Urologist is first in the world to use robot-assisted surgery to repair rare defect

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A urologist at Wake Forest University Baptist Medical Center is the first in the world to repair a rare type of hernia using robot-assisted, minimally invasive surgery. The surgery required only an 18-hour hospital stay; typically, the repair involves major surgery and three to five days of hospital care.

Ashok K. Hemal, M.D., a professor of urology, used the robot to repair a uretero-sciatic hernia, which is an abnormal opening in muscle tissue in the pelvis. In this patient's case, one of the tubes (ureters) that drains urine from the kidney to the bladder was lodged in the opening and became kinked. The condition is extremely rare and has been reported in fewer than 25 people worldwide. It resulted in poor kidney function and persistent pain.

Hemal released the ureter from the opening, inserted a stent in the ureter to keep it from re-kinking and repaired the hernia. All steps in the 80-minute procedure were performed with Hemal sitting at a surgical console and controlling centimeter-size surgical instruments.

With robot-assisted surgery, the instruments and a small camera are inserted through four centimeter-size incisions in the abdomen. The surgeon controls the four robotic arms with hand and finger movements while viewing the surgical site on a screen. The instruments are modeled after the human wrist and allow for full dexterity. The tiny instruments - as well as the ability to see the surgical site at tenfold magnification - allow for very precise, refined movements.

The advantages of the minimally invasive procedure include less blood loss, a shorter hospital stay and a quicker return to normal activities. The patient's symptoms were relieved and her kidney function was improved.

Hemal is a pioneer in robot-assisted surgery and helped develop many of the surgical protocols in use today. At Wake Forest Baptist, he uses the technology for surgeries of the prostate, kidney and bladder as well as for female pelvic organs. He recently reported having the world's largest experience using the technology to repair fistulas, or abnormal openings between the bladder and vagina. He has also published reports comparing robot-assisted surgery with conventional surgery for cases of kidney cancer and also is also a world leader using robot-assisted and laparoscopic surgery to manage bladder cancer.

Hemal is director of the Robotic and Minimally Invasive Urologic Surgery Program at Wake Forest Baptist. He is a fellow in the International College of Surgeons, the American College of Surgeons and the National Academy of Medical Sciences.

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