In medicine, something we can all expect is change. Surgical care is no different than other specialties and the most recent significant change within the surgical community is the utilization of robotics. At Lakeview Clinic, we have several of our surgeons who are trained robotically and have been community leaders in the advancement of robotic surgery using the daVinci Surgical System.
Advantages of Robotic Surgery
Robotic surgical procedures are minimally invasive procedures that have resulted from the advancement of well accepted laparoscopic procedures. The major advantage of using robotics rather than standard laparoscopic procedures is the ability of robotic techniques to simplify fine movements and stabilize the surgeon’s implementation of certain maneuvers. This results in the simplification of standard laparoscopic procedures and improving techniques allowing completion of more complex surgical procedures, previously requiring larger “open” surgical incisions.
How Robotics are Used During Surgery
Robotic surgical procedures still require significant surgeon involvement, as all the technical aspects of the procedure involve human input. This begins with the placement of abdominal cannulas (tubes) which are used to introduce instruments into the abdomen. There will be 3 or 4 cannulas placed through incisions as small as 8 millimeters (about 1/3 of an inch). Through the cannulas, a high-definition video camera and robotic instruments are placed into the abdomen, and the robot is docked to the cannulas. Once the robot is docked, the surgeon sits at the console within the operating room and views images from the high-definition video camera. Using a combination of hand and foot controls, the significant components of the surgical procedure are completed using the robot.
Who Performs Robotic Assisted Surgery?
At Lakeview Clinic, both our general surgeons and gynecologic surgeons perform robotic surgical procedures routinely. The most common procedures include abdominal wall hernia repair, gallbladder removal, hiatal hernia repair, hysterectomy, intestinal resections (particularly colon resections), and ovary and fallopian tube procedures. Many other less common procedures may also be performed using the robotic platform.
The Benefits
The minimally invasive techniques of robotic surgery result in decreased postoperative pain, shorter recovery times, reduced blood loss, shorter hospital stays, shorter operative times and a decrease in certain short-term and long-term postoperative complications. You can read or view a patient’s first-hand account on Ridgeview Foundation’s website. In Russ’s Story he talks about how well he felt post-surgery.
It is important to remember that not all surgical procedures are best performed using robotic techniques for a variety of reasons. Your surgeon can discuss whether a robotic approach is appropriate for you.
Dr. Elftmann joined Lakeview Clinic as a general surgeon in 1995. He has received additional training for complex robotic surgical cases including colon, gastric, as well as hiatal and abdominal wall hernia procedures. Dr. Elftmann has also been recognized as a Minnesota Monthly Top Doctor of General Surgery
It is important to acknowledge that prenatal care is done on an individual basis and can vary significantly depending on maternal and/or fetal conditions. The following outlines a typical schedule of obstetric visits and what you can expect during prenatal care. The Lakeview Clinic OB/GYN team takes pride in providing outstanding, evidence-based care to each of our patients.
Lakeview Clinic’s OB/GYN providers deliver compassionate, high-quality care for expecting mothers.
First Trimester Visits
5-7 Weeks Gestation
At this visit, we will confirm pregnancy, discuss personal medical risks and medication safety. Due dates will be calculated as well and are typically based on first day of last menstrual period. Other topics may include early pregnancy symptoms and concerning signs/symptoms of potential issues such as miscarriage and ectopic pregnancy.
8-9 Weeks Gestation
At this point, an optional early pregnancy ultrasound can be performed by one of the OB/GYN physicians in the office. This allows for confirming and establishing the due date, the viability, and number of fetuses.
11-13 Weeks Gestation
This is the first OB visit where your medical history is reviewed, blood work is done including optional noninvasive prenatal testing (NIPT), and we listen to the fetal heartbeat.
Second Trimester Visits
Prenatal visits typically occur every 4 weeks (16, 20, 24, and 28 weeks) with an OB physician.
20 Weeks Gestation
A fetal anatomy survey is performed in order to evaluate the fetal, maternal, and placental anatomy and confirm the estimated due date/size of the baby. This can be done in our clinic by an ultrasound technologist. The ultrasound is then read by a radiologist who will review the survey with your OB physician
26-28 Weeks Gestation
Blood work is done to evaluate for gestational diabetes, anemia, etc., Tdap vaccine and Rhogam if needed are also recommended.
Third Trimester Visits
30 Weeks Gestation
At this point prenatal visits become more frequent and take place every 2 weeks. These more frequent visits are recommended to closely monitor blood pressure and fetal growth.
36 Weeks Gestation
During this visit, a Group B Strep test is performed, and fetal presentation is confirmed (We are looking to see that baby is head down; we use the term Vertex presentation). We can tell this either by cervical check or a brief ultrasound that the OB does to confirm. Weekly visits start now.
When it is Time for Baby’s Arrival
All of our patients deliver at Ridgeview’s Birthing Center. The birthing center has six private labor rooms. Two of the rooms have large tubs and all have showers.
