Nine years of mesh removal – laparoscopic versus robotic

[Unknown Member]

Robotic is the way way to go fir mesh removal. Dr. Iacco and Janzyck probably and they are also ICU surgeons also but are especially Janzyck has been doing Robotics before Belyansky or Towfigh. He is up front same with Dr. Iacco. They don’t care about ohhh we use a robot etc for more money etc Janzyck is a pioneer of it they have like 40 robots at Royal Oak Beaumont. They are both upfront and know how to do it all. Belyansky did a triple neurectomy and said to a lady let’s see how this goes if it don’t work then I’ll remove the mesh down the road, now he’s against cutting nerves for a reason huh, with Towfigh no disrespect but she would remove mesh but have a neurosurgeon by her side while Iacco and Janzyck knew how to deal with it all themselves? They are upfront and say yes mesh can mess you up as Towfigh,Ramshaw, Belyansky say etc bit Ramshaw took it back and it’s all in our heads lol he made himself a joke. As doctors that say ohhhh your going to have a Robotic do removel etc lol it’s cause Kang, Peterson, grisckan only know how to do open surgery and have Zero skill in others as Robotic or even lap. They try to talk you in one they are skilled in! Dr. Janzyck performed a Robotic 10 hour surgery which here in Michigan The U OF M hospital is the best right lol its not they got sended to him and he saved her life. He takes his practice as his partner as an art of doing 120% and doesn’t have and anything as with his parter.
I said why don’t you post this or that andvhe said it’s all politics as Belyansky, Towfigh, Ramshaw which retired after backlash lol I’m glad I went to them cause they just want to help like a doctor/surgeon should be like. He’s been doing Robotics before Towfigh and Belyansky, he’s a pioneer of it so don’t be scared of Robotic surgery in the rightest of hands same with Dr. Iacco! In 2016 Dr.Janzyck did more Robotic surgeries than any other surgeries the US!

[pinto]

Chuck, the depths of despair you probably were in would test anyone’s mettle. I don’t think anyone here took it other than expressions of pain normally expected. I know you are still on the road toward recovery but suppose your condition has greatly improved from a year or so ago. As far as our friend, GI, is concerned, I believe he’s on a mission to destroy mesh as a medical intervention. Given the trauma he experienced, it’s understandable but it could make oneself myopic. You probably can understand him more than most. Failed surgery can be crushing. You both make contributions here, which I’m glad continues.

[Unknown Member]

pinto thanks so much for your support…yes i agree we all need to help each other as much as possible…not sure what GIs issue is…i am perfectly sane–i was just desperately injured and still am. And i want to warn newbies away from the dangeous misinformation that GI is prone to spew. Removing mesh lap is idiocy…and damaging and the lap surgeons leave a lot behiind….jacobs leaves 40 percent of the mesh robotic is the way to go….i only wish i had met you watchful bryant etc earlier before i ended my life

[Unknown Member]

