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Robotic Hernia Surgery
Dr. Ryan Enders, a general surgeon with BayCare discusses hernias and how robotic surgery is making their repair easier and faster for surgeons and patients.
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Learn more about Dr. Ryan Enders
Ryan Enders, DO
Dr. Ryan J. Enders specializes in general surgery for BayCare Medical Group, serving the Bartow area. He earned his Doctor of Osteopathic Medicine from Nova Southeastern University, College of Osteopathic Medicine in Fort Lauderdale, Florida. He then continued his medical education by completing a general surgery residency at the University of Pittsburg Medical Center, Horizon Campus in Farrell, Pennsylvania. Dr. Enders believes in an honest and trusting relationship with his patients, while providing a supportive and healing environment throughout the health care experience. As a general surgeon, he is highly trained and certified in minimally invasive interventions including advanced endoscopic, laparoscopic and da Vinci® robotics surgical techniques. Many of the procedures he performs can be on an outpatient basis. He specializes in the diagnosis of and surgical intervention for complex health conditions, like colon and breast cancers, as well as gallbladder and hernia issues. Dr. Enders is certified in laparoscopic and endoscopic surgery, with special interests in robotic hernia surgery. He is a member of the Society of American Gastrointestinal and Endoscopic Surgeons. He is affiliated with Bartow Regional Medical Center.Learn more about Dr. Ryan Enders
Transcription:
Robotic Hernia Surgery
Scott Webb: Welcome to BayCare HealthChat. I'm Scott Webb. And today, we're going to learn about hernias and how robotic surgery is making their repair easier and faster for surgeons and patients. And joining me today is Dr. Ryan Enders. He's a general surgeon with BayCare.
Dr. Enders, we're going to talk about the benefits of robotic surgery today, especially as it relates to hernias. So before we get there though, what is a hernia? You know, I think many of us may have had them. Maybe they were diagnosed, maybe not, but what is a hernia?
Dr. Ryan Enders: So, a hernia is a really general term which just describes a defect in some sort of layer of tissue with protrusion of underlying layers. For example, an abdominal wall hernia is when there's a defect in the abdominal wall, and then contents from inside the abdomen can go through the hole. And that's a bulge that patients will generally experience. You can also have something called a hiatal hernia, and that's actually a herniation of the stomach near the esophagus through the diaphragm and that's inside the abdomen. And obviously, the patients won't notice a bulge and have any kind of physical symptoms from that.
The hernias that I'll mostly will be talking about with regards to robotic surgery will be abdominal wall hernias, and they primarily occur in the umbilical region, which is the belly button or the groin region, which is called the inguinal hernias. Also, if you've ever had surgery before, anywhere you've had an incision in the abdomen, you could potentially develop a hernia at that area because that is an acquired area of weakness.
Scott Webb: Yeah. Good to set the stage there. And I'm sure that hernia surgery is maybe still open surgeries, but now robots seem to be the thing, whether da Vinci or otherwise. So let's talk about that, this of shift in paradigm or maybe shift in gold standards in terms of robotic surgery and hernias. What are the benefits of robotic surgery?
Dr. Ryan Enders: So exactly, traditionally, open surgery has been utilized to fix all these hernias. It still can be used with fairly good results. However, the advantage of robotics, specifically over laparoscopic and open surgery is really recovery and also our ability to really get the best of both worlds. What I mean by that is open surgery, you can actually physically close the defect with suture and reinforce it with mesh. It's a good repair. However, you have a bigger open incision and a longer recovery period. With laparoscopic, you can patch the hernia with mesh; however, it's very difficult to physically close the hernia defect. And for that reason, there's been a slightly higher recurrence rates with laparoscopic hernia repair versus open hernia repair. When the robotic was introduced, you have the ability to basically do everything you can do open through minimal incisions, like a laparoscopic surgery, so you have the benefit of both. So, I can close the fascial defect, reinforce it with mesh, and do a good repair like I could open, but I'm doing it through small incisions, which allows faster recovery like a laparoscopic case would be. So, that's basically the best of both worlds.
