November 14, 2024 • 40 mins
Centered on Health 11-14-24 - Robotic surgery advances in colorectal surgery with Dr. Biruk Almaz
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
I don't know if you know this, but when you
don't have time to read the Washington Post, you can
listen to it. Almost every article has a listening option,
And right now you can become a Washington Post subscriber
for just fifty cents a week. It's an incredible deal.
Stay on top of what's happening by signing up at
Washingtonpost dot com slash pod. That's Washingtonpost dot com slash po.
Speaker 2 (00:27):
D Make someone's holiday unforgettable with a Visio fifty inch
four K SMARTV now just two thirty nine ninety nine
at Target. Experienced stunning clarity that brings movie marathons to
life like never before with Watch free plus build in.
Enjoy free live and on demand TV right out of
the box. Plus dream all your favorite holiday songs with
the iHeartRadio app. Whether it's a gift for the family
(00:49):
or an upgrade to your own setup, this incredible value
delivers four K brilliance without breaking your holiday budget. Get
your Visio fifty inch four kse SMARTV at Target for
just two thirty nine ninety nine Today.
Speaker 3 (01:00):
What's up, Everybody? My name is Sammy John. Tune in
every weekday morning at nine am. Pacific Standard time and
hear my show called The Bridge. And what I do
every weekday morning is I bring you the best of
South Asian music and culture from around the world, and
that includes some of the most exclusive access to the
(01:21):
South Asian music industry. I'll bring you world premieres and
I'll bring you exclusive interviews only on Ruckus Avenue Radio.
Speaker 4 (01:31):
It's now time for Centered on Health with Baptis Help
on US Radio weight forty WJAS. Now here's doctor Jeff Tuk.
Speaker 5 (01:41):
Good evening, everybody, and welcome to tonight's episode of Centered
Ontel with Baptist Help. Here on news radio eight forty whas.
I'm your host, doctor Jeff Cullin. We're joined from the
studio by our producer mister and Ben, who's on standby
to take your calls to talk to tonight's guest. If
you have any questions or you want to call in
(02:02):
and talk to tonight's guest, that phone number is five
h two five seven to one, eight four eight four.
We'd love for you to call in and be part
of the show.
Speaker 6 (02:11):
Tonight.
Speaker 5 (02:12):
We are talking with doctor Baruke Almas. Doctor Almais is
a colo rectal surgeon with the Baptist Hospital Medical Group.
He received his medical medical degree from Saint George's School
of Medicine and did his residency at both Saint Barnabas
Medical Center and Rutgers Health New Jersey Medical School. He
did a fellowship at the Swedish Medical Center Program and
(02:33):
as a colorectal surgeon, Doctor Almas performs many procedures that you,
our listener, may be familiar with, but he also has
bought our community advanced, minimally invasive and robotics assisted procedures
which we are going to learn all about and has
improved all of our patients' lives.
Speaker 7 (02:51):
So welcome to the show, doctor Almis.
Speaker 8 (02:53):
Thanks for having me.
Speaker 5 (02:55):
We're thrilled to have you, you know, welcome, welcome to the community,
and welcome to Baptist. And I wanted to introduce you
because I wanted to start by welcoming you and kind
of have you give us a.
Speaker 6 (03:08):
Little bit of a flavor of you know, what.
Speaker 5 (03:11):
Made you choose this particular socculty surgery and then in
particular holo extal surgery.
Speaker 8 (03:19):
Initially I wanted to go into surgery because of my
upbringing and my family issues. I initially started getting interested
in coloroxial surgery because of my mentors, doctor Trentino and
doctor Guilder, who had a huge influence in me. Chlorocal
surgery encompasses both preventative medicine as well as both benign
(03:45):
and malignant diseases. I was really interested into a minimum basive.
Robotic surgery was becoming very popular when I was getting training,
and I wanted to go into more minimum base of
robotic approaches and and my surgical care.
Speaker 5 (04:04):
Well, we are definitely excited to hear about what you're
doing and what you're bringing to our Louisville community.
Speaker 6 (04:11):
Here.
Speaker 5 (04:12):
You have a little bit of a unique perspective having
trained you know, multiple places in the world. What what
have you brought with you from outside the United States
and what what what's surprising to you about medicine here
or how do you incorporate kind of all of your
training into the kind of practitioner you want to do.
Speaker 8 (04:31):
I think mostly is the diversity of training of XU
UH generally more UH more efficient in terms of how
you take care of patients, understand patients background and also
UH be more caring to patients UH disease process and
(04:52):
what they have gone through. UH and also coming from
you know, born and raised in a third third world country.
I'm very intrigued and interested in economic aspect of surgical
approaches and minimizing the cost of surgery in patients.
Speaker 5 (05:14):
And I know some of the things that you're doing
is actually achieving those goals. So that's really coming full circle,
which is really great, great to hear. We talked a
little bit about it in the intro, and you did
a nice job kind of when you introduce yourself, But
tell us what a typical day is like for colorectal surgery.
What kinds of conditions might you see? We'll get into
some of them later, but in general, what's the day
(05:35):
like for you?
Speaker 8 (05:39):
Mostly I spent my clinic days taking care of patients
from intirectual diseases, hemorrhoids, fissures, pelfect floor disorders, and continence constillations.
I also do screening and diagnostic colonoscopies. I also do
major operations both for benign colon diseases particulaitis also do
(06:01):
major complex procedures for colon and rectal cancer as well.
Speaker 5 (06:07):
And do you do any general surgery or is your
practice now mostly colorectals.
Speaker 8 (06:13):
I mainly focus just specifically for colon and rectal diseases.
Speaker 5 (06:18):
So for those of you listening out there with any
any of these conditions, you know, feel free to call
us and join the conversation.
Speaker 6 (06:26):
So doctor Alma, give us a little bit of an
anatomy lesson here.
Speaker 5 (06:29):
Tell us a little bit about when we say colo rectal,
what what is the colon and the rectum? What's the
large intestine versus the bowels like people throw these terms around.
Give us a small anatomy lesson so our patients in
our listeners and follows.
Speaker 8 (06:46):
Yeah, even though the name sounds colon and rectyl surgery,
we do see some smallbile pathologies specifically IBD, inflimmatory bowel disease,
in Clone's disease, and al sort of client. Regarding the
anatomy of the bow, the bell stars from, of course,
from the mouth all the way down through the esophagus
(07:08):
and the stomach, which are considered as foregut, which continues
to the small bell, which connects to the first portion
of the colon, which is the secum where the appendix
is attached. That then continues to the right side of
the colon, which is regarded as either right colon or
ascending colon, which is sends towards the liver and it
(07:33):
makes a turn which is considered as hepatic fletcher that
continues into the transverse colon and makes another turn at
the spleen, which is considered as the splantic fleccher, and
that continues to the left side of the colon. The
left side of the colon is also considered as descending colon,
which becomes then as shaped which is the sigmod colon,
(07:56):
then continues to become the rectum, which is then attached
to the us worthy bound woman takes.
Speaker 6 (08:02):
It and you handle pathology from all of those.
Speaker 9 (08:08):
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Speaker 1 (09:08):
I don't know if you know this, but when you
don't have time to read the Washington Post, you can
listen to it. Almost every article has a listening option,
and right now you can become a Washington Post subscriber
for just fifty cents a week. It's an incredible deal.
Stay on top of what's happening by signing up at
Washingtonpost dot com slash pod that's Washingtonpost dot com slash po.
Speaker 2 (09:36):
D make someone's holiday unforgettable with a Visio fifty inch
four KSEMARTV now just two thirty nine ninety nine at Target.
Experienced stunning clarity that brings movie marathons to life like
never before with watch free plus built in, enjoy free
live and on demand TV right out of the box,
plus dream all your favorite holiday songs with the iHeartRadio app.
(09:56):
Whether it's a gift for the family or an upgrade
to your own setup, this incredible value delivers four K
brilliants without breaking your holiday budget. Get your Visio fifty
inch four K Smart TV at Target for just two
thirty nine ninety nine Today.
Speaker 3 (10:09):
What's up, Everybody? My name is Sammy John. Tune in
every weekday morning at nine am Pacific Standard time and
hear my show called The Bridge. And what I do
every weekday morning is I bring you the best of
South Asian music and culture from around the world, and
that includes some of the most exclusive access to the
(10:29):
South Asian music industry. I'll bring you world premieres and
I'll bring you exclusive interviews only on Ruckus Avenue Radio.
Speaker 12 (10:38):
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Zoomo to stream music from iHeart nineties Radio is easy.
Or play iHeart Country or hip hop beats your choice
all for free. Stream easy with Zoomo play get live
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(10:59):
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Speaker 8 (11:10):
That is correct mainly from the colon rectum into the ainus,
but also deal with public floor disorders, for example, patients
with severe constipation from public outlet disorders or public weakness
which results into either public prollapse including continents. Also deal
(11:33):
with patients with small bowel diseases from closed diseases or bowelstructions.
Speaker 5 (11:39):
So we could have you on here multiple times to
talk about all those things that you do clearly so
as a gostor nentroologist, which is your your medical counterparts
for colon and rental surgery.
Speaker 6 (11:50):
Here.
