185. Hernia Surgeons Being Controversial

This week, the topic of discussion was: 

• New York Times
• Components Separation
• Large Hernia Repairs
• Ventral Hernia
• Mesh
• Online Courses
• Preceptorship
• Learning New Skills
• Denervation Injury
• DIEP Flap
• Plastic Surgeons

Welcome to HerniaTalk LIVE, a Q&A hosted by Dr. Shirin Towfigh, hernia and laparoscopic surgery specialist who practices at the Beverly Hills Hernia Center. This is the only Q&A of its kind, aimed at educating and empowering patients about all things related to hernias and hernia-related complications. For a personal consultation with Dr. Towfigh, call +1-310-358-5020 or email info@beverlyhillsherniacenter.com.

Guest: Dr Courtney Collins, herniated surgeon at The Ohio State University, Columbus, Ohio

If you find this content informative, please LIKE, SHARE, and SUBSCRIBE to the HerniaTalk Live channel and visit us on www.HerniaTalk.com.

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Transcript

Dr. Towfigh (00:00:10):

Hey everyone, it’s Dr. Towfigh. Welcome to Hernia Talk Live. I’m your host, Dr. Shirin Towfigh hernia and laparoscopic surgery specialist. Many of you’re joining me as a Facebook Live and some are here via Zoom. But as you know, I also live in Twitter and Instagram at Hernia doc. And this episode and all prior episodes will be available to you to share and subscribe to on my YouTube channel at Hernia Doc. And guess what? We have a fantastic new guest again and she is on Twitter. So Dr. Courtney Collins is a hernia surgery specialist at the Ohio State University in Columbus, Ohio. You can follow her on Twitter at dr co md. That’s CO for Courtney and CO for Collins md. And I’m so happy to see her because I actually did see her in Chicago last week, but I didn’t get a chance to talk to you. Welcome.

Dr. Collins (00:01:11):

Thank you. Excited to be here. I think it’s X now. I don’t think you can say Twitter anymore.

Dr. Towfigh (00:01:15):

Oh, sorry. On XI know I should say Elon

Dr. Collins (00:01:18):

Musk will come after you with his ellan going to come after me, his electric driverless. So I’m just trying to keep you safe.

Dr. Towfigh (00:01:27):

Thank you. Thank you. So I fell in love with Dr. Collins because she’s smart, she’s witty, she’s very knowledgeable, she’s part of our her new friends world. Last Sage’s meeting, she was one of our speakers on diversity in the hernias session on sages. And then this year at the American Hernia Society meeting where we both were in Chicago last week, we also had a hernias session. Were you on that panel? You were not.

Dr. Collins (00:02:05):

I was supporting the audience. There’s so many good female hernia speakers now. It’s hard to I know, get a slot, which is great. I love it. That podium’s getting so crowded.

Dr. Towfigh (00:02:16):

Well, okay, so I’m giving grand rounds tomorrow at one of our hospitals here affiliated with UCLA and one of my slides is the speakers when I went to my first a HS meeting and then the speakers now it’s definitely diverse and many more females and maybe we can just plug their new hernias alliance, which is an effort to band together and gain some omentum and improving research and knowledge of hernia care, especially in females. And so I think I shared this with you guys last year, got my little oops hernias pin, which many of us were probably wearing at the meeting. And lots of really great positive feedback. I thought the session was very well attended and very well liked and considered one of the better sessions of the meeting. What do you think?

Dr. Collins (00:03:20):

Yeah, no, I would agree with that. And we have to give a shout out of course to Jenny Shower who design the actual pin, which I think is so cute. I dunno if you guys could see, but it’s a little loop of bow that makes the end.

Dr. Towfigh (00:03:30):

Yeah, so the loop of bow is helpful because

Dr. Collins (00:03:33):

Yeah,

Dr. Towfigh (00:03:33):

It kind demonstrates the her away from Nia and there’s a hernia

Dr. Collins (00:03:39):

And it’s purple. So it’s threatened but not dead, you know what I mean? It’s not

Dr. Towfigh (00:03:45):

Strangulated, it’s just badly incarcerated hernia.

Dr. Collins (00:03:49):

It’s in trouble but it’s not too far gone. And then

Dr. Towfigh (00:03:53):

Also the pin is pink, which

Dr. Collins (00:03:55):

It’s not pink. Yeah, exactly. Probably should do something. And then also just kind of as for the hernias effort, and I think this was reflected at the meeting too, is that you don’t have to be a girl to be part of the hernias addition. No, I think as you mentioned, it is really just to increase sort of the conversation and just knowledge and just more, we just need more information I think just about how hernias and hernia disease sort of manifest differently in women. And just to understand that so we can take

Dr. Towfigh (00:04:24):

The best. I mean that’s real, right? That’s a thing. And yeah, the guys were wearing this as cufflings, which I thought was kind of cute.

Dr. Collins (00:04:35):

You do not have to be for people out there. If you want to pin just so you can tweet at either of us, we’ll get Jan to hook you up. But

Dr. Towfigh (00:04:41):

Yeah, you can follow the exactly. It’s called hernias alliance with an s hernias alliance and you can follow them on Twitter and Instagram right now. It’s the early stages of it. And hopefully as they band together to develop true research for women, you may recall those of you who follow me, Dr. Jenny Chao, who’s kind of the instigator of many of this. She was a guest on Hernia Talk Live and who else is, oh, university of Michigan. We learned on this show they are going to start a watchful waning trial for a women. How cool is that?

Dr. Collins (00:05:28):

Yeah,

Dr. Towfigh (00:05:28):

Because we don’t know anything about, we

Dr. Collins (00:05:30):

Don’t know anything. Yeah, I think that’s most of the conversation right now is it’s not even just like, oh, hernia care is good, bad, indifferent. We really don’t know because women are generally just underrepresented in a lot of the papers that we have about hernia disease, which again isn’t anyone’s fault in particular, it’s just that it is just a fact. We just don’t have as much information as we probably should in this sort of space. And again, we are not blaming anyone or mad, it’s just kind of try to bring attention so we can do the best thing for, I dunno, 50% of our patients, at least our ventral hernia patients.

Dr. Towfigh (00:06:05):

So in keeping with our title for today’s talk, hernia surgeons being controversial, I want some of the audience to chime in if you think it’s a good thing that we have this separate arm of the hernia friends world where we’re focusing specifically on women’s hernias. I think it’s a great thing, but there are definitely people out there that consider any type of discussion of women’s issues separately as divisive or what’s the other term you used earlier? Exclusionary.

Dr. Collins (00:06:43):

Exclusionary.

Dr. Towfigh (00:06:43):

I don’t know. Do you guys feel that? I think it’s a good thing, right? It’s not like we’re excluding the men, it’s just all studies have been focused on men when we should learn about women and maybe this whole idea of chronic pelvic pain and women do worse with hernia repairs than men is because we’re not treating them differently even though the anatomy is different. But do you think so?

