Robotic-Assisted Liver Surgery Could Drastically Reduce Your Recovery TimeRobotic-assisted liver surgery has the potential… +8 More
June 06, 2018 Announcer: Health information from experts supported by research. From University of Utah Health, this is thescoperadio.com. Interviewer: There's a new option for patients diagnosed with surgical liver issues. And oftentimes, it reduces the hospital stay from seven days to, in some cases, just overnight, and reduces the return to work from a three-month recovery to just a week. It's called robotic-assisted liver surgery, and it could be an option for you. Dr. George Rofaiel from University of Utah Health is a specialist that does this procedure, and we're going to learn more about it from him today. First of all, what conditions would you potentially use this surgery for? Liver cancer is one of them, but what else might you use it for? Dr. Rofaiel: So there's a wide array of issues. One of them is benign liver disease, cysts, benign tumors, bile duct issues, like bile duct injuries and bile duct tumors, of course. A lot of other conditions that can affect the liver and require surgical interventions. Traditionally, most of these have required open surgery that is traditionally requiring big incisions that usually go across the abdomen and tended to cause a lot of disability to our patients, with longer recovery times and higher than average incidents of complications from the wounds themselves. Interviewer: So the traditional surgery, like we think about, is how it used to be done. And then there are some laparoscopic or minor incision options. But this robotic surgery takes it a step further. Explain the difference between the two. Dr. Rofaiel: Laparoscopy came along many years ago, and it was definitely an advantageous advancement in surgery and surgical technology. However, it did not come close to allowing surgeons to do the same complex procedures that open surgery allowed. Interviewer: So you're still doing a lot of open surgery. There was just a limited number of things you could do with it. Dr. Rofaiel: Correct. So, traditionally, for the liver side, gallbladder surgery, and most minor of liver surgery was done laparoscopically. Interviewer: So it allows you to do the smaller incisions, but more procedures when you use the robotic technology. Dr. Rofaiel: Correct. So robotics allowed us to apply what we normally done open in terms of techniques, except through the same small incisions. And the reason for that mainly is magnification and the ability of these instruments to move in more 3D fashion, in a rested fashion, and do more complex steps that otherwise, we had to do with open surgery. Interviewer: And it's very precise and very accurate, almost more so than a surgeon doing it with their own hands, isn't it? Dr. Rofaiel: It does indeed, actually. So the advantage with technology is that it smoothens out the natural human tremor. And also it allows for the surgeon to use their dominant hand with the same, sorry, the non-dominant hand with the same precision as a dominant hand. So that allows a lot of work to be done from the small incisions and from the right and left side that traditionally even with open surgery had proven to be difficult. Interviewer: So one of the advantages of this type of surgery, the robotic assisted, is that a reduced time in the hospital and also a reduced work time recovery. What are some of the other advantages to using this procedure? Dr. Rofaiel: So this technology is relatively new, so this data is still accumulating. But for example, one of . . . to speak about some of these tumors that we're treating, one of the most important things to a tumor patient is recovering fast so that he can continue with other aspects of treatment for the tumor. So, at least in theory, the faster you recover from the surgery, the faster you can get on with other modalities of therapy, example, chemotherapy, immunotherapy, and the like. If we are able to get our patients to recover in six weeks instead of three months, which is the usual time, these patients can potentially move on with these therapies faster. Data's still accumulating. Will that really materialize in longer survival? We don't know yet, but at least we can offer this opportunity now to our patients. Interviewer: What patients would you be able to use this robotic surgery option for? Dr. Rofaiel: We hope that we are able to offer this to the majority of our patients, even the patients who have had open surgery in the past. So, for laparoscopy, for example, traditionally patient who have had open surgery in the past were not offered laparoscopic surgery secondarily. Robotics can change that. Many times, we have a patient who have had open upper abdominal work who came for liver and a bile duct work. We actually offered robotic surgery as the second procedure, and that was not possible in the past. Interviewer: That's pretty awesome. When