Speaker 5 (11:52):
We were originally struggled through the show during the month
of March, which is colon cancer Awareness month. We had
to move it, but I still think taking the opportunity
to have us together, we would be remissed not to touch
briefly just for a few minutes on colon cancer screening
since we both do that, so tell us a little
bit about the burden of colon cancer and what you
(12:12):
see and how colon astroputes can help.
Speaker 8 (12:16):
Certainly, that is correct that March was colon Cancer Awareness month. Unfortunately,
colon cancer is still the second leading cause of cancer
related death, not just in the USA, but also globally
and the general population. The risk of colon cancer is
one in seventeen and in some studies one and twenty,
(12:38):
which is about five to six percent. Colon cancer is
one of the most preventable and preventable cancer death and
with early detection and screening. In general, correctal cancer are
heterogeneous disease that develops the step wise emulation of well
(13:01):
characterized genetic and epigenetic alterations, and most colorectal tumors arise
from Precancero's polyps that are broadly categorized as either traditional
tubular adenoma or as rated polyps, and over time these
polyps increase in size, develop increasingly dysplastic features and changes
(13:24):
in architectural structures, which can eventually acquire invasive potential, which
is what we define as a colon or rectal cancer.
And this is the basis of recommendation for screening and
also doing removal of polyps to halt the progression of
polyps to becoming malignant or invasive cancer. The current recommendation
(13:48):
of screening is to start at age forty five and
continue until age seventy five. For those with high risk
including family history of colon cancers or personal history of polyps.
Specific diseases like IBD which are inflammatory about diseases and
genetic mutations may need to start screening earlier or have
(14:09):
more frequent screening. We do have a few acceptive accepted
modalities for screening, including kronoscopy, FIT tests which is a
fecal immunochemical tests, also DNA test, CT chornography, and flexible sigmatoscopy,
(14:29):
and I think there's a few potential features for circulating
DNA tests to be possibly potential screening modalities as well.
Speaker 5 (14:40):
Well. I have to tell you, doctor Amas, I had
about ten questions prepared for you with regards to colon
cancer screening, and you answered all of them in that
beautiful answer that you just cave. So thank you for
being so comprehensive, and I hope everybody was listening because
as you said, it's preventable and we have not just
more than we have more than one way to find
(15:01):
them and treat it and prevent it. So you are
listening to doctor Baruch Alms. We're talking about colorecrofurgery and
robotic surgery here on centerate on Health. You're listening to
Center on Health with Baptist Health on news radio eight
forty wh as. Our phone numbers five oh two, five
seven one, eight four eighty four.
Speaker 6 (15:19):
If you'd like to call in.
Speaker 7 (15:20):
And join the conversation, we'll be talking to you after
the breaks.
Speaker 5 (15:39):
I want to welcome you all back to centert on
Health with Baptist Health here on news radio eight forty whas.
I'm their host, doctor Jeff Covlin. And if you're just
tuning in or if you're joining us in our show,
we're talking tonight with doctor Baruch Alms, who is at
the Baptist Hospital Medical Group. He is a colorecro surgeon
and he's talking to us tonight about us to surgery
(16:00):
and robotic surgery and.
Speaker 6 (16:02):
Minimally invasive surgery.
Speaker 5 (16:04):
I want to remind you that our phone number is
five oh two, five seven one eight four eighty four,
and our producer, mister Jensen is on standby to take
your calls, Doctor Almas. Before the break, we just went
over some calling cancer screening advice, and I want to
get into some of the meat of kind of what
(16:24):
you do and what you're bringing to our community. So
before we get into sort of the robotics and all
the fancy stuff, talk to us a little bit about
some terms that I think we hear thrown around, Like
what does laperous topic versus open What do those two
terms mean and how does it impact both the type
(16:44):
of surgery somebody has and recovery.
Speaker 8 (16:48):
Yes, the traditional surgery, the open surgery is a more
invasive approach where we make an incision, bigger incision to
enter the optimen to expose both the bowels and also
abdominal contents, compared to the minimum invasive approach, which is
(17:10):
a key hole procedure where we make small decisions to
place laparoscopic camera and also place laparoscopic instruments without making
a major incision. This allows us to operate without exposing
the bowel into the environment and also be able to
reach the pulvis or areas where it's hard to visualize
(17:35):
with open surgery. This minimizes the post operative pain hospitals
say post operative complications including woon inflections, hernia rate and
also reoperative rate.
Speaker 5 (17:50):
And so minimally invasive and laparoscopic are they the same term?
Speaker 6 (17:56):
Or is minimally is lap.
Speaker 5 (17:58):
Of stopic one part of a minimum minimumly invasive approach.
Speaker 8 (18:04):
Minimum invasive is an umbrella term which we use for
both laparoscopic and robotic surgery. Robotic surgery and laposcopic surgery
are pretty much similar to each other, but the platform
is slightly different. We make similar kind of incisions. When
we do laparoscopic, we have the freedom of where we
put the incisions. When it comes to robotic surgery, we
(18:27):
use the robotic platform to be able to mobilize and
do our surgery.
Speaker 5 (18:36):
And we're going to we're going to delve into that
in a minute. We'll want to hear more about that.
You know, we've we've had some general surgeons on our show,
and I work with plenty of general surgeons that do
laposs topic and some of these techniques. When do you
think I always like for our listeners to get a
sense of, you know, what type of doctor they might
(18:56):
want to see for certain conditions. When do you recommend
things to be done with general surgery versus colorectal surgery
specifically trained.
Speaker 11 (19:04):
Is there a.
Speaker 5 (19:07):
Way that you think about that in your practice.
Speaker 8 (19:11):
I think it's mostly surgeon dependent and experience dependent. However,
if it's more advanced cancer specific UH colorectal related diseases,
of course it will be better to be taken care
of with a specialist who have a more experienced UH
and take care of those diseases and further training. However,
(19:34):
you know, the the outcome with a very experienced general
surgeon and a correctal surgeon might be pretty much the same.
We do have data and studies looking at colon cancer
outcomes based on general surgery versus a correctal surgeon, and
the outcome is superior if it's performed by a corectal surgeon.
(19:57):
And this has to do with the with the training
and being up to date in taking care of those
disease process.
Speaker 5 (20:05):
Well, that's that's an interesting statistic. So thanks for sharing
that with us. So let's you can imagine, you know,
we're we're here, we're listening to you talk and we
hear the term, you know, robotic, and we're thinking, you know,
sci fi kind of stuff here. So give us a
picture of what the robot is, and what does the
room look like? And how is it set up? What
(20:28):
are we what is the robot?
Speaker 8 (20:32):
So the robot have a few parts. Initially, the procedure
starts similar to leaparoscopic, placing small incisions over the obdomen
and placing ports which are access to the optimen. We
insufflate the obdomen with carbon dioxide to be able to
gain access to the obdomen and ssfly explore the abdominal contents.
(20:56):
We then proceed attaching the robotic arms into these ports.
The surgeon then sits on a console which have which
controls those robotic arms, which then translates into using those
arms to be able to perform more precision and uh
(21:19):
challenging cases with with safe dis sections.
Speaker 6 (21:27):
So are you the one who's actually driving the robots? Though?
Speaker 5 (21:31):
Right, it's not automatic where you say, take out the
appendix and it takes out the dependence.
Speaker 6 (21:36):
You're you're driving this and doing the Certainly.
Speaker 8 (21:40):
Maybe the future will be there, but.
Speaker 5 (21:45):
Right so you're not in California on the beach telling it.
Speaker 6 (21:48):
To do it in Louisville, Kentucky. Right, that's not.
Speaker 8 (21:52):
Not not at this time that the future probably will
go there. But at this time we are controlling the
robotic arms. It's just giving us more and more increased
dexterity and more precision. And uh, the surgeon is sitting
when operating, so you can do a very long, tedious operation,
uh and more comfortable sitting and uh. The robot also
(22:16):
gives you a more a three D kind of view
to be able to do more uh, have a more
precision surgery, especially when you do complex councer operations and
operating and very deep pulvis for rectal counters and rectal
cot lapses.
Speaker 5 (22:37):
Well, we're going to get back to some more about
this robot and a little bit.
Speaker 6 (22:40):
We do have a caller on the line.
Speaker 5 (22:43):
Anthony is calling in with a question about medicine that
he's on for his poland Anthony, are you there. You
are on with doctor Almas and welcome to Centered on Health.
Speaker 11 (22:54):
Yes, yes, doctor Almah, I've heard problems. I'm sixty three
years old and I've had cold problems since my mid twenties.
And if player's up on occasion and then I'm good.
Speaker 4 (23:12):
Black Friday is coming. And for the adults in your life.
Speaker 9 (23:15):
Who love the coolest toys, well there's something for them
this year too. Bartisian is the premiere craft cocktail maker
that automatically makes more than sixty seasonal and classic cocktails
each and oun of thirty seconds at the push of
a button. And right now Bartisian is having a huge
sight wide sale. You can get one hundred dollars off
any cocktail maker or cocktail maker bundle when.
Speaker 10 (23:37):
You spend four hundred dollars or more so, if the
cocktail lover in your life.