Scott Webb: Yeah, I love hearing that, and certainly benefits for surgeons and the team, and also patients obviously. So, let's talk about the different types of surgery then for hernia, the TAPP or TAR. Maybe you can take folks through that.
Dr. Ryan Enders: TAPP is transabdominal preperitoneal, and all that means is I access the abdomen from the inside. There's several layers of abdominal wall. Starting from the outside, you have skin, and then you have a little bit of fat tissue, and then you'll have a layer called fascia. It's a very strong layer. Underneath the fascia, there'll be a muscular layer, which is your abdominal wall muscles, and then there'll be a second layer of fascia, which envelopes the muscle. And then, there will be a little layer of fat called the preperitoneal fat. And then, there'll be a very thin lining that basically is a very thin sack that incorporates all the abdominal contents, and that's called the peritoneum. So, transabdominal preperitoneal simply means I put the ports through all the layers of the abdominal wall, and I'm inside the abdomen. And then, what I do is I make a small incision in the peritoneum, which is a very inner thin layer. I make a little pocket, and that's where the mesh will be placed. And that's called a preperitoneal mesh placement. Obviously, the advantage of that is that the mesh can be separated from any of the intraabdominal organs and lessens the complication rate and adhesion rate. But that's what that basically means.
Scott Webb: Yeah. And this sounds very insidious, but what's an incarcerated hernia? That sounds like something out of a movie or something. But I sort of have a sense of what that means. But from an expert's perspective, what does that mean, incarcerated hernia?
Dr. Ryan Enders: If the hernia cannot be reduced or pushed back in and it's stuck, that simply means it's incarcerated. Now, if it's incarcerated, it just depends on what's in the hernia. If there's just fat in the hernia, that can be uncomfortable, but safe. Generally, that won't cause any kind of significant harm to the patient other than some discomfort.
However, if there's a loop of bowel or another organ in the hernia and it's incarcerated, then you have to wonder if the blood flow to the hernia contents is intact. If the blood flow is not intact, that would be called strangulated and incarcerated, and that is a surgical emergency. And that's why we fix hernias electively, is to prevent that.
Scott Webb: Yeah, exactly right. Many reasons, but especially those things that become emergencies. If you treat them before they become emergencies, that's just better for everybody. And doctor, in doing my prep for today came across a really big word, cholecystectomy. What is that?
Dr. Ryan Enders: Cholecystectomy is a fancy way of saying removing the gallbladder.
Scott Webb: And I assume you're doing that robotically as well?
Dr. Ryan Enders: Yeah. And there's several advantages of doing it robotically, even compared to laparoscopic. Now we've been doing them laparoscopically for 25, 30 years. However, robotically, you have the ability to have increased magnification, so better visualization. You also have the ability to have three working arms that you independently as the surgeon, so you don't need an assistant. And then additionally, you have tools can be used robotically that you don't have laparoscopically, things that can control bleeding, and just makes the procedure a lot safer and a lot more smooth and efficient.
Scott Webb: So doctor, that's really interesting and, you know, I guess once a kid, always a kid, love robots and love hearing how they're being used and the benefits to everybody. As we wrap up here, what is the BRMC robotics program? Like tell us more about that, because it sounds interesting.
Dr. Ryan Enders: The hospital that I currently have privileges at is Bartow Regional Medical Center in Bartow, Florida, part of the BayCare system. And we're basically having a robotics program for a center of excellence. And all that really means is that we have a robot, and we do a high enough volume of robotic surgery and have a good enough outcomes and good data points that we can be considered a center of excellence.
So, that means not every place is a center of excellence. If you go to a center of excellence, you can be assured that you'll get the the best care they have standards for us to adhere to when it comes to robotic surgery. So, that used to be a center of excellence here before I came, but they hadn't had general surgeons for several months, so they weren't able to maintain the center of excellence because there weren't any surgeons doing the surgeries. So now that I'm here, we're redeveloping that program. And what that means is me and my partner are doing a lot of robotic surgery and we're having good outcomes and high volume so that we can achieve that center of excellence. It's kind of like a certificate. If you go somewhere and something's certified pre-owned vehicle, you know, they have their stamp of approval that says that you can rely on that service.
