Pullman Regional Hospital General Surgery & Endoscopy

Pullman Surgical Associates

Pullman Surgical Associates

We believe Less is More. Less pain, less worry, more living.

From scheduling to hospital discharge, our promise to patients and their provider is a seamless and exceptional surgical experience. Excellence doesn't have to be complicated. The practice also provides 24/7 coverage for emergency surgery to the region. Gastroenterology services are also provided at Pullman Surgical Associates.

Pullman Surgical Associates
Phone: (509) 338-0632  Fax: (509) 715-2130

Referrals fax: (509) 715-2132

825 SE Bishop Blvd #130, Pullman, WA 99163 - View on Google Maps (former Pullman office of Palouse Surgeons) 


Meet Your Team

Nancy PankoNancy Panko, MD has been providing exceptional care on the Palouse since joining Palouse Surgeons in 2019. As the Medical Director for Pullman Surgical Associates, Dr. Panko seeks to provide a seamless, simplified experience for patients and referring providers.  

Surgical Specialties: include da Vinci robotic-assisted surgical procedures


  • Medical School: University of Washington (WWAMI)
  • Surgical Residency: St Joseph Hospital, Chicago
  • Fellowship: UT Houston, advanced GI and minimally invasive surgery
Personal: In her spare time she enjoys camping, hiking, fishing, running, horseback riding, and yoga.

John VisgerJohn Visger, MD has been providing exceptional care on the Palouse since joining Palouse Surgeons in 2006.

Surgical Specialties: thyroid, breast cancer, laparoscopic cases, da Vinci robotic-assisted surgical procedures


  • Undergraduate: University of Akron
  • Medical School: Northeastern Ohio University College of Medicine
  • Surgical Residency: Western Reserve Care System in Youngstown, Ohio
  • Post-Residency: United States Air Force
  • Fellow of the American College of Surgeons

Personal: When he isn't treating patients, Dr. Visger enjoys spending time with his wife Cherish and 5 children and traveling.

Ron Martin-1-1Ron Martin's 25 years of experience as a surgeon will help serve the region's need for emergency (on-call) surgery.

Surgical Specialties: gastrointestinal surgery


  • Undergraduate: University of Vermont, BA Zoology
  • Medical School: University of Massachusetts
  • Residency: Maine Medical Center, General Surgery
  • Fellowship: Lahey Clinic Medical Center, Gastrointestinal Surgery
  • Author of more than 100 scientific papers and books
Dr. Martin is a retired US Army Reserve Colonel. He's served several combat deployments in Iraq, Kuwait and Afghanistan and was the Senior Surgical Advisor for the US Embassy in Kuwait.

Robert ConroyRobert Conroy's 25 years of surgical experience will help serve the region's need for emergency (on-call) surgery.

Surgical Specialties: gallbladders, mastectomies


  • Undergraduate: California State University, Fresno
  • Graduate: California State University, Fresno
  • Medical School: Bowman Gray School of Medicine, Wake Forest University
  • Residency: North Carolina Baptist Hospital, General Surgery

Tanda_2Tanda Ferguson, Nurse Practitioner, has over 20 years of experience consulting and managing general gastroenterology conditions. She sees patients 16+ years of age.

Specialties: Liver diseases


  • Undergraduate: Bachelor of Nursing, Washington State University College of Nursing
  • Graduate: Master of Nursing, Washington State University College of Nursing


  • American Association of Critical Care Nurses
  • American Association of Nurse Practitioners


An appendectomy is the surgical removal of the appendix, a small tube that branches off the large intestine, to treat acute appendicitis. Appendicitis is the acute inflammation of this tube due to infection. In the majority of cases, an appendectomy is an urgent or emergency surgery. Most patients go home the same day their surgery is performed. 

  • Open Appendectomy: An incision about 2 to 4 inches long is made in the lower right side of your abdomen and the appendix is removed through the incision.
  • Laparoscopic Appendectomy: 1 to 3 very small incisions are made in your abdomen. Through these port sites, a tiny camera and surgical instruments are inserted. Gas is used during the surgery to inflate your abdomen and increase visibility for your surgeon who looks at a TV monitor during the surgery to see inside and guide the instruments. The appendix is removed through one of the small incisions. This method is less invasive with smaller incisions and usually a shorter recovery time. 

