Surgery isn't what it used to be, and that's a good thing. When MarinHealth Medical Center first opened its doors, most surgeries were open (invasive) and required general anesthesia and a hospital stay.
Today, thanks to technological advances like laparoscopy, computer guidance, interventional radiology, and the da Vinci® robotic surgical system, many procedures that used to require open surgery can be performed minimally invasively. That means less anesthesia, smaller incisions, and less bleeding. Post-surgical pain is reduced and easier to manage, and patients usually go home the same day.
In this segment, Dr. Crystine Lee joins the show to discuss the benefits of treatment of hernias with robotic assisted surgery.
The Benefits of Robotic Assisted Surgery for the Treatment of Hernias
Featured Speaker:
Learn more about Crystine Lee, MD
Crystine Lee, MD
Crystine Lee, MD is a general surgeon and a member of the medical staff at MarinHealth Medical Center.Learn more about Crystine Lee, MD
Transcription:
The Benefits of Robotic Assisted Surgery for the Treatment of Hernias
Bill Klaproth (Host): If you have a hernia, minimally invasive robotic surgery may be an option for you, and here to tell us more about treatment of hernias throughout robotic surgery is Dr. Crystine Lee, a general surgeon and a member of the medical staff at Marin General Hospital. Dr. Lee, thank you for your time. First off, what is robotic surgery?
Dr. Crystine Lee (Guest): Robotic surgery is sort of an adjunct or a power tool in some ways with laparoscopic surgery, so the laparoscopic surgery technique versus open. Open usually involved large incisions. It’s what we’ve been doing 200 years ago when that’s all we had. Laparoscopic surgery was sort of developed in the 70’s initially by the gynecologists, and then general surgery started doing laparoscopic surgery in the 1980s and the sentinel operation was the gallbladder removal, which was a very common operation. Laparoscopic surgery means that the incisions – instead of being very large – are very small and therefore there's a lot less pain. More recently, the robot is sort of an addition to the laparoscopic surgeries – very small incisions about the diameter of a finger or a pen – and the robot basically gives 3D vision and also very fine control, very high resolution images. Much better vision, and of course if you're doing surgery, vision is critical.
Bill: That really gives you, the surgeon, a chance to really be effective when you're in there because you can really see.
Dr. Lee: Exactly.
Bill: That is really good and I would imagine less blood loss, and again, like I said, less pain, small incision, and probably a faster recovery time.
Dr. Lee: General yes, although, larger studies don’t really translate that because there's so many factors you’d really have to study probably tens of thousands of patients to get that to show that difference. As a surgeon myself, I can say that having all of these additional benefits of the robot will eventually translate to improvement, although it’s hard to prove when you actually do a study.
Bill: What type of training do you have to go through to learn how to operate this robotic surgery?
Dr. Lee: The robotic surgery is not a new operation. We’re just learning like the buttons of a remote control. Once you learn what buttons to press on the robot, we do the exact same operation. The training involved going to visit an expert robotic surgeon – and they become your mentor or teacher – the second aspect is going to the company and doing training and learning what the different buttons do. After that, we have to be observed or proctor by our expert surgeon. We usually pick two or three patients that agree to do it and then we are closely monitored by the proctor surgery who observes us, and then at that point, we’re signed off. Then we are still in a probational period for a certain amount of time where other surgeons at our facility make sure to monitor us to make sure we’re safe. It’s a very monitored, graduated training process.
Bill: Are there certain types of hernias then that robotic surgery is best used for?
Dr. Lee: Yes. Not all hernias need the robot. With regards to hernia repair, there are certain operations that I wouldn’t do it without the robot anymore. That would be inguinal hernia or groin hernias. The robot, what it also does, is it gives me wrists, so the traditional laparoscopic instruments are straight like chopsticks – there are no wrists to it. The robot has a wrist inside, and of course, if you had to choose between having no wrists and wrists, everyone would put their hand up and say “I want wrists.”
Bill: Are there certain types of people then that are good candidates for robotic surgery?
Dr. Lee: It’s not so much the person, but more what condition they have and the degree of the condition they have.
Bill: That’s very important. With robotic surgery, I know you were talking earlier about the studies of this type of surgery, but right now, what is the long term outcome? Is there a lower rate of the hernia returning? Do we know that at this point?
Dr. Lee: It’s not so much the robotic, but the robot is, as I mentioned, a power tool to laparoscopic surgery. There are more studies about laparoscopic surgery since we've been doing that since the general surgeons in 1980s. I think with the laparoscopic with a robotic adjunct to it versus open technique, I think the results are showing that the laparoscopic approach is better. Number one, small incisions, less pain, because the incisions are smaller, there is less wound related problems like infections, seroma – which is like a fluid blister – or hematoma – which is a blood blister – and those can be around the incisions, and also with regard to the hernia repair, I believe that laparoscopic is more durable because we can get a larger piece of mesh in, and also a mesh comes in on the inside. It’s where the pressure is coming from when you cough, laugh or sneeze, whereas with the open technique, the mesh is put on the outside, and if you cough, laugh or sneeze, it would tend to push the mesh away. It’s always better to put the mesh where the pressure is coming from.
