Scott Webb: While it's fairly indisputable that robots are cool, the thought of robotic surgery might cause some patients to wonder if it's the surgeon or the robot doing the surgery. I'm joined again today by Dr. Adam Rothermell. He's the chairman of the Department of Surgery and the director of the Genesis Center of Surgical Excellence, and he's gonna tell us about robotic assisted surgery and make it very clear that the surgeons perform the surgeries with the assistance of robots. This is Sounds of good health with Genesis. Brought to you by Genesis Healthcare System. I'm Scott Webb.

So Doctor, thanks so much for joining me today we're gonna talk about robotic assisted surgery, and I think one of the misnomers or one of the sort of myths about robotic assisted surgery is it. Folks think, well, if the robot's doing the surgery, is that maybe a good thing? Is that maybe sort of like the terminator, where the robots are taken over? And I know that's not the case, but I want to have you explain to listeners, that you are doing the surgery, you are controlling the robot, and maybe just, tell them what's really involved with robotic assisted surgery.

Dr. Adam Rothermel: Robotic assisted surgery, is just that, it is minimally invasive surgery. Just done this very similar way as laparoscopic surgery, which I think more people are familiar with. But the robotic instrumentation is being completely controlled by the operating surgeon. That robot does not have the capability to do anything on its own. All right? And so the device is kind of hooked to the instruments, that are attached to the patient. And then the surgeon is in a console that's only a few feet away from the patient, his or her fingers attached to the devices there.

So it's really an incredible technology. I encourage anybody to get on to either YouTube or some other, you know, video streaming, and look up robotic assisted surgery and just get an idea of what it is. It's pretty amazing technology.

Scott Webb: Yeah, it really is amazing. And I know there's a lot of benefits for patients, well benefits for providers like yourself or the actual surgeons and also patients. So maybe you can discuss that. What are some of the benefits, , as we're trying to sort of sell people on this amazing technology?

Dr. Adam Rothermel: Yeah. And so a huge benefit is that when I'm operating at the bedside, even laparoscopically or with an open operation, I only got two hands, you know? But with the robotic instrumentation, it's amazing. I can control all four arms. One of those arms is of course, gonna be driving the camera, and I can move that camera wherever I want to see what I need to see. And it's perfectly. Not, you know, moving around, it's not shaky. It's not the assistant, getting tired and the image is drifting, which, which of course happens with laparoscopic surgery

Scott Webb: They're humans, right?

Dr. Adam Rothermel: Yeah, the robot never gets tired. And so that image is always completely still. Another benefit of that camera is that it's a three-dimensional image that I'm seeing at that robotic console. The instruments themselves, I mean, I really encourage people to go look these things up. They are really amazing.

They're wristed instruments. So when we say wristed instruments, we mean kind of like our wrist is how they move. With straight, old-fashioned laparoscopic surgery, those instruments are perfectly straight. They can't bend at the end. , you can only kind of move them in two directions, , with, the robotic instrument, it's completely like operating with the human hand. All right? And so that really has made it possible for what we like to say is like doing open surgery, minimally invasive, so it's doing surgery laparoscopically. You had to do things differently than you would do through a larger incision with your hands just because of the limitations of the instrumentation.

But with robotic instrumentation, you can truly do what you would be doing as an open operation, but through these tiny incisions. And so that's a huge benefit too. What we've seen with even our more simple operations, the more common operations like gallbladder surgery, the inguinal hernias, the groin hernias or belly button hernias, things like that, that we might do robotically nowadays is that the postoperative pain is significantly less. Just in my practice over the last several years, totally transitioned away from routinely doing an open inguinal hernia repair that's a groin hernia.

And doing them robotically. And I've seen this enormous difference to where our patients were generally taking three, four days of narcotic pain medication along with , the ibuprofen after an opening and hernia repair. Additionally, they had more swelling in the groin, their activity was limited for longer. And now we even change to do that through these three tiny little eight millimeter incisions. And the majority of patients don't take any narcotic pain medication after that operation anymore. Yeah, they take Tylenol or Ibuprofen for the first couple of days, but people are truly amazed.

My favorite patient is somebody that has previously had an open groin hernia repair that comes to me with the other side. Now they have a hernia and I get to say, well, we're gonna do this a little bit different than the last time. And we do it robotically and they say it's night and day. It's just such an incredible difference. So yeah, the recovery is quicker and it's pretty amazing.

Scott Webb: Yeah, it really is, and I know that unless somebody has had. A robotic assisted surgery. Maybe just be hearing about this for the first time, but I know it's been around for a while and you guys have a lot of experience. Probably done thousands of these surgeries, the robotic assisted kind. Maybe you can tell us about that, just the experience level of Genesis.

Dr. Adam Rothermel: At Genesis Hospital, we have done thousands of these robotic assisted surgeries, going all the way back to, I think it was 2008, and that's before I even joined the system. My partners Dr. Brand. Alexander, Dr. Stewart Chow, were early advocates of this minimally invasive technology, and they, you know, convinced the hospital, Hey, this is where things are going in the field of general surgery and as well as other specialties too. We need to bring this, technology to Genesis. And they were early adopters. We're talking 2000 we got one of the first generations of the intuitive robot and we brought it to Genesis.

They have done a lot of surgery on it. Urology has done a lot of surgery, even dating back to then, , ob GYN as well. We updated the technology and just for the last two years we updated again and now we have, two of the newest generation, what they call XI intuitive, da Vinci robots. and it just exploded at Genesis over the past several years. So people would be really surprised to hear that. , there's something like 6,700. Surgical robots being used around the world. It's about 6,700. The intuitive and da Vinci robot company reached out to us and let us know that in, I think it was 2021, that our robot here at Little Genesis Hospital in Gainesville, Ohio was the sixth busiest robot in the world.

