Robotic Surgery Explained

Screen Shot 2017-10-10 at 12.35.38 PMRobotic surgery is a type of minimally invasive surgery. “Minimally invasive” means that instead of operating on patients through large incisions, we use miniaturized surgical instruments that fit through a series of quarter-inch incisions. When performing surgery with the da Vinci Si—the world’s most advanced surgical robot—these miniaturized instruments are mounted on three separate robotic arms, allowing the surgeon maximum range of motion and precision. The da Vinci’s fourth arm contains a magnified high-definition 3-D camera that guides the surgeon during the procedure.

The surgeon controls these instruments and the camera from a console located in the operating room. Placing his fingers into the master controls, he is able to operate all four arms of the da Vinci simultaneously while looking through a stereoscopic high-definition monitor that literally places him inside the patient, giving him a better, more detailed 3-D view of the operating site than the human eye can provide. Every movement he makes with the master controls is replicated precisely by the robot. When necessary, the surgeon can even change the scale of the robot’s movements: If he selects a three-to-one scale, the tip of the robot’s arm will move just one inch for every three inches the surgeon’s hand moves. And because of the console’s design, the surgeon’s eyes and hands are always perfectly aligned with his view of the surgical site, minimizing surgeon fatigue.

The ultimate effect is to give the surgeon unprecedented control in a minimally invasive environment. Utilizing this advanced technology, surgeons are able to perform a growing number of complex surgical procedures. Since these procedures can now be performed through very small incisions, patients experience a number of benefits compared to open surgery, including:

  • Less trauma on the body
  • Minimal scarring
  • Faster recovery times

If you’re facing general or bariatric surgery in the Las Vegas area, contact VIP SURG to learn about how we can help. Drs. Tsuda and Ryan specialize in minimally invasive procedures and are experts in robotic surgery. Call for a consultation at 702-487-6000.

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LINX: Treating GERD with Innovation

A hiatal hernia occurs when part of the stomach pushes through the diaphragm. The diaphragm normally has a small opening for the esophagus. This opening can become the place where part of the stomach pushes through. Small hiatal hernias often cause no symptoms, while larger ones can cause pain and heartburn, leading to gastroesophageal reflux disease, or GERD. In 2012, the Food and Drug Administration approved a new treatment device called the LINX Reflux Management System to offer a new approach to treating GERD, a disease that is increasing at a rate of 30 percent every decade.

Think of the stomach as a mixing bowl that allows food and digestive juices to combine to begin the digestive process. The stomach has a protective lining that prevents acid in the digestive juices from eating away at the stomach muscle and causing inflammation. Unfortunately, the esophagus does not have a similar protective lining. Instead it relies on the lower esophageal sphincter (LES) to act as a valve to prevent acid from refluxing from the stomach into the esophagus. In the situation of a hiatal hernia, part of the stomach pushes up through the opening allowing acid to pass into the esophagus causing symptoms may include the following:

  • heartburn
  • nausea, vomiting, or retching (dry heaves)
  • burping
  • water brash, the rapid appearance of a large amount of saliva in the mouth that is stimulated by the refluxing acid

Symptoms usually are worse after meals. These symptoms may be made worse when lying flat and may resolve with sitting up or walking.

In some patients, reflux into the lower esophagus sets off nervous reflexes that can cause a cough or even spasm of the small airways within the lungs (asthma). A few patientsanatomy-archers may reflux acid droplets into the back of their throat. This acid can be inhaled or aspirated into the lung causing coughing spasms, asthma, or repeated infections of the lung including pneumonia and bronchitis. This may occur in individuals of all ages, from infants to the elderly.

Fortunately, the innovative LINX procedure is helping with this significant health problem. This device is a series of magnets in the form of ring that is implanted around the bottom of the esophagus during a short, 40-minute laparoscopic procedure.

The ring of magnets is designed to stay closed and prevent the reflux valve from opening thereby preventing acid from the stomach move up into the esophagus. The magnets will open up the ring when people are eating to let food in much like a person’s native reflux valve.

 

Here are some things you need to know about the LINX procedure.