Robotic is the way to go but it takes some time to learn. The robot can move ways the hands using lap cannot, better visualization, no hand jitters like lap removal because it’s time consuming etc. Bruce Ramshaw was one if the supposed best, he’d make you see a psychiatrist before and after surgery and used to admit mesh can cause pain but when a patient asked him to do it robotically he said he didn’t know how to use the robot and said you can’t teach an old dog new tricks and had his own mesh ever called tiger mesh then he openly admitted its all in our heads and mesh doesn’t cause pain lol then retired. I had mesh bilateral bard 3dmax heavyweight with 2 huge tacks and tacks are a no no and which to me is the worst of the worse and bard knew it’s not safe at all to put in the human body but bought the cheapest plastic available to fill their pockets but they are paying for it now. Dr Iacco at Michigan hernia surgery removed all of it and the tacks in one piece to make sure he got it all which makes sense, his parter Dr. Janzyck is a pioneer in robotics and dud the highest volume of robotic surgeries in the US in 2016. I wanted both sides removed because there is no reason to get one out then the other especially when a skilled surgeon can get them both at once. Robotic surgery has a learning curve but will be the future especially with mesh removal, they have like 30 or more at the hospital I went to. A dude I know just flew from Florida to him ti get bilateral removal and he got it all out and he’s a week out and all prior symptoms are gone beside post op pain. Chuck is right on the robotics and we’ve spoke for almost a year now on the phone having each other’s back. I had my mesh in 18 months and got it removed then and had nerve damage which one nerve was cut bit on the left it started flipping in on itself. I respected there veiw saying yes mesh can cause pain dmfor some patients and 3dmax is garbage as Belyansky said. At there office they have a picture on the wall saying the groin us the most complex anatomy of the human body and when we go to some bad apples out there get told it’s a cakewalk and mesh is gold standard etc. I talked ti a surgeon that had a quarter size hernia for a decade he said it doesn’t bother me so I’m not getting surgery which most hernias especially indirect don’t hurt its just if it gets big like a orange etc yea ya gotta get it fixed but him telling me that Said alot and I bet no surgeons would put it in there son, daughter, friends etc, it’s a crapshoot. Everyone on here that made the mistake of getting polypropylene put in you know there’s hope and there are good guys not bad guys like some that can help you with removing it then the worst is over then healing takes a bit some faster than others but it will get better and better!

[pinto]

@ajm222, excellent, excellent post. Granted as you suggest it is impressionistic but it is all we can do as a patient. You make a well-reasoned proposal for the state of affairs in mesh. Let me add the previous posts I made pointing out some surgeons have publicly acknowledged that some fellow surgeons in the field have been irresponsible about post-op complications. That is an important first step by recognizing a problem. Bravo, your post.

@Good intentions, you are fortunate that Dr. T. is gracious for not putting you in your place. True, the good doctor might be so ensconced in her practice/approach she might miss the full import of competing views. Hmm, are there any dedicated professionals that could elude that characterization? How about you? Are you so balanced that you are able to view the field dispassionately? Not. You sometimes misread medical reports egregiously but refuse to recognize it like the time you reported how a routine hernia operation turned into a loss of a leg. You missed that the guy had ten operations worth of scar tissue making it an extraordinary medical challenge–exactly why the surgeon could make a public “confession” about it as he did!

@Chuck is not far off in voicing similar concern. Both of you have been through hell medically and so share commonality in opposition to mesh. Further don’t butt into people’s personal affairs not your own as when you PMed me. You see, it shows how extreme your personal campaign against mess has taken you. Your criticism of Dr. T mirrors bias you have in the opposite direction!

I was disappointed, GI, that you couldn’t see some way around the security concern when Chuck appealed to you for personal help. He was in dire straights. Apart from a personal phone call wasn’t there some other way to connect outside of HT? Chuck, if you surmise correctly about GI’s medical status, then he, as many might be, reluctant to connect personally. I’m just happy that both of you are on roads to recovery. Ironically mesh injury can strike again in making our human relations difficult. I’m glad that both of you are mending in that way as well.

[Unknown Member]

Adam…completely agree. Dr Twofigh and Yunis see tons of problems and yet continue to support the use of mesh. Dr B takes it out of people weekly same with Dr, Jancyk…and they continue to say its safe. Its really appalling. At the very least they should say look mesh is dangerous stuff…but there are problems with tissue repairs too. Please know i will do my best if you choose mesh but recognize there is a decent chance you will have a problem and it could ruin your life. In my case I really think my life is on the line. I will not live with constant chronic pain. I think the issue is that many surgeons simply cant work without mesh so they have to say its safe….when you get destroyed they make excuses. My local surgeon said he had never seen a complication. I told him i knew someone directly who he had damaged…then he said oh that guy had mental problems. So corrupt. I respect you a ton for your research diligence…and its some comfort that you spent a ton of time on this page and still selected a mesh surgery. It would be logical to say you cant trust internet posters—you have to trust the doctors.