Dr. Collins (00:07:08):

I think that’s true. And I think a lot of it, I mean honestly, you can even sort of play to people’s selfishness. It’s like women’s pelvises are very complicated, right? It’s different. And pelvic pain is very complicated in women. And so wouldn’t you as a hernia surgeon to understand that better? I know I would. I’ll be honest with you, a lot, a lot of times you get a woman with this complex sort of set of symptoms and you’re just like, I don’t know what I mean, you kind take your best guess. But it’s such kind of a black box right now that I think it would make all of our lives easier if we were able to understand that better and guide our patients through it.

Dr. Towfigh (00:07:45):

Because I’ve had a couple opportunities the past several months sitting with friends of mine, new friends of mine that are either urologist or gynecologist and I bring up the whole women’s hernia thing and it wasn’t even on their radar. So they’ll see women with interstitial cystitis, urinary frequency, chronic pelvic pain, and I’ll say, that could be just from a hernia. And they’re like,

Dr. Collins (00:08:15):

Yeah, I mean

Dr. Towfigh (00:08:18):

How is that? There’s no hernia. I’m like, they’re like, I’m no, no, no, but that’s not the point. Hernias cause pelvic floor spasm and causes chronic pelvic pain. They can have pain with an orgasm, pain with intercourse, urinary frequency, all the pelvic floor issues. And then what,

(00:08:36):

I have so many patients that aren’t getting better. I’m like, yeah, then you send ’em to pelvic floor physical therapy and they hate it. So painful because you really just have to fix their hernia and it’s just like a light bulb.

(00:08:51):

And then I have to start giving those lecture that I give to my residents to them.

Dr. Collins (00:08:57):

And then, and also on the flip side, it’s like you don’t want to do, if someone sends someone to with pelvic pain to a hernia surgeon, that’s the only thing they can think of

(00:09:04):

And

(00:09:04):

It’s not what it is. And then you end up, if the classic surgeon where you’re a hammer and everything’s a nail, you end up doing a surgery they don’t need and making it worse. So it’s like wouldn’t it be great to have a better way of navigating that? And I think that

Dr. Towfigh (00:09:20):

Exactly today literally the patient before this was a female with sciatica and a hip disorder and they found a hernia on her ultrasound. So they sent her to me. I’m like, I went through all the symptoms and by the way, the injection into her back and the physical therapy for her hip made her better and some of her pain was below the knee. I’m like, none of that’s hernia. So yes, you have a hernia, let’s make sure it’s not femoral hernia. But other than that, I’m okay with you not operating on that.

Dr. Collins (00:09:54):

I think we could all use, I mean I am a woman and I think it would be nice to have just a better algorithm and it confuses me honestly, you, and so I think it would help all of us to not

Dr. Towfigh (00:10:05):

Guessing more of the comments is yes, more please. I feel so alone despite seeing a lot of doctors. And why is that? That we don’t have one of the most common operations performed by general surgery, and yet there are doctors that don’t even know how to diagnose or they don’t understand the symptoms behind a hernia.

Dr. Collins (00:10:27):

I think it’s because pelvic, again, there’s so much going on. And to be fair, the male pelvis is also complicated, but there’s a couple of systems that are just a little different, but pelvic floor sort of dysfunction, pain has gotten so siloed. So you have the urologists who are very good at what they do. GYNs, were very good at what they do and her new surgeons were very good at what we do, but it’s kind of hard to get a real cross-disciplinary look at things and sort of figure out what’s going on. And so again, I think it’s not really, it’s not so much, I mean it is sort of a lack of knowledge, but it’s just sort of a lack of diversity of knowledge. We’re all just so

Dr. Towfigh (00:11:04):

Good.

Dr. Collins (00:11:05):

The one thing that we do, and again, we’re not asking people to become an expert on urogynecology. That’s crazy, but can we at least have some kind of better

(00:11:15):

Understanding

(00:11:16):

Of maybe when to get other specialties involved or when to just do a hernia repair and that sort of thing. It’s that crosstalk that’s missing. I think

Dr. Towfigh (00:11:24):

We had a dinner get together on I think that Friday night and I was like, one of my dreams would be to have unlimited funds,

Dr. Collins (00:11:34):

Period, period, end

Dr. Towfigh (00:11:37):

Of podcast, but to have unlimited funds and sponsor an annual meeting to just discuss female hernias and all the offshoots. So for the general, there is the International Pelvic Pain Society and there’s the endometriosis summit and a bunch of other physical therapy urogynecology meetings. But this would be for general surgeons almost never taught that. And it’ll be directed at just those in practice and just very dry. Here you go. This way you know about hernias. This is how you examine them. This is the imaging. If you feel that they may have a urologic problem, have a urologist give that talk. If you think it’s such gynecologic problem, have a gynecologist give that talk, but bring those specialists to the general surgeon. I feel like we don’t know enough, don’t you think?

Dr. Collins (00:12:40):

No, I totally agree and everyone should have several slides on when to call me. You know what I mean?

(00:12:45):

What are the buzz words and what questions to ask? I have no idea how to suss out a urologic unless it’s very obvious it burns when I pee. I get that one unless I don’t even know what to ask. And I think right now, that’s actually a really important thing to tell P when they have an unclear picture and you’re like, listen, this could be a hernia. This could not be like, I’m happy to try a repair. Or do you want to go talk to someone else? You know what I mean? I think it’s really important to not, I think sometimes we feel like we have to act like we know all the answers and sometimes, listen, I’m not sure you’re a safe surgical candidate. This is reasonable to try. But also if you’d like to involve some other specialties in the conversation, then I think that’s reasonable.

(00:13:33):

I hope people appreciate that and I think it does help set expectations.

Dr. Towfigh (00:13:38):

Yeah, I totally believe that. And I feel that I’ve learned so much from my pain, doctors, urologists, ureter, gynecologist, physical therapist that I would love to have. Most general surgeons have that experience, but I need to fundraise for that,

Dr. Collins (00:13:54):

The limited fund.

Dr. Towfigh (00:13:55):

But how cool would that be? We have a really great place to have the meeting and have a very low bar for people to be able to come and learn. And it’s one of my dreams. Here’s another comment. My doctor and I were convinced it was an ovarian cyst. It was a classic hernia, and our whole female reproductive systems are different until I found a surgeon who understood the difference between women’s hernia and men treatment, men’s treatment, I was lost. I’m so thankful for the surgeons who understand women’s hernia is, and she gives a shout out to Dr. Robert Martindale from OHSU.

Dr. Collins (00:14:32):

Oh sure.

Dr. Towfigh (00:14:33):

And Vaha Napoleon. So good for him. I’ll let him know. He got a shout out on my show.

Dr. Collins (00:14:36):

Yeah, let him know in Portland, Oregon. Love it.

Dr. Towfigh (00:14:41):

Yeah. Here’s another comment. In my 12 years of hernia surgeries, and I’ve had a lot, I feel like I’m a constant resource for other women who get a hernia and their doctors telling them it’s no big deal. The word needs to get out that women can get a hernias too. So crazy. Did you know a lot of people believe women can’t get hernias?

