Joey Wahler (Host): It's become a commonly used and more effective treatment for numerous conditions. We're discussing robotic surgery. Our guest is Dr. Brandon Murphy. He's a general surgeon. This is Wellness in Reach, a Mount Carmel podcast. Thanks so much for joining us. I'm Joey Wahler. Hi there, Dr. Murphy. Welcome.

Brandon Murphy, MD: Hi, Joey. Thank you very much for having me on.

Host: We appreciate the time. So first, in a nutshell, for those unfamiliar, what is robotic surgery? And what are the main ways in which it differs from traditional procedures?

Brandon Murphy, MD: Yeah. Robotic surgery is really just the next step in minimally invasive surgery. Forty years ago, we had a big leap in technology going from open to laparoscopic just in the last 10 years, kind of an additional leap of going from laparoscopic to robotic. It allows kind of a multimodal aspect of improving surgery to make it more minimally invasive.

A couple of those things is better visualization, 3D visuals. So instead of laparoscopic surgery being 2D, this adds and goes to 3D. Almost more of like a VR simulation of being able to see better visuals while working on the patient. Also, better dexterity. And so, It really takes that next leap from laparoscopic to robotic, allowing the patient to have better surgery, more complex surgery to be able to be minimally invasive.

Host: Gotcha. And so, we should point out, Doc, before we go any further, that the term robotic surgery throws some patients off. Robots, no, have not taken over the OR, right? There's still a human expert pair of hands behind the equipment—in this case, belonging to you. And so how does it actually work? What's the role of a surgeon like you during a given procedure?

Brandon Murphy, MD: Yeah, exactly. And a lot of times, this is a very common misconception with robotic surgery. No, it's not Alexa or AI performing the surgery, that the surgeon is by far the first thing that controls the robot.

And so, kind of to take patients through a robotic surgery, the surgeon scrubs in just like laparoscopic surgery. We place the ports, which is a long tube that allows us access into the abdomen, just like laparoscopic surgery. Where laparoscopic surgery, the instruments really just are long instruments that open and close. That's all they can do. Robotic surgery adds a wrist to those instruments.

So after we place the trocar sites, the minimally invasive sites to get into the abdomen, we dock the robot. And then, as a surgeon, unscrub, go to the console, which is typically about three to five feet away from the patient. So, we're still within the room. We're still right next to the patient. And then, I'm in the console like I'm actually within the abdomen of the patient. And I have complete control over those robotic arms. So, no, AI has no control over it. The surgeon is performing the surgery.

Host: And so, I'm going to ask you a little bit more about that. But first, which of the surgeries where it's most commonly used? Because obviously, as a general surgeon, you do various kinds of procedures.

Brandon Murphy, MD: Correct. Like these days, most residents are coming out of residency, being robotically trained. It really is the next frontier after a laparoscopic going into robotic surgery. And majority of the cases that are being done robotically are the same cases that are being majority done laparoscopically. It's the gallbladder surgery, the appendix, the hernia repairs from a general surgery standpoint. Not just general surgeons, urologists, OB-GYNs, more and more specialties are going into robotic surgery away from laparoscopic surgery as the training gets to be more robust and people are coming out, being robotically trained. We've really seen in the last 10 years robotic surgery has exponentially gotten more popular, where more and more surgeons are performing robotic surgery over laparoscopic surgery.

Host: So, what are the main benefits for patients? Because a lot of it comes down to less scarring and also a quicker, better recovery period, right?

Brandon Murphy, MD: Correct, Joey. So, overall, robotic surgery improves the patient experience in multiple ways. And so, for many surgeries, I'm able to use less incisions than I would've had to use from a laparoscopic standpoint. Especially just looking at, say, a hernia repair back 40 years ago with open hernia repairs. We still perform open hernia repairs these days as well. A lot of times with hernia repairs, patients can be in for large repairs in the hospital for four or five, six days. For laparoscopic, that knocked that down to two or three days. Now, robotic surgery has knocked it down even further. Some patients are going home same-day. Some patients are going home the next day.

And so, it really lowers that hospital length of stay for a number of reasons. One, it's less incisions a lot of times for robotic surgery. No longer do we have to tack mesh in. Now, we sew it in robotically, which is less pain postoperatively for the patient, which allows patients to get back to their just daily life a lot quicker; less length of a hospital stay, also decreases the cost to the patient. Hospital stays are not cheap. And so, any day you can decrease that for patients helps them on the monetary side. Not only that, they recover a lot faster. So, less pain means they're able to get back to their work, their daily life, a lot quicker than they would've been otherwise.

Host: As surgeons like yourself often rave about the preciseness of robotic surgery, being able to attack whatever needs to be attacked, so to speak, while leaving as much healthy tissue intact at the same time. Why is that so beneficial, both for patient and surgeon?

Brandon Murphy, MD: Yeah. So, the robotic surgery has allowed us to work in smaller spaces, whereas in laparoscopic surgery, we would've had to dissect further around where we wanted to work or have a lot larger area, which means more dissection, which means more pain for the patient. Now, that robotic surgery allows us to access smaller areas of the body, that's what causes that less pain overall. It allows for patients to be able to get through these surgeries a lot better than otherwise. Overall, the pain's better. The postoperative care is easier on the patient. Smaller incisions, smaller trocar sites than we would've had with laparoscopic surgery.

