Transcription:
Robotic Hernia Surgery

Bill Klaproth (Host): Thanks to innovations in robotic technology, hernia surgery can now be performed with less pain, a shorter hospital stay, and fewer complications. Here to talk about robotic hernia surgery is Dr. Elizabeth Honigsberg, attending surgeon with Foundation Medical Partners at Southern New Hampshire Health. Dr. Honigsberg, thank you so much for your time today. So let's start here; what exactly is robotic surgery?

Dr. Elizabeth Honigsberg, MD (Guest): Well first, let me say thank you for having me. Robotic surgery falls into the category of minimally invasive surgery. So traditionally, minimally invasive surgery is defined by the laparoscopic approach. So a camera is placed into the abdominal cavity through a small incision, and five millimeter long skinny instruments are used to perform the operation. Now robotic surgery takes minimally invasive surgery to the next level, and it is in fact computer assisted surgery, so the robot is actually a computer.


So your surgeon is going to sit at a console a few feet from the operating room table, and at that console, like a video game, the surgeon is going to control robotic arms and instruments positioned at the patient's bedside. So the robot serves as an extension of the surgeon's hands.

Bill: That is amazing. So Dr. Honigsberg, tell me, what are the benefits to the patient, and why is robotic hernia surgery a better option?

Dr. Honigsberg: So the benefit to the patient also has to do with the benefit to the surgeon. So we need to talk about the benefits to both for the patient to understand why robotics may be the better option for them. So for the surgeon, robotic surgery provides improved optics. so the surgeon is operating in 3D. In laparoscopy, the camera is limited to two dimension, so that optical improvement is a benefit to the surgeon because the surgeon sees better.

The robot also provides precision. So it eliminates any tremor a surgeon may have, and the instruments provide more motion than the actual human wrist and hand can provide. So the rotational ability of robotic instruments is superior to the human hand. And so this all translates into a potentially better operation for the patient. And the benefits that we're seeing in the data, in the studies being done on robotic surgery and the outcomes, all show an easier recovery, less post-operative pain, decreased narcotic use, decreased length of stay in the hospital, and an earlier return to work and activity. And hernia surgery, especially whether it's done open or through the laparoscopic approach, is a painful operation, and because of the precision and the technological advancements of the robot, that pain element is decreased, and therefore the patient's recovery is easier than with more traditional hernia approaches.

Bill: And I would imagine, Dr. Honigsberg, that cosmetically this is a benefit as well.

Dr. Honigsberg: Right, any minimally invasive technique where you're using small incisions - so five millimeters, eight millimeters, twelve millimeters - cosmetically is a benefit to the patient because after a year, you can barely see the scars made by the minimally invasive instruments. The one thing that I have found personally with robotic surgery is that it can potentially make you a better surgeon; the optics, the instrumentation.

So patients with a complex hernia, whether it be in the groin or of the abdominal wall, they can be done robotically versus let's say attempting it with the laparoscope and being unable to do it minimally invasive. So the robot allows more complex surgeries to be done through these small incisions, which is a tremendous benefit to the patient.

Bill: So who's a good candidate then for robotic surgery?

Dr. Honigsberg: Really anyone is a good candidate for robotic surgery. Surgeons have to take every case on a patient by patient basis, okay? You consider every patient, their surgical history, and their comorbidities. So any patient that is fit enough to undergo a moderately long operation, so you're under anesthesia for a few hours, they qualify for robotic surgery. I would say - and this is just my personal experience - is that more frail patients, elderly patients, frail patients may not tolerate the length of an operation to be done robotically. But other than that, anyone is a good candidate.

Bill: So you were just talking about the length of the operation. Are there any other risks or drawbacks with robotic surgery above those of traditional surgery?

Dr. Honigsberg: So for surgeons, whether they're coming out of training, or whether they're in practice already, the robotic surgery does add some additional time to the operation. Now as a surgeon gets past the fifty case mark, they get into 100 cases, 500 cases, the operative times do go down, but there does tend to be- it tends to be a little bit lengthier of an operation when done robotically. But that's just my personal experience.

Bill: And what other types of operations are being done robotically?

Dr. Honigsberg: So traditionally, when I was in training way back when, prostatectomies were really the first operation that the robot showed tremendous benefit for, and approximately 90% of prostatectomies, or removal of the prostate, are done robotically. Gynecology, so cancers of the gynecologic system, the reproductive system, 85% of those surgeries are being done robotically.

And now, the robot is being utilized in general surgery. So for gall bladder removal, or cholecystectomy, and now it's really showing great benefit for hernias. So hernia of the groin, which are called inguinal hernias, or hernias of the abdominal wall called ventral hernias. And you know, as the national trends are showing a decrease in open hernia surgery, and an increase in robotic hernia surgery, again for all the reasons why it's beneficial to the patient, in particular with pain and easier recovery.

Bill: So Dr. Honigsberg, tell me, why should someone choose Southern New Hampshire Health for their robotic hernia surgery?

Dr. Honigsberg: Well I'm a minimally invasive trained surgeon, so I have done a fellowship specifically to learn how to do advanced cases laparoscopically, and so therefore adopting the robotic approach has been easier for me than let's say somebody who has traditionally done their operations open. The translation from a laparoscopic hernia repair to robotic hernia repair is easier for me.

There's another surgeon in our practice, Dr. Luis Jimenez, who has an extensive- he's a senior surgeon with an extensive hernia experience. He is also utilizing the robot, so I think between my fellowship training and his experience, we offer a safe hernia repair with good outcomes.

Bill: And lastly, Dr. Honigsberg, can you share with us any other things you think might be important for us to know about robotic technology when it comes to hernia surgery?

Dr. Honigsberg: I think it is the future of hernia surgery. National hernia experts that traditionally perform their complex operations and abdominal wall reconstructions open are now translating these approaches to the robot. I think robotic surgery is here to stay, and I see it as the future of complex hernia surgery in addition to standard hernia surgery.

So I think patients should seek out a surgeon who can offer all three approaches; an open approach, a laparoscopic approach, and a robotic approach. But more and more we're seeing- I mean in 2017, one in four surgeons performed a robotic hernia surgery. So I think this technology, which is well-established in other fields, will now be having a big impact in hernia surgery as well.

Bill: Great information. Dr. Honigsberg, thank you so much for your time today. We really appreciate it. For more information about robotic hernia surgery, please visit www.SNHHealth.org. That's www.SNHHealth.org. This is Simply Healthy, a podcast by Southern New Hampshire Health. I'm Bill Klaproth, thanks for listening.