Scott Webb: Yeah. That's awesome. And this has been really educational today, and I think one of the things I've learned from hosting these and learning more about robotic surgery, especially da Vinci, is that experience really matters, right? Both for the surgeons and the patients. And when that robot's being used a lot and the surgeons are putting in hundreds, maybe thousands of surgeries with it, patients are in good hands. So, thanks so much. You stay well.
Dr. Ryan Enders: Yeah. Thank you.
Scott Webb: And for more information, go to baycare.org. And that wraps up this episode of BayCare HealthChat. Always remember to subscribe, rate and review this podcast and all of the other BayCare podcasts, so we can share the wealth of information from our experts together. I'm Scott Webb. Stay well.
Robotic Hernia Surgery
Scott Webb: Welcome to BayCare HealthChat. I'm Scott Webb. And today, we're going to learn about hernias and how robotic surgery is making their repair easier and faster for surgeons and patients. And joining me today is Dr. Ryan Enders. He's a general surgeon with BayCare.
Dr. Enders, we're going to talk about the benefits of robotic surgery today, especially as it relates to hernias. So before we get there though, what is a hernia? You know, I think many of us may have had them. Maybe they were diagnosed, maybe not, but what is a hernia?
Dr. Ryan Enders: So, a hernia is a really general term which just describes a defect in some sort of layer of tissue with protrusion of underlying layers. For example, an abdominal wall hernia is when there's a defect in the abdominal wall, and then contents from inside the abdomen can go through the hole. And that's a bulge that patients will generally experience. You can also have something called a hiatal hernia, and that's actually a herniation of the stomach near the esophagus through the diaphragm and that's inside the abdomen. And obviously, the patients won't notice a bulge and have any kind of physical symptoms from that.
The hernias that I'll mostly will be talking about with regards to robotic surgery will be abdominal wall hernias, and they primarily occur in the umbilical region, which is the belly button or the groin region, which is called the inguinal hernias. Also, if you've ever had surgery before, anywhere you've had an incision in the abdomen, you could potentially develop a hernia at that area because that is an acquired area of weakness.
Scott Webb: Yeah. Good to set the stage there. And I'm sure that hernia surgery is maybe still open surgeries, but now robots seem to be the thing, whether da Vinci or otherwise. So let's talk about that, this of shift in paradigm or maybe shift in gold standards in terms of robotic surgery and hernias. What are the benefits of robotic surgery?
Dr. Ryan Enders: So exactly, traditionally, open surgery has been utilized to fix all these hernias. It still can be used with fairly good results. However, the advantage of robotics, specifically over laparoscopic and open surgery is really recovery and also our ability to really get the best of both worlds. What I mean by that is open surgery, you can actually physically close the defect with suture and reinforce it with mesh. It's a good repair. However, you have a bigger open incision and a longer recovery period. With laparoscopic, you can patch the hernia with mesh; however, it's very difficult to physically close the hernia defect. And for that reason, there's been a slightly higher recurrence rates with laparoscopic hernia repair versus open hernia repair. When the robotic was introduced, you have the ability to basically do everything you can do open through minimal incisions, like a laparoscopic surgery, so you have the benefit of both. So, I can close the fascial defect, reinforce it with mesh, and do a good repair like I could open, but I'm doing it through small incisions, which allows faster recovery like a laparoscopic case would be. So, that's basically the best of both worlds.
Scott Webb: Yeah, I love hearing that, and certainly benefits for surgeons and the team, and also patients obviously. So, let's talk about the different types of surgery then for hernia, the TAPP or TAR. Maybe you can take folks through that.
Dr. Ryan Enders: TAPP is transabdominal preperitoneal, and all that means is I access the abdomen from the inside. There's several layers of abdominal wall. Starting from the outside, you have skin, and then you have a little bit of fat tissue, and then you'll have a layer called fascia. It's a very strong layer. Underneath the fascia, there'll be a muscular layer, which is your abdominal wall muscles, and then there'll be a second layer of fascia, which envelopes the muscle. And then, there will be a little layer of fat called the preperitoneal fat. And then, there'll be a very thin lining that basically is a very thin sack that incorporates all the abdominal contents, and that's called the peritoneum. So, transabdominal preperitoneal simply means I put the ports through all the layers of the abdominal wall, and I'm inside the abdomen. And then, what I do is I make a small incision in the peritoneum, which is a very inner thin layer. I make a little pocket, and that's where the mesh will be placed. And that's called a preperitoneal mesh placement. Obviously, the advantage of that is that the mesh can be separated from any of the intraabdominal organs and lessens the complication rate and adhesion rate. But that's what that basically means.