Speaker 9 (23:41):
Has been good this year or the right kind of bad,
get them Bartisian at the push of a button, make
bar quality Cosmopolitans, Martini's, Manhattan's, and more, all in just
thirty seconds, all for ae hundred dollars. Amazing toys aren't
just for kids. Get one hundred off of cocktail maker
when you spend four hundred. Through Cyber Monday, visit Bartisian
(24:05):
dot com slash cocktail. That's b A R T E
s I A n dot com slash cocktail.
Speaker 1 (24:13):
I don't know if you know this, but when you
don't have time to read the Washington Post, you can
listen to it. Almost every article has a listening option,
and right now you can become a Washington Post subscriber
for just fifty cents a week. It's an incredible deal.
Stay on top of what's happening by signing up at
Washingtonpost dot com slash pod. That's Washingtonpost dot com slash Po.
Speaker 2 (24:40):
D Make someone's holiday unforgettable with a Visio fifty inch
four KSEMARTV now just two thirty nine ninety nine at Target.
Experience stunning clarity that brings movie marathons to life like
never before with watch free plus build in. Enjoy free
live and on demand TV right out of the box.
Plus dream all your favorite holiday songs with the iHeart
(25:00):
Radio app. Whether it's a gift for the family or
an upgrade to your own setup, this incredible value delivers
four K brilliance without breaking your holiday budget. Get your
Visio fifty inch four K Smart TV at Target for
just two thirty nine ninety nine Today.
Speaker 3 (25:13):
What's up, Everybody? My name is Sammy John. Tune in
every weekday morning at nine am Pacific Standard time and
hear my show called The Bridge. And what I do
every weekday morning is I bring you the best of
South Asian music and culture from around the world, and
that includes some of the most exclusive access to the
(25:33):
South Asian music industry. I'll bring you world premieres and
I'll bring you exclusive interviews only on Ruckus Avenue Radio.
Speaker 12 (25:42):
The siding on what to listen to is hard Using
Zoomo to stream music from iHeart.
Speaker 13 (25:47):
Nineties Radio is easy.
Speaker 12 (25:48):
Or play iHeart Country or Hip hop beats your choice,
all for free.
Speaker 13 (25:52):
Stream easy with Zoomo Play.
Speaker 12 (25:54):
Get live and on demand entertainment with no logins, no
sign ups, no accounts, no hassle. This November, get cozy
and stay in from Movie Night with Air Force one
starring Harrison Ford and Glenn Close and the Art of
War starring Wesley Snipes, all streaming free on Zoomo Play,
Go to play dot Zumo dot com.
Speaker 13 (26:10):
Now life is hard, Zumo is easy.
Speaker 11 (26:13):
And then it'll flare up again. But the last three years,
about December, I've had problems and I had to go
see my doctor and she's I really like my doctor.
She's really good. But I'm just you know, I'm been
fighting this for so long. I'm worried about Uh. I'm
(26:33):
taking medsamalin right now. Uh is that? Did you think that?
Is that a good medicine for my condition? And what
would you recommend me to do to to uh avoid
surgery or that stay off keep my coaling from acting up.
(26:55):
Thank you.
Speaker 8 (26:57):
Uh what kind of medicine did you say you take?
Speaker 7 (27:01):
It?
Speaker 14 (27:01):
Sounds like yeah, mesal, yeah, say yeah, that's okay. I
see do you have really good I'm doing really good
on it.
Speaker 8 (27:14):
And do you say, did you say you have inflammatory
Biel disease chrones who are all sort of colitis.
Speaker 11 (27:20):
All sort of colidus, Yes, sir, I see.
Speaker 8 (27:24):
Uh, well that's a that's a great question. Mascellamine is
one of the old medications that we have used to
treat inflammatory abil disease, both chrones and al sort of
colitis to prevent and be able to control the disease process.
If you continue to have symptoms, we do have new
(27:46):
targeted therapies and we have a good biological medications. You
might want to discuss with your gaston trologists.
Speaker 6 (27:54):
Uh.
Speaker 8 (27:55):
If you continue to have symptoms and if the kornoskypy
shows uh inflammation of the colon, then we might need
to switch your medication to a more stronger form of medications.
In the past, the way how we dealt with impleammatory
about disease used to be a step up approach where
(28:16):
we start with a milder version of medication and slowly
we increase the doors, or we switch medications to a
more stronger anti inflammatory drug that slowly has changed and
shifted gears now towards where we are more proactive and
more leaning towards starting more stronger medication to prevent progressing
(28:42):
the disease and to preventing more requiring surgical interventions.
Speaker 11 (28:47):
Yes, okay, well I appreciate that. I'd like to add
my brother had chrome disease, is my older brother. He's
ten years older than me, and he had a couple
operations and they lined up having to take you colon out.
But but but colon cancer and cone disease or collides
(29:08):
has not run in our family. But uh, I just
I just, you know, worried about that when as old
as I'm getting, I'm worried about something that work real quick,
you know.
Speaker 8 (29:21):
Yeah, well, yeah, it would be impart for you. Go ahead,
dot your trouble.
Speaker 6 (29:27):
Oh no, you go ahead, doctor Olmers.
Speaker 8 (29:29):
Now it's going to say it would be important for
you to continue with your medications to make sure you
have close follow up with your gustro trilogists to make
sure you do your konoskip beyond time. UH inflammatory about disease,
and especially if you have a family history of colon cancer,
you are at a very high risk for UH colon
(29:50):
and rectal cancer. So we have to make sure you
are up to date with your kornoscopy.
Speaker 11 (29:56):
Well, I'll go, I go a year for a check
up and unless I'm having a problem. But she says,
I'm a UH means I've been fighting it so long.
I only at a hot risk anyway.
Speaker 15 (30:09):
But anyhow, Anthony, Anthony, I'm going to just jump in
here for a second too, because I have the gosain
thrialodis and someone who treats IBD on the medical side,
and we try and keep you out.
Speaker 6 (30:21):
Of doctor Almas' office. It sounds like you're.
Speaker 5 (30:24):
On a as long as you're doing pretty well symptomatically,
you're on a good therapy, and as long as you're getting.
Speaker 6 (30:30):
Your regular checkups for phone cancer, it COUNTSI here. You're
on the right track, and you appreciate you calling in.
Speaker 5 (30:35):
We do need to take a short break here, and
I'm going to remind everybody that you are listening to
Center It on Health with Baptist Health here on news
radio eight forty whas our phone number five oh two,
five seven one eight four eighty four if you'd like
to call in and join our conversation.
Speaker 6 (30:52):
We're talking with.
Speaker 5 (30:53):
Doctor Baruke Almas about coloreco surgery, robotic.
Speaker 6 (30:56):
Surgery, minimally basis surgery, and all things Poland. We're talking
to you after the break.
Speaker 5 (31:15):
Welcome back to Done It on Health with Baptist Health
here on news radio eight forty wh Your host, doctor
Jeff Publin. We're talking tonight with doctor Baruke Almas about
robotic surgery and colorecto surgery. Want to thank Anthony for
calling in before the break of the question that he
had about his meditation. That's still time to call in
(31:36):
five oh two, five seven one.
Speaker 7 (31:38):
Four eighty four if he'd like to ask the question.
Speaker 5 (31:40):
So, doctor Almas, I do want to hear more about
the robotic surgeries itself, but I really like highlighting when
we can things that you know, you in particular, are
bringing to our community. And I know that you're doing
a lot of movement in terms of how quickly patients
(32:01):
can go home from the hospital and cost analysis. Just
like you said at the beginning, your background, your experience
driving you to want to see those outcomes.
Speaker 6 (32:10):
Talk to us about what.
Speaker 5 (32:11):
You're doing that are making impacts in those areas.
Speaker 8 (32:17):
Yeah, as the soul called rectal surgeon in the Southern
Indiana and Baptist Floyd, I really great take a great
pride in my role and the opportunity to positively impact
our community, and my primary focus has been developing a
robust minimum basis program in the coal and rectal surgery.
(32:38):
While we successfully performed a number of complex and advanced
surgery for rect and colon cancer, my ultimate goal has
been to further reduce hospital states and patients with advanced
stages of both colon and rectal cancer and as well
as benign diseases. The robotic surgery has offered us several
(33:02):
benefits and the colon rectal surgery and its adoption has
positively impacted patient care in various ways. Due to the
minimum invasive nature of the surgery, patient has significantly reduced
postoperative pain, which translates to decreased or purid use in
the recovery phase. By instituting also and haanced recovery protocols
(33:25):
along with the minimum basive surgery, we have significantly impacted
and reduced hospital space. For example, in my practice, over
ninety percent of my elective colon resection patients are going
home in the same day or less than twenty four
hours since operation. Today, for example, I did a robotic
(33:45):
sigamare resection in the morning. We started at eight o'clock.
We finished ten am. Patient with away, alert, walking, tirating diet,
hitting all the milestones to be discharged and choose discharged
at home ATIA, this is a remarkable progress.
Speaker 6 (34:03):
Oh, I'm gonna stop, Let me stop.
Speaker 5 (34:05):
I'm let to stop you right there, because I am
just blown away?
Speaker 6 (34:08):
Are you?
Speaker 5 (34:09):
Did you just say that you removed part of somebody's
call in the sigamore colon this morning and they went
home this afternoon.
Speaker 8 (34:18):
That is correct.
Speaker 6 (34:19):
Yes, that's unbelievable.