  • It is focused on the underlying cause of reflux disease not the side effect. Reflux disease is a result of a damaged lower esophageal sphincter (LES).
  • It is safer than the long-term use of proton pump inhibitors (PPIs). Studies have proven that reflux disease can progress even when PPI therapy has effectively eliminated GERD symptoms. LINX is effective at reducing symptoms and improving quality of life.
  • A recent study published in the New England Journal of Medicine tracked 100 patients for three years after their LINX surgery. That study found an overall decrease in stomach contents reaching the esophagus, fewer reflux symptoms, and a substantial reduction in PPI usage.
  • The side effects disappear over time in most cases. Initially, most patients experience some discomfort, but it typically dissipates over several weeks. In addition, the most commonly reported side effect is mild difficulty swallowing, which usually subsides over time.
  • The cost can be much less than a lifetime of PPI use: a 2010 study by Consumer Reports found once-a-day PPI use can range from $2,000 to $4,500 per year for brand name prescription PPIs.
  • This is minimally invasive and is performed as an out-patient procedure.
  • LINX is reversible and can be replaced.
  • Since the LINX band is placed around the LES, the device can be removed or replaced, if necessary.
  • This procedure is recommended for those with continued GERD symptoms under maximum therapy prescribed by a specialist.
  • LINX is not for everyone with advanced GERD. Today LINX is not approved for those with Barrett’s Esophagus or anyone suffering from esophageal cancer. It is important for everyone suffering from advanced stages of reflux disease to explore all available options before their disease progresses to the point where options are limited.

It is important to take your heartburn symptoms seriously because they are signals from your body that something is wrong. Since reflux disease is a progressive chronic condition, treating it early could prevent you from having to consider surgery later on.

As the first LINX trained surgeons in Las Vegas, Dr. Shawn Tsuda and Dr. Heidi Ryan at VIP SURG are ready to help you fight back against gastroesophageal reflux disease. Schedule a consultation to learn more.

 

 

Heartburn or GERD – It makes a Difference

Acid reflux occurs when stomach contents moves backward into the esophagus. It’s also called acid regurgitation or gastroesophageal reflux (GERD). Acid reflux is a common digestive condition. According to the American College of Gastroenterology, more than 60 million Americans experience acid reflux at least once a month. More than 15 million Americans experience it every day.

Acid reflux usually causes a burning sensation in the chest. The sensation radiates up from the stomach to the mid-chest or throat. This is also known as heartburn. When symptoms that seem like heartburn persist, it could be a disease with more serious consequences. Chronic reflux can sometimes lead to difficulty swallowing and in some cases it can even cause breathing problems like asthma.

Acid reflux is caused when the muscle at the end of the esophagus, the lower esophageal sphincter (LES) is faulty or weak. The LES is a one-way valve that normally opens for limited amounts of time when you swallow. Acid reflux occurs when the LES doesn’t close properly or tightly enough. A faulty or weakened LES allows digestive juices and stomach contents to rise back up into the esophagus.

Large meals that cause the stomach to stretch a lot can temporarily loosen the LES. Other factors associated with reflux include:

  • obesity
  • stress
  • hiatal hernia (when part of the stomach pushes up through the diaphragm)
  • consuming particular foods (particularly carbonated beverages, coffee, and chocolate)

Most people experience occasional acid reflux or GERD. However, in some cases the digestive condition is chronic.

Acid reflux can affect infants and children as well as adults. Children under 12 usually don’t experience heartburn. Instead they have alternative symptoms like:

  • trouble swallowing
  • dry cough
  • asthma
  • laryngitis (loss of voice)

These alternative symptoms can also appear in adults.

Gastroesophageal Reflux Disease (GERD) is a chronic digestive disease. It’s the more serious form of GERD and can eventually cause more serious health problems if left untreated. Acid reflux that occurs more than twice a week and causes inflammation of the esophagus is considered to be GERD.

Most people with GERD experience symptoms such as:

  • heartburn
  • regurgitation
  • trouble swallowing
  • a feeling of excessive fullness

Living with acid reflux is inconvenient. Fortunately, symptoms can generally be controlled through:

  • stopping smoking
  • reducing alcohol consumption
  • eating less fat
  • avoiding foods that set off attacks
  • losing weight
  • sleeping in different positions
  • antacids
  • anti-reflux medication
  • surgery

Most people with reflux will not have long-term health problems. However, GERD can increase the risk of Barrett’s esophagus. This is a permanent change in the lining of the esophagus which increases the risk of esophageal cancer.

If you suffer from GERD that isn’t responding to treatment, schedule an appointment with Dr. Shawn Tsuda to learn about LINX http://www.linxforlife.com/. This could be the answer you’ve been searching for.