[ajm222]

It’s definitely interesting that all surgeons I’ve spoken to, when asked about the risks of mesh and what they’ve seen, will say that either it’s under 1% and almost negligible, or they will tell you routinely they’ve NEVER seen a mesh complication or chronic pain in their 20 years of experience or whatever. Which is patently absurd. Meanwhile, I spoke to about 6 close friends that had hernia repairs over the years, and 50% have had issues of one kind or another – either chronic pain, a repeat surgery to fix a problem that was a nightmare, or ongoing issues of a more minor nature. I’ve also spoke to others who, when I tell them my problems, say ‘oh, yeah, my boyfriend had hernia surgery and it’s been an ongoing nightmare’ – or my own PCP who had a patient that developed chronic pain after repair and it never got better.

It’s my belief that people get these repairs, have problems, go back to their surgeon who then dismisses them 2-3 times or more by saying give it time or there’s really nothing you can do, before the patient realizes they’ve hit a roadblock and then they go elsewhere for help. Then the surgeon dismisses all the follow-ups and decides that because the person finally stopped coming, they healed or their problems were minor enough to disregard. They then tell future patients they’ve never seen any issues. Meanwhile, the tracking of the outcomes is admittedly bad. It’s mostly just a black hole.

I really think the problems are much more widespread. Maybe it’s ‘only’ 10-15%. But it’s certainly not 1% from what I’ve seen. It’s anecdata as I have not competed any true medical studies, but I’ve been speaking to lots of people for years now. And as has been said many times, if it’s only 10%, that’s close to 100k people per year just in this country. Year after year after year.

• This reply was modified 1 year, 1 month ago by  ajm222.

[Unknown Member]

For once I agree with Good Intentions…mesh destroyed my life…virtually every surgeon I spoke with said it was safe and the complication rate was silly low. Dr Yunis echoed this in his interview with Dr. Towfigh…its all incredibly corrupt and i wonder whether Dr Yunis or Dr Towfigh would ever put mesh garbage in their own bodies…Check out the corrupt Dr. Voeller who argues strongly for mesh then goes to shouldice for his own hernias. Lap mesh surgery is particularly destructive…doctors should be required to say if this goes bad your life is over….do you still want to do it? My corrupt surgeon Sam Carvajal gave me no war nings at all…but then in his op report he said he discussed the risks of infection migration erosion in detail and that i agreed to them. Flat out lie. So many people are being destroyed…I speak to them everyday. Dr Towfigh even notes that virtually every piece of mesh she has removed has shown signs of causing significant inflammation…its criminal that this surgery is allowed to continue

[drtowfigh]

I know my responses sound defensive. But one of my roles here is to provide a counterpoint. Surgical care cannot only be seen from the patient’s viewpoint.

I also point out inaccuracies, as I don’t want this platform to run on promoting too much negativity without understanding the counterpoint.

Eg, we did discuss the longer procedure time in our study. And in our paper we analyzed why. Also, cost is usually not as important if outcomes are better or safer.

Lastly, I enjoy reading different viewpoints. It has certainly affected how I practice. I definitely don’t believe in status quo. If anything, my reputation is the direct opposite in the surgical world. It just goes to show how perspective affects interpretation.

[Good intentions]

Here is an interesting article about the financial aspects of the use of robotics. It raises the influence of other large institutions, besides the technology companies – the medical institutions that the surgeons work with, and the insurance companies (related to other recent posts). It’s a hot topic.

https://www.sciencedirect.com/science/article/pii/S1878788611000300

Financial aspects, or how to use a robot assistance without losing money. Perspectives from private practice
Aspects financiers ou comment utiliser le robot et maintenir un équilibre financier ? Point de vue libéral
P. Monod

[Good intentions]

Thanks for the reply Dr. Towfigh. My comment about returning to the pre-mesh state by removing mesh was not about the benefits of mesh removal. It was about the irreversible damage of mesh implantation. Most of my posts are about why things are the way they are now, corporate influence, etc., and about preventing or avoiding the problems rather than believing that more surgeries or “pain management” is a reasonable response to problems.

