Joey Wahler (Host): Mercy Hospital's S. A. Camp Companies Robotic Surgery Center recently reached 2,000 cases. So we're discussing the benefits of robotic surgery. Our guests, Dr. Lorenc Malellari. He's a Colorectal Surgeon and Medical Director of Mercy Hospital's S. A. Camp Companies Robotic Surgical Center. And Cherry Pancian. She's a Registered Nurse in the Post Anesthesia Care Unit at Mercy Hospital downtown. This is Hello Healthy, a Dignity Health podcast. Thanks for listening. I'm Joey Wahler. Dr. Malellari and Cherry, thanks so much for joining us.

Lorenc Malellari, MD, FACS, FASCRS: Thank you for that answer.

Cherry Pancian, RN: Pleasure. Thank you so much.

Host: So first for you, Dr. Malellari, generally speaking, what do we mean for those that don't know by robotic surgery, because it's really robotic assisted surgery, right?

Lorenc Malellari, MD, FACS, FASCRS: That's correct. There's a lot of I guess misconceptions out there about what robotic surgery is, but as you said, it's a robotic assistant. The robotic platform, which we use at the, S. A. Camp Companies Robotic Surgical Center, is the latest, most advanced technology we currently have in allowing surgeons to perform complex surgical procedures in a minimally invasive way.

And more specifically is the da Vinci Xi robotic surgical platform. Now the robotic platform itself is a tool. It basically allows surgeons to perform these complex surgical procedures through small incisions in the patient's abdomen, which obviously reduces significantly the amount of trauma that has to be applied to perform the needed procedure.

However, the robotic platform itself, or the robot itself, does not actually perform the surgery, does not have any kind of control over the surgery. The surgeon has full control of the robotic instruments and robotic arms and camera that's applied for it. It's basically, as you said, a robotic assisted surgery.

The surgeon is the one that performs 100% of the surgery.

Host: So to emphasize, robots have not taken over the operating room and the people that went to medical school and got through it like yourself, they're the ones still at the controls, right?

Lorenc Malellari, MD, FACS, FASCRS: That's correct. That's great.

Host: You mentioned the Da Vinci portion of this. That's become the state of the art piece of equipment in robotic assist. Right?

Lorenc Malellari, MD, FACS, FASCRS: That's correct. So the Da Vinci platform, there's a number of other platforms that are coming up into the market right now, but the Da Vinci was the first and most advanced robotic surgical system, and more importantly is the most mature at this time. And it's really, as I said, pretty much a gold standard for surgical procedures that involve the abdomen and even the chest. That is the Xi version of the Da Vinci platform is the latest technology that we have, in terms of the most advanced tools and, the ones that has the most flexibility for surgeons to use different types of tools and instruments to achieve the results that we want to get in terms of managing the patient's problem; whether it's a cancer removal or whether it's as simple as a hernia repair.

Host: Gotcha. So for you, Cherry, what procedure did you have actually, and what was your experience like in a nutshell.

Cherry Pancian, RN: I had a robotic assisted laparoscopic sigmoidectomy of, with Dr. Malellari. So I have that, last March.

Host: And what made you go in that direction? And what was the experience like?

Cherry Pancian, RN: When I found out my diagnosis, back in my mind, I need a robotic surgery with Dr. Malellari that's for sure. And the reason why, because I work with him and I know how it works and I know how robotic works. So I have faith that, with that type of surgery, it will help me through my process of healing, because there are a lot of benefits of robotic compared to the open.

I have three surgeries that's open, it's not robotic, and to have a robotic surgery is a blessing for me. It changed, the whole surgery experience.

Host: And you being a nurse, you're a very discerning patient, right?

Cherry Pancian, RN: Yes, so I see both worlds, being a patient and as well as a nurse, used to work in OR and, assisting with this robotic assisted surgery. So I know and I have faith and I believe and I trust how it works and how it's very helpful, not just for me, but for all the patients who needed robotic surgery if they can.

Host: So back to you, Dr. Malellari, why was robotic surgery the best option for Cherry instead of open surgery as it's called?

