Better Outcomes, Quicker Recovery [Dr. Theresa Oey]

I'm Theresa Oey. I'm a general surgeon here in Brookings, South Dakota. I work for Avera Medical Group and operate at the Brookings Health System. So I've been in general surgery here in Brookings since I got out of residency, which was just about 10 years ago now. So, I'm a general surgeon, which means that I operate mostly on the abdomen. We also do endoscopy, some thyroid, as well as breast surgeries, and on the skin too.

What does the gallbladder do?

What it does is hold bile. And so bile is made up of three components, cholesterol, bilirubin, as well as bile salts. So, bile helps to break down fats in our diet. And so if you eat a meal that has some fat in it and which basically, everything we eat has a little bit of fat in it, the stomach then sends a hormone to the gallbladder telling it to contract, the gallbladder will then contract and send the extra push of bile down to have you digest that fattier meal.

Why would someone need their gallbladder removed?

There's a few different reasons that people would need their gallbladder removed. The most common is that the person has developed stones in the gallbladder, but they could also need it removed because of functional problems with it. And really, the reason that they get it out is because they're having symptoms. So, you can have stones and if you have stones and no symptoms, you actually don't need to have it removed.

What causes gallstones?

Gallstones can be caused by a number of reasons. One of them is stasis. So, if your gallbladder isn't ejecting like it's supposed to and the bile is sitting in there, you can develop stones. Another reason is because of an overproduction of one of the components, which then is able to crystallize. And so it sits there and it's supposed to be more of a solution, but if you have one component that's a little bit higher, then that has more of a possibility of crystallizing.

What are symptoms of gallstones?

So symptoms of gallstones or even just gallbladder disease, in general, usually are right upper quadrant abdominal pain. This pain though can also be in the middle portion of the upper abdomen, and then it can also go around to the back or the right shoulder blade area. People sometimes come in feeling like they're having a heart attack. So it can be up in the chest as well. Other symptoms that people can have with the gallbladder include nausea, upset stomach, heartburn, vomiting, or even like bloating symptom where they just feel really full after a meal.

What is da Vinci robotic surgery?

So the da Vinci robotic surgical system is a tool for surgeons to use that allows us to do minimally invasive surgery with more intricate details. The instruments that we use are wristed. And so we're able to do more motions within the abdomen without torquing as much on the abdominal wall.

How is a gallbladder removed with the da Vinci system?

Using the da Vinci robot, we're able to remove gallbladders using either three or four arms kind of just depending on what is going on with the gallbladder. Whether it's inflamed or not inflamed, we grab the gallbladder by the dome and then lift it up because it does sit under the liver. When we lift it up, we're then able to find where the duct and the artery are, and then control those with clips. Then we take the gallbladder off of the liver bed and then remove it through one of the small holes. Now, the holes are usually about a centimeter in size. However, if the person has stones and the stones are larger than that, then we need to make one of the holes a little bit bigger.

What should patients know before surgery?

The main thing though is they need to know what is gonna happen during surgery, the risks, as well as the benefits of it, and if it's right for them, you know, going over the symptoms that they're having, all of the tests that have been done, and then determining whether the benefits will outweigh the risks of surgery itself.

What is the advantage of the da Vinci robotic system?

Because we have firefly technology. What that is is it's a tracer that goes through the bloodstream, into the liver, and then collects into the gallbladder. And so we're able to see the ducts and be more precise about where those ducts are than we were without that. Other advantages to it are also people have less pain when we use the robot and that's because we are able to do things in the abdomen without torquing on the abdominal wall like we would need to with laparoscopic instruments.

How long is a typical recovery?

Most recoveries are about one to two weeks. A lot of people are able to go back to work within about a week. That's the average. Some people, they recover a little bit quicker and they go back to work after just a few days, and then there are some that need two weeks off, but I would say average is about a week.

Why should patients choose Brookings Health System for surgery?

When you have your surgical procedure at Brookings Health System, you're really cared for as a family member. We are a small enough system that everybody who is taking care of you knows your name and you're not just a number in the system.