Speaker 5 (34:23):
I didn't mean to interrupt you, but I really am
just blown away by that statement.
Speaker 7 (34:28):
It's really remarkable. And tell us what you are going
to continue to say about that.
Speaker 8 (34:33):
Yeah, So this is a remarkable progress and change that
we have made done in terms of the way how
we practice. Even since my surgical training, we used to
keep the patients for about five to seven days in
the hospital, with the same kind of procedure. In addition
to quick recovery and decreased the post operative pain of
(34:56):
the robotic platform and minimum invasive is also allowing us
to do significantly complex cases with minimum invasive approach that
could have been done with a major open surgery. And
I do think that the most significant benefit of the
robotic platform over leaparoscopic surgery is the number of conversions
(35:17):
that we have from minimum invasive to open surgery, especially
when it comes to more public surgery rectal cancer or
rectal collapse procedures. For example, I had a recent surgery
that I performed on a very young, thirty two year
(35:37):
old patient. She had a BMI of sixty seven, over
four hundred pounds. She had a complicated diverticulitis with perforation.
She had over six months of IVY antibiotics. She's been
in the hospital multiple times. She had the ir drain
place to be able to avoid surgery, we did a
(35:58):
robotic colon less action on her, who recovered very well.
She went home on day two. She's been back to
work now. And in this case, it's not the quick recovery,
but I want to emphasize the possible mobidity and potential
complications that we have minimized and avoided from doing open surgery,
(36:20):
including hernia, wind infections, and reoperations.
Speaker 6 (36:26):
So you just gave us a ton of stuff to digest.
Speaker 14 (36:30):
It.
Speaker 5 (36:31):
I just want to reiterate what I heard you say
for our listeners. So sometimes if what I'm hearing what
you're saying correctly, when you try and do a minimally
invasive approach, you have to convert from the minimally invasive
approach to an open.
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Approach where you do do that big abdominal incision and
that increases morbidity and things like that. And you're saying
that with these robotic approaches you're having to convert that
less frequently. Is that what that message was that you
were talking about.
Speaker 8 (40:04):
Yes, that is correct. The principles and surgery is to
be safe and to make sure that the patient gets
the appropriate care, regardless of the way how you're approaching
the surgery versus robotic, laparoscopic or open. You want to
have the patient be safe and be taken care of
in the most appropriate way. If the case is challenging
(40:28):
to an unsafe to proceed with laparoscopic or robotic. Of course,
the standard way is to proceed with open surgery, which
gives us more tactile and potentially you know, be able
to do a more safer dissection. However, with the robot
now we're allowing to even do more complex procedures with
(40:51):
with with the minimum evasive. So I actually would like
to give you another good example. I had a lady,
elderly lady who presented with large bowel obstruction due to
severe particular stricture and the stigma with colon, and this
led her to have entire colon to significantly be descended
(41:12):
to a point there was an impending perporation of the
right colon. This means that the entire clon had to
be removed emergently. But despite this, we were able to
do this emergency case robotically with just small incisions and
she did very well with the surgery. Her morbidity after
(41:33):
surgery was minimal. She was discharged on day two and
I saw her in clinic a couple of weeks ago
and she's doing very fantastic. And I actually would like
to take this opportunity to thank the ore staff at
Baptist Floyd and the leadership for being supportive and for
allowing us to do emergent cases with minimum invasive and
(41:54):
robotic approaches. And this has been shown with multiple studies
to be safe and has less mobidity after surgery.
Speaker 5 (42:05):
Well, you know, doctor, doctor Amas, I appreciate you you
taking that moment to kind of thank the team, you know,
for lack of a better better word, because you know,
none of this happens with one piece of the puzzle.
Speaker 6 (42:18):
But I think you know, one of the things that.
Speaker 5 (42:20):
You're showing us is that you know, improved pain, obviously
patient centric, improved you know, length of stays, it's good
for patients, it's.
Speaker 6 (42:30):
Good for you know, costs of medical care.
Speaker 5 (42:32):
Like these are the things that when you see a
really healthy medical system working together, these innovative and newer
things are embraced.
Speaker 7 (42:42):
And so you know, we appreciate.
Speaker 5 (42:44):
Stop this Void for doing that, just like you said,
you for taking the time to be trained to bring
that to the community.
Speaker 6 (42:50):
So we're going to take another quick break there.
Speaker 5 (42:53):
We're going to continue our conversation with doctor Almas after
that break about robotic surgery and TOLO rectal surgery. You'll
listen to send It on Health with Baptist Health on
News Radio eight forty w AHAs.
Speaker 6 (43:04):
I'm your host, doctor Jeff Cublin.
Speaker 5 (43:06):
And if you missed any part of the show, and
I feel badly if you did, you should download the
iHeartRadio app. It's free, it's easy to use, and it
gives you access to tonight's show in its entirety.
Speaker 18 (43:16):
What do you like that, Well, welcome back to send
it on Help with Baptist.
Speaker 5 (43:35):
Health here on news Radio Age forty whas. I am
your host, doctor Jeff Covlin, and we're talking tonight to
doctor Varuk Almas about co electro surgery and robotic surgery.
Remember to download the iHeartRadio app to listen to any
of this or our previous segments and have access to
all the other features that the app has to offer. So,
(43:56):
doctor almad So, welcome back, and thank you for all
these great things that you're sharing with us. So for
our listeners that are out there, a couple of logistical things.
One is how would a patient know that this might
be a modality for them? Is this something where their
(44:19):
primary care or a general surgeon would recommend this approach
or should they be aware to ask about this approach?
So that's one question, and the second question being what
are the kinds of things that if they were a listener.
Speaker 6 (44:34):
Hearing you talk tonight, what kind of conditions might they
come to you to have done this approach.
Speaker 8 (44:44):
Yes, for most procedures in troubdominal the robotic platform can
be utilized. The outcome comparing the robotic surgery versus Lapper's
topic has been pretty much the same UH. It's dependent
on the surgeon's UH practice as well as experience and
(45:06):
the type of UH, the type of surgery that they
perform to be able to utilize either laposcopic or robotic,
and we have we have progress aggressively in terms of
minimizing UH the incisions and also doing minimum basis surgery
for almost most procedures for in tropdominal In terms of
(45:28):
my practice, I do take care of all benign and
malignant diseases of the colon rectum. I do public floor
UH the disorders as well, including rectal collapses UH. I
do interrectal diseases including palin auto hemorrhoid Fisher, and also
do patients with interrectal fisseral s.
Speaker 1 (45:49):
I b d S.
Speaker 8 (45:50):
I take care of all that as a general correctal practitioner.
Speaker 5 (45:57):
And are so wouldn't necessarily be something that a patient
needs to ask about. If the surgeon that they've chosen
and been comfortable with does it, it would usually be
something you would recommend as an approach with.
Speaker 8 (46:11):
Them that is correct. I think there are a specific
disease process that are appropriate for more minimum basive surgery,
and there are a few diseases that are more appropriate
for open surgery approach. So it's a specific disease process
and patient selections and also physician the surgeon's preference as well.
Speaker 5 (46:37):
So I heard you mentioned sort of patient characteristic, which
reminds me that earlier on you told us about a
patient that you did with a BMI of over fifty,
And for listeners to the show, that's an elevated BMI.
That's quite significantly elevated and oftentimes.
Speaker 6 (46:55):
Might preclude the ability to do something like this.
Speaker 5 (46:58):
What are the factors that might preclude your ability to
use a minimally invasive approach.
Speaker 8 (47:07):
I think the major risk factors to proceed with minimum
basis surgery is if the entropdominal is more hostile, meaning
that they've had multiple surgical interventions in the pass, mostly open,
which causes significant scarring which prevents us to carefully look inside.
(47:30):
In this case, the safest approach will be open surgery.
And some specific patients who are quaglopathic, who are decompensating,
who are not doing well, they're not going to tolerate
the numerus cuffilation or placing CO two and their obdomen,
and these patients the open approach will be more appropriate
(47:51):
than the minimum basis surgery. So in patients with with
who are frail, they're not going to tolerate more robotic
or lepers pick approach, then we still do open surgery
to be safely help them get through the whatever disease process.
Speaker 5 (48:12):
And when you do these approaches, are there any downsides
to using the robotic approach? For example, does it limit
your field of vision and you have to see.
Speaker 6 (48:26):
Less at one time? Is there any downside to.
Speaker 7 (48:29):
Choosing the robotic approach over another affair?
Speaker 8 (48:35):
The robotic approach versus laposcopic pretty much very similar in
regards to the outcome. However, you know, we can only
do minimal invasive surgery if we can continue to do
the procedure safely. Very aggressive in terms of trying to
(48:55):
do the surgery robotically and laparoscopically. It's going to be
surgeons a comfort level in terms of proceeding with a
minimum basis surgery approach or conversion to more open surgery.
But I try to do even the most complex procedures,
even the ones that will take very long to perform
(49:19):
them a minimum basive either robotic and laparoscopic. I had
a recent patient who had a rectal perforation yatrogenically, this
would have been an emergent surgery with either a resection
or diversion. I was able to closer from the inside
with the robotic approach. And these are the kind of
things that kind of allow us to minimize patients morbidity
(49:46):
or even the invasiveness of the surgery that we do
and specific patients.