Stethoscope on notebook and pencil with GERD (Gastroesophageal R

 

Tips for Choosing the Right Surgeon for You

Whether you need a complicated, invasive surgery or a simple out-patient operation, choosing the right surgeon can seem overwhelming. Even what should be relatively straightforward procedures such as gallbladder removal or hernia repair can sometimes result in serious complications, so you always want to be in good surgical hands. Here are some tips on finding the surgeon and hospital that are best for your situation.

Once you have narrowed down your list of potential surgeons, schedule a consultation. If you have a fairly urgent need for surgery, you may have to cross surgeons off of your list purely because of the wait for a visit. Otherwise, plan to meet with at least two surgeons and discuss your potential surgery.

Things to ask:

  • Is surgery necessary? The best way to avoid surgical errors is to avoid surgery entirely, so ask about the effectiveness and safety of alternatives. Compare those with the risks of surgery and the chance that it will help you.
  • Is your board certification up-to-date? Look for a surgeon who has undergone the necessary training, even after being in clinical practice, to maintain board certification in his or her specialty.
  • What’s your experience? Ask how many operations the surgeon has performed in the past year and how that compares with his or her peers.
  • What are your success, failure, and complication rates? Not all will be able or willing to tell you, but the good ones should.
  • What’s the hospital’s infection rate?
  • Does the hospital follow best practices? The federal Centers for Medicare and Medicaid Services tracks how frequently hospitals give antibiotics on schedule, control blood sugar in heart-surgery patients, prepare skin properly before incisions and take other steps proven to help prevent surgical complications.Make the right choice.

You may be expected to schedule a surgery at the end of the consultation. If you are not confident that you have found your ideal surgeon, do not schedule the surgery. Either way, it’s fine to ask for a day to consider everything the doctor has said before making the surgery official.

If the surgeon you consulted with is not your ideal surgeon, schedule a consultation with a different surgeon. Even if you think the first surgeon is your best choice, a second opinion from another surgeon can be valuable. Most types of insurance will allow for two or three consultations. If you believe you have found your ideal surgeon you can schedule your surgery, confident in your decision.

If you’re looking for an experienced general surgeon in the Las Vegas area, Dr. Shawn Tsuda specializes in minimally invasive surgical techniques including the laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric band, sleeve gastrectomy, foregut surgery, ventral and inguinal hernia repairs, endoscopy, and basic laparoscopy. Schedule a consultation to learn what he can do for you.

 

 

Hernias and Surgery

Anyone who sews or does even simple crafts or carpentry knows that for a project to be well made, the seams have to be just right so that they don’t pull apart.

Our bodies are like that too. If our numerous “seams” aren’t made just right, they can pull AdobeStock_117491372 (3).jpgapart and let body parts slide into places they don’t belong. The abdomen is surrounded by muscles to keep the stomach, small intestine, and colon where they belong, but if one of these organs starts to slip though a weakness or a hole in the muscles, it’s called a hernia.

Other parts of the body can have organ herniation too. By definition, a hernia is a bulge or protrusion of an organ through a muscle or other structure that normally serves to keep it contained. However, when people talk about hernias, they are usually talking about the abdomen. While there are many types of abdominal hernias (hiatal, umbilical, or incisional), mentioning a hernia usually means they are talking about one in about the groin.

Risk factors for developing a hernia include:

  • family history
  • premature birth
  • chronic cough
  • constipation
  • lifting heavy weights
  • being overweight
  • smoking
  • Pregnancy

Surgery is often the only way to truly repair a hernia. Hernia repair can be done using traditional open surgery or minimally invasive surgery.

Open Surgery: With open surgery, a large incision is made in your abdomen that allows your surgeon’s hands to reach and touch your organs.

Minimally Invasive Surgery: Minimally invasive surgery is also known as laparoscopy. It is done through a few small incisions using long, thin surgical instruments and a tiny camera. The camera takes images inside your body and sends them to a video screen in the operating room to guide doctors during surgery.

da Vinci Surgery is another minimally invasive surgical option for adult patients facing abdominal hernia surgery. The da Vinci System features a magnified 3D HD vision system and special wristed instruments that bend and rotate far greater than the human hand. da Vinci technology enables your surgeon to operate with enhanced vision, precision, and control.

