Gall bladder surgery is one of the most common operations in the U.S. and worldwide.
William L. Diehl, MD, FACS, Summit Medical Group board-certified general surgeon, gives an overview of how our gall bladder functions, why gall bladder "attacks" occur, and -- when gall bladder removal is necessary -- the benefits of using minimally-invasive surgical techniques.
Selected Podcast
Single Incision Laparoscopic Surgery
Featured Speaker:
William Diehl, MD, FACS
Board-certified general surgeon, William L. Diehl, MD, FACS, has expertise in general surgeries, including hernia repair, gallbladder removal, and acute surgical emergencies such as diverticulitis and appendicitis. Dr. Diehl also specializes in cancer surgery of the breast, pancreas, liver, biliary tract, esophagus, colon, rectum, and skin. Transcription:
Single Incision Laparoscopic Surgery
Melanie Cole (Host): Gallbladder attacks can be both very painful and frightening, and it's easy to understand why so many people opt for gallbladder surgery after experiencing one gallbladder attack. My guest is Dr. William Diehl. He is a member of the Department of Surgery at Summit Medical Group, and he is an attending surgeon at Morristown Medical Center. Welcome to the show, Dr. Diehl. Tell us a little bit about the gallbladder. Let's get a working definition of what this organ does and why it sometimes needs to be removed.
Dr. William Diehl (Guest): The gallbladder, the easiest way to think of it is as a reservoir. The liver produces bile that is then stored in the gallbladder. When people eat, the gallbladder then receives a series of hormonal stimulus that may get empty, and the bile is then squirted out into the intestine, where it mixes up with the food and aids with digestion of food. So that's the main function of the gallbladder.
Melanie: What might happen, or what might someone experience when they're having a gallbladder attack? What is that? What does it feel like?
Dr. Diehl: Well, a gallbladder attack is typically a very, very painful event. The pain occurs under the right rib cage, but sometimes it can occur in the pit of the stomach. Sometimes it feels like it's between the shoulder blades or on the right shoulder. The reason people get gallbladder attacks is because all of a sudden, you form stones in the gallbladder. The stones are formed quite simply just by the precipitation of bile salts, and they start like little gravels of sand, and little by little they get bigger to the point where now, all of a sudden, people, very literally, have stones in their gallbladder.
Melanie: You get these stones, and then what? Is that stone in there now?
Dr. Diehl: So that stone is in there, and sometimes it can be a single small stone or a single large stone. More commonly, there are multiple small to medium-sized stones. So what happens is that one of the stones, all of a sudden, moves and blocks the exit of the gallbladder to the other connections of the bile tree. So now, the gallbladder is trying to empty, but it is doing so against the blockage. That's when the people get the pain. They get the colic, they get the cramping, and that's why it hurts.
Melanie: People consider gallbladder surgery at some point. Their doctor says, "This is now the time. You've had one or more stones." So you do a single-incision, robotic laparoscopic surgery for gallbladder removal. When does it become necessary, before we talk about the surgery, to actually remove that gallbladder?
Dr. Diehl: Well, it varies. Nowadays, since we do have safe and relatively quick recovery times for the performance of gallbladder surgery, it has become more attractive to treat the gallbladder surgically. In times past, people needed to have a major operation, frequently entailing an incision that went all the way across the ribs on the right side or right below the ribs on the right side. People were in the hospital for three or four days and had about another three- or four-week recovery time. Now, with laparoscopic surgery or robotic surgery, the procedure is done as an outpatient. People are usually back to work within about a week, and there is a very manageable amount of pain. So it has become a more attractive option to treat the gallbladder surgically. The other reason to consider surgery for the gallbladder is that occasionally, people have complications from gallstones. They can develop pancreatitis. They can have one of the stones pass out of the gallbladder and cause jaundice, cause infections, and then it becomes a completely different disease. People are now quite ill. It's frequently a life-threatening situation, and very frequently, if it gets to that point, you then can't treat it with minimally invasive techniques.
Melanie: Speak about the single-incision laparoscopic surgery for a minute. When you say "single incision," that's it? It's just one tiny little incision and you fit everything in there to do what you need to do?
Dr. Diehl: Exactly. We can do the single incision laparoscopically or robotically. How I do it is you just make one small incision that goes right within the belly button, and then you introduce a special little port. If you're doing it robotically, the robot is attached to the instruments that go through that port. If you're doing it laparoscopically, when you're standing by the side of the patient, then you also hold the instruments that go through that port. The advantage of doing it robotically is that you are able to manipulate those instruments with greater ease than when you're doing it laparoscopically. You tend to have what we call sword fighting because your hands and your instruments are very close to each other, and they tend to collide with each other.
Melanie: When you're doing the surgery, are there any side effects to actually having your gallbladder removed? If your liver still produces bile in order to digest the fats, and now you don't have this gallbladder to squirt it out, as you said, into the intestines, then what is happening? Is it building up, or is this something you can in a sense do without if you need to?