Speaker 5 (49:54):
Well, I know that you know, just like we we
mentioned before, I mean, between the.
Speaker 6 (50:00):
Hospital time, the recovery time, the outcomes.
Speaker 5 (50:04):
That you're describing, this is a really a real forward
step in medicine here in our community.
Speaker 7 (50:12):
So we're just really thankful.
Speaker 5 (50:14):
To have you and that is going to do it
for another segment of Centered on Health. With that to help,
I've been your host, doctor Jeff Publin. I would love
to thank our guests Anthony for calling in today with
his question. We love to hear from our listeners. I
want to thank our producer mister Jim Fenn and you
the listener are special. Thank you to doctor Baruke Alma,
(50:34):
not only for bringing his expertise to Louisville and Southern Indiana,
but for sharing all of that with us tonight. Have
a great week, join us every Thursday night, and I
hope everybody has a safe and healthy weekend.
Speaker 6 (50:47):
We'll see you next week.
Speaker 19 (50:53):
This program is for informational purposes only and should not
be relied upon as medical advice. The content of this
program is it's not intended to be a substitute for
professional medical advice, diagnosis, or treatment. This show is not
designed to replace a physician's medical assessment and medical judgment.
Always seek the advice of your physician with any questions
or concerns you may have related to your personal health
(51:16):
or regarding specific medical conditions. To find a Baptist health provider,
please visit Baptistealth dot com.
Speaker 17 (51:22):
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What's up, Everybody? My name is Sammy John. Tune in
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every weekday morning is I bring you the best of
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that includes some of the most exclusive access to the
(52:43):
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Speaker 3 (01:00):
What's up, Everybody? My name is Sammy John. Tune in
every weekday morning at nine am. Pacific Standard time and
hear my show called The Bridge. And what I do
every weekday morning is I bring you the best of
South Asian music and culture from around the world, and
that includes some of the most exclusive access to the
(01:21):
South Asian music industry. I'll bring you world premieres and
I'll bring you exclusive interviews only on Ruckus Avenue Radio.
Speaker 4 (01:31):
It's now time for Centered on Health with Baptis Help
on US Radio weight forty WJAS. Now here's doctor Jeff Tuk.
Speaker 5 (01:41):
Good evening, everybody, and welcome to tonight's episode of Centered
Ontel with Baptist Help. Here on news radio eight forty whas.
I'm your host, doctor Jeff Cullin. We're joined from the
studio by our producer mister and Ben, who's on standby
to take your calls to talk to tonight's guest. If
you have any questions or you want to call in
(02:02):
and talk to tonight's guest, that phone number is five
h two five seven to one, eight four eight four.
We'd love for you to call in and be part
of the show.
Speaker 6 (02:11):
Tonight.
Speaker 5 (02:12):
We are talking with doctor Baruke Almas. Doctor Almais is
a colo rectal surgeon with the Baptist Hospital Medical Group.
He received his medical medical degree from Saint George's School
of Medicine and did his residency at both Saint Barnabas
Medical Center and Rutgers Health New Jersey Medical School. He
did a fellowship at the Swedish Medical Center Program and
(02:33):
as a colorectal surgeon, Doctor Almas performs many procedures that you,
our listener, may be familiar with, but he also has
bought our community advanced, minimally invasive and robotics assisted procedures
which we are going to learn all about and has
improved all of our patients' lives.
Speaker 7 (02:51):
So welcome to the show, doctor Almis.
Speaker 8 (02:53):
Thanks for having me.
Speaker 5 (02:55):
We're thrilled to have you, you know, welcome, welcome to the community,
and welcome to Baptist. And I wanted to introduce you
because I wanted to start by welcoming you and kind
of have you give us a.
Speaker 6 (03:08):
Little bit of a flavor of you know, what.
Speaker 5 (03:11):
Made you choose this particular socculty surgery and then in
particular holo extal surgery.
Speaker 8 (03:19):
Initially I wanted to go into surgery because of my
upbringing and my family issues. I initially started getting interested
in coloroxial surgery because of my mentors, doctor Trentino and
doctor Guilder, who had a huge influence in me. Chlorocal
surgery encompasses both preventative medicine as well as both benign
(03:45):
and malignant diseases. I was really interested into a minimum basive.
Robotic surgery was becoming very popular when I was getting training,
and I wanted to go into more minimum base of
robotic approaches and and my surgical care.
Speaker 5 (04:04):
Well, we are definitely excited to hear about what you're
doing and what you're bringing to our Louisville community.
Speaker 6 (04:11):
Here.
Speaker 5 (04:12):
You have a little bit of a unique perspective having
trained you know, multiple places in the world. What what
have you brought with you from outside the United States
and what what what's surprising to you about medicine here
or how do you incorporate kind of all of your
training into the kind of practitioner you want to do.
Speaker 8 (04:31):
I think mostly is the diversity of training of XU
UH generally more UH more efficient in terms of how
you take care of patients, understand patients background and also
UH be more caring to patients UH disease process and
(04:52):
what they have gone through. UH and also coming from
you know, born and raised in a third third world country.
I'm very intrigued and interested in economic aspect of surgical
approaches and minimizing the cost of surgery in patients.
Speaker 5 (05:14):
And I know some of the things that you're doing
is actually achieving those goals. So that's really coming full circle,
which is really great, great to hear. We talked a
little bit about it in the intro, and you did
a nice job kind of when you introduce yourself, But
tell us what a typical day is like for colorectal surgery.
What kinds of conditions might you see? We'll get into
some of them later, but in general, what's the day
(05:35):
like for you?
Speaker 8 (05:39):
Mostly I spent my clinic days taking care of patients
from intirectual diseases, hemorrhoids, fissures, pelfect floor disorders, and continence constillations.
I also do screening and diagnostic colonoscopies. I also do
major operations both for benign colon diseases particulaitis also do
(06:01):
major complex procedures for colon and rectal cancer as well.
Speaker 5 (06:07):
And do you do any general surgery or is your
practice now mostly colorectals.
Speaker 8 (06:13):
I mainly focus just specifically for colon and rectal diseases.
Speaker 5 (06:18):
So for those of you listening out there with any
any of these conditions, you know, feel free to call
us and join the conversation.
Speaker 6 (06:26):
So doctor Alma, give us a little bit of an
anatomy lesson here.
Speaker 5 (06:29):
Tell us a little bit about when we say colo rectal,
what what is the colon and the rectum? What's the
large intestine versus the bowels like people throw these terms around.
Give us a small anatomy lesson so our patients in
our listeners and follows.
Speaker 8 (06:46):
Yeah, even though the name sounds colon and rectyl surgery,
we do see some smallbile pathologies specifically IBD, inflimmatory bowel disease,
in Clone's disease, and al sort of client. Regarding the
anatomy of the bow, the bell stars from, of course,
from the mouth all the way down through the esophagus
(07:08):
and the stomach, which are considered as foregut, which continues
to the small bell, which connects to the first portion
of the colon, which is the secum where the appendix
is attached. That then continues to the right side of
the colon, which is regarded as either right colon or
ascending colon, which is sends towards the liver and it
(07:33):
makes a turn which is considered as hepatic fletcher that
continues into the transverse colon and makes another turn at
the spleen, which is considered as the splantic fleccher, and
that continues to the left side of the colon. The
left side of the colon is also considered as descending colon,
which becomes then as shaped which is the sigmod colon,
(07:56):
then continues to become the rectum, which is then attached
to the us worthy bound woman takes.
Speaker 6 (08:02):
It and you handle pathology from all of those.
Speaker 9 (08:08):
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Speaker 3 (10:09):
What's up, Everybody? My name is Sammy John. Tune in
every weekday morning at nine am Pacific Standard time and
hear my show called The Bridge. And what I do
every weekday morning is I bring you the best of
South Asian music and culture from around the world, and
that includes some of the most exclusive access to the
(10:29):
South Asian music industry. I'll bring you world premieres and
I'll bring you exclusive interviews only on Ruckus Avenue Radio.
Speaker 12 (10:38):
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Speaker 8 (11:10):
That is correct mainly from the colon rectum into the ainus,
but also deal with public floor disorders, for example, patients
with severe constipation from public outlet disorders or public weakness
which results into either public prollapse including continents. Also deal
(11:33):
with patients with small bowel diseases from closed diseases or bowelstructions.
Speaker 5 (11:39):
So we could have you on here multiple times to
talk about all those things that you do clearly so
as a gostor nentroologist, which is your your medical counterparts
for colon and rental surgery.
Speaker 6 (11:50):
Here.
Speaker 5 (11:52):
We were originally struggled through the show during the month
of March, which is colon cancer Awareness month. We had
to move it, but I still think taking the opportunity
to have us together, we would be remissed not to touch
briefly just for a few minutes on colon cancer screening
since we both do that, so tell us a little
bit about the burden of colon cancer and what you
(12:12):
see and how colon astroputes can help.