Early clinical data suggests: da Vinci Ventral Hernia Surgery offers the following potential benefits:

  • Low rate of pain
  • Low rate of the hernia returning
  • Low rate of surgeon switching to open surgery
  • Short hospital stay

Your doctor controls the da Vinci System, which translates his or her hand movements into smaller, precise movements of tiny instruments inside your body. Dr. Shawn Tsuda is one of a growing number of surgeons worldwide offering da Vinci ® Surgery. Schedule an appointment to discuss the best treatment for you.

Find Out If Minimally Invasive Surgery Can Benefit You

Minimally invasive operating techniques have had a tremendous impact on surgery since the 1990s. Patients who choose these innovative procedures over conventional surgery usually have shorter hospital stays and quicker recovery. This means getting back sooner to the things that are important in life.

These kinds of procedures are not for everyone and only your doctor can determine if a minimally invasive surgery is right for you. These procedures have been proven to be as effective as those of conventional surgery, and more than 20 million Americans have had them.

Not only do these procedures usually provide equivalent outcomes to traditional open surgery (which sometimes require a large incision), but minimally invasive procedures (using small incisions) may offer significant benefits as well:

  • Quicker Recovery – Since a minimally invasive procedure requires smaller incisions than conventional surgery, your body may heal much faster.
  • Shorter Hospital Stays – Minimally invasive procedures help get you out of the hospital and back to your life sooner than conventional surgery.
  • Less scarring – Most incisions are so small that it’s hard to even notice them after the incisions have healed.
  • Less pain – Because these procedures are less invasive than conventional surgery, there is typically less pain involved.

There is a range of conditions that can occur at any point in your digestive tract. While the symptoms of some conditions range from mild discomfort to severe pain, other conditions may have no symptoms at all. Whatever it is you’re feeling, it’s important to talk to your doctor about it, regardless of how minor or embarrassing it may seem. This should include discussion of screening for those conditions that do not have any symptoms.

If you’ve already seen a doctor and have been diagnosed with a condition such as acid reflux/heartburn or hiatal hernia, minimally invasive could be right for you. Contact Dr. Heidi Ryan for a consultation. She can help you find the treatment that is right for you.

Read more online at: http://www.mayoclinic.org/tests-procedures/minimally-invasive-surgery/basics/definition/prc-20025473

laparoscopic surgery

The Laparoscopic Technique

The Laparoscopic Technique | Dr. Shawn TsudaMany surgeries are being done these days without having to use the traditional large incision that leaves large scars and long recovery times. Laparoscopic surgery is the umbrella term that is used for this type of surgery. Laparoscopic techniques have revolutionized the field of surgery with benefits that include decreased postoperative pain, earlier return to normal activities following surgery, fewer postoperative complications, and the added bonus of being virtually scarless. Laparoscopic surgery, sometimes called keyhole surgery or minimally invasive surgery (MIS), is a widely accepted surgical technique that uses small incisions and long pencil-like instruments to perform operations with a camera.

Today, almost all abdominal surgeries are performed laparoscopically including:

  • hernia repairs
  • gastric bypass
  • bowel resection
  • organ removal

Laparoscopic surgery has successfully replaced open surgery as the preferred treatment option for issues such as bariatric surgery and gallbladder removal. The treatment of gastroesophageal reflux disease (GERD) is now also carried out using laparoscopic techniques too.

Laparoscopic surgery is also known as MIS because the surgeon is able to use a laparoscope with a small camera on it to go directly where the surgery is needed. This allows surgeons to find out where or even if a larger incision is needed to perform an operation.

Laparoscopic surgery involves several small incisions, which is why it is sometimes called keyhole surgery. The Laparoscope goes into one small incision and special surgical instruments go into the others. The scope is attached to a video monitor, so the surgeon can see what is going on inside the body part that is being examined.

Because of the less invasive nature of the surgery, laparoscopic surgery recovery time is shorter than that of traditional surgery. Most laparoscopic surgery can be done on an outpatient basis, although depending on the specific surgery, an occasional hospital stay is necessary.

As with any surgery, it is normal to feel tired for a few weeks after a procedure. Your specific recovery time will depend on your physical condition when you went in for the surgery.

If you are considering surgery, contact Dr. Tsuda to see if a laparoscopic procedure is right for you.

Read more online at: http://www.surgery.usc.edu/divisions/tumor/pancreasdiseases/web%20pages/laparoscopic%20surgery/WHAT%20IS%20LAP%20SURGERY.html