St. Marys Journal Argus
About 25 years ago, significant advancements began to be made in the methods used to remove infected gall bladders, with a movement away from a large incision across the abdomen to a set of very small incisions through which surgeons could pass their specialized instruments.
But now another great leap forward has been made in the world of “cholecystectomies” (gall bladder removals), thanks in part to the willingness of St. Marys Memorial Hospital Register Practical Nurse Melanie Sabino to play a role in a first-ever-in-Canada “da Vinci single-site” robotic surgery.
Sabino, who lives in Wellburn, was diagnosed with infection of the gall bladder — a small organ which stores bile from the liver, then passes it on to the intestine so it can be used to break down fatty foods — last spring. She described her case as involving the typical symptons of gall bladder inflammation: Searing pain that felt like it started at her shoulder and then moved towards the centre of her body.
“It felt like I was having a heart attack,” she recalled in an interview last week with the Journal Argus.
Having been referred to London Health Sciences Centre surgeon Dr. Christopher Schlachta, Sabino eventually was booked for surgery on Friday, Sept. 13 (“my mother-in-law was born on the 13th, so we’re not superstitious about it. In fact, it’s a lucky number for us”). She was usually able to manage the pain, in the meantime, by adjusting her diet.
Coming away from her initial consultation with Dr. Schlachta, however, it wasn’t his advice about managing the pain that tweaked Sabino’s interest. Instead, it was an offer to play the role of the patient in what he described as a first-ever-in-Canada cholecystectomy performed by a remotely-control robotic instrument.
According to a news release sent out by LHSC following the Sept. 13 surgery, “Dr. Anthony Gonzalez, chief of surgery and minimally invasive and robotic surgery at Baptiste Hospital in South Florida was one of the first surgeons in North America to perform single-site robotic surgery and has since performed 300 single-site gallbladder removals robotically.”
According to Sabino, what are now referred to as “traditional” laparoscopic (using very small instruments) gall bladder removals “are already, typically, performed without complications, as a day surgery.” And, ever since this technology began to become more common starting about 25 years ago, patients could expected an approximately five-day period of recovery during which they couldn’t do much but rest. They would typically also experience some discomfort from the incisions.
For her Sept. 13 surgery, Sabino still visited to the operating room on a day surgery basis. As with the traditional cholecystectomy, she was under general anaesthetic. But in some very crucial other ways, her surgery was completely different.
“Basically, they fold my belly button out and, with the robot, they put all the instruments they need in through the incision in my belly button.”
“My surgeon wasn’t even standing with me,” she explained. “He was across the room in this little portal working the robot from there. It was like a video game.”
According to the LHSC news release, “this is a whole new world that we plan to apply to even more complex surgeries including colorectal cancer surgery, anti-reflux surgery, kidney surgery, as well as pancreatic and liver surgeries.”
And that was definitely one of the attractions for Sabino when she agreed to offer her own case of gall bladder inflammation as a test for this first-time-in-Canada technology.
“That was definitely something I was interested in . . . Just being in the medical field, working in it on a day-to-day basis, you don’t necessarily get to be a part of such a big change very often. I was excited about it.”
As for the surgeon, she said “I didn’t get the sense that (Dr. Schlachta) was concerned at all.” Afterwards, “he reported that it went as smoothly as he would have expected.”
Sabino added that the surgeon wasn’t aware she was a nurse during the first consultation. But as they continued their communication, he soon noticed that she was comfortable with the terminology, and asked if she had a medical background.
“Nurses aren’t always the best patients. That’s what they say sometimes,” But “he said it made it easier for him because there was a lot of explaining that needed to be done about the procedure.”
For the general public, meanwhile, Sabino says the big attraction for robotic surgeries like this will be promise of the lack of a discernible scar and the increased recovery time. And, in her case, both certainly held true.
“There’s no scar at all. Nothing. It’s all hidden in my belly button.” There were no stitches to remove, and no post-operative care. The surgeon called, just out of interest, on Day 3 of her recovery and she told him she was up and about, getting meals, and doing things around the house. He was thrilled.
For her, the first two days of recovery were uncomfortable but by the third, she was feeling quite well. And the surgeon reported that, with the old procedure, Day 3 is often the worst.
“So even just for recovery time, if someone doesn’t care about having no scars, it’s still a much better way to go.”