HJBR Sep/Oct 2024

HEALTHCARE JOURNAL OF BATON ROUGE  I  SEP / OCT 2024 49 Dani Cobb, MD General Surgeon Our Lady of the Lake Health IT’S AN EXCITING TIME to be a hernia surgeon! Never before have we had so much technology and information helping us to better serve our patients. The robotic options available today can successfully treat complex cases that previously re- quired open surgery. My practice focuses on revisional hernia surgery and abdominal wall reconstruc- tion. Surgeons in this field come from a variety of training backgrounds and com- fort levels with robotic surgery technology. Interestingly, in some other regions, the complex hernia field is mainly composed of plastic surgeons without any minimally invasive experience. At the last meeting of the American Hernia Society, a seemingly simple question was posed to the audience of hernia surgeons: “Howwould you repair a 3-centimeter primary umbilical hernia in a healthy 45-year-old lady with a BMI of 35?” There’s more than one way to skin a cat Pardon the taxidermy euphemism, but it holds true in my field. There was no clear consensus among the audience members, but three main approaches led the way. The first was the open surgical approach with no cameras at all, using a larger inci- sion to insert amesh behind the hernia and sew up the overlying fascia. The second was the robotic or laparoscopic approach, inserting the mesh inside the abdomen and sewing up the defect. Advantages here are a smaller chance of mesh infection, ability to see previously undiagnosed her- nias (which are frequently encountered), and for some a more cosmetically accept- able outcome. The third is to use the robot to improve upon the second technique, placing the mesh in a plane that does not contact the abdominal cavity. This trans- abdominal preperitoneal (TAPP) approach is my preferred method, and the robotic platform makes it simpler to perform on all patients. Patient concerns regarding mesh placement might be something you are familiar with in your own practice. Meshpocalypse TV ads abound with class-action law- suits regarding mesh complications. Pa- tients have valid reasons to be concerned when choosing to undergo hernia sur- gery. The reason to use mesh instead of suture-only repair is that it dramatically reduces the chance of recurrent hernia. I separately discuss the risks, benefits, and alternatives when considering them for mesh placement in hernia repair. Mesh infections are devastating and can turn a simple procedure into months of down- time for the patient, along with repeat surgery. Anything that can decrease this chance is extremely valuable. Multiple studies have demonstrated the advantage of a minimally invasive ap- proach in decreasing infection rates. The robot also allows for the removal of old meshes through small incisions instead of creating a wide field of damage. I can also offer robotic pain-relief surgery to lyse nerves causing pain associated with previous hernia surgery. A more nuanced discussion about the technique used for mesh placement can be quite detailed. Put simply, the robot allows for perfect mesh placement, leading to fewer complications. Robotics and the future of hernia surgery My favorite part of being a surgeon is helping patients return to their normal lives without painful hernias, and my sec- ond favorite is training future surgeons. Surgeons in training can now practice on simulators before ever stepping foot in the operating room. The robot allows both trainees and practicing surgeons to improve their skills with quality metrics at their fingertips and more resources than ever before. Video capabilities have fostered the growth of a library of robotic surgical approaches, leading to nationwide discussions that previously could only happen at annual meetings. The field is now frequently adopting a minimally invasive approach in what was once a maximally invasive world. I am looking forward to learning about the latest innovations at the upcoming soci- ety meeting next month and sharing them with the LSU surgery residents and the medical community in Baton Rouge. n Dani Cobb,MD, joinedOur Lady of the Lake Physician Group Surgeons Group of Baton Rouge in 2022 as a general surgeon specializing in abdominal wall re- construction.Originally fromHouma,she is certified by the American Board of Surgery and is a Fellow of theAmerican College of Surgeons. She spent much of her LSU residency in Baton Rouge.She is part of a teamof specialized surgeons who can provide treat- ment for the toughest hernia cases,even for patients with previous failed surgery. She is amember of the American Hernia Society.