News Feed Discussions Problems with robotic surgery

  • Problems with robotic surgery

    Posted by ajm222 on April 15, 2021 at 8:04 am

    I thought I’d pose a topic to the group concerning issues with robotic surgery.

    I have had two robotic surgeries now – mesh implantation and mesh explantation.

    The benefits are clear – mobility is pretty much immediate after surgery, and the incisions and scars are smaller (even if there are more of them).

    But in my experience, I have come to believe that there are some long term impacts of using the robot and inflating the abdomen and peeling all of that fascia away in order to perform surgery. I am probably more sensitive than most, but I feel like my abdomen has never been quite the same since these surgeries, particularly on my right side where I had my hernia, and I think the potential damage caused by this process is underappreciated.

    I can’t be sure it was caused by the robot, but I have a puffiness on my right side that I never noticed before the surgery, and it exists right around where the right trocar was placed. There apparently is no incisional hernia here or any other issues detected by any sort of imaging or exam, and nothing special was noted about that spot at the time of the second surgery when the mesh was removed. But my right side has never quite felt the same since the first surgery, and the mild discomfort extends all the way up to just under my ribcage.

    I would also add that while I was mobile immediately after surgery, I felt awful for several days due to extremely uncomfortable feelings of bloating and swelling and just general malaise, and I don’t just mean the discomfort in my shoulders from the gas – it was all over my abdomen. This eventually went away, but 2 months now after the second surgery, my stomach still feels bigger and firmer.

    I also developed nerve pain in the fatty part of my abdomen, not associated with the groin. This has thankfully faded, but I still have sensations in the umbilical area of tightness and pulling that I am sure are related to the surgery and the healing process and scar tissue. I am hoping this continues to ease and feel more natural over time, but it does make me wonder in general about robotic surgery.

    Anyway, it seems robotic surgery and lap surgery are advertised as being very ‘minimally invasive’ and yet the area impacted by this surgery is at times much larger than that of open surgery, and I wonder if the potential issues that this can cause is really being fully appreciated by patients and surgeons.

    Curious what other think. I have spoken with a number of friends who have had both lap and open hernia repairs, and they all seemed to think that ultimately the open surgeries were easier on balance even if the lap surgeries got them mobile sooner.

    • This discussion was modified 2 years, 10 months ago by  ajm222.
    Ben999 replied 2 years, 10 months ago 4 Members · 5 Replies
  • 5 Replies
  • Ben999

    April 17, 2021 at 6:04 am

    From my understanding one of the big advantages of lap/robotic is that the chance of nerve damage in the groin is tiny compared to open, since these nerves lie anterior to the abdominal wall. And damage to these nerves is one of the main reasons for chronic pain after hernia surgery.

  • ajm222

    April 15, 2021 at 10:39 am

    I’ll say in my case I don’t really notice any big difference in the pain in the inguinal area after all the surgeries. That’s been pretty consistent no matter what. Again, just in my case. I assume every case of mesh removal could have different results.

    Speaking of scar tissue, someone posted an interesting MRI image the other day that seemed to very clearly show scar tissue, and involvement of some nerves in said scar tissue. I wonder if MRI imaging 6-12 months (or longer) after mesh removal could be at all useful in determining whether it would be worth ‘cleaning up’ scar tissue or adhesions, assuming there are symptoms. I had assumed you couldn’t actually see scar tissue very much regardless of image type.

  • JamesDoncaster

    April 15, 2021 at 10:22 am

    I have had one laparoscopic repair and one robotic mesh removal. I still have a “deep pain” that comes and goes. I always assumed this was from scar tissue that formed when the mesh was put it and subsequently removed. But, I wonder now if it could also be from peeling off the peritoneum twice.

  • ajm222

    April 15, 2021 at 8:40 am

    Thank you, Dr. Towfigh. Yes, that’s helpful.

    I guess in my mind I was thinking that with robotic/lap surgery, it’s always been my understanding that at least in terms of inguinal hernia repair, a very large amount of the fascia is peeled away from the abdominal wall. I know fascia apparently regrows quickly, but I’ve also read it’s quite important to how abdominal contents are held in place and positioned, and I wonder if that process of peeling it away is more invasive and potentially problem-causing than is often appreciated. But perhaps not.

  • drtowfigh

    April 15, 2021 at 8:31 am

    Interesting discussion.

    Laparoscopic and robotic approaches are fundamentally the same. The taking down of the peritoneum, for example, is the same when done laparoscopically or robotically.

    What is different between the two is how the surgeon commands the robot. For example, with laparoscopy, one is at the bedside and maneuvers the instruments. The surgeon directly controls how much the abdominal wall is impacted by their instruments. With robotic surgery, the instruments are manipulated by the surgeon at a separate console. If the surgeon is early in their learning curve or not aware of what is happening at the patient’s side, the arms may be moving more than is necessary, which can cause more pressure or pulling on the abdominal wall by the robotic arms.

    When comparing to open surgery, laparoscopic and robotic surgery is considered less invasive for two reasons: 1) less incisions and scars on the abdominal wall, 2) less manipulation of the tissues, resulting in less scarring and adhesions inside. However, from a practical standpoint, the same operation is done on the inside.

    Everyone has a different trajectory of recovery from open, laparoscopic, and robotic approaches. The skill and tissue manipulation of the surgeon can also play a factor in your recovery.

    I hope this is helpful.

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