When all else fails, or is less effective, bring in the robots.
Robotic abdominal wall reconstruction is a minimally invasive surgery usually performed in patients who have large incisional hernias. But when the sheer size of the hernias renders traditional repair techniques inadequate, even requiring muscle releases to allow for the complete reconstruction of the entire abdominal wall, robotic abdominal wall reconstruction saves the day – and has been doing so for the past 14 months.
“Instead of a large, open incision, I can do the entire operations using just six small incisions,” said Mazen R. Al-Mansour, MBBS, assistant professor in the University of Florida College of Medicine’s department of surgery. “Although it doesn’t apply to every patient with a large hernia, I’m seeing about half of the patients that would otherwise require an open operation.”
The advantages of robotic approaches to abdominal wall repair are twofold. Smaller incisions means a less painful operation, which in turn leads to a faster recovery, Al-Mansour explained. It also minimizes the risk of wound complications, like infection, which is one of the most common roadblocks to an otherwise smooth recovery.
“With a standard open operation, the length of stay is somewhere between three to seven days,” Al-Mansour said. “But the robotic approach enables most of my patients to leave the next day.”
Significantly reducing the length of stay is a sought-after quality metric in both resources and patient satisfaction. But it also frees up hospital beds for other patients, Al-Mansour pointed out. In fact, it’s a significant driver of why he chose to specialize in minimally invasive surgery.
“As a surgeon trained in minimally invasive approaches, I am always asking myself: ‘How can I accomplish this with a smaller incision?’, which has been ingrained in me since my fellowship training and repeated robotic surgery courses that helped refine those skills,” he said.
To date, Al-Mansour is one of the only surgeons in North Central Florida offering robotic abdominal wall reconstruction. “Of course there are other surgeons doing abdominal wall reconstructions, but their primary method is opening up the patient. The robotic thing is kind of my twist to it,” he said.
Al-Mansour’s list of patients seeking the minimally invasive approach is lengthy, and a testament to the institution’s ability and capacity to manage complex cases that require complex procedures. In the future, Al-Mansour plans to focus on even more difficult patient populations by collaborating with the transplant team. This population of patients is immunosuppressed, leaving them particularly susceptible to infections – in which case an approach known for reducing chance of infection could become the next standard of care.
“I really believe our department of surgery is an expert in this – a center of expertise in its own right,” Al-Mansour said. “And the best part is, we’re just beginning to see what we can do.”