Hernia Surgery Game Changer

Robotic surgery in the operating room becomes more popular because it eases hernia recovery.


Published:

Dr. Rockson Liu, a surgeon at Sutter Health's Alta Bates Summit Medical Center, demonstrates how the robotic surgery works. Liu is an expert in advanced hernia repair with robotic surgery.

Photo by Marcus Hänschen

In 2013, Oakland resident Kathryn Gin discovered a small lump in her abdomen. Following a CT scan, a computer-linked x-ray which provided detailed images of the area inside her body, Gin was told the lump was a piece of fat. “I wasn’t in any pain and remained active, but the lump continued to grow,” said Gin. Fast-forward six years and the lump was now the size of a watermelon. “I returned to my primary care physician who suspected it was a hernia and that’s when I went to see Dr. Liu.”

Rockson Liu, M.D., that is. Liu is a surgeon at Sutter Health’s Alta Bates Summit Medical Center in Oakland. And Liu is an expert in advanced hernia repair with robotic surgery. A hernia occurs when an organ or fatty tissue squeezes through a weak spot in the muscle or connective tissue. Hernias most typically involve the lower abdomen or groin and often create a lump, which can be painful. Hernia repair is common; over one million of these surgeries are done each year. What is not common is the use of a robot to facilitate the repair.

Gin was diagnosed with a right-side abdominal hernia and scheduled for robotic surgical repair in late September. “I went into the hospital early on a Friday. The surgery took about three hours, and I was back home on Saturday at 2 p.m. By Sunday I was very mobile and back to work part time that week,” said Gin.

A shorter hospital stay and a much quicker and smoother recovery are among the many advantages to robotic surgery, according to Liu. Time off work following a traditional open surgical hernia repair averages five to eight days, said the surgeon. After robotic surgery, patients, are back to normal activity within a couple days. Additional benefits to robotic surgery include less blood loss, less pain, minimized scarring, and a reduced risk of complications, like infection, he added.

“The use of robotic surgery has taken off in the past few years,” said Liu, who has performed over 400 robotic hernia surgeries. Sutter Health now has two robotic surgery suites and 25 surgeons certified to perform robotic surgery. Over 800 robotic surgeries were done at the medical center in 2018 almost tripling the use of the technology over the past five years. Despite the upswing in and benefits of robotic surgery, the number of general surgeons using technology nationwide is small, only 2 percent, said Liu.

During surgery, Liu sits at a surgeon’s console about 6 feet from the patient, who lies on the operating table sedated and monitored by an anesthesiologist, a circulating nurse, a scrub technician, and often a physician in training. The robotic equipment is wheeled next the patient and the robot’s arm extended over the body. A scope with a camera is inserted inside the abdomen, which provides Liu with a high-definition 3D-visual field. “This enables me to see structures, vessels, and nerves that are not visible with the naked eye. The magnification is improved 10-fold,” said Liu.

Using his thumb and middle finger Liu manipulates the robotic arms. For hernias, he manages three tools: a grasper, a scissor and a needle driver. Most hernia repairs require three, small, ½-inch incisions versus the long, sometimes cross-body, incisions previously required, but the surgery does take about 50 percent longer. Robotic instruments have flexible joints and a fuller range of motion, which makes them easier to operate compared to the traditional laparoscopic instruments, which Liu compared to stiff chopsticks that require a fair amount of muscle to use.

“Robotic surgery is taking the human hand to the next level,” said Liu. The robotic arms filter the tremors that occur naturally with the human hand. Some patients initially fear that the robot works autonomously, independent of the physician, but that’s never the case, explained Liu. Although he no longer has the direct sense of touch on the patient, he has learned to feel with his eyes as he works with the robot.

“The surgeon’s skill still matters. The robot augments and amplifies a surgeon’s ability to do complex laparoscopic surgeries. It’s more precise,” Liu said.

One of the primary benefits Liu finds with robotic surgery is the reduced need for narcotics to manage pain. In the past, he might prescribe 20 to 30 narcotic pills to a patient following a traditional inguinal hernia operation. With robotic surgery that number has dropped to just three pills and often the patients do not require any prescription pain medication. Gin took Tylenol while in the hospital and nothing for pain once she got home. “I felt completely normal within three days,” said Gin.

And what about cost? Robotic surgery comes with the significant upfront costs of the equipment, maintenance, and training. But taking in the total cost of care, Liu believes those costs are more than offset by the shorter hospital stays, lost wages, caregiver expenses. Liu sees robotic as a game changer for surgery. “The technology will continue to improve. The way we operate will becomes faster, easier, and safer. And like other areas of medicine, artificial intelligence will get incorporated, too.” 

“I was surprised. I didn’t know what to expect from robotic surgery,” said Gin. “Dr. Liu was thorough. The team was compassionate. And the recovery was really quick. Already my three tiny incision lines are starting to disappear.”