Scott Webb: Yeah. And this sounds very insidious, but what's an incarcerated hernia? That sounds like something out of a movie or something. But I sort of have a sense of what that means. But from an expert's perspective, what does that mean, incarcerated hernia?
Dr. Ryan Enders: If the hernia cannot be reduced or pushed back in and it's stuck, that simply means it's incarcerated. Now, if it's incarcerated, it just depends on what's in the hernia. If there's just fat in the hernia, that can be uncomfortable, but safe. Generally, that won't cause any kind of significant harm to the patient other than some discomfort.
However, if there's a loop of bowel or another organ in the hernia and it's incarcerated, then you have to wonder if the blood flow to the hernia contents is intact. If the blood flow is not intact, that would be called strangulated and incarcerated, and that is a surgical emergency. And that's why we fix hernias electively, is to prevent that.
Scott Webb: Yeah, exactly right. Many reasons, but especially those things that become emergencies. If you treat them before they become emergencies, that's just better for everybody. And doctor, in doing my prep for today came across a really big word, cholecystectomy. What is that?
Dr. Ryan Enders: Cholecystectomy is a fancy way of saying removing the gallbladder.
Scott Webb: And I assume you're doing that robotically as well?
Dr. Ryan Enders: Yeah. And there's several advantages of doing it robotically, even compared to laparoscopic. Now we've been doing them laparoscopically for 25, 30 years. However, robotically, you have the ability to have increased magnification, so better visualization. You also have the ability to have three working arms that you independently as the surgeon, so you don't need an assistant. And then additionally, you have tools can be used robotically that you don't have laparoscopically, things that can control bleeding, and just makes the procedure a lot safer and a lot more smooth and efficient.
Scott Webb: So doctor, that's really interesting and, you know, I guess once a kid, always a kid, love robots and love hearing how they're being used and the benefits to everybody. As we wrap up here, what is the BRMC robotics program? Like tell us more about that, because it sounds interesting.
Dr. Ryan Enders: The hospital that I currently have privileges at is Bartow Regional Medical Center in Bartow, Florida, part of the BayCare system. And we're basically having a robotics program for a center of excellence. And all that really means is that we have a robot, and we do a high enough volume of robotic surgery and have a good enough outcomes and good data points that we can be considered a center of excellence.
So, that means not every place is a center of excellence. If you go to a center of excellence, you can be assured that you'll get the the best care they have standards for us to adhere to when it comes to robotic surgery. So, that used to be a center of excellence here before I came, but they hadn't had general surgeons for several months, so they weren't able to maintain the center of excellence because there weren't any surgeons doing the surgeries. So now that I'm here, we're redeveloping that program. And what that means is me and my partner are doing a lot of robotic surgery and we're having good outcomes and high volume so that we can achieve that center of excellence. It's kind of like a certificate. If you go somewhere and something's certified pre-owned vehicle, you know, they have their stamp of approval that says that you can rely on that service.
Scott Webb: Yeah. That's awesome. And this has been really educational today, and I think one of the things I've learned from hosting these and learning more about robotic surgery, especially da Vinci, is that experience really matters, right? Both for the surgeons and the patients. And when that robot's being used a lot and the surgeons are putting in hundreds, maybe thousands of surgeries with it, patients are in good hands. So, thanks so much. You stay well.
Dr. Ryan Enders: Yeah. Thank you.
Scott Webb: And for more information, go to baycare.org. And that wraps up this episode of BayCare HealthChat. Always remember to subscribe, rate and review this podcast and all of the other BayCare podcasts, so we can share the wealth of information from our experts together. I'm Scott Webb. Stay well.