Discharge Instructions for Laparoscopic Appendectomy

Colectomy, also known as a bowel resection, is a surgery to remove a portion of the large intestine to treat colon diseases such as cancer, diverticulitis, or inflammatory disease. The surgeon will remove the diseased portion of the colon and either connect the 2 healthy portions of the colon together or create a colostomy, which is an opening to the outside of the body. The surgery is either an open or laparoscopic surgery and requires a stay in the hospital for a day or two. 

Open Colectomy: A long, vertical incision is made in your abdomen and the diseased portion of the colon is removed and the repair is made through this incision. 

Laparoscopic Colectomy: Small incisions are made in your abdomen. Through these port sites,  a tiny camera and surgical instruments are inserted. Gas is used during the surgery to inflate your abdomen and increase visibility for your surgeon who looks at a TV monitor during the surgery to see inside and guide their instruments. The diseased portion of the colon is removed and the repair is made through this incision. 

A biopsy is a diagnostic test involving the removal of tissue or cells for examination under a microscope. This procedure is also used to remove abnormal breast tissue. A biopsy may be done using a hollow needle to extract tissue (needle biopsy).

A lump may be partially or completely removed (lumpectomy) for examination and/or treatment.

A mastectomy is the removal of all or part of the breast. Mastectomies are usually done to treat breast cancer. There are several types of mastectomies, including the following:

  • Partial (segmental) mastectomy, involves the removal of the breast cancer and a larger portion of the normal breast tissue around the breast cancer.

  • Total (or simple) mastectomy, in which the surgeon removes the entire breast, including the nipple, the areola (the colored, circular area around the nipple), and most of the overlying skin, and may also remove some of the lymph nodes under the arm, also called the axillary lymph glands.

Breast Biopsy Discharge Instructions

A cholecystectomy is surgery to remove the gallbladder (an organ under your liver that creates bile). A gallbladder may need to be removed if the organ is prone to troublesome gallstones, if it is infected, or becomes cancerous. Most patients go home the same day their surgery is performed. 

Open Cholecystectomy: An incision about 4 to 6 inches long is made in the upper right side of our abdomen and the gallbladder is removed through the incision. 

Laparoscopic Cholecystectomy: 3 to 4 very small incisions are made in your abdomen. Through these port sites, a tiny camera and surgical instruments are inserted. Gas is used during the surgery to inflate your abdomen and increase visibility for your surgeon who looks at a TV monitor during the surgery to see inside and guide their instruments. The gallbladder is removed through one of the small incisions. This method is less invasive with smaller incisions and usually a shorter recovery time. 

Discharge Instructions for Laparoscopic Cholecystectomy

Hemorrhoids: Swollen and inflamed veins in the rectum and anus can cause discomfort and bleeding. Hemorrhoids are usually caused from straining during bowel movements, obesity, or pregnancy. If you have large hemorrhoids, or if other treatments haven’t helped, you might need a hemorrhoidectomy.

Hemorrhoidectomy is the permanent removal of internal or external hemorrhoids, which is when the veins or vessels around the anus or rectum become swollen and irritated, causing pain and bleeding. Surgical removal is the most effective treatment for severe hemorrhoids. The most common approach is a closed hemorrhoidectomy, where the surgeon excises the hemorrhoids with a scalpel and closes the incision with a suture. Another options is hemorrhoid banding where your surgeon places a special rubber band around the hemorrhoid to cutoff the blood flow and they wither away over the next 3 to 7 days. 

Discharge Instructions for Hemorrhoid Banding


The da Vinci surgical robotics system is nothing short of amazing in the hands of a skilled surgeon. When compared to traditional or laparoscopic surgery, patients report less pain, less scarring, a shorter hospital stay, and a quicker return to their daily activities.

da Vinci surgery requires only a few small incisions versus a long, larger incision used in traditional open surgery. Some da Vinci procedures can also be done with just a single incision in the belly button. 

