In this video you’ll meet Dr. Skandalakis who explains how he will help return you to a normal lifestyle quicker, thanks to the benefits of robot-assisted hernia surgery.
Hernia Surgeon Video Transcription
Hello my name is Lee Skandalakis. I’m a hernia surgeon.
I was born and raised here in Atlanta. I went to undergraduate school at Georgia Institute of Technology and medical school at Emory University.
I trained in Chicago at Cook County Hospital and developed interest in hernias there from my program chairman who was Lloyd Nyhus.
My father was also a general surgeon who enjoyed doing hernias so after training in Chicago I moved to Atlanta and began private practice here.
Part of my practice was hernias the balance of the practice was your bread-and-butter general surgery such as gall bladders and colons. Over the past few years I’ve decided to focus more on hernia surgery and now approximately 95% of the cases I do are hernia-related.
So what is a hernia? A hernia is a defect in the abdominal wall or the inguinal region where the muscles aren’t quite together and then you can have something protruding through that, through that tear or that hole in the abdominal wall.
There are very many different types of hernias.
There are inguinal hernias which are growing hernias. There are umbilical hernias which are at the belly button area and then there are ventral hernias which can occur anywhere on the abdominal wall and the ones that are most interesting are the incisional hernias and the recurrent incisional hernias. These hernias frequently require some type of abdominal wall reconstruction where one is going in and separating out the muscle layers and placing a piece of mesh in between the muscle layers which affects a very good repair on these hernias.
So with regards to mesh placement we’ve talked about mesh and there are many different types of mesh made from many different types of materials.
You’ve probably heard or read about mesh and litigation associated with it.
Mesh repairs in this country are pretty much the standard of care. Mesh reduces the recurrence rates by as much as 10 fold so someone who’s got a fairly routine inguinal hernia, if you use mesh, the recurrence rates are somewhere in the neighborhood of 0.5 percent. If you do not use mesh the recurrence rates are closer to 5 percent. That may not seem very much but statistically it’s a tenfold difference so with regards to these hernias mesh is the way to go.
Approximately 80% if not more of the hernias that I do are done with the da Vinci robot. The robot is just a little bit of a different human interface compared to the routine laparoscope. With the laparoscope you have a monitor that’s sitting a few feet away from you and you have these laparoscopic instruments within the abdomen dissecting out the hernia and placing the mesh.
With the robot you are several feet away from the patient. The surgeon is in a console and the screen that the surgeon is looking at is three-dimensional high-definition, so you really get a good look at the anatomy and the surgical field. I think this is a fairly new technology, it’s just been around for a few years and it’s promising to give much better results than either with an open repair or with a laparoscopic repair.
That is not to say that all hernias should be done with the robot because there are clearly some that this should not be done and these patients are not candidates for that procedure. In that case we would do an open procedure which would require an incision and very likely the patient would need to spend a few days in the hospital compared to when you’re using the da Vinci technology patients usually go home the same day if not usually within 24 hours.
So because we’re using the robot specifically the da Vinci system for repair of these hernias there are three or four small incisions usually measuring ten millimeters or less compared to an incision that may be 15 or 20 centimeters for an open procedure so the patient can heal faster can get back to work sooner and have lower recurrence rates compared to some of the other type of procedures that we would do.
So not all patients are candidates for the robot. If a patient’s abdomen has been entered several times sometimes it’s extremely difficult to introduce the instruments safely into the abdomen and under those circumstances the patient would require an open procedure.
So one of the more interesting aspects of what I have to do with a Facebook group called the International Hernia Collaboration. This is the largest private group on Facebook. It numbers about 7,000 surgeons from all over the world and the interesting thing about this is you can go on and post your case, x-rays, history, physical examination and get the input from hundreds of people from all over the world as to how this problem needs to be approached.
If you’re a new patient to the practice you come in and get a chance to sit down with me and talk and I examine you and try to figure out what would be the best operation for you at that point we’ll get you scheduled over at the hospital or the outpatient facility just depending on what best fits your needs.
So on the day of surgery you’ll come in usually a couple of hours before the scheduled time then the nurses will get you plugged into the system they’ll start IVs so after I’ve seen you in the pre-op area and make sure all your questions are answered before we go back the anesthesiologist will then take you back to the operating room, put you to sleep under general anesthesia you will then be prepped and draped and the procedure will begin.
These procedures depending on the complexity of the repairs can last an hour and a half to maybe three or four hours.
After the procedure is done you’ll have a binder placed on you in the operating room and this is an abdominal binder that just provides a little compression and support and then you’re brought back to the recovery room. You’ll be there for approximately two hours if you’re planning on going home, and if not, after two hours you’ll be transferred up to one of the beds in the hospital. The decision process as far as discharge really has to do with how complex the surgery was, how much dissection was needed to get the mesh properly in place and if things have gone fairly smooth and straightforward then the likelihood of you going home is extremely high. Very few patients get admitted overnight.
So when you’re discharged to home you can expect to be up and around the next day you can walk as much as you want the big no-no as far as recovery is lifting, so I ask patients not to do any heavy lifting greater than 15 pounds and that could be for a month or it could be up to six months depending on what type of repair we did.
So I ask patients when they go home to advance their own diets to whatever they feel comfortable eating.
As far as driving again that depends on the type of hernia repair. For the smaller ones you can expect to be driving within two or three days, for the larger repairs that have taken a few hours you can expect probably a week or so before you’re able to get back behind the wheel and that is all just dependent on the patient how comfortable they are and how mobile they are in the post-operative period.
So I hope this video has answered most of your questions. If not I’m very happy to see you in consultation where we can figure out what’s going on with you and the best procedure for you whether it be the da Vinci technology to repair your hernia or whether it’s an open procedure.
There is no standard approach to these hernias. The surgery that I do is individualized for each patient and their unique problem.
I appreciate you watching and hopefully I’ll have the opportunity to see you in consultation in the office.