Dr. Collins (00:15:01):

Oh, it’s funny. Literally. And this was this very small internal grant mechanism at Ohio State, but we got this kind of bonkers application, which was rejected. But part of the thing now when you would do any study is you have to say what you expect, how many women versus men you’re going to enroll. And I can’t remember what the study was. It was was hernia related, but I think it was more like education. It was like

(00:15:24):

Training residents or students or something. It was not bi surgeons. I think it was a med school thing, but they literally wrote in their application that they weren’t going to recruit women because women didn’t get inguinal hernias. That was their understanding. And again, this was not a surgeon, so this was, oh my god. But it was somebody in a medical adjacent sort of specialty. And I was like, wow. I honestly stopped reading right there. I was like, this person doesn’t understand the disease process that they’re putting a thing around. But yeah, someone, I don’t remember who it was.

Dr. Towfigh (00:15:55):

Gynecologists. They’re gynecologists that didn’t know that women get hernias.

Dr. Collins (00:15:59):

It’s crazy. Anyone, can we get them proportionally inguinal ones at least proportionally less. That is true, but the less is not Never I, but

Dr. Towfigh (00:16:11):

I teach at the UCLA medical school and I say, Hey, by the way, when do you guys get taught about angle hernias and it’s during their male reproductive system?

Dr. Collins (00:16:24):

That’s a great question. Course I’m going to ask our med

Dr. Towfigh (00:16:27):

Students, ask your students. Let me know.

Dr. Collins (00:16:29):

I’m going to, I have no idea. When they learn that, I would assume I’ll come up to, I’m going to ask them. That’s a great question.

Dr. Towfigh (00:16:35):

I do their physical exam, standardized patient thing, and of course I find hernias in everyone and these people that have been examined, they do it for a living every quarter, every semester they show up and they have students examine them as part of their practice of how to do a good physical exam. And so I’m like one guy, he did it five times. I’m like, they never told you you have a rectus diastasis and umbilical hernia.

Dr. Collins (00:17:03):

No. Yeah, right. No. Yeah. Alright. I see that a lot of, when I operate for an inguinal, I always check their belly buttons and I was like, have. And it’s funny, I mean, not that it really matters. I’m like, some of ’em, like their little hernia, they’re like, no, I’ll just keep it. You’re like, all right, that’s fine.

Dr. Towfigh (00:17:18):

There’s a whole online fetish about belly button hernias. Did you know that

Dr. Collins (00:17:21):

I can

Dr. Towfigh (00:17:22):

Just, or belly buttons. I

Dr. Collins (00:17:23):

Mean literally fill in the blank here. That should be our next thing. Weirdest internet communities. People can put that in the chat. Did

Dr. Towfigh (00:17:30):

You know I got a DM on Instagram. Someone was asking how they can make an umbilical hernia, how they can get one.

Dr. Collins (00:17:41):

An outtie, you

Dr. Towfigh (00:17:41):

Wanted an outtie? Yeah. Okay.

Dr. Collins (00:17:46):

I guess that technically violates or do no harm thing, right? You probably can’t do that. A plastic.

Dr. Towfigh (00:17:51):

I was like, I mean I guess you could get silicone injection or something. I

Dr. Collins (00:17:54):

Guess that Yeah, that’s true. Now we’re down a whole rabbit hole. Who knows? How

Dr. Towfigh (00:17:58):

Crazy is that?

Dr. Collins (00:18:00):

I know some people are very attached to their, and that’s fine as long as it’s not causing problems.

Dr. Towfigh (00:18:05):

So I was teaching them how to do hernia. I’m like, when did you guys learn? I don’t remember if it’s about hernias as the diagnosis or as a physical exam finding, but it’s during the male, so they’re never taught how to examine a female.

Dr. Collins (00:18:20):

Oh yeah. I would just say hernia exams in general I find overwhelming for medical students, but I know the one’s really important. I swear to God, anyone going into primary care should have to go through a really intensive hernia, hernia exam course because I think obviously that’s where a lot of ’em are found. And I have referring doctors who are very good at them and I’ve referring doctors who are very bad. So I’m like, should build this an internal medicine residency.

Dr. Towfigh (00:18:49):

So for those of you who are watching, if you think that developing a hernias alliance, which is focused on women’s hernias is too exclusionary, let us know. But if you think it’s a good idea, I’d also like to know and I’ll share it with our women’s group. Here’s another comment. I’m an rn, registered nurse. I had a total hysterectomy for endometrial cancer and was asked to have an umbilical hernia repaired, and I asked to have an umbilical hernia repaired during the operation, but no one could coordinate it and the hernia is now worse.

Dr. Collins (00:19:30):

That sucks.

Dr. Towfigh (00:19:30):

I’m curious if you had your hysterectomy robotically or open. Also, I have two kidney stone surgeries. Does that also weaken the abdominal wall kidney stone surgeries, like actual surgery or It was through the cystoscope the question, but yeah, it’s totally reasonable to have your belly button hernia repaired at the time of another elective operation, right?

Dr. Collins (00:19:56):

Absolutely. Yeah. I mean depending on what kind of repair you’re looking at I think and that sort of thing. But assuming it’s just a little belly button one, actually, I sort of wonder, I’m like for some of these really tight, because a lot of the times the challenge in the coordination, just like they mentioned, so I mean this just happened. I mean we were able to coordinate it, but it’s like some lady needed, she needs little bit of has a gastric cancer, she needs a partial gastrectomy, but then needs someone to close her belly. And so they’re looking for then started bleeding so she needed to wired way. They’re trying to, and it becomes this huge coordination thing. But I think kind of your point, no one should have to undergo two surgeries just because schedules don’t line up. So another great opportunity kind for crosstalk is like OBGYNs do amazing stuff. I mean they do. So part of me is like, gosh, maybe we should just teach other specialties. I mean, if we’re talking just throwing a stitch in a belly button,

Dr. Towfigh (00:20:48):

Some of them can, I would say can,

Dr. Collins (00:20:50):

Yeah. But it’s like we should go teach people. I should teach people at Ossu and if you just have a little thing, here’s how to do it. You do much harder stuff than that. So you can definitely handle it.

Dr. Towfigh (00:20:59):

I mean a surgical, the gynecologic oncologist, they do a lot of really complex stuff, so they should be able to fix that. I’m sorry that happened to you. Yeah, we probably don’t need, and she’s a nurse, so she probably knows the doctors. I

Dr. Collins (00:21:14):

Kind of realized on us being not as possessive of that. But again, a little belly button thing, I have full confidence that

Dr. Towfigh (00:21:20):

Maybe it was bigger and they wanted me

Dr. Collins (00:21:22):

Or something. That could be. And then another

Dr. Towfigh (00:21:25):

Comment, excuse me. I finally convinced my plastic surgeon to refer me to a hernia repair specialist. I have two Spider-Man hernias, one on each side. I think they mean spa, not spider

Dr. Collins (00:21:39):

Spa. Those are fun. Yeah. Okay.