somebody is in your office and you're telling them about this procedure, give me three common questions that arise. What are the kind of the common things? Dr. Rofaiel: The first one is, can you do this? Because this is not . . . usually patients have not heard about this before they come to my office or came to our offices. That's number one. Number two, can you do it with the same precision as what they expected to be open surgery? And the last thing is a traditional question, "How fast can I get out of the hospital? How fast can I go back on with my life or my next phase of therapy?" Interviewer: Yeah, and it varies from patient to patient, but very much increased return to normal life, it seems like. Let's pop back to the one question, the result compared to open surgery, does it provide the same result? Dr. Rofaiel: In general, we will not offer an operation for a patient that will provide less than the exact same result as an open surgery. So robotics, the only difference it provide compared to open surgery is that opportunity of doing the same exact operation is just simply from a different approach that's more or less invasive. But in terms of recovery, just to give you an example, the first case we have done in this institution, that patient received a liver resection and went home the very same day. That's unheard of. Interviewer: And in the past, how many days would it have taken that patient to go home? Dr. Rofaiel: A week, on average. Interviewer: Yeah. Did that just amaze you, too? Dr. Rofaiel: It surprises me sometimes. Interviewer: Yeah, that's incredible. Dr. Rofaiel: It is, really. And the patients just look better. They recover faster. Blood loss is less in the operating room, and that's probably a value of magnification of these instruments. We, essentially, we're operating with a microscope. This machine works with a magnification that's at least 10 times as a human eye compared to just the usual 3 times when we do it with open surgery. And blood loss is indeed, I feel it's less. Again, data is accumulating on this, but that has at least been proven in some other urologic procedures that this technology has been used for a longer period of time. Interviewer: So it sounds like it's just as safe as open surgery. Offers a lot more benefits, allows people that have had other procedures before to have this instead of open surgery. So it sounds pretty good. Is this something that's generally offered, or does a patient need to ask for this type of treatment over the other options? Dr. Rofaiel: If they come to our institution, we will always try to offer this option. Interviewer: So University of Utah Health, we have it here. We have the equipment. We have you that can run the equipment, the expertise, the knowledge. Dr. Rofaiel: Absolutely. In other places, patients need to start asking. This is only being offered now in a handful of centers around the United States, but hopefully, with time, the knowledge and the technology will be more available. Patients need to look into this. We shouldn't be always resigned that if I have these big liver tumors, that I'm going to be cut open and I'm going to be in the hospital for a couple of weeks and I'm going to be recovering at home for several months. And, you know, that mindset needs to be changed. That has already changed in other specialties, and I think it's time for it to happen in liver and hepatobiliary surgery. Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com. |
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Gastrointestinal surgery in the pregnant patientOB/GYN grand rounds +4 More
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Top 5 Reasons for ER VisitsEmergency physician Dr. Troy Madsen breaks down… +7 More
May 07, 2014
Family Health and Wellness Interviewer: Top five reasons people might end up in the ER. Think about what you think they might be, and you'll find out next on The Scope. Intro: Medical news and research from the University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope. Interviewer: One of the top five reasons people come in the ER. We're with Dr. Troy Madsen, University of Utah Hospital Emergency Room Physician. Let's go over the top five reasons somebody might end up in the ER. Number five. Dr. Troy Madsen: This is based on actual research we've done. So we looked at patients who come into the Emergency Department, and we try to quantify why did they actually come in. The number five reason on that list was back pain, and oftentimes this was an acute back injury. Maybe they twisted their back or just stood up wrong or something happened. Or sometimes it's chronic back pain. It's pain they've had for years, and they come into the ER for this. Interviewer: Let me ask you one question further. Is that a reason to go to the ER? Should you go to urgent care? Dr. Troy Madsen: It is a reason to go to urgent care. The reason to come to the ER is if