Dr. Aaron Epstein of CMC Surgical Associates said that he is fully involved in the operations while using the new da Vinci Robotic Surgery platform.
“People think I’m going to just hit a button, then go play a round of golf,” Epstein joked. “I’m in the room, for every movement … it is not automated. The surgeon is in control.”
Epstein, who said he performs 300 hernia surgery procedures yearly, showed off the robotic surgery option to more than 50 residents who attended a free hernia screening and demonstration Tuesday.
A hernia is a hole in the muscle fascia which allows “guts”, as Epstein said, to come through it, causing an outward bulge.
He said that 75 percent of the time they can be diagnosed on physical exam alone. Other interventions such as ultrasound and cat scan can aid in the diagnosis if needed.
He said he loves what he does, and hernia repair is one of his favorite procedures to perform.
“I have loved taking things apart and putting them back together since I was a kid,” Epstein said.
The usual procedure involves putting the “guts” back where they belong, closing the hole and attaching a piece of mesh over it.
He said without mesh, there is a 60 percent chance of the hernia reoccurring, versus a 10 percent chance with the mesh used.
Some expressed concern about mesh issues that they heard about on television.
“They say ‘Doctor, what about that mesh?’ Doctors don’t do things to make people’s lives miserable. Don’t succumb to lawyer sorcery. You have not heard that mesh was bad from doctors, you’ve heard it from lawyers,” Epstein said.
He said that hernias are very common, with more than 800,000 cases in the U.S. each year, and the da Vinci equipment helps keep CMC on the cutting edge.
Candidates for the robotic surgery will have the benefits of its different types of cuts and cauterizations to greatly minimize blood loss, and lessen pain and scarring.
Other questions from the audience involved wondering what kind of certification and practice it takes for doctors to be allowed to use the da Vinci equipment.
Epstein said he had to do 100 hours of simulator time, pass a skills set test, do five operations on a pig, five operations on a human cadaver, among other tasks before he was allowed to be certified.
As for complications with robotic surgery versus laparascopic surgery, Epstein said they were the same as any laparoscopic procedure, and probably even less with robotic.
“Because [with robotics] we have 3-D vision, versus 2-D,” he said.
There is no upcharge for having robotic surgery, either, the procedure is coded the same with Medicare, he said.
While hernias are more common in men, women can also develop them, he said.
Patients can experience groin pain, nausea or a bulge in the affected area. However, some patients have no symptoms, which is why screening is so important.
Epstein stressed the importance of early detection in getting to the hernia for repair (if needed - sometimes it is not - he said) before tissue began to die and further complications form.