David Thomas, MD, Bariatric and General Surgeon for the Comprehensive Center for Weight Loss who practices at Baptist Health System talks about gastric bypass surgery that is done robotically and what that means for patients.
Interview conducted by Ivanhoe Broadcast News in May 2018.
Explain the surgery in a nutshell and how this helps people.
Dr. Thomas: The surgery is called gastric bypass, it’s done laparoscopically or robotically through small incisions. It involves making a pouch out of the stomach so patients feel full quickly and don’t eat as much. And then bringing a limb of intestines up to meet that pouch and effectively the stomach is bypassed and you don’t absorb food quite as well either. So you lose weight in two aspects. You can’t eat as much and you feel full quickly and you don’t absorb food quite as well.
So how does this interact with the gut hormone or how is this groundbreaking and what’s different about it?
Dr. Thomas: A couple of things are groundbreaking. One, the surgeries are all done laparoscopic or minimally invasive with a robot. The robot technology is pretty new and pretty innovative. It’s an amazing thing to see in person, it really does help the patient recover a lot faster. They’re up and moving very quickly after surgery and the pain is a lot less so that’s one aspect. Another aspect is the sleeve gastrectomy is the newest operation that we offer, one of the most popular ones in the United States being offered right now. And really it influences the gut hormones by eliminating the hormone called ghrelin and making patients not feel full or not feel hungry as often. Their appetite is not stimulated quite as much and they don’t eat as much as a result.
What’s the connection between what the robot does it and the patient healing more quickly?
Dr. Thomas: The robot technology allows me to sit at a console, it allows me to operate through the hands of the robot which ideally does not cause as much trauma to the patient. The robot operates around a pivot point so the abdominal wall of the patient is not manipulated so much. And that allows for quicker healing is the thought behind that.
If you were doing it and not the robot what would be the difference?
Dr. Thomas: If I was doing it when you’re standing next to a patient you tend to lean on a patient a little bit, you manipulate the incision sites a little bit differently as compared to a robot you know it operates around a single point and it’s fixed. When you hold on to the trocars instead of the robot you may manipulate it a little bit differently. That influences a patient’s pain and helps with the recovery time.
The trocars; are those the chopstick extensions?
Dr. Thomas: Similar to that, they’re like the hands that we use to operate through, correct yeah.
So a robot doesn’t get tired, doesn’t get emotional, doesn’t lean on the patient, what else doesn’t it do?
Dr. Thomas: Well the nice thing about the robot is the vision is much better than typical laparoscopic surgery. You have 3-D, 1080P vision through the robots eyes, the hands are also very dexterous so you have wristed movement. You can control and sew many times better than you would be able to do otherwise.
So paint a visual picture and then I need to get video or some pictures of you doing this. Are you sitting at a console, are you one off from the OR, where are you?
Dr. Thomas: You’re located physically in the same room as the patient. But there is a console off to the corner and you sit and look in to the console and then you put your hands in the console and you are able to manipulate. And it’s connected to the patient and the robot is sitting above the patient and the trocars are inside.
If you for example get in the middle of this and you sneeze what does the robot do?
Dr. Thomas: It really depends on whether you have your head in the console. It has this sensitivity where if you’re looking at the monitor it detects your head and then your hands must be engaged with the robot to actually move the instruments. So if you were to sneeze you could pull your head back essentially and do whatever you needed to do. The robot stays in the exact same position until you engage with the machine again.
Is the robot mind melting with you or you just are manipulating the trocars?
Dr. Thomas: It’s not mind melted, you still have to go about your normal thought process that you would engage in during a surgery. It doesn’t do it for you but it does help quite a bit.
Are you at that stage where you’re thinking, okay buddy I’m still going to do the thinking for you?
Dr. Thomas: I still want to do the thinking. At this point it’s an assistance and it helps a lot but it doesn’t do the job for you yet. I think one day we may be there though.
The very first time that you did this via robotic surgery what was going on in your head?
Dr. Thomas: What was going on in my head, mostly wow this is pretty amazing that we can do this now. The robot has a lot of benefits that it offers the surgeon. It’s potentially a way to prolong your career because you’re not standing it’s not so stressful on you as a person. But it’s a pretty amazing technology. I mean it really does some amazing things.
What’s the delay on your end and the robot?
Dr. Thomas: It’s near instantaneous there’s not much delay. I’m sure if you were to measure it in terms of milliseconds there is some delay but it’s pretty quick.
How long did it take you to get used to doing it and when you went in and said, oh this is second nature?
Dr. Thomas: I still don’t think that I’m quite there yet. There are those cases that are pretty straight forward and easy and they go according to plan and you don’t have to spend too much time worrying and thinking. But the night before I’m going to be in the operating room I still run through steps in my mind, I still try to plan what I’m going to do and I still think about every single thing. Maybe one day I’ll be there when I’ve been doing this for ten or fifteen more years but not quite yet I don’t think.
I love what you just said because it’s very seldom that I hear a physician admit or say that. So walk us through the night before, what exactly are you thinking?
Dr. Thomas: For most operations it’s broken down in to a series of steps. The first part would be the patient goes to sleep and then you gain entry to the abdomen. So in some way you have to get your instruments inside without causing injury to anything else that you’re trying to work on. So there are techniques to do that. You get entry in to the abdomen and then you begin placing your trocars that you’re going to use for the surgery. You want to think about what part of the body you’re trying to operate on and you have to provide a good view of that part of the body. So for instance if you’re operating on the stomach your trocars will be placed in a completely different area than say you’re operating on the gallbladder or you’re operating on the small intestines. So the thing about a sleeve gastrectomy is it’s mostly operating on the stomach. A gastric bypass is operating on a combination of the intestines and the stomach. And so the trocars are placed a little bit differently for those two it’s kind of similar but a little bit different. And then you’re working through the steps. For instance, a gastric bypass the first part would be to go down to the intestines and divide at a certain point. I’m thinking how far I go or how I mark it, how I divide it and how I make the connections. I’m running through the steps. Kind of I would imagine similar to like an airline pilot thinking about take off, landing, you know where they’re going that sort of thing.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Natalie Gutierrez, Baptist PR
210-297-1028
Natalie.Gutierrez@baptisthealthsystem.com
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