Bill: That makes sense. With the robotic surgery, you're able to put that on the inside.
Dr. Lee: Exactly.
Bill: That makes sense. Dr. Lee, thank you for your time today and talking with us about treatment of hernias through robotic surgery. For more information, visit MarinGeneral.org. That’s MarinGeneral.org. This is the Healing Podcast brought to you by Marin General Hospital. I'm Bill Klaproth. Thanks for listening.
The Benefits of Robotic Assisted Surgery for the Treatment of Hernias
Bill Klaproth (Host): If you have a hernia, minimally invasive robotic surgery may be an option for you, and here to tell us more about treatment of hernias throughout robotic surgery is Dr. Crystine Lee, a general surgeon and a member of the medical staff at Marin General Hospital. Dr. Lee, thank you for your time. First off, what is robotic surgery?
Dr. Crystine Lee (Guest): Robotic surgery is sort of an adjunct or a power tool in some ways with laparoscopic surgery, so the laparoscopic surgery technique versus open. Open usually involved large incisions. It’s what we’ve been doing 200 years ago when that’s all we had. Laparoscopic surgery was sort of developed in the 70’s initially by the gynecologists, and then general surgery started doing laparoscopic surgery in the 1980s and the sentinel operation was the gallbladder removal, which was a very common operation. Laparoscopic surgery means that the incisions – instead of being very large – are very small and therefore there's a lot less pain. More recently, the robot is sort of an addition to the laparoscopic surgeries – very small incisions about the diameter of a finger or a pen – and the robot basically gives 3D vision and also very fine control, very high resolution images. Much better vision, and of course if you're doing surgery, vision is critical.
Bill: That really gives you, the surgeon, a chance to really be effective when you're in there because you can really see.
Dr. Lee: Exactly.
Bill: That is really good and I would imagine less blood loss, and again, like I said, less pain, small incision, and probably a faster recovery time.
Dr. Lee: General yes, although, larger studies don’t really translate that because there's so many factors you’d really have to study probably tens of thousands of patients to get that to show that difference. As a surgeon myself, I can say that having all of these additional benefits of the robot will eventually translate to improvement, although it’s hard to prove when you actually do a study.
Bill: What type of training do you have to go through to learn how to operate this robotic surgery?
Dr. Lee: The robotic surgery is not a new operation. We’re just learning like the buttons of a remote control. Once you learn what buttons to press on the robot, we do the exact same operation. The training involved going to visit an expert robotic surgeon – and they become your mentor or teacher – the second aspect is going to the company and doing training and learning what the different buttons do. After that, we have to be observed or proctor by our expert surgeon. We usually pick two or three patients that agree to do it and then we are closely monitored by the proctor surgery who observes us, and then at that point, we’re signed off. Then we are still in a probational period for a certain amount of time where other surgeons at our facility make sure to monitor us to make sure we’re safe. It’s a very monitored, graduated training process.
Bill: Are there certain types of hernias then that robotic surgery is best used for?
Dr. Lee: Yes. Not all hernias need the robot. With regards to hernia repair, there are certain operations that I wouldn’t do it without the robot anymore. That would be inguinal hernia or groin hernias. The robot, what it also does, is it gives me wrists, so the traditional laparoscopic instruments are straight like chopsticks – there are no wrists to it. The robot has a wrist inside, and of course, if you had to choose between having no wrists and wrists, everyone would put their hand up and say “I want wrists.”
Bill: Are there certain types of people then that are good candidates for robotic surgery?
Dr. Lee: It’s not so much the person, but more what condition they have and the degree of the condition they have.
Bill: That’s very important. With robotic surgery, I know you were talking earlier about the studies of this type of surgery, but right now, what is the long term outcome? Is there a lower rate of the hernia returning? Do we know that at this point?
Dr. Lee: It’s not so much the robotic, but the robot is, as I mentioned, a power tool to laparoscopic surgery. There are more studies about laparoscopic surgery since we've been doing that since the general surgeons in 1980s. I think with the laparoscopic with a robotic adjunct to it versus open technique, I think the results are showing that the laparoscopic approach is better. Number one, small incisions, less pain, because the incisions are smaller, there is less wound related problems like infections, seroma – which is like a fluid blister – or hematoma – which is a blood blister – and those can be around the incisions, and also with regard to the hernia repair, I believe that laparoscopic is more durable because we can get a larger piece of mesh in, and also a mesh comes in on the inside. It’s where the pressure is coming from when you cough, laugh or sneeze, whereas with the open technique, the mesh is put on the outside, and if you cough, laugh or sneeze, it would tend to push the mesh away. It’s always better to put the mesh where the pressure is coming from.
Bill: That makes sense. With the robotic surgery, you're able to put that on the inside.
Dr. Lee: Exactly.
Bill: That makes sense. Dr. Lee, thank you for your time today and talking with us about treatment of hernias through robotic surgery. For more information, visit MarinGeneral.org. That’s MarinGeneral.org. This is the Healing Podcast brought to you by Marin General Hospital. I'm Bill Klaproth. Thanks for listening.