Dr. Diehl: You can do without. Gallbladder surgery is one of the most common operations in this country and worldwide. What happens is that the bile is still produced by the liver, but it gets excreted into the intestines on a continuous basis, and eventually, the food catches up with it, then it exerts its normal digestive function. So it's usually not a problem. The main concern that we have from gallbladder surgery is not so much the long-term effects but, rather, the risks of the injury to either the bile ducts or the small intestine or the colon and some of the neighboring structures. That has been a problem that has plagued surgeons since the days of open surgery and has persisted through to laparoscopic and robotic surgery.
Melanie: Is there any way to prevent gallstones, Dr. Diehl?
Dr. Diehl: Not really. We don't entirely know the genesis of gallstones. It may be dietary induced, but it probably has to do with many other factors.
Melanie: Because people listening want to know if there are certain foods to avoid, certain foods that might help. "More fiber or any of these green foods?" Certainly, people will ask this question.
Dr. Diehl: Well, we always teach the medical students that the typical profile of a patient with gallstones is somebody who is female, fat, fertile, and 40—the four F's of gallbladder surgery. We think that excess weight somehow or other has something to do with the production of gallstones, but women are more likely to get gallstones than men, and it's usually around that age of 40 or so. But clearly, there are many people that fall outside of this profile and still have gallstones.
Melanie: What's the recovery time on a single-incision surgery to have gallbladder removal?
Dr. Diehl: The recovery time is very quick. You have the surgery as an outpatient, go home that same day. You are usually on some painkillers for two or three days. Most of my patients are back to work within anywhere between 5 to 10 days depending on how they feel. The huge benefit of having the procedure done that way is that cosmetically, you can hardly tell after everything heals that there has been an operation. Since you were able to hide it within the belly button, many times, you could be wearing a two-piece bathing suit and nobody would ever know that you had surgery.
Melanie: And this is really outpatient?
Dr. Diehl: Yes. This is done as an outpatient.
Melanie: That's just amazing. Now, does insurance cover robotic surgery? Has it caught up with the times? Is this pretty much understood now?
Dr. Diehl: Yes. Robotic surgery is one of the options. It is covered by insurance. They cover it just as they would laparoscopic surgery, which has now been the standard therapy since about 1990.
Melanie: What else might you use, just very quickly—we only have a minute left—the single-incision laparoscopic surgery for?
Dr. Diehl: The laparoscopic surgery, you can do just about anything. I've done it for colon surgery. I've taken out spleens that way, done some pancreatic surgery. So it has wide applicability. But, again, it is a little bit more cumbersome to do it laparoscopically than it is when you make multiple small little puncture sites.
Melanie: Well, thank you so much, Dr. William Diehl. We've been talking about single-incision robotic laparoscopic surgery for gallbladder removal. You're listening to SMG Radio. For more information on Summit Medical Group, you can go to summitmedicalgroup.com. That's summitmedicalgroup.com. This is Melanie Cole for SMG Radio. Thanks so much for listening.
Single Incision Laparoscopic Surgery
Melanie Cole (Host): Gallbladder attacks can be both very painful and frightening, and it's easy to understand why so many people opt for gallbladder surgery after experiencing one gallbladder attack. My guest is Dr. William Diehl. He is a member of the Department of Surgery at Summit Medical Group, and he is an attending surgeon at Morristown Medical Center. Welcome to the show, Dr. Diehl. Tell us a little bit about the gallbladder. Let's get a working definition of what this organ does and why it sometimes needs to be removed.
Dr. William Diehl (Guest): The gallbladder, the easiest way to think of it is as a reservoir. The liver produces bile that is then stored in the gallbladder. When people eat, the gallbladder then receives a series of hormonal stimulus that may get empty, and the bile is then squirted out into the intestine, where it mixes up with the food and aids with digestion of food. So that's the main function of the gallbladder.
Melanie: What might happen, or what might someone experience when they're having a gallbladder attack? What is that? What does it feel like?
Dr. Diehl: Well, a gallbladder attack is typically a very, very painful event. The pain occurs under the right rib cage, but sometimes it can occur in the pit of the stomach. Sometimes it feels like it's between the shoulder blades or on the right shoulder. The reason people get gallbladder attacks is because all of a sudden, you form stones in the gallbladder. The stones are formed quite simply just by the precipitation of bile salts, and they start like little gravels of sand, and little by little they get bigger to the point where now, all of a sudden, people, very literally, have stones in their gallbladder.
Melanie: You get these stones, and then what? Is that stone in there now?
Dr. Diehl: So that stone is in there, and sometimes it can be a single small stone or a single large stone. More commonly, there are multiple small to medium-sized stones. So what happens is that one of the stones, all of a sudden, moves and blocks the exit of the gallbladder to the other connections of the bile tree. So now, the gallbladder is trying to empty, but it is doing so against the blockage. That's when the people get the pain. They get the colic, they get the cramping, and that's why it hurts.
Melanie: People consider gallbladder surgery at some point. Their doctor says, "This is now the time. You've had one or more stones." So you do a single-incision, robotic laparoscopic surgery for gallbladder removal. When does it become necessary, before we talk about the surgery, to actually remove that gallbladder?
