da Vinci Procedures Improves Recovery for Hernia Repair [Sara Marroquin]

My name is Sara Marroquin. I'm a general surgeon at the Avera Medical Specialty Group.

What is a hernia?

So, a hernia is a weakness in the abdominal wall. And what that means is basically at that area where your abdominal wall is weak, there's really no muscle or abdominal strength layer, which is called the fascia, covering that part. So, it's really just a bulge where there's the peritoneal layer, which is kind of the inside layer of the abdomen, and skin only, without any muscle or abdominal wall fascia connecting it.

Where can a hernia develop?

So, there's three areas that hernias typically develop. So, first is, and probably most common, is the inguinal canal or the groin region. And that can be from wear and tear, or it can be from congenital. And then the second is the umbilical hernia, which is where your belly button is, and that most of the time is a congenital hernia from umbilical cord that you have, and then it just develops a little...it gets a little bigger over time until it becomes symptomatic. And then the third is an incisional hernia, or basically where you've had an incision in your abdomen from a previous surgery, and now that area is weak because it was cut open and then, you know, sutured back up, and over time, it becomes weak enough that it becomes a hernia.

What are symptoms of a hernia?

So, the two major symptoms is pain and a bulge essentially. So, you know, most people initially don't notice hernias if they are not painful. And that's the main reason why we bring people to the operating room, to fix them, is for pain. But then, over time, the bulge can get bigger. And when we see really big hernias, we fix those, even if they're not painful, because the risk is that something can get stuck in them.

When is surgery considered?

So, it kind of depends on the size of the hernia and where the hernia is, and if you can push the hernia back in. So, most of the time if your hernia is not painful, and it's just a bulge and it's easy to push back in, it's not an emergency surgery, and we don't need to repair it unless the patient wants it repaired. If you have a hernia that's bulging out and you can't push it back in or it hurts to push it back in, then that's actually a reason you should go see a doctor, or at least your primary care doctor to start with, or a surgeon.

Who is a good candidate for da Vinci robotic surgery?

The majority of people are pretty good candidates to have the da Vinci, you know, minimally invasive hernia repair. It's really good for patients who have inguinal hernias, especially if they're large, or if you have two, like, one on each side. And I think it's really good for umbilical and ventral hernias that are, you know, greater than a centimeter in diameter, which is the majority of them. There are a few patient populations though that it's not really good for. Most of these would be like higher-risk patients who can't do general anesthesia because you do need to have general anesthesia to do laparoscopic surgery. So, those are patients that have, you know, like, really high-risk heart and lung problems, and at that time, we would recommend an open surgery because you can do open surgery with just mostly local anesthetic and a little sedation.

How does the da Vinci technology work?

So, the da Vinci robotic surgical system is essentially a tool for surgeons to do minimally invasive surgery. So, I know there's a lot of misnomer about a robot, it's doing your surgery, but it's really not the robot doing the surgery, I still have to do the surgery and I control the surgery, but it allows me to do the surgery in the most minimal, you know, invasive way possible. And it also allows you to use, like, a 3D imaging, that's much more advanced than just normal laparoscopic imaging when you're actually doing this surgery.

How is a hernia repair performed?

Most hernia surgeries require three small incisions, the incisions are about a centimeter, so, you know, just this big, and we put what's called robotic ports in or trocars. Basically, they're little instruments that we put within the abdomen, so that we can put our longer instruments in and do our hernia surgery. It kind of depends on where the hernia is, is where those little incisions are. And then once those ports are in, we actually dock what's called the robot, robotic arms. So, once the robot's docked, I'm actually at the console, which is, like, right next to the patient, and I do the surgery. The vast majority of hernia surgeries, we do use mesh to repair it. And what that means is basically we find the hole in the abdominal wall, we usually sew it up, and then we put a mesh on it to reinforce it so that it essentially can't get a hole again.

What are the benefits of using da Vinci technology?

I think the big benefit with hernia surgery is you're allowed to do more complex hernias and you're allowed to do, like, multi hernias with, you know, little, small incisions for the patient. It also allows me to be my own assistant and my own camera driver, which I think makes the surgery easier for me and maybe even safer for the patient because I get to control everything and my...you know, the assistant at the bedside, they do help, like, change instruments, but they're not really controlling it. And I think it makes them feel more at ease as well. So, I think that's the big advantage. Postoperatively, I think the big advantage for the patient is that there are studies that show the patient has less pain afterwards than like a normal open surgery, which makes sense because they have a lot smaller incisions. And there's higher, you know, patients who have robotic surgery go back to work faster, they use less narcotics, and they have less pain.

What are typical recovery times following surgery?

So, I counsel patients that you need to give yourself a full six weeks to recover from hernia surgery. That doesn't mean that whole six weeks you're just like laying on a couch not doing anything. Most people actually feel essentially back to normal after two weeks, but it does take that tissue to heal and to incorporate that mesh, that whole process does take about six weeks. So, most people go back to work four to seven days after surgery. And most people need narcotic pain medications, you know, one to three days after surgery. So, the initial first week is kind of rough and after that most people feel great.

Why do you recommend surgery at Brookings Health System?

I think patients should choose to have their hernia repairs at Brookings because we have all the same high-tech technology that they have in Sioux Falls. You know, me and my partner are both equally trained as the surgeons in Sioux Falls to do these surgeries, but you're in Brookings, which is like a small, you know, family-friendly area. It's just easier to navigate the health care system here. It's easier to check in and check out of same-day surgery. You know, the people who are taking care of you, I mean, they take pride in taking care of their family, friends, and neighbors and I think overall the experience is better when you're in a situation where, you know, you feel like you're really well cared for here.