New robotic technology at Legacy Salmon Creek Medical Center is making general surgery procedures easier and quicker, requiring less anesthesia and resulting in less cost for the health care system.
“And it’s a better operation,” said Dr. Leslie Disher, a general surgeon at The Vancouver Clinic.
For the last few years, Disher has performed robot-assisted surgeries using the da Vinci Si robot. In December, Legacy Salmon Creek upgraded to the latest version of the robot, the da Vinci Xi, making it the first hospital in Southwest Washington with the new technology.
The older version, which was launched in 2009, was designed for single-quadrant surgery, such as prostate cancer procedures and hysterectomies, said Jeff Gillam, a da Vinci clinical sales representative. The new robot gives surgeons more mobility, allowing them to move around the abdomen to perform more complex procedures, such as hernia repair and colon procedures, he said.
On Wednesday afternoon, Disher performed a robot-assisted left inguinal (groin) hernia repair surgery in about an hour. Her patient, a 58-year-old man from Camas, returned home that evening.
“The technology is really helping people,” she said.
After inflating the patient’s belly and connecting the robotic arms to three ports in the patient’s abdomen, Disher took her seat at a console in the corner of the operating room. There, Disher peered through a viewfinder that gave her a 3-D view of her patient’s insides, with images coming from the camera inserted in one of the ports.
Disher’s thumbs and forefingers operated the controls of the two instruments: a grasper and scissors with the ability to cauterize. Disher used floor pedals to maneuver the camera position and apply the heat.
After locating the hernia, Disher cut a small pocket around the hole. Then, using the graspers, she placed a 10-centimeter-by-16-centimeter piece of mesh into the pocket and sutured it into place. She pulled the tissue over the mesh and sutured it closed, completing the laparoscopic procedure.
Improved mobility
About 50 percent of the inguinal hernia repair surgeries done nationally are performed as open procedures, Gillam said. Other hernia surgeries have rates as high as 70 percent, he said.
Open surgeries — as opposed to laparoscopic or robot-assisted procedures — are typically more painful for patients, come with more risk for nerve issues and require a longer recovery period and hospital stays, Disher said.
With an open surgery, Disher tells her patients they can’t do any heavy lifting for five weeks.
“It’s a long recovery,” she said. “Open hernia surgeries are painful.”
With a robot-assisted procedure, patients are only limited for two weeks, Disher said.
While the procedure can also be performed laparoscopically, using a robot comes with added benefits, particularly the mobility afforded to surgeons, Disher said. Gillam compares the robot capabilities to the human wrist, whereas laparoscopic arms are like using chopsticks.
With the robot, Disher has multiple degrees of motion that she doesn’t have when performing laparoscopic procedures.
“It’s as if your hands are the instrument,” she said of using the robot. “It’s very difficult to suture laparoscopically.”
Without the robot, laparoscopic hernia surgeries use tacks, which resemble staples, to hold the mesh in place. But the tacks can cause significant pain. Sutures don’t cause any pain for the patient, Disher said.
“That’s a huge advance,” she said.
Most patients are happy to have the option of a robotic procedure that results in less pain, a smaller incision and faster recovery than other methods, Disher said. And she’s grateful to be able to give patients the option.
“To have this ability to give the patient choices and fit technology where it’s going to benefit my patients — and to be able to see the anatomy from the inside and be able to fix it — it’s pretty amazing,” she said.
