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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.
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