Issue link: https://viewer.e-digitaledition.com/i/611652
Experienced, fellowship-trained surgeons, from left, Lee Farber, DO, John Choi, MD, MS, FACS, and Pranat Kumar, MD, lead the robot-assisted surgery team at Vassar Brothers Medical Center. The trio specializes in advanced, minimally invasive and robotic technology to provide patients with up-to-date and cutting-edge treatments for complicated surgical problems. disease (GERD). Robot-assisted anti- reflux surgery, which is performed at Vassar Brothers Medical Center using the da Vinci Xi Surgical System, is ty pically a two-part procedure that involves repairing the hiatal hernia (if one exists) and performing a 180-, 270- or 360-degree fundoplication. Though a hiatal hernia isn't always present in cases of GERD, the two condi- tions often occur concurrently. Patients with a hiatal hernia may present with acid reflux and/or difficulty eating or breathing because the contents of the stomach put pressure on the organs in the chest, including the lungs. During a hiatal hernia repair, surgeons reduce the contents of the stomach so it returns to its normal anatomical position within the abdomen a nd close the defect. Depending on the size of the hernia, mesh may be used to reinforce the repair. Following a hiatal hernia repair, a f undoplication — which involves wrapping and suturing the fundus of the stomach around the lower end of the esophagus — is performed to address the remaining acid reflux. Preoperative testing helps physicians determine the degree and angle of fundoplication that is most beneficial for each patient's anatomy. Cases of GERD that occur concurrently with a paraesophageal hernia are addressed similarly. As with other surgeries, patients who opt for the minimally invasive approach to anti- ref lux surgery have less pain, shorter hospital stays and recoveries, improved cosmesis, and a lower incidence of respiratory complications. "The overall goal of medicine today is to control costs while also identifying the approaches that lead to the best outcomes," Dr. Choi says. "Remaining innovative, keep- ing an open mind and collaborating with other surgeons both on a national and world- wide level allows physicians to forge ahead and continue making advancements that enhance patient outcomes, such as these recent developments in general surgery." For more information about the robotic surgical capabilities at Health Quest, visit healthquest.org/roboticsurgery and select "da Vinci Robotic Surger y." ■ Surgical System is the ability to perform the component separation technique in cases of large abdominal hernias. "Component separation previously required a laparotomy and a subsequent three- to seven-day hospital stay," he says. " Wit h t he robotic approach, patients who have a component separa- tion are often discharged the next day." In ca ses in wh ich a component separation is necessary, the hernia is so large the abdominal fascia cannot be reconnected without tension, which requires releasing components of the abdominal wall laterally. During a typi- cal open procedure, surgeons release the external oblique muscles. However, Dr. Choi usually performs robot-assisted component separation by releasing the transverse abdominis muscle plane laterally, which allows the fascia to be reconnected without tension, and then reinforcing the repair with mesh. "Following the robot-assisted repair, patients have much less pain," he says. "The potential for a laparotomy-related complication, such as a skin infection, is a lso greatly reduced, which is especially beneficial for patients who smoke, are morbidly obese or have other comorbidities." Addressing the Anatomical Cause of Gastroesophageal Reflux Disease A nti-ref lux surger y, including f undoplica- t i o n , a l l e v i a t e s t h e s y m p t o m s o f s e v e r e gastroesophageal reflux The dedicated and courteous office staff with the robot-assisted surgery team at Vassar Brothers Medical Center guides patients through the entire process. They start with an initial, thorough consultation and move through the expert surgical experience that includes postoperative care. COV ER FE AT UR E 1 0 | Mid Hudson MD NEWS ■ M D N E W S . CO M