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A new gallbladder surgery, performed through a single incision in the navel, hastens recovery and eliminates visible scarring

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When a gallbladder hurts from gallstones or other causes, the best option almost always is surgery. Gallbladder removal is one of the most common surgeries performed in the United States. Now, a new technique allows surgeons to remove a gallbladder through a single incision in the navel, making patients' recovery times faster and leaving no visible scar.

  The gallbladder's main purpose is to produce bile, which aids in digestion. When someone has gallstones or their gallbladder functions poorly, the digestive process is inhibited, which is why patients often associate food with pain from a gallbladder attack. Abdominal cramps, nausea and vomiting are the symptoms most people in need of gallbladder surgery experience. In severe cases, such as when a gallstone becomes lodged in a bile duct, people also may suffer from chills, fever and jaundice. Gallstones, hard masses made of cholesterol and bile salts, are usually the source of gallbladder concerns. Unfortunately, there are no definitive predictors for who will develop gallstones, nor is there a way to prevent them from forming.

  Dr. Chris Casten, a 50-year-old veterinarian from Mandeville, can attest to how painful a gallbladder attack can be. He'd been living with gallstones for some time before one became lodged in a bile duct. "I turned jaundiced (and had) very intense pain," Casten says. He met with Dr. Joseph F. Uddo Jr., a surgeon at East Jefferson General Hospital and one of only 60 surgeons in the country trained to perform single-port gallbladder removal with the da Vinci Robotic Surgical System.

  This type of surgery is called robotic laparoscopic single-incision cholecystectomy. In laymen's terms, that means a surgeon can remove a patient's gallbladder making only one incision instead of four.

  "Traditional laparoscopic surgery for gallbladder removal involves four incisions — a 10mm incision at the belly button and three 5mm incisions across the top of the abdomen," Uddo says. "The scars they leave are small, but you can see them. For single-port surgery, the upper incisions are gone. Cosmetically, it looks great because the incision essentially disappears, and when it heals there is almost nothing visible."

  The da Vinci® is equipped with a 3-D camera that provides high-definition views of the surgery location. "You can zoom in on anatomy and get startlingly close views," Uddo says. "That means we can be more precise during surgery, and I think, ultimately, it will provide more safety."

  Because of the increased precision and the single incision, the instrumentation is less susceptible to movement, resulting in the absence of pain from the upper abdominal area and an easier recovery. Many patients return to work within a week.

  Casten had even better results. "The next day I actually was back to work," he says. "I did a half a day. Had some minimal abdominal discomfort for a few days, but ... it just felt like someone doing too many sit-ups."

  Although gallbladder's role is more substantial than, say, the appendix's, the body adapts to the organ's absence fairly easily. "The gallbladder stores bile and bile is made in the liver," Uddo says. "In a healthy, functioning gallbladder, it pours bile into the intestines. When you no longer have a gallbladder, the main bile duct and the bile in the liver take over. People feel much better after surgery."

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