The Latest Advancements in Hernia Surgery Using the da Vinci® Robotic Surgical System
Listen to Tuan Nguyen, MD on our podcast Memorial Health Radio in the new episode titled Hernia Surgery.
Transcription
Melanie Cole (Host): Today’s topic are the latest advancements in hernia surgery with the da Vinci Surgical System. My guest is Dr. Tuan Nguyen. He’s a general surgeon with Memorial Health System. Welcome to the show, Dr. Nguyen. People don’t always know what a hernia is or the different types that are out there. So, explain a little bit about what a hernia is and the different types.
Dr. Tuan Nguyen, MD (Guest): In general, a hernia is a weakness in the abdominal wall, and the two types I deal with are the ones on the abdominal wall which can occur from birth at the belly button called umbilical hernia. The second type of hernia that we see is usually resulting from previous surgery such as colon surgery, gallbladder surgery, and the tissue does not heal back appropriately, and people get a bulge or a weakness in that abdominal wall, and people can feel a bulge on their abdomen, and sometimes they can see it, and it can cause pain and discomfort, especially when they move. The second type of hernia I deal with are called inguinal hernias or hernias that are down in the groin. A lot of people think of them as sports hernias and things like that, but essentially, they are a weakness in the groin. Men and women can have it, and it can come from strenuous activity such as weight lifting, straining, people who do a lot of heavy lifting with their work. Certainly, obesity can increase the risk of hernias in all people along with smoking and poor wound healing and wound infections.
Melanie: So, would they always notice a hernia? You mentioned it as a bulge that sticks out, and you’ve gotten, you know, very in detailed with the risk factors, but would somebody always know that they have a hernia or are sometimes they not noticeable or not painful?
Dr. Nguyen: Initially, a hernia can start out being a large hernia which will be very noticeable. Sometimes hernias start out as a small opening, a small hole, and people may not initially notice the bulge, but over time, it can enlarge and get much bigger, and it can become much more symptomatic. Same with people initially may feel a small tug, but over time it can increase with amount of pain. Sometimes a piece of bowel can get trapped in the hernia, and it can cause severe pain, a bowel obstruction, and bowel death if not treated.
Melanie: So, if there are certain complications to untreated hernia, when do you determine that surgery is necessary?
Dr. Nguyen: Well, all surgical decisions should be made between a patient and a surgeon, but in general, if a patient is healthy enough to have surgery, and the hernia is bothering them, in general, we will fix all hernias to prevent the discomfort and certainly to prevent the complication of strangulation of bowel and sometimes a piece of fat called omentum, which is in our abdomen can also get trapped, and it can also cause severe pain and discomfort.
Melanie: So, tell us about hernia surgery, the types of hernia surgery that are available now, and what you’re doing there at Memorial Health System with the da Vinci Robotic Surgical System.
Dr. Nguyen: Well, surgeons have been fixing hernias for a very long time, and initially, how we fixed those were we did open surgery, made an incision over the hernia, and try to bring the tissue back together. Unfortunately, this method has a very high rate of the hernia coming back because you’re putting suture through tissue that’s already very weak. The next advancement in hernia surgery, basically, we did it open, but we put a screen in there to reinforce the weakened tissue, and that was found to have much better success rate in terms of the hernia coming back. The third advancement, we started doing laparoscopic with minimally invasive techniques with smaller incisions, leading to less pain and more importantly, you don’t make an incision directly over the mesh, which decreases the risk of mesh infection which would necessitate a second surgery, and sometimes a third surgery to remove the mesh and to repair the hernia again. The fourth advancement, after laparoscopic surgery, is the robotic da Vinci Intuitive System, and basically what this allows us to do is do much more intricate, fine-detailed surgery. A lot of times a piece of bowel will get stuck in a hernia, and if you’re not careful, and you nick and injure the bowel, this certainly can lead to perforation of the bowel, severe infection in the abdomen, infection of the mesh. So, basically, the da Vinci System allows us to do, laparoscopically, very safely, to do much bigger surgery and much more complex surgery without the added risk of injury to the bowel. And—
Melanie: What’s the—
Dr. Nguyen: Go ahead.
Melanie: Go on. Go on, I’m sorry.
Dr. Nguyen: And it also lets us close the defect in hernias much the same way that we would do with open surgery that we cannot do laparoscopically.
Melanie: What is the recovery process like and how soon can somebody get back to activity if they’ve had this type of surgery? Is this something that you want them to not move around for a while to kind of keep it so that it makes sure to stay tight in there? I mean what can they do? What’s recovery like?
Dr. Nguyen: With the robotic da Vinci System, we are able to very securely adhere the mesh to the abdominal wall. So that immediately after surgery, the patients can move around, move about, walk, perform their daily normal activities. We ask that the patients don’t do any strenuous activities, just to let the body heal the mesh and absorb the mesh into the abdominal wall, which can take up to several weeks. So, immediately, they’re able to be mobile and go about their daily business, but we do ask that they not do anything heavy lifting more than 10 pounds and nothing strenuous and don’t restart any exercise program other than walking for about six weeks.
Melanie: Are there any complications such as mesh infections that people should be concerned about?
Dr. Nguyen: We have seen a dramatic decrease in the rate of mesh infection. As a matter of fact, I have not had a mesh infection in the last three years since we’ve been doing the laparoscopic surgery with the da Vinci System, but certainly mesh infection is always possible. One of the biggest problems with hernia surgery is that despite any type of techniques or what type of mesh material we use, there’s always a risk that the hernia can come back. The way to prevent hernia recurrence is to secure the mesh such as what the Intuitive System, the da Vinci System, the robot, and really is to fix the hernia when it is smaller. The rate of the hernia coming back is directly proportional to the size of the hernia, so we can find them when they’re smaller, and we can fix them. That gives the patient the best chance of a cure and a permanent fix.
Melanie: So, what would you like to tell listeners about getting in to see a doctor about their hernia as you’ve just said, you know, if you fix it early, you have less of a chance of recurrence and probably a better outcome in general? So, what would you like to tell them about getting in to see their doctor, when they should do that, and what you’re doing here at Memorial Health System?
Dr. Nguyen: Well, I think all patients who have any questions, whether they know they have a hernia or whether they think they may have a hernia is to go see their primary care doctor, who can give them a referral to a surgeon, or they can directly call the surgeon’s office, but I think it is very important to come in early to discuss whether they even have a hernia, and if they do have a hernia, whether they are a candidate for surgery, and to fix a hernia as soon as possible, to prevent it from getting bigger and making surgery much more complicated on down the road.
Melanie: Thank you so much; it’s really information. You’re listening to Memorial Health Radio with Memorial Health System. For more information, please visit mhsystem.org. That’s mhsystem.org. This is Melanie Cole. Thanks so much for listening.
