New Gallbladder Removal Surgery

Video Transcript

I'm Dr. Oey-Devine. I am a general surgeon. I work at both Avera Medical Group Brookings and the Brookings Health System.

I was born and raised in South Dakota, I went to USD for my undergrad as well as medical school, and then I went down to Kansas for my residency, so I've been there for my last five years. I've done thousands of surgeries in my residency as well as my medical career.

What is Single-Site da Vinci Surgery?

Single-Site da Vinci Surgery is a minimally-invasive surgery that we're able to remove the gallbladder through a small incision at the belly button. The incision itself is about two and a half centimeters, it goes right through the belly button, and basically when you're fully healed you can't tell where this incision was because it just blends in with the rest of the folds in your belly button.

What is the Advantage of Single-Site Surgery?

The main advantage to doing Single-Site gallbladder removal is cosmetic. Another thing is, is that if you do have some stones in there, our incision is two and a half centimeters even though at the end it doesn't look that big, so it allows us to remove big stones through the incision that we already have instead of having to expand one of the incisions that we made.

What Does the Gallbladder Do?

The gallbladder stores bile that our liver makes, so even if we take out the gallbladder, you still are getting bile. But it stores bile, so when we eat a fatty meal our stomach releases a hormone that goes to our gallbladder and tells it to contract to express a little bit extra bile to help to digest that fatty meal.

Why Would Someone Need Their Gallbladder Removed?

Somebody would possibly need to have their gallbladder removed if they had gallstones that they were having symptoms from. Another reason would be what we call biliary dyskinesia, that's where the gallbladder isn't functioning to the normal level that it usually does. What people usually experience with gallbladder disease is right upper quadrant pain that sometimes goes around to their back. They can also have pain in the epigastrium, which is right at the top where their ribcage comes together. Some people just have nausea. Other people don't experience any nausea and just don't feel well. So gallbladder symptoms can be very variable in people.

Can Someone Live Without Their Gallbladder?

People can live without their gallbladder. About one million people get their gallbladder taken out in the United States every year. What they may experience right away though is a little bit of loose stools when they eat fatty meals. That, in most people, goes back to normal. However, there are some people who they have that chronic loose stools after fatty meals.

Who is a Good Candidate for Single-Site Surgery?

A good candidate for Single-Site surgery is somebody who is really concerned about scarring because this provides a way for them to have less scarring. Another thing is, is that their abdominal wall can't be thicker than the port that we place in that area.

Is Single-Site Surgery Safe?

Single-Site da Vinci surgery is safe, it's just as safe as any other laparoscopic or da Vinci surgery that we do. It was approved by the FDA in 2011. The main thing is, is that you need to have a safe surgeon who's going to watch what they're doing and be aware of where their instruments are at all times.

How is Robotic Surgery Performed?

A Single-Site gallbladder surgery is performed with a two and a half centimeter incision through the belly button. It has to be two and a half centimeters because otherwise the port won't fit in there, and the instruments won't fit through the port. What we do is we hook up the camera through the port with one of the other ports that we usually use in the Multi-Site ones. And then we have special trocars that are curved that go through the port and are angled. We watch them go in directly with the camera to make sure that there is no injury to other structures. Then the gallbladder is taken out the same way. The robot doesn't actually perform the surgery. A surgeon needs to be there to tell the robot what to do, and by telling the robot what to do, I mean actually moving the robot's arms and the graspers that we use and everything. The robot does not move unless I move for it, so the robot doesn't actually know what to do. We're telling it everything to do.

What is the Difference Between Multi-Port and Single-Site Surgery?

So Multi-Port is usually three incisions and then a little poke hole. With the Single-Site, it's one incision through the belly button. The difference is that the incision through the belly button is just slightly bigger than the port sites are. Overall, the pain is very comparable to the Multi-Site.

What to Expect After Surgery

The recovery for Single-Site gallbladder surgery is really the same as a Multi-Site. It's really patient-dependent. Some people come in, have their gallbladder removed, go back to work in about five days. My last patient actually said that and she was a Single-Site. Some people, it takes a lot longer. Some people take two weeks off of work before they're ready to go back. But really, I would say a person feels pretty much back to normal in about two weeks.

Why Brookings Health System?

I would recommend da Vinci surgery at Brookings Health System. It's the same technology as available in Sioux Falls, at Avera, as well as Sanford. It’s well-trained surgeons and OB-GYN’s doing the procedures. The staff that we have working with the da Vinci robot is dedicated to the da Vinci robot so we know that our results are reproducible.