Answering Your Questions About Robotic Hernia Surgery

Intro: This is Weekly Dose of Wellness brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Welcome to the show. I am Deborah Howell, and today we will be answering your questions about robotic hernia surgery. Our guest is Dr. Elvira Klause from Saddleback Memorial Hospital. Welcome, Dr. Klause.

Elvira Klause, MD: Thank you.

Deborah Howell (Host): Let's start with the basics. What is robotic hernia surgery?

Elvira Klause, MD: Well, there are two most common types of hernias, which are the inguinal or otherwise known as groin hernias, and the other abdominal hernias. Robotically assisted hernia surgery is basically or essentially a minimally invasive surgery, some people know it as keyhole incision surgeries. This minimally invasive surgery is aided or done using a motion-capable computer between me and the patient.

Deborah Howell (Host): Okay. And you need specific skills for that. I'm sure you train heavily for it.

Elvira Klause, MD: Yes, laparoscopic skills are very necessary, which would mean doing the minimally invasive surgery in addition to that you have to have other training in order to know and understand how the robot works.

Deborah Howell (Host): I have some basic questions for you, but I just have an aside. Is it true that people who are better gamers make better doctors?

Elvira Klause, MD: Better laparoscopic and minimally invasive surgery, that definitely comes hand in hand.

Deborah Howell (Host): Okay, great. What types of patients are eligible for robotic hernia surgery?

Elvira Klause, MD: The ideal robot-assisted patient is an individual who has not had many abdominal surgeries. But the subset of surgery patients who would not be considered candidates for the robotic surgery for hernia repair is becoming very small. Using the da Vinci robot allows us to perform minimally invasive surgery on more patients than we have ever before because we can see better with the robot, and the dexterity of the instruments is so good that it allows us to be able to do very finite and detailed surgery. Ultimately, though, the decision will be up to the surgeon and the patient's primary care physician.

Deborah Howell (Host): For sure. The da Vinci has really changed the game, hasn't it?

Elvira Klause, MD: Yes, very much so.

Deborah Howell (Host): What are the benefits of robotic hernia surgery?

Elvira Klause, MD: The benefits of robotic surgery are many, many. Patients will generally experience less blood loss during the surgery and absolutely less pain following surgery, which has been one of my primary findings, and fewer postoperative complications including infection, which also allows for faster recovery and less scarring. Now, with the increased dexterity of the robot as well as the advantage of seeing 3D optics, it makes it for a better and safer operation. These factors combine to frequently allow the patient to return to normal activity much faster. And, as well as, early clinical data suggests that recurrence of these hernias may happen less frequently.

Deborah Howell (Host): Okay. What should patients know when considering robotic hernia surgery beforehand?

Elvira Klause, MD: Patients should know that the surgeon manually connects the patient to the robot. That's the most important thing, and that he or she sits in the console of the robot a few feet away from the patient. And using microsurgical instruments, which essentially become the surgeon's hands, and the viewing of these through a 3D vision system, it kind of looks like a pair of huge binoculars, this allows magnification of ten times that of the naked eye. So the procedure is performed in much more detail. It makes it for a more safer, ergonomic, and detailed surgery.

Deborah Howell (Host): Interesting. So you're really not even that close to the patient. How many feet away did you say?

Elvira Klause, MD: Between five or six feet. Depends on the setting of the room, and it's not too far. We're always in access to, direct access to the patient, direct communication with the anesthesiologist, which is next to the patient.

Deborah Howell (Host): It just sounds so sci-fi to me.

Elvira Klause, MD: It is quite neat.

Deborah Howell (Host): Are there any downsides?

Elvira Klause, MD: As with any surgery, there are always risks to the patient. I will say that because of the exceptional visualization and manipulation of tissues by the surgeon using the da Vinci robot, many of us feel that the robotic surgery is safer than other approaches. And, as we know, any surgical tool and the robot is just another sophisticated tool, is only as good as the surgeon using it. Today, I have performed thousands of minimally invasive hernia procedures, and an even more number of these have been robotic surgeries. Now, the robot-assisted surgery is a new technology, and as of yet, there are no long-term follow-up studies. But the preliminary experience and results from early clinical data are very promising.

