May 19, 2021

First-ever robotic liver surgery at UW helps patient get back on her feet

Syed Nabeel Zafar portrait and pull quote

For Cheryl Mihelich, it started with some stomach pains. Then things got complicated.
In the process of getting the pain checked out, a scan turned up an unexpected and concerning lesion on her liver.

“The only way they caught it is because I was going in for the stomach problems,” she said. “So I guess I was lucky.”

After a biopsy of the lesion came back as atypical, she faced a choice: watch and wait, ablate the affected part of her liver, or have it surgically removed: the only option which would definitively tell her whether or not the lesion was cancerous.

Having previously undergone surgery for a prior cancer scare, she wasn’t exactly eager to repeat the process. But after consulting with doctors, including Syed Nabeel Zafar, MD, a surgical oncologist with the UW Carbone Cancer Center, she opted for the surgery, but with a caveat: she needed it done quickly and without a lengthy recovery process.

So from her home in Calumet, Michigan – near the northern tip of the Upper Peninsula – she and her husband made the six-hour drive to Madison for the procedure.

And thanks to a little surgical wizardry, they were on their way back home in less than 24 hours.

A traditional liver resection surgery would usually land a patient in the hospital for at least three days. But, in order to speed things along, Mihelich was presented with another option: to have a minimally-invasive liver resection performed using a surgical robot. The catch was that she’d be the first-ever patient at UW to have this specific procedure done with the robot’s aid.

On the surface, the idea of a robot performing surgery sounds like something straight out of science fiction. But in reality, the process involves a surgeon controlling a set of robotic instruments to perform precise surgical techniques and maneuvers not possible with just a set of human hands and some tools. Robotic surgery is already being used to treat other types of cancers, such as prostate and colorectal, with positive results.

“With robotic cancer surgery, you can really give the patient the operation they need with, in many circumstances, better post-operative recovery,” Zafar said. “Even compared to laparoscopic surgery, in many circumstances you can just do more with the robot and do it better.”

Being the first patient to undergo any new procedure can be nerve-wracking, to say the least. But Mihelich said she was so focused on getting through the surgery, she wasn’t even thinking about who – or what – was doing it.

“I was so nervous, the significance of it didn’t really dawn on me until the next day,” she said. “Then it hit me. That’s how they did it. I was just in awe. It’s really something that they can do things like this now.”

As an added bonus, she was also able to have an incisional hernia – likely caused by her previous surgery – repaired alongside the liver resection without making an additional incision.

“Being able to use the robot to do both procedures at the same time, it was a huge benefit,” Zafar said.

As for her recovery, Mihelich said it’s going well. After some initial pain in the days following the surgery, she was back on her feet and moving around comfortably within two weeks. “It was really less of an ordeal than I thought,” she said. “It went well. It is going well. So I feel good.”

The best news of all was that the part of the liver that came out was not cancerous. While her doctors will still have to keep an eye on things in the future, the immediate scare has passed.

While Mihelich was the first liver surgery patient to be treated with the surgical robot, Zafar said she won’t be the last. He hopes to be able to expand the robot’s use to help even more patients, especially those requiring complex procedures.

“The goal is to ramp up to bigger liver operations in the future,” Zafar said. “You have to start somewhere and then grow from there. We have patients who appreciate the use of this newer technology and could benefit from it. Robotic surgery has a definite role in the right patient in the right situation.”