Transcription:
Single-Site Robotic Gallbladder Removal

Deborah Howell (Host): Hello and welcome to the show. You are listening to weekly dose of wellness brought to you by MemorialCare Health System. I am Deborah Howell. Today’s guest is Dr. Tam Le, a board certified general and colorectal surgeon at Orange Coast Memorial Medical Center. He is experienced in open laparoscopic and robotic assisted surgery and is also one of the first surgeons in Orange County to perform single site cholecystectomy. Welcome Dr. Le.

Dr. Tam Le (Guest): Hello. Thank you. I appreciate being here.

Deborah: We are very-very happy on our side to have you. You know most of us still have our gallbladders, but what are some of the reasons that somebody would need to have their gallbladder removed and is this common procedure?

Dr. Le: Yeah, typically patients need their gallbladder removed because of abdominal pain either underneath the breast bone or underneath the ribcage of the right side cased by gallstone. Gallstone can also cause infection of the gallbladder requiring removal and uncommonly gallbladder polyps that abnormal growth is their gallbladder detected by ultrasound. We need to remove to prevent gallbladder cancer and after commonly pain can also caused by nonfunctioning gallbladder requiring the removal. In the US, more than 500,000 patients require removal of the gallbladder every year.

Deborah: So, it is pretty common.

Dr. Le: Yes, it’s very common.

Deborah: So, then my next question would be to you doctor. How is cholecystectomy removal of the gallbladder and stones performed?

Dr. Le: Yeah, typically now a day it’s removed by the laparoscopic method with the videocamera called laparoscopic cholecystectomy. It has been performed in the last 20 years. Traditionally, open surgery is required, the large incisions likely kind of 8 inches to 11 inches incision underneath the right ribcage that was done, but this caused a lot of pain, but with laparoscopy, they are less painful, the patient often goes home the same day. Recently in the last few years, robotic surgery has been very useful and I believe has more benefit than laparoscopic cholecystectomy.

Deborah: Are you talking now about single-site robotic cholecystectomy?

Dr. Le: Yes. Even though, you can use the robot to do gallbladder removal with multiple incision just like a laparoscopy, but as far the robot, you can make this one incision at the umbilicus about 2½ cm incision to remove the gallbladder instead of making four incisions in laparoscopic surgery.

Deborah: So that is huge-huge benefit. Are there other benefits the patient would derive from the single-site approach.

Dr. Le: Yes. I believe besides the cosmetics benefits of one single incision at the umbilicus because once it healed, the scar would be invisible. The pain for the patient I believe is less than if you met four incisions in the laparoscopic surgery.

Deborah: Sure.

Dr. Le: And the robotic system for a lot better visualization for the surgeon, you have a three-dimensional image instead of two-dimensional image in laparoscopy, so the surgeon can see the anatomy while operating a lot clearer. My analogy as you can see the fish on the ground, you can dive in like a snorkeling, you can see the fish a lot clearer and that’s the different in image between the laparoscopy and robotic. You can see the anatomy much clearer, so I believe the surgery can be performed safer with less risk of injury to patients.

Deborah: Yeah. What’s better for the doctor certainly always better for the patient?

Dr. Le: Yes. It’s more comfortable too. In robotic surgery, the surgeon is actually sit down and operate rather than standing right at the bedside.

Deborah: That’s great.

Dr. Le: Let me also clarify that people think then when you do robotic surgery, the robot is on its own, but actually the robot is just a sophisticated instrument that the surgeon control to operate the picture of the patient.

Deborah: Right, so the robot itself is not holding the instruments.

Dr. Le: It does hold instrument, but the surgeon controlled the robotic arms to move the instrument. The robot is not programed to move by itself. The surgeon actually plays the instrument into the patient held by the robot and then the surgeon sit at the console to control the robot to move the instrument. The instrument is likely the miniature arm that the surgeon can put inside the patient.

Deborah: I would imagine. This is a strange word to use when it come to surgery, but its kind of fun right.

Dr. Le: Well, you know it’s actually for the surgeon, its fun and its pleasure to perform for me you know the robotic surgery. The surgery can see things so clearly and your movement is a lot smother. It’s more ergonomic to control the robotic instrument than to control the laparoscopic instruments.

Deborah: Wonderful and then what are the benefits and reasons for the removal of the gallbladder in the first place?

Dr. Le: Typically because patient has a lot of pain, abdominal pain brought on by eating and it prevents complications of gallstones that are like contraction. People can get quite ill from infections with fever, abdominal pain, and affects other organs and if the stone travel, it can cause pancreatitis, inflammation of the pancreas, or if it obstruct the main bile duct, people can have jaundice, yellowing of the skin and the eye, and infection of the liver which can be caused life-threatening, though for the patients who are affected by gallstone or gallbladder, this is a life-changing and saving procedure.

Deborah: Awesome. I am assuming there are still a few risks for single-site robotic cholecystectomy may be you could go over those for us.

Dr. Le: It’s typical like any surgery, but the risks are small. The risk of bleeding and infection associated with the surgery is very small less than 1%. There is concern about hernia like protrusion of tissue at the site, but the incision is 2.5 cm or an inch versus 1 cm and a few other 5 mm incision in the laparoscopic surgery with incidents of problems are very small and the main thing we have concerned about just like in open laparoscopic surgery is injury to the common bile duct, the incident of injury to the common bile duct, the main duct from the liver then go down to the small intestine is very small. It's a one in the few hundred thousand cases.

Deborah: Well, that’s leads me to my next question. You have to be you know quite careful and concerned about what surgeon that you are looking for when dealing with such a sensitive surgery so, what should somebody research when looking for a surgeon to perform single-site cholecystectomy.

Dr. Le: It’s true with any new technique, there is a learning curve, so the surgeon typically has to be trained properly, usually does a training program requirement before the surgeon can perform a robotic surgery, so the patient should make sure that the surgeon is properly trained and then after that is the experience, you need some time to perform the procedure under supervision and then have procedure to perfect your techniques or the speed, so typically we take about 25 cases or 25 patients to do on your own before I think that the surgeon will feel comfortable that goes with me and other surgeon who perform a robotic surgery.

Deborah: How many have you performed yourself single sites?

Dr. Le: I have done robotic surgeries since 2011 and I have done more than 100 cases now.

Deborah: Wonderful. Well, it's a pleasure to have you on our show. Please tell everybody and your staff, we were glad to borrow a few minutes from you today and thank you so much Dr. Le for being with us.

Dr. Le: Thanks so much for opportunity to speak with you and your patients.

Deborah: Our pleasure. We have been talking about the advances and options in gallbladder surgery with Dr. Le. To listen to the podcast for more info, please visit memorialcare.org. I am Deborah Howell. Join us again next time as we explore another weekly dose of wellness brought to you by MemorialCare Health System. Have a fantastic day.