Speaker 8 (12:16):
Certainly, that is correct that March was colon Cancer Awareness month. Unfortunately,
colon cancer is still the second leading cause of cancer
related death, not just in the USA, but also globally
and the general population. The risk of colon cancer is
one in seventeen and in some studies one and twenty,
(12:38):
which is about five to six percent. Colon cancer is
one of the most preventable and preventable cancer death and
with early detection and screening. In general, correctal cancer are
heterogeneous disease that develops the step wise emulation of well
(13:01):
characterized genetic and epigenetic alterations, and most colorectal tumors arise
from Precancero's polyps that are broadly categorized as either traditional
tubular adenoma or as rated polyps, and over time these
polyps increase in size, develop increasingly dysplastic features and changes
(13:24):
in architectural structures, which can eventually acquire invasive potential, which
is what we define as a colon or rectal cancer.
And this is the basis of recommendation for screening and
also doing removal of polyps to halt the progression of
polyps to becoming malignant or invasive cancer. The current recommendation
(13:48):
of screening is to start at age forty five and
continue until age seventy five. For those with high risk
including family history of colon cancers or personal history of polyps.
Specific diseases like IBD which are inflammatory about diseases and
genetic mutations may need to start screening earlier or have
(14:09):
more frequent screening. We do have a few acceptive accepted
modalities for screening, including kronoscopy, FIT tests which is a
fecal immunochemical tests, also DNA test, CT chornography, and flexible sigmatoscopy,
(14:29):
and I think there's a few potential features for circulating
DNA tests to be possibly potential screening modalities as well.
Speaker 5 (14:40):
Well. I have to tell you, doctor Amas, I had
about ten questions prepared for you with regards to colon
cancer screening, and you answered all of them in that
beautiful answer that you just cave. So thank you for
being so comprehensive, and I hope everybody was listening because
as you said, it's preventable and we have not just
more than we have more than one way to find
(15:01):
them and treat it and prevent it. So you are
listening to doctor Baruch Alms. We're talking about colorecrofurgery and
robotic surgery here on centerate on Health. You're listening to
Center on Health with Baptist Health on news radio eight
forty wh as. Our phone numbers five oh two, five
seven one, eight four eighty four.
Speaker 6 (15:19):
If you'd like to call in.
Speaker 7 (15:20):
And join the conversation, we'll be talking to you after
the breaks.
Speaker 5 (15:39):
I want to welcome you all back to centert on
Health with Baptist Health here on news radio eight forty whas.
I'm their host, doctor Jeff Covlin. And if you're just
tuning in or if you're joining us in our show,
we're talking tonight with doctor Baruch Alms, who is at
the Baptist Hospital Medical Group. He is a colorecro surgeon
and he's talking to us tonight about us to surgery
(16:00):
and robotic surgery and.
Speaker 6 (16:02):
Minimally invasive surgery.
Speaker 5 (16:04):
I want to remind you that our phone number is
five oh two, five seven one eight four eighty four,
and our producer, mister Jensen is on standby to take
your calls, Doctor Almas. Before the break, we just went
over some calling cancer screening advice, and I want to
get into some of the meat of kind of what
(16:24):
you do and what you're bringing to our community. So
before we get into sort of the robotics and all
the fancy stuff, talk to us a little bit about
some terms that I think we hear thrown around, Like
what does laperous topic versus open What do those two
terms mean and how does it impact both the type
(16:44):
of surgery somebody has and recovery.
Speaker 8 (16:48):
Yes, the traditional surgery, the open surgery is a more
invasive approach where we make an incision, bigger incision to
enter the optimen to expose both the bowels and also
abdominal contents, compared to the minimum invasive approach, which is
(17:10):
a key hole procedure where we make small decisions to
place laparoscopic camera and also place laparoscopic instruments without making
a major incision. This allows us to operate without exposing
the bowel into the environment and also be able to
reach the pulvis or areas where it's hard to visualize
(17:35):
with open surgery. This minimizes the post operative pain hospitals
say post operative complications including woon inflections, hernia rate and
also reoperative rate.
Speaker 5 (17:50):
And so minimally invasive and laparoscopic are they the same term?
Speaker 6 (17:56):
Or is minimally is lap.
Speaker 5 (17:58):
Of stopic one part of a minimum minimumly invasive approach.
Speaker 8 (18:04):
Minimum invasive is an umbrella term which we use for
both laparoscopic and robotic surgery. Robotic surgery and laposcopic surgery
are pretty much similar to each other, but the platform
is slightly different. We make similar kind of incisions. When
we do laparoscopic, we have the freedom of where we
put the incisions. When it comes to robotic surgery, we
(18:27):
use the robotic platform to be able to mobilize and
do our surgery.
Speaker 5 (18:36):
And we're going to we're going to delve into that
in a minute. We'll want to hear more about that.
You know, we've we've had some general surgeons on our show,
and I work with plenty of general surgeons that do
laposs topic and some of these techniques. When do you
think I always like for our listeners to get a
sense of, you know, what type of doctor they might
(18:56):
want to see for certain conditions. When do you recommend
things to be done with general surgery versus colorectal surgery
specifically trained.
Speaker 11 (19:04):
Is there a.
Speaker 5 (19:07):
Way that you think about that in your practice.
Speaker 8 (19:11):
I think it's mostly surgeon dependent and experience dependent. However,
if it's more advanced cancer specific UH colorectal related diseases,
of course it will be better to be taken care
of with a specialist who have a more experienced UH
and take care of those diseases and further training. However,
(19:34):
you know, the the outcome with a very experienced general
surgeon and a correctal surgeon might be pretty much the same.
We do have data and studies looking at colon cancer
outcomes based on general surgery versus a correctal surgeon, and
the outcome is superior if it's performed by a corectal surgeon.
(19:57):
And this has to do with the with the training
and being up to date in taking care of those
disease process.
Speaker 5 (20:05):
Well, that's that's an interesting statistic. So thanks for sharing
that with us. So let's you can imagine, you know,
we're we're here, we're listening to you talk and we
hear the term, you know, robotic, and we're thinking, you know,
sci fi kind of stuff here. So give us a
picture of what the robot is, and what does the
room look like? And how is it set up? What
(20:28):
are we what is the robot?
Speaker 8 (20:32):
So the robot have a few parts. Initially, the procedure
starts similar to leaparoscopic, placing small incisions over the obdomen
and placing ports which are access to the optimen. We
insufflate the obdomen with carbon dioxide to be able to
gain access to the obdomen and ssfly explore the abdominal contents.
(20:56):
We then proceed attaching the robotic arms into these ports.
The surgeon then sits on a console which have which
controls those robotic arms, which then translates into using those
arms to be able to perform more precision and uh
(21:19):
challenging cases with with safe dis sections.
Speaker 6 (21:27):
So are you the one who's actually driving the robots? Though?
Speaker 5 (21:31):
Right, it's not automatic where you say, take out the
appendix and it takes out the dependence.
Speaker 6 (21:36):
You're you're driving this and doing the Certainly.
Speaker 8 (21:40):
Maybe the future will be there, but.
Speaker 5 (21:45):
Right so you're not in California on the beach telling it.
Speaker 6 (21:48):
To do it in Louisville, Kentucky. Right, that's not.
Speaker 8 (21:52):
Not not at this time that the future probably will
go there. But at this time we are controlling the
robotic arms. It's just giving us more and more increased
dexterity and more precision. And uh, the surgeon is sitting
when operating, so you can do a very long, tedious operation,
uh and more comfortable sitting and uh. The robot also
(22:16):
gives you a more a three D kind of view
to be able to do more uh, have a more
precision surgery, especially when you do complex councer operations and
operating and very deep pulvis for rectal counters and rectal
cot lapses.
Speaker 5 (22:37):
Well, we're going to get back to some more about
this robot and a little bit.
Speaker 6 (22:40):
We do have a caller on the line.
Speaker 5 (22:43):
Anthony is calling in with a question about medicine that
he's on for his poland Anthony, are you there. You
are on with doctor Almas and welcome to Centered on Health.
Speaker 11 (22:54):
Yes, yes, doctor Almah, I've heard problems. I'm sixty three
years old and I've had cold problems since my mid twenties.
And if player's up on occasion and then I'm good.
Speaker 4 (23:12):
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Speaker 1 (24:13):
I don't know if you know this, but when you
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and right now you can become a Washington Post subscriber
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Speaker 2 (24:40):
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(25:00):
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Speaker 3 (25:13):
What's up, Everybody? My name is Sammy John. Tune in
every weekday morning at nine am Pacific Standard time and
hear my show called The Bridge. And what I do
every weekday morning is I bring you the best of
South Asian music and culture from around the world, and
that includes some of the most exclusive access to the
(25:33):
South Asian music industry. I'll bring you world premieres and
I'll bring you exclusive interviews only on Ruckus Avenue Radio.
Speaker 12 (25:42):
The siding on what to listen to is hard Using
Zoomo to stream music from iHeart.
Speaker 13 (25:47):
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Speaker 12 (25:48):
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Speaker 13 (25:52):
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Speaker 12 (25:54):
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Speaker 13 (26:10):
Now life is hard, Zumo is easy.
Speaker 11 (26:13):
And then it'll flare up again. But the last three years,
about December, I've had problems and I had to go
see my doctor and she's I really like my doctor.
She's really good. But I'm just you know, I'm been
fighting this for so long. I'm worried about Uh. I'm
(26:33):
taking medsamalin right now. Uh is that? Did you think that?
Is that a good medicine for my condition? And what
would you recommend me to do to to uh avoid
surgery or that stay off keep my coaling from acting up.
