survival rates, yet it plays an important role in the emotional recovery process.

Flap reconstruction

Our surgeons can reconstruct breasts after mastectomy with tissue taken from another part of the body (autologous tissue) or with implants. The various techniques each have their advantages and disadvantages. Together, surgeons and patients choose a method that balances patient preference, body type, cancer type, and need for post-operative radiation and chemotherapy.

Free TRAM (transverse rectus abdominis muscle) flap

A refinement of the older pedicled TRAM flap, this microsurgical technique completely detaches and reattaches the flap tissue with the aid of a microscope, allowing “free” transfer of lower abdominal skin, fatty tissue, and muscle. This technique minimizes problems at the abdominal donor site while maximizing the amount of tissue available for reconstruction. Microsurgical breast reconstruction has largely replaced the pedicled TRAM as the procedure of choice at the Mount Sinai Hospital.

Perforator TRAM flap / DIEP (deep inferior epigastric perforator) flap

The latest refinement in breast reconstruction, this microsugical technique transfers abdominal skin and fatty tissue to the breast without sacrificing any of the abdominal six-pack muscles. This technique requires meticulous dissection of the perforating blood vessels within the abdominal muscles. Reconstruction with perforator flaps requires a plastic surgeon who is also experienced in microvascular surgery.

Latissimus dorsi (LD) myocutaneous flap

This previously popular technique transfers tissue from the back, using latissimus dorsi muscle as the blood supply. The procedure often requires the addition of an implant, making it a secondary choice to TRAM flaps as a reconstructive option.

SGAP (superior gluteal artery perforator) flap

This technique transfers the skin and fatty tissue taken from the upper gluteal area to rebuild the breast. The scar ends along the panty line.

IGAP (in-the-crease gluteal artery perforator) flap

This procedure takes skin and fatty tissue from the lower buttock to rebuild the breast. The buttock crease helps hide the resulting scar.

Skin expansion

Mastectomy also removes skin and may leave no room for immediate implant placement. To create space, the surgeon inserts a balloon-like tissue expander beneath the skin and chest muscle. He or she gradually fills the expander by injecting it with saline, a salt-water solution, over several weeks. Once the skin has stretched enough, the surgeon removes the tissue expander and replaces it with a permanent breast implant, filled with either saline or silicone gel. Reconstruction of the nipple and areola, the darker skin surrounding the nipple, takes place in a separate operation.

The actual procedure varies according to the individual patient. Some women do not require tissue expansion and receive a permanent breast implant as a one-stage reconstruction after mastectomy. Most women, however, are candidates for two-stage reconstruction.

Most colon and rectal cancers require a combination of therapies to be cured. Our surgeons take a whole-disease approach to colon and rectal cancer. We work with other specialists in the institution to create a custom treatment program that includes radiation therapy and chemotherapy as needed. This multidisciplinary approach treats the full patient, and not just the source of the disease.

Local excision of rectal cancer and polyps

The surgeon inserts an instrument into the rectum and removes the tumor without the need for an abdominal operation. This procedure is often appropriate for rectal cancers found at an early stage.

Colectomy

The surgeon removes the part of the colon with the tumor and nearby tissues containing lymph nodes. The procedure typically reconnects, or anastomoses, the healthy colon with the rectum.

Mount Sinai surgeons frequently perform this type of surgery with minimally invasive techniques (laparoscopy) that allow for less pain, faster recovery, and superior cosmetic results. In fact, our surgeons participated in the national randomized trial on laparoscopic surgery for colon cancer.

Colostomy

In rare cases, the surgeon cannot safely reconnect the two ends of the colon. Should this happen, the surgeon brings the free end of the colon through the abdominal wall, where it empties waste into a special appliance worn underneath the clothing. Though usually temporary, there are some cases in which the colostomy is permanent.

Ileostomy

Occasionally, the surgeon cannot safely reconnect the two ends of the small intestine. When this happens, the surgeon brings the free end of the small intestine through the abdominal wall, where it empties waste into a special appliance worn underneath the clothing. Usually a temporary condition, there are some cases in which the ileostomy is permanant.

Proctocolectomy, or total colectomy

This procedure removes rectum and part of the colon for advanced rectal cancer. Radiation and chemotherapy often precede surgery. The rectum is then removed, and the colon is attached to the area just above the sphincter muscles. The creation of a J-pouch, a new reservoir, improves post-operative bowel function with fewer, more formed bowel movements.

Esophageal cancer is a serious form of cancer that starts in the inner layer of your esophagus. The most common symptom of esophageal cancer, usually occurring late in the disease, is difficulty swallowing and a sensation of food getting stuck in your throat or chest. In the past, the outlook for people with esophageal cancer was poor. But survival rates have improved, in part because close monitoring of Barrett's esophagus—a serious, premalignant complication of acid reflux disease—which can help detect cancer early, when it's more likely to respond to treatment. In addition, diet and lifestyle changes can significantly reduce your chances of ever developing esophageal cancer. Mount Sinai's surgical oncologists work as a team to treat cancers of the upper gastrointestinal tract, which includes the esophagus.

Our surgeons treat patients with both benign and cancerous gallbladder disease.  The vast majority of benign gallbladder disease can be removed laparoscopically. The standard treatment for gallbladder cancer is radical cholecystectomy. Unlike a standard cholecystectomy, which removes only the gallbladder, this procedure removes part of the liver, as well as part of the common bile duct and its adjacent lymph nodes.