While we all thoroughly enjoy attending the deliveries of our own patients this is not always possible. In general, we try our best to be there for our patient’s labor and delivery. If we are unavailable, one of the other Lakeview OB partners who is on call will attend and take great care of you during labor and delivery. You can also expect to see one of us every day that you are in the hospital both while in labor and postpartum. We are also happy to help you get established with an experienced provider for newborn care at Lakeview Clinic. Newborn visits are available daily. We also follow up with you in the office 6 weeks postpartum and sooner whenever needed. Our patients are our priority, and we welcome and accept newly pregnant patients every day.
Dr. Erin Chinnock sees patients at Lakeview in Chaska and Waconia. Her practice involves both obstetrics and gynecology. She cares for patients with a wide variety of concerns related to reproductive health, pregnancy, and menopause. Her areas of interest include preventative care, low and high-risk obstetrics, contraception and sexual health.
Dr. Heidi Wuerger’s Experiences Through Volunteering
Sometimes when I’m not in the office, Watertown staff ask “where’s Dr. Wuerger? Much of that time has been spent volunteering in places as far as Ecuador. In the last year I have been fortunate enough to spend time on 3 service trips. At Lakeview Clinic, part of our mission is service and Lakeview clinic employees serve every day in and out of the clinic.
In August of 2023, I spent a week in Belize with my church as an adolescent Leader. We had a group of 54 people who spent time in the city of San Antonio on the western side of Belize near Guatemala, and Bermudian Landing near Belize City. We ran children’s camps, dug trenches, helped clean up a recreation camp, delivered food to underserved at their homes and developed international friendships and knowledge. We also learned how difficult it can be to get a high school education, much less a college or medical school education, which only exists in Belize city. This is one of the reasons Belizeans do not have access to occupational or speech therapy and have very little physical therapy.
In January to February this year I spent 2 weeks with Common Ground International in a medical Spanish immersion program in Costa Rica. Rory and Leslie, the co-owners and founders of common ground, have 2 immersion trips -one to Costa Rica and the other to Ecuador. I had made a commitment to learn Spanish, so with the help of Google, I searched Spanish immersion and medical. This led me to Common Ground and in the end of January I found myself flying into San Jose, Costa Rica.
During this trip, I stayed in Santo Domingo de Heredia with a lovely family of 5, including 3 boys ages 5-12. I walked to Spanish school, Lapa Verde each day and spent 4 hours in intense Spanish class every weekday and made the commitment to speak only Spanish for 2 weeks. During this experience, we learned about the culture, donated to the community and helped serve in the community clinics. Multiple days we went to CEDCAS (a non-profit organization in Costa Rica for Health Education and Services) community center and took weight, height, blood pressures, blood sugars, reviewed medications and answered questions. This specific center helps the shanty town area Guarari.
The last week in June I went to Chicago with 26 other adolescents and adults on another service trip. Many kids and families were nervous for the trip due to media reports about Chicago. We stayed in a church and did service events around the city. We learned about refugee resettlement where the main message was that they are people just like us. We bought supplies for 2 different families, one from Bangladesh and the other from Pakistan and then set up their apartments. It was about $750 to set up basic supplies for a family of 4 in one apartment. These families spend on average 5-6 years living in refugee camps with about 14 square foot space and blankets for walls. They go through significant vetting processes to get into the US and have given up their belongings, except if they’re lucky a backpack. Once they arrive, they are required to pay back most of the cost, including their plane tickets
We also worked with A Just Harvest, a greenhouse and garden in the city which serves lunches for the homeless. Another day was spent at Projectcure.org – a medical warehouse where we sorted donated medical supplies to go to countries in need. We also went to Berniesbooks.org -a warehouse filled with new books, where volunteers help organize, label and separate the books that are donated to kids in need in the area.
All of these opportunities allowed people to open their eyes to see people and places differently. It’s amazing to see that process, especially on the face of a teenager. And when people ask ‘Where’s Dr Wuerger’-I might be on another service trip, hopefully meeting more people, learning more Spanish and creating more heartfelt connections in the world. Yet, I know it’s not just happening on these trips but happening in our clinic and our community as well. So, THANK YOU, to all those at Lakeview Clinic and in the surrounding communities who SERVE.
Dr. Heidi Wuerger
Family Physician, Dr. Wuerger has training and experience in the care of patients from infancy through adulthood. She enjoys full spectrum family practice including sports medicine, gynecology procedures and urgent care. When she is not working, Dr. Wuerger enjoys spending time with her family and outdoor pursuits such as camping, gardening and running an apple orchard.
Diabetes is a growing disease in America. Almost 96 million Americans are followed for diabetes in 2024. If you are followed for diabetes, your physician will stress the importance of a comprehensive eye examination. This is because uncontrolled diabetes can cause changes in your vision and the development of cataracts. The most severe complication is diabetic retinopathy.
What is Diabetic Retinopathy?