(26:55):
Thank you.
Speaker 8 (26:57):
Uh what kind of medicine did you say you take?
Speaker 7 (27:01):
It?
Speaker 14 (27:01):
Sounds like yeah, mesal, yeah, say yeah, that's okay. I
see do you have really good I'm doing really good
on it.
Speaker 8 (27:14):
And do you say, did you say you have inflammatory
Biel disease chrones who are all sort of colitis.
Speaker 11 (27:20):
All sort of colidus, Yes, sir, I see.
Speaker 8 (27:24):
Uh, well that's a that's a great question. Mascellamine is
one of the old medications that we have used to
treat inflammatory abil disease, both chrones and al sort of
colitis to prevent and be able to control the disease process.
If you continue to have symptoms, we do have new
(27:46):
targeted therapies and we have a good biological medications. You
might want to discuss with your gaston trologists.
Speaker 6 (27:54):
Uh.
Speaker 8 (27:55):
If you continue to have symptoms and if the kornoskypy
shows uh inflammation of the colon, then we might need
to switch your medication to a more stronger form of medications.
In the past, the way how we dealt with impleammatory
about disease used to be a step up approach where
(28:16):
we start with a milder version of medication and slowly
we increase the doors, or we switch medications to a
more stronger anti inflammatory drug that slowly has changed and
shifted gears now towards where we are more proactive and
more leaning towards starting more stronger medication to prevent progressing
(28:42):
the disease and to preventing more requiring surgical interventions.
Speaker 11 (28:47):
Yes, okay, well I appreciate that. I'd like to add
my brother had chrome disease, is my older brother. He's
ten years older than me, and he had a couple
operations and they lined up having to take you colon out.
But but but colon cancer and cone disease or collides
(29:08):
has not run in our family. But uh, I just
I just, you know, worried about that when as old
as I'm getting, I'm worried about something that work real quick,
you know.
Speaker 8 (29:21):
Yeah, well, yeah, it would be impart for you. Go ahead,
dot your trouble.
Speaker 6 (29:27):
Oh no, you go ahead, doctor Olmers.
Speaker 8 (29:29):
Now it's going to say it would be important for
you to continue with your medications to make sure you
have close follow up with your gustro trilogists to make
sure you do your konoskip beyond time. UH inflammatory about disease,
and especially if you have a family history of colon cancer,
you are at a very high risk for UH colon
(29:50):
and rectal cancer. So we have to make sure you
are up to date with your kornoscopy.
Speaker 11 (29:56):
Well, I'll go, I go a year for a check
up and unless I'm having a problem. But she says,
I'm a UH means I've been fighting it so long.
I only at a hot risk anyway.
Speaker 15 (30:09):
But anyhow, Anthony, Anthony, I'm going to just jump in
here for a second too, because I have the gosain
thrialodis and someone who treats IBD on the medical side,
and we try and keep you out.
Speaker 6 (30:21):
Of doctor Almas' office. It sounds like you're.
Speaker 5 (30:24):
On a as long as you're doing pretty well symptomatically,
you're on a good therapy, and as long as you're getting.
Speaker 6 (30:30):
Your regular checkups for phone cancer, it COUNTSI here. You're
on the right track, and you appreciate you calling in.
Speaker 5 (30:35):
We do need to take a short break here, and
I'm going to remind everybody that you are listening to
Center It on Health with Baptist Health here on news
radio eight forty whas our phone number five oh two,
five seven one eight four eighty four if you'd like
to call in and join our conversation.
Speaker 6 (30:52):
We're talking with.
Speaker 5 (30:53):
Doctor Baruke Almas about coloreco surgery, robotic.
Speaker 6 (30:56):
Surgery, minimally basis surgery, and all things Poland. We're talking
to you after the break.
Speaker 5 (31:15):
Welcome back to Done It on Health with Baptist Health
here on news radio eight forty wh Your host, doctor
Jeff Publin. We're talking tonight with doctor Baruke Almas about
robotic surgery and colorecto surgery. Want to thank Anthony for
calling in before the break of the question that he
had about his meditation. That's still time to call in
(31:36):
five oh two, five seven one.
Speaker 7 (31:38):
Four eighty four if he'd like to ask the question.
Speaker 5 (31:40):
So, doctor Almas, I do want to hear more about
the robotic surgeries itself, but I really like highlighting when
we can things that you know, you in particular, are
bringing to our community. And I know that you're doing
a lot of movement in terms of how quickly patients
(32:01):
can go home from the hospital and cost analysis. Just
like you said at the beginning, your background, your experience
driving you to want to see those outcomes.
Speaker 6 (32:10):
Talk to us about what.
Speaker 5 (32:11):
You're doing that are making impacts in those areas.
Speaker 8 (32:17):
Yeah, as the soul called rectal surgeon in the Southern
Indiana and Baptist Floyd, I really great take a great
pride in my role and the opportunity to positively impact
our community, and my primary focus has been developing a
robust minimum basis program in the coal and rectal surgery.
(32:38):
While we successfully performed a number of complex and advanced
surgery for rect and colon cancer, my ultimate goal has
been to further reduce hospital states and patients with advanced
stages of both colon and rectal cancer and as well
as benign diseases. The robotic surgery has offered us several
(33:02):
benefits and the colon rectal surgery and its adoption has
positively impacted patient care in various ways. Due to the
minimum invasive nature of the surgery, patient has significantly reduced
postoperative pain, which translates to decreased or purid use in
the recovery phase. By instituting also and haanced recovery protocols
(33:25):
along with the minimum basive surgery, we have significantly impacted
and reduced hospital space. For example, in my practice, over
ninety percent of my elective colon resection patients are going
home in the same day or less than twenty four
hours since operation. Today, for example, I did a robotic
(33:45):
sigamare resection in the morning. We started at eight o'clock.
We finished ten am. Patient with away, alert, walking, tirating diet,
hitting all the milestones to be discharged and choose discharged
at home ATIA, this is a remarkable progress.
Speaker 6 (34:03):
Oh, I'm gonna stop, Let me stop.
Speaker 5 (34:05):
I'm let to stop you right there, because I am
just blown away?
Speaker 6 (34:08):
Are you?
Speaker 5 (34:09):
Did you just say that you removed part of somebody's
call in the sigamore colon this morning and they went
home this afternoon.
Speaker 8 (34:18):
That is correct.
Speaker 6 (34:19):
Yes, that's unbelievable.
Speaker 5 (34:23):
I didn't mean to interrupt you, but I really am
just blown away by that statement.
Speaker 7 (34:28):
It's really remarkable. And tell us what you are going
to continue to say about that.
Speaker 8 (34:33):
Yeah, So this is a remarkable progress and change that
we have made done in terms of the way how
we practice. Even since my surgical training, we used to
keep the patients for about five to seven days in
the hospital, with the same kind of procedure. In addition
to quick recovery and decreased the post operative pain of
(34:56):
the robotic platform and minimum invasive is also allowing us
to do significantly complex cases with minimum invasive approach that
could have been done with a major open surgery. And
I do think that the most significant benefit of the
robotic platform over leaparoscopic surgery is the number of conversions
(35:17):
that we have from minimum invasive to open surgery, especially
when it comes to more public surgery rectal cancer or
rectal collapse procedures. For example, I had a recent surgery
that I performed on a very young, thirty two year
(35:37):
old patient. She had a BMI of sixty seven, over
four hundred pounds. She had a complicated diverticulitis with perforation.
She had over six months of IVY antibiotics. She's been
in the hospital multiple times. She had the ir drain
place to be able to avoid surgery, we did a
(35:58):
robotic colon less action on her, who recovered very well.
She went home on day two. She's been back to
work now. And in this case, it's not the quick recovery,
but I want to emphasize the possible mobidity and potential
complications that we have minimized and avoided from doing open surgery,
(36:20):
including hernia, wind infections, and reoperations.
Speaker 6 (36:26):
So you just gave us a ton of stuff to digest.
Speaker 14 (36:30):
It.
Speaker 5 (36:31):
I just want to reiterate what I heard you say
for our listeners. So sometimes if what I'm hearing what
you're saying correctly, when you try and do a minimally
invasive approach, you have to convert from the minimally invasive
approach to an open.
Speaker 9 (36:48):
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(37:10):
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Speaker 3 (38:48):
What's Up, Everybody, My name is Sammy John. Tune in
every weekday morning at nine am Pacific Standard time and
hear my show called The Bridge. And what I do
every weekday morning is I bring you the best of
South Asian music and culture from around the world, and
that includes some of the most exclusive access to the
(39:09):
South Asian music industry. I'll bring you world premieres and
I'll bring you exclusive interviews only on Ruckus Avenue Radio.
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Speaker 5 (39:48):
Approach where you do do that big abdominal incision and
that increases morbidity and things like that. And you're saying
that with these robotic approaches you're having to convert that
less frequently. Is that what that message was that you
were talking about.