Deborah Howell (Host): What other treatment options are there and how is robotic hernia surgery different from them?

Elvira Klause, MD: Now there's three basic surgical options for any abdominal hernia surgery. One is the open, two is the laparoscopic, which is the minimally invasive keyhole incision surgery, and three is the robotic-assisted surgery. In addition to the advantages that we've already discussed, large scrotal hernias, recurrent hernias, bilateral inguinal hernias, and abdominal wall hernias are generally easier to repair with the robot. Again, because of the superior visualization and because of the dexterity of the instruments, it allows us to have this advantage.

Deborah Howell (Host): Okay. And why would someone elect to do a robotic surgery over the other treatment options?

Elvira Klause, MD: Personally, I feel that the chances of complications, which are already low to begin with, are further reduced. I also feel that your chances of recurrence of your hernia are lower. Plus, you will very likely have less pain and return to your normal level of activity sooner. And, you know, really who doesn't want that? I personally have found that my patients have absolutely or a considerable amount of less pain post-robotic surgery compared to the laparoscopic or open procedures.

Deborah Howell (Host): And what percentage of your operations are robotic versus open?

Elvira Klause, MD: We have three types of surgeries. So I'll go over the three. The open depends basically on the patient itself, the type of hernias that they have, and the type of previous abdominal surgeries. So as of right now, there are less patients that I'm doing open due to the fact that of those criteria that I'm using. So most of the patients that we do for single hernia repair are done as an outpatient procedure.

Deborah Howell (Host): Okay, got it. And what's the most important thing in your opinion that patients should know about robotic hernia surgery that they probably don't?

Elvira Klause, MD: The most common misconceptions regarding hernia surgery that is done with the robot is that the robot is performing the surgery. On the contrary, I have absolute control over every movement made by the robot. The da Vinci robot literally just copies and miniaturizes my exact hand motions with very small specialized instruments inside the patient.

Deborah Howell (Host): That is just fascinating. But you have other physicians and perhaps nurses attending the body or maybe closing the incision or...

Elvira Klause, MD: Yes, we have the anesthesiologist, we have a scrub tech and a specialized nurse that is only addressing the robotic surgeries, and they are first-hand at the bedside at all times.

Deborah Howell (Host): Okay, good to know. And what about recovery time?

Elvira Klause, MD: Recovery time is just like with any surgery, is not the nature of the robot, is the nature of the procedure, but I have found the patients bounce back much faster with the robotic surgery than the standard traditional surgeries.

Deborah Howell (Host): Meaning a couple of days, a couple of weeks?

Elvira Klause, MD: Again, depends on the surgery, it could be between a couple of days or a couple of weeks, but definitely it decreases by days the amount of recovery period.

Deborah Howell (Host): And also you mentioned decreases the amount of pain as well, which is always a good thing.

Elvira Klause, MD: Exactly, and hence because it decreases the pain, it decreases the recovery period.

Deborah Howell (Host): Okay. And lastly, how does a person know if one has a hernia or might have a hernia?

Elvira Klause, MD: Well, there are certain typical signs that people are maybe aware of having a bulge in the area of the groin or the umbilical region. Also some pain in that area that need to be evaluated by their primary or their surgeon to see whether there is a hernia indeed from that.

Deborah Howell (Host): Very good. Is there anything else you'd like to add today?

Elvira Klause, MD: No, just that the laparoscopic, the robotic-assisted hernia is a very safe procedure and it is a very precise procedure, so it makes it for a much better, much beautiful, much better recovery procedure.

Deborah Howell (Host): A wonderful day to be a hernia patient.

Elvira Klause, MD: Absolutely.

Deborah Howell (Host): Well, thank you so much, Dr. Klause, for your time today. We appreciate it.

Elvira Klause, MD: Thank you very much, and it's an honor to be here.

Deborah Howell (Host): Wonderful to have you. For more information or to listen to a podcast of this show, please go to memorialcare.org. That's all for this time. I'm Deborah Howell. Thanks so much for listening and have yourself a great day.