BERLIN, Wis. – Thelma Hierlmeier is a bit of a local celebrity, though not many people may know why. She was the first patient to undergo robotic surgery at ThedaCare Medical Center-Berlin in March 2021 when Dr. Horace Lo, a general surgeon at ThedaCare, repaired an abdominal hernia for her.
“Dr. Lo called me his celebrity,” Hierlmeier said. “I felt very comfortable being his first robotic surgery patient in Berlin. He performed my colon cancer surgery five years ago, and I have complete confidence in him.”
ThedaCare Medical Center-Berlin is a Critical Access Hospital (CAH), a designation given to eligible rural hospitals by the Centers for Medicare and Medicaid Services (CMS). To provide access to the best care possible, keeping patients in their communities, leaders at ThedaCare Medical Center-Berlin saw the need to provide robotic surgery using Da Vinci surgical systems.
“It’s a striking endorsement of the commitment ThedaCare is making to our community,” said Dr. Lo. “Patients and families can be confident that they are receiving the state of the art, exceptional care they need, right where they need it — close to home.”
Hierlmeier, 75, noticed a bulge on one side of her abdomen after losing 40 pounds last summer. She noticed she was getting a little winded walking to her mailbox, and decided she needed to get into better physical condition.
“I just started walking about five days a week, increasing my distance regularly,” she said. “By the end of the summer, I was walking four miles a day and had lost 40 pounds.”
During an annual checkup, Hierlmeier mentioned the bulge to her primary care provider, Gregory Harley, a physician’s assistant at ThedaCare Physicians-Wild Rose. He checked it and advised she had an abdominal hernia and should have it repaired.
“I immediately knew that I wanted Dr. Lo to perform the surgery if possible,” recalled Hierlmeier.
Dr. Lo said after reviewing Hierlmeier’s care plan, he determined her hernia repair was a great opportunity for the first robotic procedure at the hospital.
“Her hernia was a smaller one, and very amenable to be our first robotic case here,” he said. “Before the da Vinci surgical system, we would have done the repair through ‘open’ surgery with an incision across her abdomen or via a laparoscopic procedure. With the new technology, robotic surgery provided a much more durable repair. We were able to close the hole in her abdominal wall and then stitch in a mesh reinforcement layer on top of the area, and she was able to go home the same day.”
Hierlmeier spent a couple of days at a daughter’s home after the surgery. She said her recovery has been very smooth.
“I have no pain from the surgery,” she said. “I’m getting more strength back every day, and I’m looking forward to starting my daily walks again now that spring has arrived. Being able to have the surgery in Berlin, close to my home, was wonderful. I’m not one to drive in larger cities, to be able to have the procedure and my checkups in the area is so convenient. I know the doctors and the nurses there, and that makes me feel very comfortable.”
da Vinci Surgical System
The robotic system ThedaCare Medical Center-Berlin is now using is a da Vinci Surgical System Xi robot, according to Dr. Lo.
“It is essentially the next generation of camera or laparoscopic surgery,” he said. “It’s a significant step up in technology. The da Vinci robot has wristed instruments that will bend and turn 360 degrees and flex like a human wrist. It’s an extension of my hand, in a sense. It also has a 3D camera that provides depth perception and allows us to look and work around corners. That offers a potential safety benefit with improved visualization and dexterity in the body. In addition, there’s an imaging technique built into the camera that can help us visualize important nearby structures when we’re working in certain areas of the body, potentially avoiding injury.”
The advanced technology also helps recovery for patients.
“With traditional laparoscopic surgery, the instruments we use are straight instruments with a handle that controls the tips, which don’t flex, so you’re working in a straight line with no articulation,” explained Dr. Lo. “From a patient perspective, there’s a lot of tension across those small incisions. Even though laparoscopic surgery is minimally invasive, there can still be a lot of pain for the patient at the incision sites. With robotic surgery, there is the potential for less tension and less pain for the patient during recovery. If all is well, the patient can potentially go home the same day as their surgery as compared to traditional techniques which would require hospitalization for pain control or other recovery factors, which is a great improvement in care.”
Dr. Lo noted da Vinci Surgical Systems is a significant financial investment by health systems. There are currently about 3,000 da Vinci systems in use in the United States.
“To have the da Vinci Surgical System at a Critical Access Hospital like ThedaCare Medical Center-Berlin is relatively unheard of,” said Dr. Lo. “Through our personalized approach to care, and commitment to bringing the best technology to our patients, we can deliver the level of expertise that patients here in Wisconsin deserve.”
In addition to Berlin, ThedaCare offers robotic surgery options at ThedaCare Regional Medical Centers-Appleton and Neenah.
In order to perform surgery using the da Vinci robot, Dr. Lo had to undergo a training program.
“If a surgeon is adept at advanced laparoscopic surgery, it’s a pretty easy transition to robotic surgery because the flexibility of the wristed instruments actually improves the range of maneuvers you can perform during the procedure,” he explained. “My training began with what da Vinci calls ‘console time.’ Basically, you practice the movements of the robot’s pedals and instruments via a series of video training modules. After that, you work on a plastic model of a patient, practicing stitching, knot tying and other techniques. Once you have mastered those techniques, you train at a facility for lab certification. Finally, you’re assigned to a proctor – a da Vinci-certified surgeon who has performed hundreds of robotic surgeries – who observes when you perform your first surgeries.”
Dr. Lo’s proctor was Dr. Cynthia Geocaris at ThedaCare Medical Center-Neenah. Dr. Amanda Hein at ThedaCare Medical Center-Berlin was also recently certified for robotic surgery. Dr. Lo said he is excited about the opportunities for improved care through the use of the da Vinci Surgical System.
“Often, patients who undergo robotic surgery can experience shorter recovery times and possibly less pain,” he said.
There is also the benefit of keeping care close to home.
“Their primary care physicians are often located in the area, their specialists are here and now they can have their minimally invasive robotic surgery at the same location,” he said. “Everything can be done in their community, which can lead to better outcomes and improved care. We’re proud to offer these services at ThedaCare Medical Center-Berlin. Our teams are here to empower our patients and families to live their best lives through better health.”
For more than 110 years, ThedaCare® has been committed to improving the health of the communities it serves in northeast and central Wisconsin. The organization delivers care to more than 600,000 residents in 18 counties and employs approximately 7,000 health care professionals. ThedaCare has 180 points of care, including seven hospitals. As an organization committed to being a leader in Population Health, team members are dedicated to empowering people to live their best lives through easy access to individualized care, supporting each person’s own health and wellbeing. ThedaCare also partners with communities to understand unique needs, finding solutions together, and encouraging health awareness and action. ThedaCare is the first in Wisconsin to be a Mayo Clinic Care
Network Member, giving specialists the ability to consult with Mayo Clinic experts on a patient’s care. ThedaCare is a not-for-profit health system with a level II trauma center, comprehensive cancer treatment, stroke and cardiac programs, as well as primary care.
For more information, visit thedacare.org or follow ThedaCare on social media. Members of the media should call Cassandra Wallace, Public and Media Relations Consultant at 920.442.0328 or the ThedaCare Regional Medical Center-Neenah switchboard at 920.729.3100 and ask for the marketing person on call.