Lorenc Malellari, MD, FACS, FASCRS: Cherry actually brought a very important point up that, she's been kind of on both sides of the screen here. So she's taken care of patients who've had robotic surgery and she obviously had to go through unfortunately the surgery herself. So her perspective was very important.

But from my perspective, in terms of the benefits of robotic surgery, in her particular case, we needed to remove a piece of her colon, the sigmoid colon in this particular case. And in order to do that, we basically have to enter the abdominal cavity. Remove a piece of the bowel or the colon and put things back together afterwards.

Now you can do this in numerous ways. You can do it with an open incision. You can do it even laparoscopically. But the robotic assisted part of this is really the best way that we have to perform the best surgery on this particular problem. But more importantly, to allow Cherry and patients like her who need the surgery, to basically heal and recover and get out of the hospital as soon as possible so they can continue their recovery at home or continue any further treatments that they might need.

And in her case she actually did really good with her recovery, with the surgery itself and the recovery as well. And she went home within I believe it was two or three days after surgery which would not have been the case if she had had an open surgery. We've actually looked at some of our data here in Bakersfield, in patients who receive open versus robotic surgery for bowel resection, and on average, the majority of patients who receive robotic surgery are in the hospital for half the time that the patients who receive open surgery require.

And they're able to basically get back to their families, get back to their lives, get back to their jobs and move on with their life and, recover from this traumatic event.

Host: And simply putting layman's terms, doc, what is it about the robotic procedure compared with the open surgery that enables that smoother, more limited rehabilitation process. Why is that?

Lorenc Malellari, MD, FACS, FASCRS: So the issue when we're dealing with problems inside of the abdominal cavity, is that you got to get to that problem, you got to get to the organ, you got to get to the cancer, if you're removing a piece of a bowel for cancer, for example. In order to get to that area, you have to open the abdominal wall, and that involves cutting the skin, cutting the tissues underneath the skin, and even cutting the muscles that make up the abdominal wall.

That incision, depending on where the problem is, or how big of a problem it is, can be quite significant, from a couple of inches to, you know, sometimes a foot or more in length. Now, the surgery inside of the abdomen, whether it's done robotically assisted or open, is exactly the same. What that means is that the wound inside of the belly will be exactly the same between the two surgeries.

However, the added wound on the abdominal wall is what increases the risk of having wound infections and having complications from the healing process or even significantly more pain than you would otherwise. The robotic instruments, require only about 8 millimeter diameter or 8 millimeter length of incision, in order for these instruments to be placed inside of the abdominal cavity.

So comparing a few 8mm incisions to a 7, 10 inch length of an incision has a significant difference in terms of the amount of pain that these patients will experience after surgery and also how long those wounds will need to heal. Again, the surgery inside of the abdominal cavity is exactly the same, which means the wound they have to heal, the patients have to heal on the inside of the abdomen is exactly the same between the two surgeries.

However, the added wound on the abdominal wall is what really affects their recovery and also what is improved with robotic surgery. Just to give you an example, patients that have, like Cherry, who have a piece of their colon removed, they're basically out of bed and walking the day of surgery, meaning as soon as they have recovered from anesthesia, we help these patients get out of bed, walk around the nursing station, walk around their room, as they're slowly recovering from the surgery. And, as I mentioned earlier, they're able to get out of the hospital and continue their recovery at home, while patients who have open incisions, usually will require significantly more days in the hospital to recover because of the amount of pain that they will experience from that large incision in their abdomen.

Host: Well, Cherry, we certainly appreciate you sharing your story with us. So just to be clear, tell us please what your condition was that necessitated this procedure. And then also tell us a little bit more about what your recovery was like and whether it lived up to the billing of getting you up and at them faster, then you would have otherwise.

Cherry Pancian, RN: So, with this type of procedure, I went through the robotic surgery. My case, for example, for me, I have colon cancer. I have a six point something, diameter, big mass in my colon, which adhering to my abdominal wall. For me, it was like a miracle for Dr. Malellari to totally take all of that. I chose robotic cause I know I work with him and I know how these patients deal with after surgery compared to like what he said, open surgery. So when we have patients in recovery room that has robotic surgery compared to open, it's a good thing, it's robotic, not open because we deal with them.