Dr. Towfigh (00:21:41):

I kind of want a Spider-Man hernia. Yes. I’m going to call them that

Dr. Collins (00:21:44):

Now. That’s a much better name.

Dr. Towfigh (00:21:46):

I’m going to take that. Yes. Spa hernia, one on each side. Those are in the lower abdomen, by the way, but they’re not groin and a small umbilical hernia. I now have a counsel with Dr. Horn at Mayo Clinic on October 3rd. So Dr. Charlotte Horn was one of my guests as well. Go back and listen to her. At that time she was at Hershey, Pennsylvania, but she’s moved and she’s now the main hernia doctor at the main Mayo Clinic in Rochester, Minnesota.

(00:22:16):

Phenomenal. She’s

(00:22:17):

Phenomenal. Yeah, you’re in good hands, the surgery together. So I’m very happy about that. But I’m wondering what to expect for the procedure and recovery. Yeah, spga and belly button hernias. Oh, this is the same patient. The same patient. No different patient. Yeah. I mean she does a lot of robotic surgery. I assume SPI hernia will be done

Dr. Collins (00:22:42):

Tap

Dr. Towfigh (00:22:42):

Right? I would assume.

Dr. Collins (00:22:43):

Yeah, usually. I would assume so. It kind of depends on the, well at least what I do with combos with plastics is it kind of depends on what plastics is going to end up doing. If we’re going to think of giant incision to take extra skin out or something like that, then sometimes we’ll just do the whole thing through that and save the time. But if not, because at the end of the day, I do a lot of robotic surgery as well. So if it saves somebody an incision, I think robotics is never wrong. If they’re going to get a giant incision anyway, then I can just use that one, that one incision. So

Dr. Towfigh (00:23:14):

Here’s my thought on plastic surgery combo with laparoscopic or robotic surgery, the laparoscopic or robotic surgery messes up the plastic surgery because you’re insufflating CO2, and that can get into the fat and soft tissue. So it destroys the, not destroys, but it affects the cosmetic outcome of what the plastic surgeon can do. Now, gas in the soft tissue potentially. And they want to make sure it’s very flat, very soft, very smooth contour, let’s say when they’re doing a tummy tuck. And if you are doing their hernia repair, robotic robotically or laparoscopically before the tummy tuck part at the same surgery though, then your gas can affect the cosmetic outcome of their operation. So I don’t recommend it, but like you said, if it’s a big operation like a tummy tuck and the hernias are right there and easier to repair, that would be to me a better option to just get all at the same time open as opposed to robotically plus robotically, you get scars in areas that will not be removed during the tummy tuck, so why would you want that?

Dr. Collins (00:24:38):

Exactly.

Dr. Towfigh (00:24:39):

But if you’re paying so much for plastic surgery,

Dr. Collins (00:24:42):

Which is funny, this kind of segues into the other kind of thing we were going to talk about today, but I think the robot, so again, I’m a huge robotic fan. I love you doing it, but I’m actually, in terms of especially my complex stuff, I’m actually about 50 50 open versus taking plastic surgery even off the table because I think robot,

Dr. Towfigh (00:24:59):

The small ones,

Dr. Collins (00:25:00):

Yeah, I think robots are a great tool, but I think they’re not, every surgery needs to be done robotically. And I think there’s certainly a role still for open surgery. I think a lot about skin, a lot of times maybe they don’t need plastic surgery, but I’m like, they have a giant, really ugly scar from their trauma or whatever they had. I’m like, well, do you want that scar revised? And maybe sometimes they don’t. Sometimes they’re like, no, I don’t care. But because again, I emphasize this a lot, I’m on the inside, it’s the same operation, you know what I mean? It’s the exact same. And I really am very clear on that. I’m

(00:25:33):

On the

(00:25:34):

Inside. This is exactly the same. But do you have concerns about the cosmesis, the scar, all that sort of thing? Because that’s something I as you can’t really fix with a robot and becomes more difficult to do for the plastic surgeon. And so if they don’t like their scar or they have a really big ugly one, or they’re worried about the extra, those really big hernias, you’ll get the skin and they want that resected. And I’m like, well, then we’ll just do it open again. It’s the exact same operation. And

(00:26:00):

Then

(00:26:01):

You can often get a better cosmetic result.

Dr. Towfigh (00:26:04):

And for hernias, I mean there are pros and cons to open end, laparoscopic and robotic, but there are situations where it’s not that much better. It’s not malpractice to do something open, even though it can be done laparoscopically or robotically. And so you got to see what the situation is.

Dr. Collins (00:26:24):

Exactly.

Dr. Towfigh (00:26:24):

So here’s the situation. It sounds like she is, I think she’s had denervation. It says generation, but I think it means denervation from a deep flap surgery, DIEP. So yeah, denervation. Okay. She’s confirming that. So the denervation surgery, I don’t know if you do those, but it’s a horrible complication with very poor outcomes from the surgery. But when I do those, it’s basically an open side tummy tuck. You just plicate that weakened muscle. And I put a very huge, very wide mesh to the ribs and to the hip and the angle ligament and crosses the midline. So it sounds like it’s not as cosmetic of a procedure, it’s actually to deal with the

Dr. Collins (00:27:23):

Complication

Dr. Towfigh (00:27:24):

Complication from a prior operation. So yeah, that would be interesting kind of combo. But with that for sure, all the flaps are opened up just like a tummy tuck

(00:27:37):

And

(00:27:38):

It would expose Spigelian hernias and

Dr. Collins (00:27:41):

Right there in front of you,

Dr. Towfigh (00:27:44):

You might as well. Plus the surgeon, I hope, is going to add mesh because it doesn’t work without mesh. So that’ll be the mesh based repair for these

Dr. Collins (00:27:53):

Hernias most likely. That’s again having with obviously the caveat that we haven’t seen pictures or anything, but that sounds like very, very reasonable approach.

Dr. Towfigh (00:28:03):

Alright, so it sounds like everyone’s very supportive online with this whole female bent.

Dr. Collins (00:28:11):

Good. I’ll

Dr. Towfigh (00:28:12):

Tell you, glad

Dr. Collins (00:28:13):

To hear it.

Dr. Towfigh (00:28:14):

My first job, I was the only female, full-time female faculty. There was another female who was part-time, a plastic surgeon in the entire department, big department. And we had, I would say about 25 30% female residents and they had no one to go to, so they sucked onto me. And I just finished residency, so it was a little bit overwhelming, but I took it on and my chair took me aside and said, Sherin, I don’t want you doing any more of these women in surgery events.

Dr. Collins (00:28:55):

Oh gosh. And I

Dr. Towfigh (00:28:57):

Was so oblivious. I was like, oh, but it’s so good. We really need it. We have all these residents that are in need and I’m just helping them with mentorship and career guidance and advancements. And so he said, it’s a little bit divisive and exclusionary and I don’t recommend it. And I said, oh, wow, for a chair to say that. And then I said, wait a minute, as a white guy, I didn’t say it out loud, but I did say it. Aren’t you an honorary member of SAS at the Society of Black Academic Surgeons? And they have honorary members? And he’s like, yeah, I don’t believe in that either. It’s too divisive. I was like, oh, shoot. Wow. Okay. Guess what? I never listened to him and I eventually left the job kind of how it was. But yeah, you definitely need it. I feel like you need it.

