Men and Machines

How a skilled surgeon with a robot tackled a Greene County man’s hernia.

By Steve Sullivan and Jason Mortvedt

Dan Towers has vivid memories of his first hernia surgery. It was in 1984 and resulted in a six-inch scar and weeks of pain.

“For the first few days I didn’t want to cough or laugh,” he recalls.

Flash forward to 2014. Towers once again is facing hernia surgery but this time the outcome is much, much different. Hardly any scar. No pain. The difference? This time around, Towers, like so many hernia sufferers, had robot-assisted surgery at Mary Greeley Medical Center.

Minimally Invasive

As Greene County Conservation Director, Towers operates tractors to maintain conservation areas, cleans boat ramps, revs up a chain saw on occasion, and does a variety of other chores that involve heavy lifting. This is an active guy who doesn’t have time to be laid up with another hernia.

“I didn’t really have any discomfort, but there was a bulge that would come out from time to time that I could pop back in,” says Towers describing the reoccurrence his ailment. “I have a history of hernias. I had a repair in 1984 and another one in 2004 so I just assume it’s a hereditary thing, weak abdominal walls or something. It wasn’t a single incident that caused it.”

A hernia is a weak spot or a hole in what’s called the fascia, which is the strong layer of connective tissue in the abdominal wall. An inguinal hernia, which Towers suffered from, is a weak spot in the groin area and is often genetic.

Hernia Repair Surgery

Dr. Loyal Stierlen meets with Dan Towers
before his robot-assisted hernia
repair surgery at Mary Greeley.

“That weak spot gets bigger and bigger over time and stuff from inside your abdomen starts to push out that opening or weak spot. So then you get a bulge down in your groin,” explains Dr. Loyal Stierlen, a general surgeon with McFarland Clinic who did Towers’ surgery.

Stierlen, an Ames native who joined the McFarland staff in 2013, has been doing hernia surgeries for years. He started doing traditional open surgery repairs and then went into minimally invasive laproscopic surgery. He’s now using the da Vinci robot at Mary Greeley.

“I’ve found that all along this path, the reason why I switched approaches was less pain,” Stierlen explains. "With the robotic repairs, both the anterior abdominal wall and the inguinal hernias, we’re having so much less pain than we’ve seen in the past with previous approaches.”

Like laproscopic, robot-assisted surgery is minimally invasive but patients usually experience less bleeding and pain, and a quicker healing period. Robot-assisted surgery involves three small incisions in the abdominal area. A surgeon makes the incisions, and then inserts ports through those incisions. Surgical instruments, including a camera, are inserted through the ports. The surgeon manipulates the instruments at a console that provides high-definition, 3D images from inside the patient’s body. Single-site robot-assisted surgery involves a small incision in the naval.

“You can do so many different things using the robot, because of the articulating or moving hands and the quality of the visualization. The instrumentation is just amazing,” says Stierlen. “You’re able to do the things you do with your hands in a normal situation, like tie knots. Except now you’re doing it, using an instrument inside the abdomen. It really increases our ability to be able to do much more complicated procedures through much smaller incisions.”

No Pain

Tiny scars

Following the surgery, Towers had just
three tiny incisions (about 8 mm wide).

Towers had two previous surgeries to treat hernias, both open surgeries. The hernia on the left side of his groin has reoccurred. Using the robot, Stierlen dissected away section of colon attached to the hernia, which was causing Towers some problems. Using mesh, Stierlen was then able repair the new hernia. The robot enabled Stierlen to repair Towers’ hernia without having to cut through scar tissue from the previous surgeries, which would have caused considerable pain.

“It’s such a nice repair,” Stierlen says of the procedure. “People have been extremely happy with it. I’ve had more than a few patients come back and tell me they never need any pain medication afterwards.”

After the surgery, Towers looked at his three incisions, each less than an inch long, and knew he wouldn’t be experiencing the discomfort of the previous surgeries.

“And I didn’t,” he says. “I never took any pain pills. There were some prescribed but I really didn’t need them. I was very surprised. Dr. Stierlen said it would be like this. But still, I don’t believe it until I see it. But there was really was no after effects of any kind. After two weeks, I pretty much started doing things as normal.”

Well, to be honest, Towers couldn’t resist getting back to his usual routine a little bit sooner.

“I don’t know if I want to tell Dr. Stierlen this but I take care of a cemetery on the side, and there was a burial coming up,” he confesses. “I wanted to at least mow the part of the cemetery where this was, so 24 hours after the surgery, I was out there on the riding lawn mower. I took it slow and easy but I really didn’t have any effects from that. That’s something I never would have dreamt of doing 30 years ago when I had that surgery.”

daVinci in action

We take you inside the operating room with this video featuring Mary Greeley’s robot-assisted surgery program. Watch an actual full-length hernia repair surgery using the da Vinci robot. Viewer discretion is advised.

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