New method of surgery leaves patients virtually scar free

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Monday, July 9, 2012

— Gallbladder removal used to require an incision under the ribs big enough for the surgeon to reach in and pull out the organ.

Then came laparoscopic surgery, which requires four small incisions in the abdomen to remove the gallbladder.

Now, state-of-the-art technology allows the same organ to be removed through one small incision in the belly button, leaving a virtually invisible scar.

While 98 percent of gallbladder surgeries are done laparoscopically, Mercy Hospital and Trauma Center in June started doing single-site incision surgery using the da Vinci robot, said Dr. Patricia Garner, a general surgeon at Mercy.

The robot-assisted surgery through one incision allows for faster recovery, virtually no scarring and less pain, she said.

"Eventually, this will become the standard way of doing things," Garner said.

The U.S. Food and Drug Administration approved the procedure in February, so the medical community is just starting to see the benefits, she said.

Patti Ciardo, 53, Whitewater, was the first patient to have the procedure using the da Vinci Surgical Si HD dual-console system, which Mercy bought in 2009.

She was having abdominal pain, and her gallbladder wasn't properly processing bile. When Garner said she was training to do the surgery with the robot and told Ciardo she could be the first patient, she agreed.

"I said, 'OK, this could be really cool,'" she said.

She was a little apprehensive because it was her first major surgery, but she said it went well. She was off prescription pain medication after two or three days.

She's recovering well and said people wouldn't even know she had surgery.

"It's a lot easier than having to make a big incisions in your stomach like they used to," she said.

St. Mary's has a da Vinci robot at its Madison hospital, and two of the St. Mary's Janesville Hospital obstetrics and gynecology surgeons use the technology when appropriate, hospital spokeswoman Joan Neeno said.

"Given how expensive the equipment is, we want to be certain there is enough demand in Rock County to justify the cost of providing robotic surgery locally," she said in an email.

How it works

Gallbladder removal is the most common surgery for a general surgeon, Garner said. She once estimated she removes 150 gallbladders in a year, with many other general surgeons in the hospital doing the same thing. People need the organ removed either because they have gallstones or the organ isn't properly storing and processing bile from the liver to the small intestine.

In the new surgery, an incision is made in the belly button and a rubber port is inserted for a camera and three instruments.

Each of the three instruments is a hand of the robot, which Gardner controls with her fingertips at the console. The instruments have a greater range of motion—more than 360 degrees—than a surgeon's fingertips, Garner said.

"We're able to reach and turn and sew and do all kinds of different things," she said.

The three-dimensional view gives depth perception.

She's even told one of her patients, "I feel like my face is planted in your abdomen," she said. "That's what it feels like. The view is just worth it right there, then this extreme range of motion is even better."

To prevent the gallbladder from rupturing or spilling, it is placed inside a small bag inserted into the abdomen through a port, she said. The organ can be removed through an incision less than one inch long.

Carrie Kane-Huebner, 30, Janesville, already has recommended the surgery to a family member after her successful surgery June 14.

When doctors decided her gallbladder needed to be removed, her response to the single-site surgery was, "Sure, why not?" she said.

She slept for much of the first four days after surgery and ate soup and liquids. She was back to normal and returned to work after about 10 days, a shorter recovery period than the two weeks her friends needed after laparoscopic surgery.

She's still keeping her scar clean, and her belly button doesn't look exactly like it used to, she said. Garner was able to make the incision in a scar Kane-Huebner had from a former belly button piercing, then close it to eliminate the scar.

"You can't even tell that I had a surgery," Kane-Huebner said.

Last updated: 4:59 pm Tuesday, August 27, 2013

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