you're having any bladder or bowel something, like, where you just cannot urinate or you can't hold it, like, you just urinate on yourself because then we actually worry more about spinal cord compression. Interviewer: Okay. Dr. Troy Madsen: The other reason to go to the ER is if you've had an injury to the back, like, direct trauma to the back, something that could cause a fracture. Interviewer: All right. Dr. Troy Madsen: Again, another reason to go to the ER. Interviewer: But just a pain or an ache? Dr. Troy Madsen: Yeah. Just aches and pains, especially these chronic aches and pains. It's probably a better reason to see your primary care doctor. Interviewer: All right. Number four. Reasons people might end up in the ER. Dr. Troy Madsen: Number four reason is coughing and congestion. A lot of upper respiratory symptoms. So they just got a cold. They're just feeling kind of miserable. Maybe they have a fever along with this, but this is a very common thing we see in the Emergency Department. Interviewer: Just the kind of coughing that doesn't stop? I could never imagine going just because I'm coughing. Dr. Troy Madsen: Yeah. And one thing you're going to find as we go through this list, you'll find a lot of things here that maybe you could not imagine going to the ER for. But when I think I started working in the ER, that was the biggest thing that surprised me. It was a lot of the kind of more minor things that we see on a regular basis, but, you know, I think people get very concerned. They may just have really, quite honestly, just a cold. But for whatever reason, they're concerned that something more serious may be going on. Interviewer: Again, coughing. Is that a reason to go to the ER or is it more of an urgent care situation? Dr. Troy Madsen: That's a great thing to go to an urgent care for or see your primary care doctor. Interviewer: All right. Dr. Troy Madsen: The exception being is if you have underlying immune system disorders or if you're on chemotherapy, anything there where you have a fever is going to be more concerning and is a reason to go to the ER. Interviewer: Or you just can't breathe. Dr. Troy Madsen: Exactly. Yeah. Interviewer: All right. Dr. Troy Madsen: If you're just not breathing, your lungs are really tight with asthma or something like that. Interviewer: Top five reasons people come into the ER. Number three. Dr. Troy Madsen: Number three is chest pain. We see a lot of chest pain, and this is definitely something to come to the ER for. This is something that's very concerning, especially in older adults. Once people start to get into their 50's or even older, and especially if you have risk factors for heart disease. If you have high cholesterol, high blood pressure, any family history of heart attacks, it's absolutely a reason to come to the ER, and it's one of the more common things we see. Interviewer: Number two. Dr. Troy Madsen: Number two is trauma and orthopedic injuries. We certainly see a lot of people after car accidents, people who were brought in by the ambulance and then people who walk in themselves either were seen at the scene of an accident and released by the ambulance but drove themselves in for some pain. Or people who have traumatic injuries from falls, from orthopedic injuries such as twisting their knee, hurting their legs, you know. So here we're talking about a full spectrum of traumatic injuries, you know, very serious. The things that, you know, maybe are kind of more sprains or strains. Things like that. Interviewer: Is there a way that a patient could make the determination whether, again, they should go to urgent care or the ER for something like that? Dr. Troy Madsen: You know, my general rule of thumb is, "If it's something that's from a car accident, and it involves your spine, your chest, or your abdomen, these are things to go to the ER for. If it's something where you've twisted your knee but you can put some weight on it, and even if you're having some trouble putting some weight on it, still, it's a great thing to go to an urgent care for." Interviewer: All right. Top five reasons people come into the ER. Number two. Dr. Troy Madsen: It works up to number one. Interviewer: Oh. Top five reasons people come into the ER. Number one. Dr. Troy Madsen: Number one. The top reason we see people and the most patients we see are abdominal pains, surprisingly. It's up to maybe about 25 percent of patients we see are there because their stomach hurts. They may have had some nausea, some vomiting, maybe some diarrhea, maybe just some cramping, or maybe it's something more serious like an appendicitis or cholecystitis, which is their gall bladder being infected. So we see kind of a full spectrum of things there as well, but that is the number one thing we see in the Emergency Department. Interviewer: And the same question, how do I know if it's maybe just an urgent care or primary care physician issue versus