Host: What factors typically determine, Doc, if a patient is a good candidate for this? Or perhaps to put it another way, are there any patients that typically aren't candidates for this?

Brandon Murphy, MD: Yeah, a couple things that kind of come to mind that, even with laparoscopic surgery and robotic surgery, the number one thing is how many surgeries has the patient gone through before. Have they had multiple abdominal surgeries, which could have scar tissue, which could cause adhesions? Have they had previous complications from previous surgeries? We'll factor in whether a patient is a good candidate for robotic surgery or even laparoscopic surgery.

Now, where robotic surgery kind of flourishes is even with patients that have had a few abdominal surgeries in the past, or we are expecting adhesions or scar tissue, being able to use the robotically assisted laparoscopic surgery allows us to still perform a lot of those surgeries minimally invasive, where previously if it was just the laparoscopic option, we might say, "Oh no, it is just too high risk. We may have to do this open," which obviously is a lot bigger surgery for the patient, whereas majority of the time now we will still say, "Let's try this minimally invasive now that we are able to do this robotically assisted laparoscopic surgery." It allows us to do more complex surgeries, more patients who have had previous adhesions or scar tissue. It gives us a better chance of being able to get the patient through this minimally invasively.

Host: As a general surgeon, I would imagine, Doctor, that a question you're often asked by patients is, "When can I return to what I was up to before" whether it's workwise, socially, activities. Do you have a recent success story in mind where the turnaround time was so fast and so efficient that someone was able to get back on the golf course or whatever the case may have been?

Brandon Murphy, MD: Yeah, exactly. So like you mentioned, one of the first things patients ask is when can they get back to work? When can they go on vacation? When can they go golfing? When can they get back into the pool? As far as with smaller incisions, robotically assisted, laparoscopic surgery allows patients to get back on that golf course, get back to work a lot quicker. I would say in, earlier in my career, when we were doing just purely laparoscopic surgery. A lot of times, I'd tell patients, "Hey, plan on taking a week off before really getting back into the normal routine." Nowadays, with the addition of robotic surgery, I'm having patients call two, three, four days after surgery and say, "Hey, I feel great. Can I get back on the golf course? Can I get back to work?" And my answer is always, if you feel up to it, yeah, you can get back on that golf course, you can get back to work. It allows patients to really feel back to themselves, being able to do everything they want to do after surgery, which then gets them in the better mindset and actually improves healing. When they can get back to their normal routine, they're less thinking about, "Oh, postoperative pain." They're less thinking of things they can't do and more looking forward to the things they can now do that they might not have been able to do before the surgery. Hernias, gallbladders. I've had many patients, especially with gallbladder issues that have told me in the past that they couldn't even go out to eat anymore. They couldn't enjoy a good meal. And now, after robotic surgery, they're able to go out one, two, three days after surgery and have a fun time with their family, less worried about they just went through surgery and more enjoying that time now that they can enjoy a good meal, enjoy time with their family.

Host: You mentioned earlier one main misconception, perhaps numero uno, is the fact that people sometimes think mistakenly that robots are actually performing the surgery. We've debunked that. Any other misconception people have about robotic-assisted surgery? Is it maybe just the fact that often they don't know all the benefits that we're talking about right here?

Brandon Murphy, MD: Yeah, exactly. I would say the two biggest misconceptions with robotic surgery is, one, they don't think their surgeon is actually doing the surgery. For every robotic surgery, the surgeon is in the room. After we dock the robot, we're three to five feet away from the patient And we can be at the patient's bedside within a couple seconds. So foremost, the surgeon is definitely the main aspect of the person doing the surgery. And then, secondly, it's not Alexa or AI doing your surgery. The surgeon is in full control of those robotically-assisted arms throughout the entire surgery.

And then, I'd say less so these days, I would say 10 years ago, a lot of patients were very unaware of what the robot could offer. What robotically assisted laparoscopic surgery improved upon from a patient aspect. It's a little less of an issue these days, but I'll still have patients coming in. And I'll tell them about the benefits of robotic surgery. And I think a lot of times, it's eye-opening on how much better it is from a patient experience, having that robotic-assisted laparoscopic aspect of more minimally invasives, less incisions, less pain, getting the patients being able to get back to their normal life a lot quicker.

Host: And then, in summary here, doctor, if someone joining us is considering robotic surgery for whatever the case may be, what's the main thing they should know?

Brandon Murphy, MD: Yeah. As always, it is going to be a discussion between the patient and the surgeon. There's definitely different scenarios where robotic versus laparoscopic versus open individually has their benefits and disadvantages. And so, I think the number one thing is talk to your surgeon. There's no bad questions in a patient-physician relationship. And so, I tell patients all the time, any questions you have is a good question. As I want patients to be familiar with the surgery, they're going to undergo and be comfortable what they expect to happen. And that includes robotically-assisted laparoscopic surgery, the benefits and the disadvantages. I think the biggest thing is just have that communication, have that dialogue with your surgeon, and not be afraid to ask questions.

Host: Yeah. Medical professionals always preach to always be your best advocate as a patient. Well, folks, we trust you are now more familiar with robotic surgery. Dr. Murphy, keep up all your great work and thanks so much again.

Brandon Murphy, MD: Well, thank you very much for having me.

Host: Absolutely. And for more information, please do visit mountcarmelhealth.com/services/surgery/roboticsurgery. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. Thanks so much again for being part of Wellness in Reach, a Mount Carmel podcast.