 And that was back when we had one, we had only one robot at that time, and it was, we were just every day, utilizing that technology. , and everybody was really afraid that, wow, we didn't even realize this until we kind of looked at the numbers but you guys are really pounding away at the robotic surgery and it's going great. And so that's when administration at Genesis said we, need to reinvest in this. This is really benefiting our patients. So they got the newest generation and actually two of them. So, yeah, it's been really cool. We've been doing it for years. I know a lot of, like other local hospitals or ho hospitals in the region have just recently adopted it.

And I think that's great. Whatever it takes to kind of provide the best care and outcomes to patients, is a good thing. But people would be surprised to see that we've been doing thousands of these surgeries over the last, 15 years or so.

Scott Webb: Yeah. Well, as you said, you know, the robot never gets tired and now you've got two of them. So the, maybe if there was like sort of a line outside the OR of docs lining up to try to get in there. Now at least with two of them you can, do even more. On a daily basis and wondering, you mentioned some of the other hospitals, are there some surgeries that you're still able to do at Genesis because you had the experience and you've had the robots longer that maybe folks can't have done somewhere else?

Dr. Adam Rothermel: Yeah, it comes down to experience of a surgeon and what specialties you have utilizing the, technology. And then how comfortable are you in your health system doing more complex procedures on the robotic instrumentation. And in the field of general surgery, most hospitals are gonna start by doing the groin hernias, the belly button, hernias, gallbladder surgery. And then once after a couple years, they get more comfortable with that. They, maybe those surgeons will expand some more complex operations.

We're kind of beyond that and myself personally, I believe I did 44, , robotic colon surgeries alone in 2022. So that's a very high volume of minimally invasive robotic colon surgeries for one surgeon to be doing. And I'm not the only surgeon doing them at Genesis, you know?

Scott Webb: You know, and I think you're right, doctor, I think it comes down to the experience level, the support from the administration, and the level of. Experience of those working in the, OR doing these robotic assisted surgeries, wondering when you're working with patients and open surgery or even laparoscopic surgery is still an option. How do you talk about this with patients? Obviously you're a fan of the robots and I can certainly understand why, but when all things are an option, how do you counsel, patients families, how do you convince them that the Da Vinci is the right way to go?

Because I'm just picturing sort of some people, despite hearing a podcast like this and, all the benefits we've talked about here, they might still be on the fence. So how do you, bring them over to the Da Vinci side?

Dr. Adam Rothermel: Like anything in surgical decision making, it's gotta be a collaborative decision between the surgeon and the patient. And a lot of times I'll have this discussion with folks kind of laying out, here's why in many circumstances I utilize the robotic instrumentation. And here are the benefits of doing that. But it's not for everybody, or it's not necessarily indicated in everybody, in every condition. But they Can be some of the more challenging operations that we do. If somebody has had prior abdominal surgery, if somebody is substantially overweight, if they have had. Bad gallbladder attacks to where you expect to find a lot of inflammation, a lot of scarring of that gallbladder.

If they have liver disease. There's just a number of things that we know as surgeons, we're gonna be benefit from having the visualization from the robotic camera, the articulation of those instruments, and even some other benefits like the utilization of a special dye that we can give patients through the IV. And only the robotic camera can light up that dye during surgery and help you better identify the anatomy, especially for gall bladder surgery.

And I even use it during colon surgeries as well. So we're gonna know and we're going to very openly layout here is why I think we should, or we don't necessarily need to utilize this instrumentation for your surgery. You're gonna be on narcotics for a couple of weeks and well, I hope you don't get drainage from your incision or have an infection, but it might happen it's the colon, it's kind of dirty. And you're gonna be spending, three, four, maybe five days in the hospital after surgery. To now saying much more what I, what used to sound like a gallbladder conversation of, Hey, we're gonna make these multiple little incisions on your belly. Yes, you're gonna stay the night in the hospital, but the next day you're gonna be up, you're gonna be walking, you're gonna be eating regular food.

 I expect you to pass gas or have a bowel movement the day after surgery. And once you do, you are free to go home. Yeah, you probably gotta take two weeks off of work for a colon surgery, even minimally invasive. But at that point, most people are looking at me going, do I really have to stay? Can I please go back to work? They feel invasively, totally recovered at that two week post-operative visit. So it's just been a paradigm shift. I'm just so passionate about the robotic assisted colon surgery because I've seen just tremendous difference in the outcomes for our patients of Genesis.

I mean, it's just been a huge shift and I just know there's not a lot of hospitals out there that are doing this at the volume that we're doing it at Genesis, and volume is very important when you talk about complex minimally invasive surgery.

Scott Webb: Just the experience, as you say. First of all, these robots are expensive, so a lot of hospitals may not have them, or if they have them, they haven't had 'em very long. So the surgeons don't have the experience that you guys have at Genesis. I mean, there's just so many benefits for, , the surgeons, for the patients, their families, for their employers to get them back to work sooner. It's just a win-win, win. And just every, everybody's winning all the way. and I feel like one of the winners here today too, Doc, because this is really educational and fun. Great to have you back on again. Thank you so much. You stay well.

Dr. Adam Rothermel: I really appreciate it. Thank you very much.

Scott Webb: And for more information on robotic surgery at Genesis, go to genesishcs.org and search robots. And thanks for listening to Sounds of Good Health with Genesis, brought to you by Genesis Healthcare System. If you found this podcast to be helpful, please be sure to tell a friend and subscribe, rate and review this podcast. And check out the entire podcast library for additional topics of interest. I'm Scott Webb. Stay well.