coming into the emergency room? Dr. Troy Madsen: Yeah, and this is always kind of a tough one, but I often, you know, think of the more serious concerns in the abdomen being on the right side. So the right lower side is your appendix. The right upper side is your gall bladder. If you're a lot of pain in those places, if you push in there and it hurts, and even more concerning if when you release, it hurts even worse, those are signs that you should probably go to the ER. Interviewer: Is there some place you could call before you maybe make that call if you're on the fence? Dr. Troy Madsen: Usually, calling your doctor's office might be helpful. Sometimes it's a little tough because you're probably not talking to your doctor. You're probably just talking to someone answering the phones. So it's a little bit tough, but see what you can do there. Interviewer: All right. So just use your best judgment? Dr. Troy Madsen: Yes. Use your best judgment. If you're concerned, come into the ER. And I think the biggest take-home point from this list is if you come into the ER and you think it's not that serious, trust me, there have been people there with much less serious things than what you have. So err on the side of caution, and don't feel ashamed if you need to come to the ER. Outro: We're your daily dose of science, conversation, medicine. This is The Scope, the University of Utah Health Sciences Radio. |
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Dude, What’s Wrong With My Stomach?Is it food poisoning? A stomach bug? The latest… +7 More
December 30, 2013
Digestive Health
Family Health and Wellness Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope. Scot: You end up with some stomach pains and it's always hard to know if it's something you ate, or if you're paranoid like I am you assume it's food poisoning, or E. Coli, or something worse like the latest stomach bug that you read about in the news. What I'm looking for is a breakdown, an easy to remember symptoms that can help the average person decide if it's something to worry about or if it will pass. I'm here with Dr. Troy Madsen Emergency Medicine at the University of Utah Hospital. Dude what's wrong with my stomach? How common do you see stomach issues in the ER? Dr. Troy Madsen: Extremely common. It's a very large number and I expect when I work a shift in the ER I'm going to see at least a handful of people that are there because they're having some abdominal pain. Scot: How about a breakdown of easy to remember symptoms that can help like the average person like me decide if it's something to worry about, or if it's something that will pass, or if it's something that I can take some Tums for. Dr. Troy Madsen: You know when people come in the ER that's the question in their mind. Do I really need to be there for this? And we see a lot of people in the ER who probably just have some kind of a stomach virus. You know the number one thing I would say is if you're really concerned come to the ER. I don't want to tell you not to come because your judgment is certainly better that just, than hey this, this, this and this. Scot: Better safe than sorry. Dr. Troy Madsen: Yeah, but there are some rules of thumb that can help you to try and decide is this really serious or not. One thing that is a real red flag is if you're in your car, let's say someone's driving you somewhere because you're just kind of feeling nauseated, you're going to the pharmacy to get something, and every bump you hit in your car makes your stomach just hurt like crazy that's a bad sign. Scot: Okay. Dr. Troy Madsen: Because then I worry whatever's going on in your abdomen if it's your appendix, or your gall bladder has gotten so inflamed and infected that it's actually infected the lining of your abdomen and that's what causes that really severe pain. Scot: Okay. Dr. Troy Madsen: So that's a big reason to come in right there. Scot: So if bumps are hurting you when you're in the car... Dr. Troy Madsen: Yeah. Scot: ...that's a warning sign? Dr. Troy Madsen: You're hitting the bump your abdomen just hurts like crazy with every bump come in. Scot: All right, what are some other stomach issues and symptoms? Dr. Troy Madsen: So some other things are think about the right side of your abdomen. If you're having a lot of pain on the right side, so if you feel it on your right upper side that's your gall bladder, your right lower side that's your appendix, and then people who are otherwise healthy those are the two big things I look for. The left side of the abdomen not a whole lot going on over there. The right side those are the two big things that cause problems. So if you push in that right side of your abdomen and the right upper side hurts, the right lower side and that hurts, that's something you need to come in for. You may have an infection in your gall bladder or your appendix. Scot: So if the rights not right go to the ER. Dr. Troy