Dr. Collins (00:30:00):

Yeah, I think all this stuff, and again, we’re ing a time when kind of anything related to this sort of DEI, anything, even if it’s patient facing, gets very triggering. I think for

(00:30:10):

People.

(00:30:11):

What I sort of fall back on is the literature shows that we don’t know as much about. I mean, it doesn’t have to be political at all. Literature kind of shows that women are promoted less, that women struggle, they build their practices much slower, that they’re to lose referrals after a bad outcome where men keep their referral bait. We have a lot of data to sort of back up the idea that there’s still some sort of cultural issues, even just looking at men versus women, which is one of the least divisive sort of, I think.

Dr. Towfigh (00:30:46):

Yeah, all

Dr. Collins (00:30:47):

Not even getting into race or LGBT and sensational, I’m using other people’s words, not mine.

Dr. Towfigh (00:30:54):

Yeah.

Dr. Collins (00:30:56):

We actually do have, this isn’t based in just our feelings and our feelings being hurt. This is actually something that we can back up our significant differences.

Dr. Towfigh (00:31:08):

So the other thing we’re going to talk about, just trying to be controversial.

Dr. Collins (00:31:14):

I know

Dr. Towfigh (00:31:16):

Many of you may have read, there was an article in the New York Times, it was dated. Oh wow. It’s almost a year.

Dr. Collins (00:31:24):

I know, right?

Dr. Towfigh (00:31:25):

October 30th, 2023. Were you ever called by the reporters?

Dr. Collins (00:31:30):

I was not. I know a lot of people quote it. They mostly talk to people at the Cleveland Clinic, which they say in their articles, but I’m not outing anybody.

Dr. Towfigh (00:31:38):

I was called, I was called.

Dr. Collins (00:31:39):

You were called? Yeah, I was not. I got a

Dr. Towfigh (00:31:43):

Couple of emails and then they interviewed me on the phone. My name didn’t make it through it, but the title, okay, it’s Under Operating Profits is the subtitle and the title says How a Lucrative Surgery Took Off Online and Disfigured Patients. And then there’s a little byline which says more surgeons are opting for a complicated hernia repair that they learn from videos on social media showing shoddy techniques. And I think it did actually did it. I think it hinted on our research, which was we took the top 50 hernia repairs on YouTube, her pair of videos on YouTube based on number of viewerships. And we scored them based on Ed Felix and Jorge Diocese, a scoring to see how many of the nine commandments it followed for safe operations. And there was a good chunk of them that had a score of zero,

(00:32:51):

Did nothing safe. And these were thousands of thousands of viewers. And we were saying, listen, if you want to learn online about new techniques, don’t go to YouTube necessarily. You have to go to sages or one of those societies where they vetted the video first before it makes it online. Anyone can put their video online. So I was one of the three surgeons that scored these videos and I was getting PTSD because some of them were so bad and they had multiple videos up and it was just giving me just palpitations, watching these horrible surgical techniques. But anyway, so this anger, this New York Times article, I thought it was fine. Honestly, I am okay being exposed and it’s good for surgeons to understand how they’re viewed. I’ll give you something interesting. When I was a pre-medical student, I was volunteering in the er, a mom and her kids got hit in their minivan and the trauma came in with the mom and a bunch of kids, and it was a bad car accident. So all I heard as a pre-medical student, I’m in college volunteering was they brought ’em in. The ER. Doctor’s like, all right, she’s paralyzed. And what they meant was they gave a paralytic through the iv,

(00:34:35):

So they chew down and care. I thought, oh my God, this mom is now paralyzed. And it’s just perception. If you don’t know the lingo or if you use the wrong language, you have to be very careful around patients how you talk. Because the lingo of doctors talking to each our vocabulary is a little bit different. We write in our notes, A patient denied this, that and the other. We’re not accusing them. It’s not like a denial in a jury trial. Do you deny you weren’t there during the shooting, but it’s just unfortunately some of our medical lingos like that. So this article, I think is one of those articles where it’s showing you the patient’s point of view of something that doctors didn’t really even think twice about.

Dr. Collins (00:35:32):

Don’t

Dr. Towfigh (00:35:33):

You think?

Dr. Collins (00:35:33):

Yeah. It’s funny. So I did a debate about this at Sages, obviously for hernias, surgeons, this really hit a lot of people hard.

Dr. Towfigh (00:35:43):

Yeah, it really did. Angry, so many

Dr. Collins (00:35:46):

Angry people, it’s really angry. People were very upset about this article and I think because for a lot of people, they feel like this is their life’s work is to put up good videos and kind of disseminate new techniques to places where maybe it wouldn’t get to before.

Dr. Towfigh (00:36:02):

So helpful.

Dr. Collins (00:36:03):

And there is value in that for sure. And so I think that’s why it hit so many people hard. The article I thought was, I do, in fairness to kind of both sides of it, I do wish that the article had done a little more, just mentioned a little more about that. And just that there have been some positive things from disseminating video, certainly, because before what you read a book, and I mean let’s not forget where 50 years ago you learn a new technique. Some guy described it to you and then you would go try it. I mean, adapting new techniques has always been difficult. So I do that. Videos for sure have conferred benefits. That being said, I do think it raise a lot of great points about how do we control this? And so now we have videos out and you can’t stop somebody from watching them and then doing what they see. And so how do we sort of control the narrative a little better and how do we sort rein and who’s responsible for it?

(00:37:12):

If I post a video and then someone tries to replicate what I do and does a bad job, am I then somehow responsible for it because I put that out there and led them down the, I don’t know. And I think we’re starting to figure that out, but I think it raises really interesting question of how do we, not even with just hernia surgery, but in general, what’s the right way to disseminate new techniques? Because you don’t want to just only do things that you learned in residency for the 40 years of your career that doesn’t make sense. You want your patients to have access to the best treatment offered, but how do you disseminate that in kind of a safe way? I think, again, across specialties, that’s a whole,

Dr. Towfigh (00:37:55):

I mean, I’ve had surgeons be like, Hey, so we’re going to do this case different hospitals. It’s not even a hospital where I can go to myself and oversee them. These are outside of my area. And they’re like, yeah, I’ll just going to do a What’s that you guys are doing nowadays? He’s like, I’m just going to do component separation.

Dr. Collins (00:38:14):

Oh yeah,

Dr. Towfigh (00:38:15):

Have you done one before? He’s like, no, but it can’t be that hard. And I’m like, you can really screw someone over if you don’t know what you’re doing.

Dr. Collins (00:38:24):

Absolutely.

