When extreme-sports enthusiast Samuel Arango was told he’d need urgent surgery to repair a hernia, he feared he’d be sidelined for a month or more.
Instead, Arango became one of London, Ont.’s, first patients to benefit from robot-assisted hernia surgery – a procedure that allowed him to return to regular activities within days.
St. Joseph’s Health Care London (St. Joseph’s) has become a pioneer among Canadian ambulatory hospitals by introducing robot-assisted, minimally invasive hernia repairs.
Patients whose hernia surgeries have been aided by St. Joseph’s da Vinci robotic system have experienced less pain, less scarring, faster recovery and speedier return to work than those who underwent conventional or laparoscopic hernia surgery, says Dr. Ahmad Alnahas, who specializes in minimally invasive surgery.
While robot-assisted hernia repairs do take place elsewhere in Canada, St. Joseph’s is understood to be an early adopter among ambulatory care teaching hospitals, Elnahas says.
Conventional, open surgery usually takes place with the patient under local, regional or general anesthesia. In the laparoscopic option, the abdominal area is illuminated with one thin camera-equipped tool through one small incision, while the surgeon operates another long inflexible surgical tool to repair the tissue through a different small hole.
The da Vinci Xi surgical system, manufactured by Intuitive Surgical, enables even greater precision since it offers a three-dimensional look at the patient’s tissue and better control of instruments.
When the robot’s command console is docked to a four-armed patient-side cart with surgical instruments, Elnahas uses his pincer-grasp and foot pedals on the console to direct the machine on where and how to cut, move, stitch and cauterize.
While the robot does that work, Elnahas is in control of the procedure at all times.
He received extensive training, including hours of simulation and hands-on instruction, from experts in the field.
“The transition felt easier for me because I was taking the principles I knew from laparoscopic surgery and applying it to robotic surgery,” says Elnahas, who performs the procedure at St. Joseph’s but ordinarily works from London Health Sciences Centre.
Improved patient experience
The community donated more than $1.25 million through the St. Joseph’s Health Care Foundation towards the purchase of this da Vinci Xi robot system.
It is generally used at St. Joseph’s in urology, for prostate, kidney and bladder surgeries, and its use in hernia repair is not yet considered standard of care in Canada.
‘Whole process was positive’
Arango says he was pleased the specifics of his case made him a candidate for robotic-assisted surgery, which took place under general anesthesia.
“It was a very smooth and quick recovery. The whole process was positive, the nurses were super-super-great and follow-up has been really comprehensive.”
Beyond its direct benefit in patient care, the procedure is a stewardly use of limited hospital resources: it can fill in gaps when the da Vinci isn’t otherwise being used for urology procedures, says Dr. Muriel Brackstone, a St. Joseph’s surgeon and Lawson Research Institute Scientist, who leads the initiative with Elnahas.
“While currently there is very limited access to the robot for surgeons to perform these procedures in London, we hope this will increase in the future to allow surgeons the ability to offer all types of surgical access and make those decisions based on which approach is best for each individual patient,” she says.
Building such expertise in London also allows surgeons here to lead in training residents for emerging specializations, says Elnahas. Eventually, he predicts, it will become just another skillset taught in Canadian medical schools. “If we want to be leaders in the field, we have to continue to grow programs and procedures like these.”