Dr. Diehl: Well, it varies. Nowadays, since we do have safe and relatively quick recovery times for the performance of gallbladder surgery, it has become more attractive to treat the gallbladder surgically. In times past, people needed to have a major operation, frequently entailing an incision that went all the way across the ribs on the right side or right below the ribs on the right side. People were in the hospital for three or four days and had about another three- or four-week recovery time. Now, with laparoscopic surgery or robotic surgery, the procedure is done as an outpatient. People are usually back to work within about a week, and there is a very manageable amount of pain. So it has become a more attractive option to treat the gallbladder surgically. The other reason to consider surgery for the gallbladder is that occasionally, people have complications from gallstones. They can develop pancreatitis. They can have one of the stones pass out of the gallbladder and cause jaundice, cause infections, and then it becomes a completely different disease. People are now quite ill. It's frequently a life-threatening situation, and very frequently, if it gets to that point, you then can't treat it with minimally invasive techniques.
Melanie: Speak about the single-incision laparoscopic surgery for a minute. When you say "single incision," that's it? It's just one tiny little incision and you fit everything in there to do what you need to do?
Dr. Diehl: Exactly. We can do the single incision laparoscopically or robotically. How I do it is you just make one small incision that goes right within the belly button, and then you introduce a special little port. If you're doing it robotically, the robot is attached to the instruments that go through that port. If you're doing it laparoscopically, when you're standing by the side of the patient, then you also hold the instruments that go through that port. The advantage of doing it robotically is that you are able to manipulate those instruments with greater ease than when you're doing it laparoscopically. You tend to have what we call sword fighting because your hands and your instruments are very close to each other, and they tend to collide with each other.
Melanie: When you're doing the surgery, are there any side effects to actually having your gallbladder removed? If your liver still produces bile in order to digest the fats, and now you don't have this gallbladder to squirt it out, as you said, into the intestines, then what is happening? Is it building up, or is this something you can in a sense do without if you need to?
Dr. Diehl: You can do without. Gallbladder surgery is one of the most common operations in this country and worldwide. What happens is that the bile is still produced by the liver, but it gets excreted into the intestines on a continuous basis, and eventually, the food catches up with it, then it exerts its normal digestive function. So it's usually not a problem. The main concern that we have from gallbladder surgery is not so much the long-term effects but, rather, the risks of the injury to either the bile ducts or the small intestine or the colon and some of the neighboring structures. That has been a problem that has plagued surgeons since the days of open surgery and has persisted through to laparoscopic and robotic surgery.
Melanie: Is there any way to prevent gallstones, Dr. Diehl?
Dr. Diehl: Not really. We don't entirely know the genesis of gallstones. It may be dietary induced, but it probably has to do with many other factors.
Melanie: Because people listening want to know if there are certain foods to avoid, certain foods that might help. "More fiber or any of these green foods?" Certainly, people will ask this question.
Dr. Diehl: Well, we always teach the medical students that the typical profile of a patient with gallstones is somebody who is female, fat, fertile, and 40—the four F's of gallbladder surgery. We think that excess weight somehow or other has something to do with the production of gallstones, but women are more likely to get gallstones than men, and it's usually around that age of 40 or so. But clearly, there are many people that fall outside of this profile and still have gallstones.
Melanie: What's the recovery time on a single-incision surgery to have gallbladder removal?
Dr. Diehl: The recovery time is very quick. You have the surgery as an outpatient, go home that same day. You are usually on some painkillers for two or three days. Most of my patients are back to work within anywhere between 5 to 10 days depending on how they feel. The huge benefit of having the procedure done that way is that cosmetically, you can hardly tell after everything heals that there has been an operation. Since you were able to hide it within the belly button, many times, you could be wearing a two-piece bathing suit and nobody would ever know that you had surgery.
Melanie: And this is really outpatient?
Dr. Diehl: Yes. This is done as an outpatient.
Melanie: That's just amazing. Now, does insurance cover robotic surgery? Has it caught up with the times? Is this pretty much understood now?
Dr. Diehl: Yes. Robotic surgery is one of the options. It is covered by insurance. They cover it just as they would laparoscopic surgery, which has now been the standard therapy since about 1990.
Melanie: What else might you use, just very quickly—we only have a minute left—the single-incision laparoscopic surgery for?
Dr. Diehl: The laparoscopic surgery, you can do just about anything. I've done it for colon surgery. I've taken out spleens that way, done some pancreatic surgery. So it has wide applicability. But, again, it is a little bit more cumbersome to do it laparoscopically than it is when you make multiple small little puncture sites.
Melanie: Well, thank you so much, Dr. William Diehl. We've been talking about single-incision robotic laparoscopic surgery for gallbladder removal. You're listening to SMG Radio. For more information on Summit Medical Group, you can go to summitmedicalgroup.com. That's summitmedicalgroup.com. This is Melanie Cole for SMG Radio. Thanks so much for listening.