Dr. Towfigh (00:38:25):

And I’m like, just refer them to me or someone else that can do it. You shouldn’t do it. So then I started telling them all the things to be afraid of, and then I freak them out a bit. But I can see a lot of doctors, especially if they don’t work in an area where there’s easy access to a specialist where they’ll just go online and do their due diligence, which to learn, and then they get themselves into trouble. And I think because they’re not dealing with the heart or the brain or the spine or something that sounds really dangerous. It’s just the muscle, just the abdominal wall. Just a

Dr. Collins (00:39:07):

Hernia. Just a

Dr. Towfigh (00:39:09):

Hernia, yeah.

Dr. Collins (00:39:11):

A lot of, I think the just a hernia rhetoric is the thing that hurts us the most. Right? Because I think hernia or abdominal wall surgery in general has suffered from people thinking that it’s just this really simple thing. And it can be, right? I mean, we’re talking about little belly button, certainly like a little tiny belly button hernia. That is a simple

Dr. Towfigh (00:39:27):

Thing. So the gynecologist could do it,

Dr. Collins (00:39:30):

But if a gynecologist surgeon doing component separation, so again, in theory, I could probably talk myself through a hysterectomy I guess, but I mean I shouldn’t. I know where the uterus is. I know generally how to take things out of people, but that doesn’t mean that I shouldn’t be offering that to patients because,

Dr. Towfigh (00:39:48):

So the video has the video, the New York Times article has a bunch of pictures of really deformed people. They’ve had nerve damage to their abdominal wall. And lately I’ve been hearing a lot from patients who’ve had this deep flap from, and I wonder if there are way too many plastic surgeons doing these flaps and are causing injury when maybe a specialist should be doing it anyway, same kind of line of thought, but I lost my train of thought.

Dr. Collins (00:40:23):

I think it’s also important to remember that in hernia surgery especially, I mean maybe this is true for other specialties too, but our complications tend to show up a little bit later unless it’s a bowel injury or something.

Dr. Towfigh (00:40:32):

Yes,

Dr. Collins (00:40:33):

That’s right. But our recurrences and our issues tend to show up a long time later. And surgery, I think especially people tend to go to another surgeon. And so I think people are out there kind of thinking they’re killing it. They’re doing these, and I noticed that a lot in this article. They’re like, I’ve done all this and I’ve never had a problem. And for sure you haven’t had a problem because not confident in that. I’ve been operating for, this is my seventh year at Ohio State, and I’ve never had a major, but honestly, I probably have. They just are like, oh, that Collins girls know what she’s doing, so I’m going to go to, I don’t actually know. I don’t have a hundred percent.

Dr. Towfigh (00:41:09):

Yeah, I think you’re right. That is definitely one of the issues, which is that it’s not right there. When you’re injuring the nerve or you’re in the wrong plane or you’re putting it in the match too tight and it’s going to rip whatever that situation is that will deform the patient. They’re going to show up with a bulge and you’ll be like, ah, just swelling, go home. Then maybe it’s just a fluid collection and then they won’t come back to you again. And that’s very true. So the pictures are look horrible. These are patients, mostly women that are very deformed with their abdominal wall. And then on top of that, they linked this notion of surgeons are just learning online with financial incentive because now they’re doing a more complicated operation that will pay them more than if they did a lesser operation. And so they’re kind of trying to say this was financially motivated as opposed to trying to do what’s best for the patient.

Dr. Collins (00:42:14):

Yeah, I mean it’s tough. I want to believe that isn’t true, but humans, it’s probably true for someone out there. I mean, just because humans have all shades of behavior, I don’t think that’s true. I hope that’s not true for the majority of people.

Dr. Towfigh (00:42:33):

So here’s my thought on that. Certainly

Dr. Collins (00:42:35):

Not how I make decisions in

Dr. Towfigh (00:42:36):

The operating. They asked me this specifically during the interview, and so the Michigan data, there’s state data shows. There’s all of a sudden out of nowhere there’s this spike in using the specific CPT code, which is a code for surgical procedures that we use to bill, whereas in the past decade, no one’s been using it. All of a sudden people are using this code, which implies that a very much more complicated operations being done. And my thought was, we don’t really know what operation was done. It is possible. Up until recently, people have been using just a regular hernia repair code and then they learned that you can get more reimbursement if you bill it a different way. And even though technically they weren’t doing a full component separation, if they were doing just a little bit, they were coding it as if they were because they’re doing more work. And so I was cautioning them saying, just because you’re seeing a spike in codes doesn’t mean those codes are representing exactly what you think is going on. A certain percentage of those patients are not getting true component separations.

Dr. Collins (00:43:53):

I think that’s a really good point because I mean just people can bill for anything and describe anything. You don’t know what’s actually happening.

Dr. Towfigh (00:44:00):

I think

Dr. Collins (00:44:01):

You have this kind of confluence of factors too iss and so the transverse abdom release, the tars, which are kind of the big

Dr. Towfigh (00:44:08):

Posterior components. Yeah,

Dr. Collins (00:44:10):

The big kind. That’s

Dr. Towfigh (00:44:11):

The one.

Dr. Collins (00:44:12):

The Cadillac of hernia repairs, which is what this article is about, is describing Those are relatively new surgery in terms of, I mean, in terms surgical lifetime, it’s only

(00:44:22):

Been,

(00:44:24):

It hasn’t been that long, so of course it’s going to uptick because relatively new, but the billing thing also happened, and then the robot also happened. And I do think we actually have data to show this. People are more likely to do a tar if you match for all hernia factors like the size and the, you’re actually more likely to do a tar robotically than open. Yes,

Dr. Towfigh (00:44:46):

That’s right. That’s right. Yeah,

Dr. Collins (00:44:48):

We have some, I don’t know, I can speculate about the reasons for that. I think it’s harder to get the sheath back together when you have your belly and deflated. I think tars are a little bit easier robotically. The visualization is so good. You’re like, oh, it’s right there. So that’s sort of thing. So all these anyways, you have the tarp being invented, you have the billing changes, and you have the robot. And I think all of those kind of combine to kind of make an uptick. And then to your point, we don’t really know what’s being done. So I think it’s hard to know what to make of all of that. I do in my heart though, believe that I do think there are people getting components separations inappropriately

Dr. Towfigh (00:45:27):

For sure.

Dr. Collins (00:45:27):

Seen them in our offices.

Dr. Towfigh (00:45:28):

Right? Absolutely. Yeah.

Dr. Collins (00:45:30):

And I guess what I’m sort of wondering is because I have this person right now who, I mean, yeah, when I’m reading her note, it looks to me, I don’t know, it looks to me she had a surgery someplace else outside driving, which of course is driving up from three hours away, which adds a whole layer to it. It looks to me. She essentially has a whole linear simular injury on one side, which for people out there means that they sort of stabilized her muscle complex on one side, which probably means that they dissecting in the wrong place. That’s what it looks like to me on her scan now, which is kind of a, when it’s that big, it can be a catastrophic complication because again, all the muscles on your side of your belly anchor,

Dr. Towfigh (00:46:17):

The nerves are there. That’s a problem. And you’re causing new hernias in an area where the muscles are very thin. So fixing those, hers is a disaster.

