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  • Dr. Muffoletto

What Makes a Surgeon an Expert?

As a general surgeon, it is difficult to be an expert in all fields of training. This is the reason why most surgeons have focused on particular fields of interest so that they can offer their patients the best possible care and outcomes. For example, an expert hernia surgeon should have a tremendous amount of experience in dealing with the challenges of abdominal wall, inguinal (groin) and forgut (diaphragm) hernias. That particular surgeon should have a high volume of hernias in his or her practice such that the most complicated hernias seem routine after awhile. An expert hernia surgeon should have all the tools in his or her toolbox to tackle most any problem. For example, if an expert surgeon only has one method of repairing a problem then I would question whether he or she is truly an expert. Abdominal wall hernias can be very challenging and may require the most up to date and technical expertise to repair them. I have made hernia repair a focus of interest in my practice for over 20 years. I have technically matured with the evolution of minimal invasive techniques and have transformed my practice from once making large open incisions to now using small robotic port sites. Using the DaVinci Xi robot, I am now able to tackle very complicated hernias through just three 8mm port sites. I have been able to draw on my experience of repairing thousands of hernias in the past, either laparoscopic or open, in order to become an expert robotic surgeon. I am proud to announce that I am the first surgeon in Alaska to be performing Robotic Extended-View Totally Extraperitoneal Technique (ETEP) and Robotic Transversus Abdominis Release (TAR) hernia repairs. These are both very technically advanced robotic procedures that utilize myofascial releasing incisions in order to repair crippling and deforming abdominal wall hernias. Simply put, you just can’t suture/close large hernias together, there is too much tension and the hernia will come back. You must make lateral tissue releasing incisions in order to decrease the tension when closing the large midline hernia defect. I also utilize the Xi Robot and the myofascial releasing technique in tacking large hiatal or paraesohageal hernias.These are hernias that develop when large portions of the stomach herniate into the chest causing pain or debilitating gastroesophageal reflux. By making a small lateral incision on the diaphragm on either side of the hiatus, the crura muscles are more successfully brought together without tension which leads to a more successful repair. My robotic experience allows me to tackle complicated recurrent inguinal (groin) hernias with previous mesh products. Again, a very challenging problem that can be handled as an outpatient procedure with full activity within 2-3 weeks. Less trauma equates to less pain and faster healing.There is no longer the necessity of having to stay in the hospital for days with a large incision. Granted, even the most experienced robotic surgeon cannot fix every hernia robotically, but that is what makes you the expert. The expert surgeon needs to be comfortable and skilled with all the possible techniques in hernia repair in order to tailor the repair for each individual patient.

1 http://www.journalofmas.com/article.asp?issn=0972-9941;year=2019;volume=15;issue=3;spage=198;epage=203;aulast=Baig

2 https://www.ncbi.nlm.nih.gov/pubmed/28730275

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Dr. John Muffoletto  MD  PC

2751 DeBarr Road  Suite 290

Anchorage AK  99508

Phone   907-276-1046

Fax        907-222-6898