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surgeries. Dr. Jiser and his colleagues per- form exclusively minimally invasive colon surgeries using traditional or robot-assisted laparoscopic techniques. Utilizing either minimally invasive modality offers patients faster recovery time. "After open colon surgery, the gastroin- testinal tract slows down, and patients can't eat," Dr. Jiser says. "This requires five to seven days of hospitalization. Performing these surgeries laparoscopically enables the GI tract to heal more rapidly. We can reduce patients' length of hospitalization to as few as two days because they're recovering from a 2-inch incision as opposed to a 6- to 8-inch incision." Minimally invasive techniques for repair of inguinal hernias — a condition in which the small bowel breaks through a weak area of the inguinal ring in the groin — also optimize recovery. While open surgery requires six weeks of postsurgical activity limitations, such rigid restrictions are not necessary following laparoscopic hernia repair. Patients return to activities whenever they're comfortable, Dr. Jiser notes. Nationwide, approximately one-fifth of such procedures are performed laparo- scopically, he adds, but almost all hernia repairs are performed laparoscopically at Lowell General. The hospital also has one of the most robust programs in the state for bariatric surgery, and is an American College of Surgeons Level 1A Accredited Bariatric Center. Minimally invasive techniques are used exclusively for all bariatric procedures, including Roux-en-Y gastric bypass, sleeve gastrectomy and laparoscopic banding. Gynecologic Applications William Galvin, MD, President-Elect of the Medical Staff, notes that minimally invasive surgery has become the preferred approach for treating a growing number of gynecologic conditions. "Patients experience a much quicker recovery with minimally invasive gyne- cological procedures versus traditional open surgical methods, including less pain, smaller incisions, shorter hospital stays and less scarring," Dr. Galvin says. "Women are able to return to work and normal activities in a much shorter period of time." In 2013, Dr. Estella used the da Vinci Si Surgical System to perform the hospital's first single-site hysterectomy. While differ- ing only in instrumentation and cosmesis from multiport robot-assisted laparoscopy, the robotic modality makes the minimally invasive option available to all women, who frequently face slower recuperation and impaired mobility after open surgery. The robotic platform resolves the need to lift large amounts of subcutaneous tissue during a procedure performed on a patient with a larger pelvic volume, Dr. Estella points out. "The da Vinci platform makes perform- ing a hysterectomy on a patient with a larger pelvic mass equivalent to performing the procedure on someone of average uterine size by giving surgeons the visualization we need and the instruments where we need them, as well as making it possible to articulate the instruments and maneuver the cameras," Dr. Estella says. "It equalizes the playing field." Well-versed in robot-assisted laparoscopy, Dr. Estella uses both single-site and multi- port approaches to hysterectomy, with the decision largely depending upon uterine anatomy. The single-site procedure is best for women with smaller uterine volumes undistorted by multiple masses or tumors, whereas the multiport approach can easily handle larger uterine volumes and the presence of large fibroids. Dr. Estella estimates that she performs as many as 400 surgeries per year, using laparoscopic methods to perform infertility treatments, treat endometrial and cervical cancer, and remove cysts, tubes and masses. She also utilizes hysteroscopic methods to excise polyps and fibroids. "If there is a minimally invasive surgical option, we offer it. The resulting benefits to patients' recovery and to their ability to resume active lifestyles are immeasurable." — Michael Jiser, MD, FACS, Chief of General Surgery and Director of Bariatric Surgery at Lowell General Hospital Nonnie-Marie Estella, MD, performed the hospital's first single-site hysterectomy with robot-assisted laparoscopy. PHOTOS © KASKONS PHOTOGRAPHY M D N E W S . CO M ■ MD NEWS Greater Boston | 7