Speaker 8 (40:04):
Yes, that is correct. The principles and surgery is to
be safe and to make sure that the patient gets
the appropriate care, regardless of the way how you're approaching
the surgery versus robotic, laparoscopic or open. You want to
have the patient be safe and be taken care of
in the most appropriate way. If the case is challenging
(40:28):
to an unsafe to proceed with laparoscopic or robotic. Of course,
the standard way is to proceed with open surgery, which
gives us more tactile and potentially you know, be able
to do a more safer dissection. However, with the robot
now we're allowing to even do more complex procedures with
(40:51):
with with the minimum evasive. So I actually would like
to give you another good example. I had a lady,
elderly lady who presented with large bowel obstruction due to
severe particular stricture and the stigma with colon, and this
led her to have entire colon to significantly be descended
(41:12):
to a point there was an impending perporation of the
right colon. This means that the entire clon had to
be removed emergently. But despite this, we were able to
do this emergency case robotically with just small incisions and
she did very well with the surgery. Her morbidity after
(41:33):
surgery was minimal. She was discharged on day two and
I saw her in clinic a couple of weeks ago
and she's doing very fantastic. And I actually would like
to take this opportunity to thank the ore staff at
Baptist Floyd and the leadership for being supportive and for
allowing us to do emergent cases with minimum invasive and
(41:54):
robotic approaches. And this has been shown with multiple studies
to be safe and has less mobidity after surgery.
Speaker 5 (42:05):
Well, you know, doctor, doctor Amas, I appreciate you you
taking that moment to kind of thank the team, you know,
for lack of a better better word, because you know,
none of this happens with one piece of the puzzle.
Speaker 6 (42:18):
But I think you know, one of the things that.
Speaker 5 (42:20):
You're showing us is that you know, improved pain, obviously
patient centric, improved you know, length of stays, it's good
for patients, it's.
Speaker 6 (42:30):
Good for you know, costs of medical care.
Speaker 5 (42:32):
Like these are the things that when you see a
really healthy medical system working together, these innovative and newer
things are embraced.
Speaker 7 (42:42):
And so you know, we appreciate.
Speaker 5 (42:44):
Stop this Void for doing that, just like you said,
you for taking the time to be trained to bring
that to the community.
Speaker 6 (42:50):
So we're going to take another quick break there.
Speaker 5 (42:53):
We're going to continue our conversation with doctor Almas after
that break about robotic surgery and TOLO rectal surgery. You'll
listen to send It on Health with Baptist Health on
News Radio eight forty w AHAs.
Speaker 6 (43:04):
I'm your host, doctor Jeff Cublin.
Speaker 5 (43:06):
And if you missed any part of the show, and
I feel badly if you did, you should download the
iHeartRadio app. It's free, it's easy to use, and it
gives you access to tonight's show in its entirety.
Speaker 18 (43:16):
What do you like that, Well, welcome back to send
it on Help with Baptist.
Speaker 5 (43:35):
Health here on news Radio Age forty whas. I am
your host, doctor Jeff Covlin, and we're talking tonight to
doctor Varuk Almas about co electro surgery and robotic surgery.
Remember to download the iHeartRadio app to listen to any
of this or our previous segments and have access to
all the other features that the app has to offer. So,
(43:56):
doctor almad So, welcome back, and thank you for all
these great things that you're sharing with us. So for
our listeners that are out there, a couple of logistical things.
One is how would a patient know that this might
be a modality for them? Is this something where their
(44:19):
primary care or a general surgeon would recommend this approach
or should they be aware to ask about this approach?
So that's one question, and the second question being what
are the kinds of things that if they were a listener.
Speaker 6 (44:34):
Hearing you talk tonight, what kind of conditions might they
come to you to have done this approach.
Speaker 8 (44:44):
Yes, for most procedures in troubdominal the robotic platform can
be utilized. The outcome comparing the robotic surgery versus Lapper's
topic has been pretty much the same UH. It's dependent
on the surgeon's UH practice as well as experience and
(45:06):
the type of UH, the type of surgery that they
perform to be able to utilize either laposcopic or robotic,
and we have we have progress aggressively in terms of
minimizing UH the incisions and also doing minimum basis surgery
for almost most procedures for in tropdominal In terms of
(45:28):
my practice, I do take care of all benign and
malignant diseases of the colon rectum. I do public floor
UH the disorders as well, including rectal collapses UH. I
do interrectal diseases including palin auto hemorrhoid Fisher, and also
do patients with interrectal fisseral s.
Speaker 1 (45:49):
I b d S.
Speaker 8 (45:50):
I take care of all that as a general correctal practitioner.
Speaker 5 (45:57):
And are so wouldn't necessarily be something that a patient
needs to ask about. If the surgeon that they've chosen
and been comfortable with does it, it would usually be
something you would recommend as an approach with.
Speaker 8 (46:11):
Them that is correct. I think there are a specific
disease process that are appropriate for more minimum basive surgery,
and there are a few diseases that are more appropriate
for open surgery approach. So it's a specific disease process
and patient selections and also physician the surgeon's preference as well.
Speaker 5 (46:37):
So I heard you mentioned sort of patient characteristic, which
reminds me that earlier on you told us about a
patient that you did with a BMI of over fifty,
And for listeners to the show, that's an elevated BMI.
That's quite significantly elevated and oftentimes.
Speaker 6 (46:55):
Might preclude the ability to do something like this.
Speaker 5 (46:58):
What are the factors that might preclude your ability to
use a minimally invasive approach.
Speaker 8 (47:07):
I think the major risk factors to proceed with minimum
basis surgery is if the entropdominal is more hostile, meaning
that they've had multiple surgical interventions in the pass, mostly open,
which causes significant scarring which prevents us to carefully look inside.
(47:30):
In this case, the safest approach will be open surgery.
And some specific patients who are quaglopathic, who are decompensating,
who are not doing well, they're not going to tolerate
the numerus cuffilation or placing CO two and their obdomen,
and these patients the open approach will be more appropriate
(47:51):
than the minimum basis surgery. So in patients with with
who are frail, they're not going to tolerate more robotic
or lepers pick approach, then we still do open surgery
to be safely help them get through the whatever disease process.
Speaker 5 (48:12):
And when you do these approaches, are there any downsides
to using the robotic approach? For example, does it limit
your field of vision and you have to see.
Speaker 6 (48:26):
Less at one time? Is there any downside to.
Speaker 7 (48:29):
Choosing the robotic approach over another affair?
Speaker 8 (48:35):
The robotic approach versus laposcopic pretty much very similar in
regards to the outcome. However, you know, we can only
do minimal invasive surgery if we can continue to do
the procedure safely. Very aggressive in terms of trying to
(48:55):
do the surgery robotically and laparoscopically. It's going to be
surgeons a comfort level in terms of proceeding with a
minimum basis surgery approach or conversion to more open surgery.
But I try to do even the most complex procedures,
even the ones that will take very long to perform
(49:19):
them a minimum basive either robotic and laparoscopic. I had
a recent patient who had a rectal perforation yatrogenically, this
would have been an emergent surgery with either a resection
or diversion. I was able to closer from the inside
with the robotic approach. And these are the kind of
things that kind of allow us to minimize patients morbidity
(49:46):
or even the invasiveness of the surgery that we do
and specific patients.
Speaker 5 (49:54):
Well, I know that you know, just like we we
mentioned before, I mean, between the.
Speaker 6 (50:00):
Hospital time, the recovery time, the outcomes.
Speaker 5 (50:04):
That you're describing, this is a really a real forward
step in medicine here in our community.
Speaker 7 (50:12):
So we're just really thankful.
Speaker 5 (50:14):
To have you and that is going to do it
for another segment of Centered on Health. With that to help,
I've been your host, doctor Jeff Publin. I would love
to thank our guests Anthony for calling in today with
his question. We love to hear from our listeners. I
want to thank our producer mister Jim Fenn and you
the listener are special. Thank you to doctor Baruke Alma,
(50:34):
not only for bringing his expertise to Louisville and Southern Indiana,
but for sharing all of that with us tonight. Have
a great week, join us every Thursday night, and I
hope everybody has a safe and healthy weekend.
Speaker 6 (50:47):
We'll see you next week.
Speaker 19 (50:53):
This program is for informational purposes only and should not
be relied upon as medical advice. The content of this
program is it's not intended to be a substitute for
professional medical advice, diagnosis, or treatment. This show is not
designed to replace a physician's medical assessment and medical judgment.
Always seek the advice of your physician with any questions
or concerns you may have related to your personal health
(51:16):
or regarding specific medical conditions. To find a Baptist health provider,
please visit Baptistealth dot com.
Speaker 17 (51:22):
I bet you're smart.
Speaker 16 (51:24):
Yeah, and you like to hold your own in the
group chat.
Speaker 17 (51:27):
We can help you drop even more knowledge. My name
is Martine Powers.
Speaker 16 (51:31):
And I'm a la Heye Azati. We host a daily
news podcast called Post.
Speaker 17 (51:35):
Reports Every weekday afternoon. Post Reports takes you inside an
important and interesting story with the kind of reporting that
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Speaker 16 (51:45):
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Go find it now and hit follow.
Speaker 2 (51:52):
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Speaker 3 (52:23):
What's up, Everybody? My name is Sammy John. Tune in
every weekday morning at nine am Pacific Standard time and
hear my show called The Bridge. And what I do
every weekday morning is I bring you the best of
South Asian music and culture from around the world, and
that includes some of the most exclusive access to the
(52:43):
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I'll bring you exclusive interviews only on Ruckus Avenue Radio.
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