Your surgeon is 100% in control of the da Vinci System, which translates his or her hand movements into smaller, more precise movements of tiny instruments inside your body.  Your surgeon sits at a console and controls the robotic arms that mimic the movements of your surgeon’s hands, bending and rotating just like a wrist. A three-dimensional, high-definition camera gives your surgeon enhanced vision with ten times magnification of the operative field. Fluorescence imaging further contributes to patient safety and reduces risk, illuminating vessels otherwise hidden to the naked eye.

da Vinci procedures

  • Abdominal perianal resection
  • Cholecystectomies & colorectal surgery
  • Colectomy & sigmoid colectomy
  • Hernias
  • Nissen fundoplication (for acid reflux)
  • Splenectomy

An endoscopy is a procedure used in medicine to look inside the body. 

Upper endoscopy is a procedure used to visually examine your upper digestive system with a tiny camera on the end of a long, flexible tube. It's done to diagnose and, sometimes, treat conditions that affect the esophagus, stomach and beginning of the small intestine.

Your doctor may recommend an endoscopy procedure to:

  • Investigate symptoms. An endoscopy may help your doctor determine what's causing digestive signs and symptoms, such as nausea, vomiting, abdominal pain, difficulty swallowing and gastrointestinal bleeding.
  • Diagnose. Your doctor may use an endoscopy to collect tissue samples (biopsy) to test for diseases and conditions, such as anemia, bleeding, inflammation, diarrhea or cancers of the digestive system.
  • Treat. Your doctor can pass special tools through the endoscope to treat problems in your digestive system, such as burning a bleeding vessel to stop bleeding, widening a narrow esophagus, clipping off a polyp or removing a foreign object.

A colonoscopy is an exam used to detect changes or abnormalities in the large intestine (colon) and rectum. During a colonoscopy, a long, flexible tube (colonoscope) is inserted into the rectum. A tiny video camera at the tip of the tube allows the doctor to view the inside of the entire colon. If necessary, polyps or other types of abnormal tissue can be removed through the scope during a colonoscopy. Tissue samples (biopsies) can be taken during a colonoscopy as well.

Your doctor may recommend a colonoscopy to:

  • Investigate intestinal signs and symptoms. A colonoscopy can help your doctor explore possible causes of abdominal pain, rectal bleeding, chronic constipation, chronic diarrhea and other intestinal problems.
  • Screen for colon cancer. If you're age 50 or older and at average risk of colon cancer — you have no colon cancer risk factors other than age — your doctor may recommend a colonoscopy every 10 years or sometimes sooner to screen for colon cancer. Colonoscopy is one option for colon cancer screening. Talk with your doctor about your options.
  • Look for more polyps. If you have had polyps before, your doctor may recommend a follow-up colonoscopy to look for and remove any additional polyps. This is done to reduce your risk of colon cancer.

The surgical removal of tissue is generally referred to as excision of masses. Tumors are masses and commonly described as non-cancerous (benign) or cancerous (malignant) 

Skin cancer—the abnormal growth of skin cells—most often develops on skin exposed to the sun. But, this common form of cancer can also occur on areas of your skin not ordinarily exposed to sunlight. There are three major types of skin cancer — basal cell carcinoma, squamous cell carcinoma and melanoma. To diagnose skin cancer, your doctor will likely biopsy to test and additional tests may follow to determine the extent. Skin cancer can be removed through surgery.

A lipoma is a slow-growing, fatty lump that's most often situated between your skin and the underlying muscle layer. They usually aren't cancerous but can be painful or bothersome. A lipoma excision is the surgical removal of the lump, and generally, reoccurrences are uncommon. 

A pilonidal cyst is an abnormal pocket in the skin that usually contains hair and skin debris and they are very common near the tailbone, at the top of the cleft of the buttocks. Pilonidal cysts usually occur when hair punctures the skin and then becomes embedded. If a pilonidal cyst becomes infected, the resulting abscess is often extremely painful. Surgical removal is called a pilonidal cystectomy

Crohn's disease is a chronic inflammatory bowel disease that affects the lining of the digestive tract. It can cause abdominal pain, diarrhea, weight loss, anemia, and fatigue. Crohn's disease cannot be cured. Medications can slow the progression of disease but if they aren't effective, a patient may require surgery. Additionally, patients with Crohn's disease may need to receive regular screening for colorectal cancer due to increased risk.

Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus. Many people experience acid reflux from time to time. GERD is mild acid reflux that occurs at least twice a week, or moderate to severe acid reflux that occurs at least once a week. Most people can manage the discomfort of GERD with lifestyle changes and over-the-counter medications. But some people with GERD may need stronger medications or surgery to ease symptoms.

Hepatitis refers to an inflammatory condition of the liver. It’s commonly caused by a viral infection, but there are other possible causes of hepatitis. These include autoimmune hepatitis and hepatitis that occurs as a secondary result of medications, drugs, toxins, and alcohol.

Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine. Signs and symptoms include cramping, abdominal pain, bloating, gas, and diarrhea or constipation, or both. IBS is a chronic condition that you'll need to manage long term. Some people can control their symptoms by managing diet, lifestyle and stress. More-severe symptoms can be treated with medication and nutrition counseling.

Ulcerative colitis is an inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Symptoms usually develop over time, rather than suddenly. Your doctor may recommend total colectomy or proctocolectomy if medications aren't helping to control your signs and symptoms. Proctocolectomy may also be recommended if precancerous changes are found during a colonoscopy.

Inguinal hernias are when the small intestine bulges through a weak area in the lower abdominal muscles. An inguinal hernia occurs in the groin. Surgical repair pulls the intestine back to its original location.

  • About the Procedure: Robotic/Laparoscopic/Open

A ventral hernia is a sac (pouch) formed from the inner lining of your abdomen that pushes through a hole in the abdominal wall. Ventral hernias often occur at the site of an old surgical incision.

  • About the Procedure: Laparoscopic/Open

An umbilical hernia occurs when part of your intestine bulges through the opening in your abdominal muscles near your bellybutton. They are most common in infants, but they can affect adults as well.

  • About the Procedure: Open

Lymph node biopsy is a test in which a lymph node or a piece of a lymph node is removed for examination under a microscope. Lymph nodes are located in many parts of the body, including the neck, armpit, chest, abdomen, and groin. This is typically an outpatient procedure done with anesthesia and patients go home the same day with a few stitches.

A port-a-cath, also referred to as a port, is an implanted device which allows easy access to a patient’s veins. A port-a-cath is surgically-inserted completely beneath the skin and consists of two parts – the portal and the catheter. 

Ports are indicated for patients requiring frequent and long-term intravenous therapy, such as the oncology population. Having a port allows healthcare professionals easy access to a major vein with low risk of infection.

This benefit is extremely important for the immunocompromised population of oncology patients. Additionally, it reduces the pain that would otherwise be experienced with countless needle pokes for IVs, since the skin over a port hub becomes thicker and desensitized.

Splenectomy is a surgical procedure to remove your spleen. The spleen is an organ that sits under your rib cage on the upper left side of your abdomen. It helps fight infection and filters unneeded material, such as old or damaged blood cells, from your blood.

Thyroidectomy is surgical removal of all or part of the thyroid gland, which is located in the front of the neck. The thyroid gland releases thyroid hormone, which controls many critical functions of the body.

Surgeons often perform a thyroidectomy when a patient has thyroid cancer or some other condition of the thyroid gland or goiter. 

Vasectomy is a form of male birth control that cuts the supply of sperm to your semen. It's done by cutting and sealing the tubes that carry sperm. Vasectomy has a low risk of problems and can usually be performed in an outpatient setting under local anesthesia.

Related Information


When I learned my breast cancer required surgery for a double mastectomy, I was referred to Dr. Visger. I can describe my whole experience with Dr. John Visger and Pullman Regional Hospital with one word – competence. 

Peggy McDonnell

Dr. Visger was so kind, compassionate, and thorough in his discussion with my father and I. It is an amazing blessing to have such a skilled and kind surgeon in Pullman. It meant the world to my family that he could heal my father.

Phyllis Hunt
“I’ve been in 10 different hospitals and Pullman Regional Hospital is at the top of the list."
Holly Allen

“Everyone was so friendly and sympathetic. From food service, to housekeeping to nursing staff. Considering the circumstances, it really was pleasant.”

Edward Mace

I cannot speak highly enough about this hospital. My husband had emergency surgery here and everyone treated us so well and took very good care of him.

Lyddle O.