MDNews - San Antonio

" W hat has been found is that when y o u d o t h e b y p a s s r o b o t i c a l l y, i t essentia lly doesn't leak. The reason it doesn't lea k is that when you can sew that connection between the pouch and sma ll bowel with the robot, you place every suture within 1/10th of a milli- meter where you want it, cinch it down tight as air, a nd you ca n put multiple stitches in." LIVER The Texas Liver Tumor Center is an offshoot of University Transplant Center, a partnership between University Health System and UT Health San Antonio. Two of its liver surgeons, Danielle Fritze, MD, Assistant Clinical Professor of Surgery, and Tarunjeet S. Klair, MD, Assistant Professor of Surgery at UT Hea lth San A ntonio, have been doing liver resec- tions robotica lly. T he rob ot i s e spe ci a l ly u sef u l i n patients whose ca ncer would be ha rd to excise lapa roscopica lly because of its location. " I t h i n k t he ke y a s I s e e it i s t he p ot ent i a l t o e x pa nd t he m i n i m a l ly i nv a s ive a ppr oa c he s t o op er a t ion s a nd patients who other wise wouldn't have been ca ndidates for a minima lly i nva sive approach, a nd to be able to do the operations with the sa me high- qua lity oncologic outcomes just through sma ller incisions and shorter recovery," Dr. Fritze says. Obesit y a nd d iabetes a re com mon denominators in many of the conditions the surgeons treat. Dr. McCann says the majority of robotic cases she performs a re for endometr ia l ca ncer, which is associated with obesity. "Most of the patients we operate on a re obese a nd have mu ltiple medica l comorbid it ies t hat put t hem at h i g h risk for postoperative complications," Dr. McCann says. "The robot a llows us to do these complicated surgeries on very sick people and gets them back on their feet faster. " Traditiona lly we were doing tradi- tiona l surgeries on these women with midline laparotomies," says Dr. McCann, who added that readmission rates a re sig nif ica ntly higher w ith that proce- dure. " That 's a ssociated w it h higher costs, decrea sed qua lit y of life a nd a lower cha nce of sta r ting a ny adjuva nt t h e r a p y t h e y m i g h t n e e d o n t i m e . Robotic surger y a lmost eliminates a ll those complications." Universit y Hea lth System recently obtained a new AirSea l system for per- forming minima lly invasive surgeries, which uses lower pressure to insufflate t he abdomen . That helps t he patient breathe better during surger y a nd has been associated with lower postoperative pain. It is especia lly helpful with obese patients, Dr. McCann says. The surgeons continue to expa nd the usef ulness of robotic surger y. Dr. Va n Sick le says his tea m ha s beg un doing abdomina l wa ll reconstruction roboti- ca l ly, peeling layers of the abdomina l w a l l a n d p u t t i n g i n m e s h u s i n g tiny incisions. " I thin k the unique thing about our prog ra m is ou r abi lit y to do complex ca ses — whet her it 's complex pelv ic surger y or complex upper abdom ina l surger y," Dr. McCa nn says. "In the com- munit y practice, more of the complex patients will get referred to an academic center. That 's where we fa l l, in being able to do those complicated cases here minima lly invasively." For more information about University Health System's robotic surgery programs, contact Steve Soliz at 210-643-4441 or email steve.soliz@uhs-sa.com. n complication seen in these patients — leakage at the connection between the pouch created from the stomach and the small intestine. T h at c on ne c t ion , i f it lea k s , i s a devastating complication that can be life-threatening, requiring weeks in the hospital, Dr. Van Sickle says. Even high-volume centers can see a leak rate of about 2 percent. Kent Van Sickle, MD, Chief of the Division of General and Minimally Invasive Surgery at UT Health San Antonio 0 8 0 8❱❱❱❱❱ C O V E R F E A T U R E

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