Mount Sinai is currently the leading referral center in the United States for primary liver cancer. Liver cancer may start in the liver (hepatocellular carcinoma and cholangiocarcinoma) or spread there from other sites, most often the colon or rectum. We offer a cross-disciplinary liver cancer program that unites specialists in medical liver disease, cancer treatment, and surgery. This state-of-the-art treatment center has experience successfully managing highly complex advanced liver disease with a full range of therapies.

Partial hepatectomy

The surgeon removes the part of the liver that contains the abnormal mass, as well as a small amount of healthy tissue. The remaining liver grows and functions as a whole organ. Many liver resections at Mount Sinai are performed laparoscopically.

Total hepatectomy with liver transplant

This procedure removes the entire liver and replaces it with a healthy organ. To be eligible for a transplant, the disease must be confined to the liver. The patient receives additional treatment as needed while awaiting transplant of a suitable donated liver. Transplants at Mount Sinai are done with both living donor organs and standard cadaver organs.

Radiofrequency ablation

This technique uses a special probe with tiny electrodes that burn the cancer in the liver to destroy it. This procedure eliminates the need for surgery, and can often be done without any incision.

Transarterial chemo-embolization

Surgeons gain access to the patient’s arterial system via the groin. They then advance a catheter inside the blood vessels until the artery supplying the liver and, more specifically, the one supplying the tumor are located. Medication and particles are given directly into the blood vessel that supplies the tumor in order to destroy it and control its growth.

Surgical procedures for pancreatic cancer are either curative, which remove the tumor, or palliative, which relieve symptoms when the tumor has spread and cannot be removed. Our surgeons also treat benign tumors of the pancreas. These can be pre-cancerous (cystic tumors of the pancreas) or benign (pancreatic pseudocysts)

Curative procedures

Surgeons use several different techniques to remove pancreatic tumors. In many cases, these procedures may take a minimally invasive approach.

Distal pancreatectomy

This procedure removes the body and tail of the pancreas. It often involves removing the spleen as well.  Mount Sinai is a leader in performing this procedure laparoscopically, which results in a shorter hospital stay, less post-operative pain, and minimal scarring.

Whipple procedure, or pancreaticoduodenectomy

The surgeon removes the head of the pancreas, part of the stomach and small intestine, the gallbladder and the common bile duct. The procedure leaves enough pancreas intact to produce insulin and digestive juices.  Our surgeons favor leaving the entire stomach (pylorus-preserving pancreaticoduodenectomy) when this does not compromise tumor removal.

Total pancreatectomy

The surgeon removes the entire pancreas and several surrounding structures. The procedure typically removes part of the stomach and small intestine, as well as the common bile duct, the gallbladder, the spleen, and nearby lymph nodes.

Palliative procedures

If the cancer has spread and surgeons cannot remove it, several treatments can help relieve symptoms.

Biliary bypass

Surgeons use this procedure to correct a blockage in the bile duct or pancreas that obstructs the normal flow of bile from the liver. He or she attaches either the gallbladder or the bile duct to another area of the small intestine, creating a new path around the blocked area.

Gastric bypass

In some cases, a tumor may prevent food from leaving the stomach and entering the small intestine. This procedure attaches the stomach directly to the small intestine and allows the patient to eat normally.

Stent placement

Sometimes a mass blocks the bile duct and blocks the normal flow of bile from the liver. The surgeon inserts a thin plastic tube, called a catheter, in the duct to bypass this blockage. The catheter can take the bile outside the body or directly into the small intestine.

Peritoneal Carcinomatosis is the extensive, or very widespread, metastasis of cancerous tumors onto the inside surfaces of the abdomen. People with peritoneal carcinomatosis until recently were considered inoperable and terminally ill. Now at Mount Sinai, a program has been developed that involved aggressive cytoreductive surgery and administration of heated intraperitoneal chemotherapy (HIPEC). Early results are promising for improving survival and symptoms in this aggressive disease. A number of different tumor types are considered suitable for this approach. Data shows that the less extensive the peritoneal tumor the more successful the surgery.

Medical advances have vastly improved the lives of individuals with the rare groups of cancers known as sarcomas. These cancers can occur anywhere in the body.  Surgery to remove the tumor remains the primary therapy. In addition, chemotherapy and radiation therapy typically supplement tumor removal to produce the best results. Our surgical oncologists work closely with other cancer specialists throughout the institution to develop a custom treatment plan that manages all aspects of the disease. Our team of experts oversees all aspects of therapy to ensure optimal outcomes.

Our surgeons are skilled in removing all forms of skin cancer, including melanoma. We offer sentinel lymph node biopsy, a minimally invasive procedure that maps the route by which the cancer spreads to lymph nodes. The surgeon then removes and studies only one or two sentinel nodes for traces of disease. These glands are the first to receive lymphatic drainage from a tumor.  If these lymph nodes are cancer-free, no more lymph nodes are removed. Removing only a few nodes prevents long-term problems of swollen legs (lymphedema).

We have extensive experience treating cancers of the stomach at all stages. Our surgeons work with experts in chemotherapy and radiation therapy to create a custom treatment plan that offers the best possible outcome. These alternate therapies supplement surgical treatment, which typically involves gastrectomy. In this procedure, the surgeon removes all (total) or part (subtotal) of the stomach. In a total gastrectomy, the esophagus is connected directly to the small intestine.  Our surgeons also perform this operation laparoscopically for early cancers.