Dr. Collins (00:46:27):

You’re mentioning with the deep stuff, you can kind of get it a little better, but fixing it is not, she’s always going to bulge on that side. She’s relatively young, and I read her note for them, for the indication for it, and I’m like, this girl didn’t need this at all. I mean, this is

Dr. Towfigh (00:46:45):

A five centimeter.

Dr. Collins (00:46:47):

Yeah, it was not big enough. It was mostly diastasis. And this is news. I’m still muddling sometimes I’m still muddling over to you. I’m like, do I reach out to this surgeon? And I’m like, just so you know, this happened. I’m not,

Dr. Towfigh (00:47:04):

Have you done that before?

Dr. Collins (00:47:06):

I haven’t because I don’t really know how to frame it. But again, to the point, it’s like if I’m sending people out with abdominal catastrophes, I would want to know

Dr. Towfigh (00:47:14):

That. I would want to know yes.

Dr. Collins (00:47:15):

You know what I mean? Because again,

Dr. Towfigh (00:47:16):

And I would be very grateful.

Dr. Collins (00:47:19):

And so I have to figure out maybe, and maybe we should do that, and if we can figure out a way to frame it as like, Hey, I’m not trying to yell at you, but I’m just letting you know that this is a patient of yours and they have this complication

(00:47:31):

And

(00:47:32):

You do whatever you want with that information. But I think, again, if we never see our complications, I mean, how can we blame people for thinking that they’re doing these operations correctly? If in their mind everyone’s out just

Dr. Towfigh (00:47:44):

Living. I used to do that when I first got really into doing all these complications. I talked to my mentor, he’s like, you should call these people. And that’s what I do. I send them my notes or whatever. So I started calling them or sending my opera report, but I thought I should call them and I got so much hate.

Dr. Collins (00:48:08):

I’m sure

Dr. Towfigh (00:48:08):

It was like denial. I don’t know what I’m doing. And they were like, no, there’s nothing wrong with them. And I’m saying, maybe you should. Nope. That’s how I’ve done it. It’s always been. And it was just horrible. Every time I made a phone call, I was the one being blamed for misdiagnosing over diagnosing, whatever the situation was. And so I stopped doing it. And I feel bad every time. No one, one learns if you don’t hear about your mistakes as they’re supposed to

Dr. Collins (00:48:42):

Learn from their mistake. Yeah, what I would expect on it. That’s the thing. Part of me is if I reach out to this, it is a guy just for the record, not gender, but it is a guy. I doubt he’ll take it very well, but I don’t dunno. Part of me is like, it’s probably my job to tell him anyway. Told him, and maybe it’s true, maybe he’s done 5 million of these and this is the, because we all certainly, we’re all human. Things go bad, surgery’s hard, and maybe it’s true. Maybe this is the one person where this went bad for and that certainly is possible. I don’t know. But again, I think we’re really lacking feedback in how good of a job we actually do in a way that cancer, surgery, cancer, the cancer’s gone and the cancer’s gone. That’s it. You get the answer right there. Negative margins. Yes. No, it’s very clear. You can kind of control it better, but hernia stuff is just harder. Just very hard to,

Dr. Towfigh (00:49:40):

Yeah, they say good for you. I mean, if I know the person personally, the surgeon, I usually call ’em. But if it’s totally out of the blue, I choose not to.

Dr. Collins (00:49:51):

Yeah, it’s really, it’s

Dr. Towfigh (00:49:52):

Trying to be abused. Here’s some more comments. I realize it is a gross generalization, but women tend to be more detailed. The assessment should be based on how the patient feels not on preconceived bias. True, true. Here’s another one. Trying to lose weight to have surgery for umbilical hernia that has gotten bigger and hoping to have a tummy tuck at the same time. Have you had patients that have lost weight and had the repair and not gained the weight back, and is mesh usually needed? I carry most of my weight in my stomach area as a female. Sounds like it’s a female who’s talking. Yeah. What do you know about the weight gain and weight loss and how it affects the repair, especially if the mesh ISS used?

Dr. Collins (00:50:38):

So in terms of the mesh decision will probably be based on how big your hernia is and not necessarily the, I would guess, and it kind of depends how much weight loss we’re talking. It’s hard to know, right? Again, you repair someone’s hernia and if they gain weight again, you may never see them again by the time they recur, if they recur, weight gain tends to happen slowly. So usually the repair has time to adjust. That being said, anytime you put a significant amount of weight on, it’s always going to stress any abdominal, obviously. It’s always better. I mean, for a

Dr. Towfigh (00:51:15):

Match doesn’t stretch, right? So it’s a problem sometimes

Dr. Collins (00:51:17):

Stretch.

Dr. Towfigh (00:51:18):

Yeah.

Dr. Collins (00:51:18):

But it’s very rare that people go and you don’t usually get a hundred pounds in a month. So it is usually something

Dr. Towfigh (00:51:24):

That’s a good point

Dr. Collins (00:51:26):

Your body can adjust to.

Dr. Towfigh (00:51:27):

Do you do bariatric surgery too?

Dr. Collins (00:51:29):

No. Yeah, God. Does anybody now with ozempic, I mean,

Dr. Towfigh (00:51:36):

I had a patient who said, yeah, I don’t want to go to that doctor because I asked him what percentage of his work is hernias. I always say if you’re looking for hernia specialists, at least 50% of their work should be hernia related. I think I’m trying to be generous. And they said, well, I used to do a lot of bariatric surgery, but now since Ozempic I don’t. So it’s mostly hernias and the patient, this is perception again, the patient interpreted that as he’s looking for work and that’s why he wants to fix my hernia surgery. And I know the surgeon, he’s definitely not anyone who would tell you to have surgery because he needs to pay his bills. He’s a legit doctor. But that’s the way the surgeon phrased it, made it sound to the patient that he’s just for the money because he can’t have enough volume anymore of bariatrics. He has to make up for it from the hernia set.

Dr. Collins (00:52:38):

Just go looking for hernias. I know, right? It’s all about perception. They probably are looking for work though. I mean, I don’t think that’s why they’re doing the hernia repair to be clear, but they probably are from the ORs with something. Yeah, I don’t know where that’s, I will say I found, I guess this is kind of related, but I found that those weight loss stroke are really good for my hernia patients because you kind of get someone stalled at the, to fix big hernias especially.

Dr. Towfigh (00:53:05):

Oh, because hard to lose that much weight.