This might feel offensive but I think that you are so deep in to the use of mesh for hernia repair, and modern surgical technology, that your natural inclination in your replies is to defend the status quo. Most of your replies seem to do that.

My original post was just restating, almost verbatim, what the presenter shows in his video, and adding a comment about what he did not state but which seems clear. Longer procedure time (under anesthesia), and higher equipment costs. The actual value of robotics technology is a hot topic today, there are many publications about it.

I did not mention Intuitive Surgical in my post, or you specifically, except as a co-author of the work presented in the video.

[drtowfigh]

Not sure how our data is misinterpreted. It’s pretty clear in the short video and you can choose to read the published paper online for more details.

In summary:
– in my experience lap vs robotic mesh removal outcomes were similar
– patients significantly improved after mesh removal regardless of technique
– with lap mesh removal, I had 2 conversions to open due to major external vein injury and statistically higher blood loss with lap, so in my practice I prefer robotic over lap.
– thought robotic time was higher, it was because we could do more robotically that we could not do lap, Eg, tissue based hernia repair and salvaging of the peritoneum, which are both additional reasons why I prefer robotic approach

There is no obvious superiority to laparoscopic approach, looking at facts and data, especially when we show there is higher incidence of major vessel injury and conversion to open. At the most we can claim it’s non-inferior, which is the most conservative interpretation of our data and what we concluded. And I don’t see how Intuitive Surgical is influencing my data interpretation.

Also, to address your comments, revisional surgery can never claim to return someone back to their original state. But our experience is that mesh removal significantly improves outcome in those who need it. More surgeons should share their mesh removal outcomes. Our paper is the first to do so for laparoscopic and robotic mesh removal.

[Good intentions]

Attacking me personally and posting in the Topics I create is not helping you “offer hope to others”.

If your argument is strong you won’t need to attack the character of other people on the forum. What you’re doing has been well-known and described for centuries. It is the sign of a weak or losing argument or lack of knowledge about the subject being discussed.

It’s called “ad hominem”.

https://en.wikipedia.org/wiki/Ad_hominem

https://www.google.com/search?q=ad+hominem

[Unknown Member]

I am self centered—yet i offer to help anyone who asks in any way i can…you had the identical surgery made precisely the same mistake I did yet offered zero help. Many others here chatted with me online and by phone and helped me make he the correct removal decision…a decision you obviously botched. Your original posts about removal were so negative it almost dissuaded me from pursuing it…thankfully smarter and more caring individuals from the forum got me straightened out. Removing lap mesh laproscopically is moronic when you have a talented robotic surgeon like Dr B. Yet your post encourages folks to do it lap. In numerous posts you suggest that anyone getting mesh out is pretty much physically destroyed….maybe you are because you left the garbage in for so long…and then removed it wrong..but there is hope for those who are meshed…you offered me no hope I am here to offer hope to others….but I am the self centered one…

[Good intentions]

You missed the point of my post Chuck. It’s about the influence of large corporations and the unwillingness, maybe even fear, of today’s surgeon representatives to speak ill of corporate influence.

The rest of the world does not revolve around you Chuck, even though you are in the center of your own small universe. I’m sure that you have heard that before. Try to be objective and let other people express their opinions. It will actually make your opinions look stronger. Your constant efforts to undermine people that don’t share your views, or didn’t “help” you when you demanded it (why would any rational person want to give somebody like you have been on this forum their phone number. That would be insane), clearly shows your lack of objectivity. Everything is about Chuck. Ironically, making your views less trustworthy. The more you try to shut other people down, the worse your opinions look.

Best to stay silent or just express a different, rational, view, a counterpoint, in a separate thread as you have been trying to do. Since you’ve called me out directly, again, I feel compelled to point out your self-centered nature. It’s a vicious cycle that doesn’t really help anyone. I assume that you will, of course, create another venting session after I post this. Hopefully not though. Good luck.