Madsen: That's a good way to remember it. Scot: Well good. So but the left side it's interesting if you have severe pains on the left side what could that be then? Dr. Troy Madsen: It can be a number of things, and if it's an older person I worry about an infection in the colon, usually that's more people who are 55 and older. Something called Diverticulitis. If it's down really low and you're a female I worry about the ovaries, maybe an ovarian cyst, or something twisting there, but usually with the ovary it's going to be really severe pain, but if it's just some kind of vague pain over on that left side of your abdomen usually not something to be too concerned about. Again use your judgment to see how you're feeling overall but the right side's the side that really gets me concerned as a doctor. Scot: How do I know if I've got food poisoning? That's always a big question for me. Is it just upset stomach or food poisoning? Dr. Troy Madsen: The only real way we can say, "Hey it was food poisoning." Is if there were several people who ate the same thing who were having the same symptoms. There's no real test we do for it. Most cases of food poisoning are going to pass within 12 to 24 hours. You're probably going to feel miserable. If you feel just so miserable that you're not keeping any fluids down, if you're dehydrated that's a reason to come in to the ER because we'll give you IV fluids, get you some nausea medication to try and help you feel better. Scot: What about cramps, gas bubbles, like your stomach feels rock hard? Dr. Troy Madsen: Yeah. Scot: Are those major concerns or is it just gas? Dr. Troy Madsen: You know most of the time it's just gas. A lot of times it's just some kind of viral infection that's making things feel kind of crumby. You can try some over-the-counter medications see if that helps you out, see if you can wait it out. Again if you're getting those real bad symptoms a lot of pain, just getting dehydrated because vomiting is associated with it, or diarrhea, other reasons to come to the ER, but you know that's a lot of what we see is exactly what you're describing, and you know most cases are probably okay to wait it out a day or two. Scot: All right one more, so if it's food poisoning usually it will pass 12 to 48 hours you said? Dr. Troy Madsen: Yeah usually yeah. Scot: All right, what about if it's something more dangerous, E. coli, is there any sort of difference in the symptoms between the or maybe the latest bug that you hear about in the news that's going around? Dr. Troy Madsen: Yeah you know those are things that sometimes something will come out in the news people will get really concerned, but E. coli is a very serious thing. It's not a lot that we see it but the big thing that we see with it is that often times bloody diarrhea that's kind of the classic thing we see with the most severe cases of coli. Scot: With stomach issues what should one do to kind of take care of an issue themselves if they believe it's not a major issue, if it's on the left side, maybe it's gas, what would you recommend? Dr. Troy Madsen: Yeah again try some over-the-counter stuff, maybe some Pepto Bismol, something like that to help with some of the symptoms, some of the cramping, drink fluids, don't force feed yourself, you know don't make it so you're just drinking so much fluid that you're vomiting it up, which I've seen some people do, try and stay hydrated. And again if things are just getting to a point where it is very dehydrated, you just feel absolutely miserable feel free to come to the ER. We can make sure nothing more serious is going on and get you the treatment you need. Scot: What's the difference between using an antacid and like a Pepto Bismol? Dr. Troy Madsen: An antacid is going to be more specific just for acid production in your stomach. So let's say you've got a little bit of a stomach virus that's just causing some irritation in the stomach where Pepto Bismol is going to be a little bit better at controlling things like diarrhea, you know controlling maybe some more nausea, more issues with cramping, where if it's just acid where you feel like kind of a burning feeling kind of going up in your chest you're probably fine just taking an antacid like Maalox, or Tums, or something like that. Scot: What about a gas bubble? Dr. Troy Madsen: Gas bubble, you know for that kind of thing where you're having a lot of gas and cramping Pepto Bismol is going to be better. An antacid usually is not going to do a whole lot for that. Scot: All right dude thank you for telling me what's wrong with my stomach. Dr. Troy Madsen: My pleasure Announcer: We're your daily dose of science, conversation, medicine. This is The Scope University of Utah Health Sciences Radio. |
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Gallbladder AttackLisa Deschamps, RN explains the the symptoms of a… +6 More
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