Dr. Collins (00:53:08):

And again, it’s not tiny. It’s a BMI of 40, which is still pretty, it’s reasonable. But yeah, you’ll get people kind of stuck. I think it’s actually, I think they’ve been really helpful to get people to the OR for these kind of more complex ones that you don’t really want to go after until they’re at a more reasonable way. So I think, I probably shouldn’t tell the bariatric surgeons this, but I’m like, I think it’s pretty good. I think it helps me anyway, so I know it’s probably hurting their bottom line, but I think it’s getting people to,

Dr. Towfigh (00:53:41):

So going back to the article, there’s some programs, I think American Hernia Society is one, maybe SAGE is where if you sign up for a course, this is not online video, there’s a mentorship program assigned to it. So you take the course and then as part of the course, you’re actually also having a surgeon from that course come to your hospital to observe you doing those. Well, I think first you go to that surgeon’s hospital and you observe them. Then you take the course, then you go to your own hospital and that’s surgeon. Teacher comes to your hospital and mentors you through the process because it’s different when you’re doing it yourself. Like, oh, where did I put that again? How is it?

Dr. Collins (00:54:32):

Yeah, exactly. Patient selection and kind of that.

Dr. Towfigh (00:54:35):

Yeah, they make sure you, exactly, it’s appropriateness of surgery, who you choose and so on, and then they follow up with you. I think they follow up with you at six months or a year or something. Right? So I think that ideally that’s the right way to do these things.

Dr. Collins (00:54:49):

I think if I could make this rules, I think that is how, and again, across specialties, when they make new cardiac stents, when they make new anything, I think preceptorship is because I essentially learned through preceptorship. I did mostly open tars and mostly open complex stuff. In my fellowship. I came to Ohio State, which is a robotic powerhouse.

Dr. Towfigh (00:55:11):

How many robots do you have?

Dr. Collins (00:55:12):

I don’t even know. They move around, but I have our, actually, no, at one campus, they move at the other campus, they stay in their rooms. But all of my, OR days at my, I predominantly operate our east campus. I have eight or days a month there and seven of them are robot days. It’s just crazy.

Dr. Towfigh (00:55:30):

Wow.

Dr. Collins (00:55:30):

I always use it. Sometimes I’m doing open surgery with the robot looking at me, but

Dr. Towfigh (00:55:33):

There watching, but

Dr. Collins (00:55:34):

It’s there. I know, right? I feel bad about it, but as I said, I don’t think you need the robot for every case. So I don’t always use it. But she is there. Her name is Rosie. She’s wonderful. I was like, I really want to learn this stuff. But that’s exactly how I did it. I didn’t just watch videos. You have to go to a course, I think to get, oh no, that’s just my robot course. Nevermind. That was just to learn the new robotic system. So that

(00:55:58):

Wasn’t really,

(00:55:59):

But my partners and I have wonderful partners, which I know not everybody. No one has partners as good as mine, but I have this,

Dr. Towfigh (00:56:05):

I don’t have any partners, so I can’t disagree

Dr. Collins (00:56:07):

With you. Yeah. Oh, my partners are fantastic. I would not be where I was, but that’s what they did. I would watch them and then they literally, my first, I don’t even know how many, God bless ’em. They would just come with their laptops and just sit there and watch me and point in point stuff and be like, do. And then I sort of transitioned to, I would book it when I knew they were in the building, so I could be like, can you come and just watch me do the

Dr. Towfigh (00:56:31):

Tricky part? That’s the right way to do it. Yeah.

Dr. Collins (00:56:32):

You know what I mean? But that was really key I think in getting me from, because I can intellectually understand, I’m a fairly intelligent person. I can watch a video and read words and understand what the words say, but really transitioning to doing by myself, I sort of wanted a gradual approach. And I think it was really, I can’t imagine doing it just from a video. I think that to me that when I wrote this article, I’m like, I understand that people are doing that, but it just to me sounds crazy. I just would never

Dr. Towfigh (00:56:58):

Have, can you imagine if a patient reads it, how

Dr. Collins (00:57:00):

Crazy it sounds. I know, but I think kind of getting back, it’s very important. I think just for any surgery you have, don’t be afraid to ask surgeons how many of these they do. Especially for complicated. This is not just hernia stuff, but since we’re talking about hernias, but if you have a big hernia that’s going to be complicated. Is your 12th repair fine? And if they bristle at the question, that’s weird. You know what I mean? You are entitled to ask your surgeon, do you do these a lot? And if the answer’s not something you like, then find someone you’re comfortable with. Because again, I wouldn’t want to be getting a pancreatic surgery

Dr. Towfigh (00:57:37):

Case. That’s the beauty of the US health system. Free to go wherever you want,

Dr. Collins (00:57:41):

Wherever you want. And I think sometimes people feel afraid to a ask or B switch surgeons. But again, it’s like, especially for these complex things, you want someone who does those a fair amount. There are many surgeries I can’t do, and I’m pretty frank about, I’m like, no, I don’t do that surgery, but here’s a list of 20 people who do. And I think that’s fine. But don’t be afraid to ask, how long have you been doing this? How many have you done? And waiting for an answer That seems reasonable

Dr. Towfigh (00:58:14):

To I get second opinions. Yeah, always get second opinion. I think everyone for any surgery should get a second opinion. I had surgeries myself I knew the surgeon, I trusted the surgeon, and yet I still got second opinion just to make sure all the questions that I need to ask were asked and I was doing the right thing. It’s surgery.

Dr. Collins (00:58:35):

Absolutely, you should be comfortable. It’s kind of a team thing. You want to both be comfortable. And so I don’t want to drag someone or trick someone into the or. That’s never a good idea, but don’t be afraid to, again, with all this new or any doctor, they’re like, oh, I’m going to use this new against stent’s. The only word I can think of, I’m going to use this new stent. You’re like, okay, cool. How many of those have you put in? That’s always a fine, especially with new things. That’s always a fine thing to ask.

Dr. Towfigh (00:58:59):

Well, I feel we haven’t been controversial enough this hour.

Dr. Collins (00:59:02):

Well, that’s tough. Do me part two and we’ll get a go off about optimizations. I was like on that smoke, we operate on smokers. I actually think, yes, but anyway,

Dr. Towfigh (00:59:13):

On smokers and people with a high

Dr. Collins (00:59:15):

BMI. Yeah. I think here now if we could go to, we’re segueing to hour two now, but I think cutoffs for surgery, strict cutoffs are a bad idea. I think it’s, anyway, we’ll talk about that next time.

Dr. Towfigh (00:59:29):

Well, that’s the end of our Hernia, Talk Live tonight. It was fun. I’ve always enjoyed my time with Courtney, Dr. Collins. She’s amazing, smart, funny. I like the funny part. Great person to speak with. I’ll miss you. We’ll see you at the next meeting. What am I going to

Dr. Collins (00:59:47):

See? Absolutely, I’ll see you. We’ll talk again soon.

Dr. Towfigh (00:59:50):

Okay. Alright. Thanks everyone for joining us. Don’t forget, go to YouTube to watch this and all prior episodes subscribe, but also guess what? We have a podcast. Podcast, so you actually listen to the audio as a true podcast, all 185 or so episodes. So Hernia Talk Live as a podcast. Enjoy it and go back. And I think there was one question about University of Michigan hernia specialists. There are many, and I’ve see I have interviewed two of them. So go back and search for the two fantastic hernia specialists at University of Michigan and I’ll see you all next week. See you all buddy.