Less pain, like I said. So for my case, I had robotic surgery and I chose robotic and luckily, Dr. Malellari agreed that it's going to be robotic and I was at ease about it. I didn't know that the surgery usually takes about three hours to four hours. He even did it shorter than I expected, compared to my situation and I was amazed by it.

And then the recovery phase was actually, I didn't have to take any strong drugs for pain. I was able to, just the regular tramadol that he usually have, the pain was manageable for me. Like I said, I have to get up in the bed day of the surgery that night, and two days, three days, the nurses was like walking them because I was walking in the hall most of the time, and they were amazed by how the recovery of the robotic, and I don't have any infection.

I didn't lose a lot of blood, and in a house, I was able to walk around fine compared to my other abdominal surgery, which is really painful. I have to take stronger medications, stronger pain medication compared to robotic. I was able to return quickly to my normal activity with that robotic surgery.

Host: That's excellent. So back to you, Dr. Malellari, we mentioned Mercy's S. A. Camp Companies Robotic Surgery Center recently reached big milestone, 2000 robotic cases. So what does that number mean in your view for Kern County residents?

Lorenc Malellari, MD, FACS, FASCRS: That's a huge milestone in my opinion, and I think it's one of those things that just emphasizes amount of work and the accomplishments of all of the staff at the Mercy Hospital and the Robotic Surgical Center that we have there. The robotic technology, again, is a tool for the surgeons, but this is really a tool that allows surgeons to take care of our community and take care of our patients in their most dire need and time.

So achieving 2,000 plus procedures in less than five years that this robotic center has been established is an incredible achievement and milestone in my opinion. And on top of that, the robotic surgical center has also achieved a distinction, as a center of excellence in robotic surgery by the Surgical Review Corporation, which is also another important milestone and important confirmation of the good work that our physicians and our staff is doing and the amount of skill that we're able to provide to our community at large.

And really a dedication of the excellence of the work that everyone providing, to our community, at Mercy Hospital.

Host: And I was going to ask you about that center of excellence achievement next, but you led beautifully from one answer into the other, which brings us back to Cherry, just to kind of sum things up here and Cherry, based on your experience, what should people listening know most about robotic surgery if they're considering it themselves?

Cherry Pancian, RN: I'd like people to know about here in Kern County, robotic surgery is a cutting edge medical technology. It's a new invention that help us, help us to have these lesser complications, a lesser pain, get back quicker return to our normal activity or work if people are too busy, it is a way to go to rather than having an open surgery.

If you need to have a surgery, do it robotically, then open, because it's a lot of benefits than having an open surgery.

Host: And Dr. Malellari, for more information about robotic surgery, where can patients turn?

Lorenc Malellari, MD, FACS, FASCRS: So we have a website that people can read more about this in our surgical center at dignityhealth.org/bakersfield, be able to find more information on the robotic procedures as well, but also more importantly the different surgical specialties that we're able to provide the robotic platform for, and I just wanted to mention them a little bit at the end if you don't mind.

That includes minimally invasive general surgery, colorectal surgery as, we've been speaking about today, but also gynecology, urology, urogynecology and gynecology oncology procedures on top of general surgery procedures as well. So quite a wide breadth of surgical procedures and specialized surgeons who are able to offer this technology to our community here in Kern County.

Host: Indeed, and thank you for mentioning that it's really robotic surgery taken hold in all those different areas that you mentioned, as well. Folks, we trust you're now more familiar with robotic surgery. Dr. Lorenc Malellari and Cherry Pancian, thanks so much again.

Cherry Pancian, RN: Thank you so much for having us.

Lorenc Malellari, MD, FACS, FASCRS: Thank you for having us.

Host: And again, that website for more information, you can visit dignityhealth.org/Bakersfield/roboticsurgery. Now, if you found this podcast helpful, please share it on your social media. I'm Joey Wahler, and thanks again for listening to Hello Healthy, a Dignity Health Podcast.