Diabetic retinopathy causes damage to the blood vessels of the retina, which is the back layer of the eye. One in 12 people with diabetics have diabetic retinopathy. Diabetic retinopathy is the leading cause of blindness for people under the age of 60.
Diabetic retinopathy can develop in anyone with type I or type II Diabetes. The longer you have diabetes, the more likely you are to develop diabetic retinopathy. Most often patients will not have symptoms of early diabetic retinopathy. As retinopathy progresses, you may develop blurred or fluctuating vision, floaters (spots in your vision that may appear like black or gray specks, strings, or cobwebs), a quick change in your vision, dark spots in your vision and even blindness.
In this example of how people with normal vision see, there are no visual symptoms of floaters or damaged blood vessels.
This is a simulated example of how someone with diabetic retinopathy may see. As retinopathy progresses, individuals may begin noticing blurred vision, dark spots, and floaters.
Early Diabetic Retinopathy
In early diabetic retinopathy, the walls of the retinal blood vessels are weaker. The small blood vessels will leak fluid and blood into the retina. Large vessels will dilate. As retinopathy progresses, more vessels become blocked causing more blood in the retina. Sometimes, the macula, which is the center of portion of the retina, will develop a buildup of fluid. This will cause a dramatic decrease of the vision.
Severe Diabetic Retinopathy
In severe diabetic retinopathy, new blood vessels will leak into the clear jellylike vitreous which fills the center of the eye. Scarring of the retina can even cause a retinal detachment.
How Eye Doctors Diagnose Retinopathy
It is very important to have a dilation during the eye examination. This means that your eye doctor will instill eye drops to enlarge your pupils. With a slit lamp and other specialized equipment, your eye doctor can thoroughly examine the retina. Photography or scanning may be performed to look for macular or retinal edema. If there is significant fluid or bleeding of the retina, a consultation will be scheduled with a retinal specialist.
Managing Risks
The loss of vision from diabetic retinopathy can be significant. The risk of diabetic retinopathy increases with poorly controlled blood sugars, high blood pressure, high cholesterol and tobacco. Careful management of your diabetes is the best way to prevent vision loss. Is very important to see your eye doctor for a yearly eye examination with dilation, even if your vision is fine. In addition, healthy eating and physical activity are important to control your diabetes.
If you have questions regarding diabetic retinopathy, consult your eye doctor. He or she will advise your physician of the appearance and progression of diabetic retinopathy.
Dr. Jackson joined Lakeview Clinic in December 2003 and enjoys providing comprehensive eye care for all age groups. She also fits contacts and sees patients for emergency eye care.
Decrease drinking alcohol- any amount of alcohol increases your risk of breast cancer. At the very least try to drink less than three drinks per week.
Be active!! Move your body every day, especially after meals!
Control your weight- women after menopause who are overweight have an incrementally increased risk of breast cancer.
If you have been taking a combined estrogen/progesterone medication for more than 3 years discuss the risks of this with your doctor.
Can I detect breast cancer early? YES!!!
It is possible to detect breast cancer before it is even Stage I! This type of cancer is called DCIS (ductal carcinoma in-situ). These changes can be detected on mammogram even before the cancer leaves the lining of the duct of the breast.
How can breast cancer be detected early?
If you are a normal risk woman, get your mammogramevery year starting at age 40. 3-D mammograms are available at many healthcare facilities, including Lakeview Clinic. If 3-D mammograms are available in your area, get one! It is better at detecting small changes.
What if my mammogram report says I have dense breast tissue?
Having dense breast tissue makes self and physician breast exams important. If you notice any change when feeling your breast tissue, see your doctor. Depending on other risk factors, such as strong family history, you may be a candidate for other types of imaging including ultrasound or MRI.
Can I have mammograms more than once a year if I am at increased risk for breast cancer?
No, but you could be a candidate for other lab tests, imaging tests or even medication or surgery to decrease your risk. Other factors (besides having breast tissue) that put you at increased risk include if you have had certain cancers before, family history of breast, ovary or pancreas cancer, history of radiation treatment to your chest, biopsy of breast tissue in the past showing atypical cells or lobular carcinoma in-situ (LCIS), or a genetic mutation of BRCA 1 or 2.
Wow! That is a lot of information.
Can my doctor help me determine my risk? YES!!
As early as the age of 25 your doctor should be asking you questions about you and your family history to determine if you have an increased risk of breast cancer. Based on the answers to these questions, you may need to start your mammograms before age 40 or have other image testing such as MRI.
Source: NCCN (National Comprehensive Cancer Network) More information is available on their website nccn.org.
General Surgeon, Dawn Stapleton, MD
Dr. Stapleton’s practice includes surgical and endoscopic services. She has special interests in cancer surgery and robotic surgery for cancers and benign conditions including hernia repairs. She also performs colonoscopies.
Dr. Stapleton is the Cancer Liaison Physician for Ridgeview Medical Center and monitors cancer care quality at the hospital.
