Family Health: Robotic surgery improves hernia repair and pain

If you’ve had a hernia, or know someone who has, you’re likely to link this condition to one particular concept: pain. Hernias, also called ruptures, can hurt a lot, both when they occur and when they are surgically repaired.

At least, that used to be the case. For most hernias, surgeons today can use a new technology that sends people home the same day and back to work a few days later – with little or no pain. That technology is the da Vinci surgical robot. 

Hernias are among the most common surgical problems in the U.S. For men, the odds are especially high for the most common type – inguinal, or groin hernia. One in four males and about 2 percent of women will develop one or more of these hernias over their lifetime. Inguinal hernias happen when part of the intestine, fat tissue or another abdominal organ protrudes through a weakened area in the groin muscles. You may feel a bulge on one or both sides of your groin, and it may disappear when you change positions. In some cases you can push the bulging tissue back to its normal position – these hernias are called “reducible.” 

Hernias don’t always hurt. But when they do, the pain can be an intense burning sensation. And if the intestine becomes trapped and can’t be pushed back, the situation can quickly become dangerous. This “strangulated” hernia happens because the blood supply to that part of the intestine is cut off. If you don’t get help immediately for this condition, you could need emergency surgery.

The only way to fix a hernia is to have surgery. Most hernia repairs are done with the traditional “open” method, in which the surgeon makes an incision in your groin, moves your intestine or other tissue back into your belly and stitches the weak spot closed. Hernias can also be repaired laparoscopically, which involves several smaller incisions where the surgeon inserts thin tubes with a camera and instruments to accomplish the repair. In both cases, a small piece of mesh may be placed over the weak spot to strengthen it. These methods work well and complications are uncommon. However, they tend to be more painful.

Now with robotic hernia surgery, you get less pain and several other important advantages. Dr. Tim Richards is the first surgeon to bring this procedure to Missoula. He states there are good reasons why this technology is at the forefront of hernia surgery. 

“With robotic surgery, the mesh is placed in a way that makes it difficult for the hernia to recur,” Richards says. “It also minimizes the risk for nerve damage, which can be up to 10 percent with open surgery. And the vast majority of patients take very little pain medication and can go back to work right away.”

Despite its name, robotic surgery doesn’t mean the technology takes over. Instead, the surgeon is always in control, using instruments placed through incisions similar to those for laparoscopic surgery. The da Vinci robot provides 3D, high-definition views that Richards calls “phenomenal.” The extremely responsive instruments allow for fine movements and a range of motion that is similar to, or better than, that of the human hand. This flexibility inside the abdomen means less movement at the incision sites, and less pain after surgery. 

Robotic surgery can also be used to repair incisional hernias, which occur near the scar from a previous surgical incision. Like inguinal hernias, they can result in a lump where the internal parts bulge through. Both types can become strangulated, and you should get immediate medical help if:

  • Your pain gets suddenly worse.
  • The bulge becomes very red and tender.
  • You have a fever.
  • You have nausea and/or vomiting.