Life Changer

Robotic-assisted surgical weight-loss procedure improves health, well-being.

Amy after photo by Jordan Pysz. Amy before photo courtesy of Manatee Weight Loss Center

Amy Semanie

At 41, Amy Semanie is starting over. Recently divorced, she has gone back to school to begin working toward a degree in psychology, and for the first time in years, she’s paying close attention to her own personal health and wellness.

“It’s all part of what I call my life change,” Amy confirms. “I’m in the gym a lot more now and actually seeing a trainer twice a week. And when I’m not working out, attending classes or studying, I’m spending more time with family and friends.”

Those changes may not seem all that drastic to some, but they are for Amy, who up until about a year ago was sheltering herself away in her home, largely because of a weight problem that had spiraled out of control.

Brought on by the combination of a condition that can cause insulin to function abnormally in the body (polycystic ovarian syndrome) and her own poor eating habits, Amy’s weight problem dates back to early adulthood.

“I never really had a weight problem when I was younger,” she says. “But I’ve carried extra weight pretty much my entire adult life. As I got into my late thirties, I got to a point where I just felt trapped by the amount of weight I was carrying.

“I was stuck inside all the time because I couldn’t stand for very long or walk long distances. Everyday things that you normally don’t even think about like walking to the kitchen and standing and making your dinner became a chore for me.

“I was very unhappy and unhealthy, not going anywhere or doing anything, and when I hit the age of forty, I had this aha moment where I decided I had to start investing more time in myself and into my physical and mental health.”

When that aha moment came, Amy weighed 419 pounds. In addition to seeking help from a mental health counselor, one of the first investments she made in herself was to find a diet program that would help her lose weight.

The program she chose actually worked for her. After about a month, Amy lost more than 30 pounds. But all along, she had it in her mind that she wanted to have surgery to help her lose weight and keep from gaining it back.

After doing some research on procedures such as gastric bypass surgery, which she wanted to avoid, Amy discovered Stelios Rekkas, MD, FACS, FASMBS, of the Manatee Weight Loss Center, which is part of the Manatee Physician Alliance/Manatee Healthcare System.

Dr. Rekkas performs a minimally invasive surgical procedure called robotic sleeve gastrectomy during which 60 to 80 percent of the patient’s stomach is removed by robotic arms that are controlled remotely by the physician.

Less Is More

As its name suggests, the robotic sleeve gastrectomy procedure leaves the patient’s reduced stomach in the shape of a small sleeve. With a smaller stomach, patients eat less because they feel full faster, which naturally leads to weight loss.

The robotic sleeve gastrectomy has a far lower complication rate than gastric bypass surgery and, according to Dr. Rekkas, it has surpassed the LAP-BAND® System as the most common bariatric procedure performed on people suffering with obesity.

“LAP-BAND surgery has been all but phased out because patients were only losing about forty percent of their extra weight through it,” Dr. Rekkas explains. “With robotic sleeve gastrectomy, patients can lose up to eighty percent of their excess weight.

“Most people think weight-loss surgery is this extreme, scary, crazy thing, but it’s actually one of the safest surgeries we can offer patients.” – Dr. Rekkas

“And because there are no big incisions, this is a far more elegant procedure that allows the patient to get home and return to work quicker. In fact, most patients are up and walking four hours after surgery. And the complication rate is less than one percent.”

In order to qualify for a robotic sleeve gastrectomy, a person must be approximately 100 pounds over their ideal body weight or have a body mass index, or BMI, of at least 35 with medical conditions or 40 without medical conditions.

Dr. Rekkas performs the surgery at Manatee Memorial Hospital, which he lauds for its investment in three robotic platforms. Those platforms have made Manatee Memorial one of the few hospitals in the state that performs all of its bariatric procedures robotically.

“The hospital has done a great job of providing us with the tools we need to do our best work,” he states. “It has taken the initiative to be an advanced minimally invasive surgical center, and it provides excellent nursing care.

“In addition, it provides a bariatric coordinator for all of our patients, and we work hand in hand with them. As a result, most patients stay only one day in the hospital, and with the coordinator’s help, we make an impact and a difference in our patients’ lives.”

Hoping it would make a difference in her life, Amy opted to have the robotic sleeve surgery after meeting with Dr. Rekkas, who typically spends about three to six months prepping patients for the surgery by guiding them through an “optimization period.”

“We take a multidisciplinary approach to weight loss, so it’s not just a matter of having surgery,” Dr. Rekkas informs. “Prior to surgery, all of our patients meet with our in-house dietician, and we get them on a diet and exercise program.

“We want them to fully understand the diet and exercise portion because that part is very important. We also do blood work and endoscopies to make sure there aren’t any other conditions that may prevent them from having the surgery.

“Our goal is to get our patients as healthy as we can prior to surgery, and that includes going through a psychological screening. There is an entire process that leads up to the surgery itself, which is what we’re working toward during the optimization period.”

Dr. Rekkas says the surgery itself lasts about 45 minutes. During that time, Dr. Rekkas makes five small incisions in the abdomen of the patient, who is put to sleep through general anesthesia. He then  performs and completes the procedure by controlling four robotic arms from a remote console.

“Everything is done through those little incisions, one of which is about an inch long, while the rest are less than half an inch in length,” Dr. Rekkas states. “The size of those incisions is one of the reasons people have less pain and recover so quickly from this procedure.

“For years, this procedure was done through an incision that was about a foot long, and the surgeon had to stand over the patient and manipulate his instruments. It was hard to see sometimes and was a very stressful procedure.

“But now, once those incisions are made, a camera goes inside one of them that allows me to see everything inside clearly and in a three-dimensional environment. Next, a retractor elevates the liver, which allows me to go in and free up the stomach.

“Then a special robotic stapler is used that actually clamps the stomach, seals it and cuts it. Finally, the part of the stomach that has to be taken out gets removed from the body through another small incision in the abdomen.”

Amy first met Dr. Rekkas last December. Impressed with what she learned from him about the surgery, she spent the next three months going through the optimization period and then had the robotic sleeve gastrectomy surgery in April.

At the time of her surgery, she weighed in at 387 pounds. Since the surgery, she has lost more than 100 pounds, and she’s confident the effects of the surgeryand the support she receives from Dr. Rekkas’ weight-loss team will allow her to lose plenty more.

“I’m so happy I had the surgery,” Amy exudes. “It was definitely worth it. I feel so much better now, and I’m so glad that Dr. Rekkas performed the surgery because I’m surrounded now by people who are going to help me achieve my goals.

“The dynamic inside that office and the support they offer are just incredible. Everyone is so caring and helpful. Just being in that environment has been a great help to my success because it can be easy to give up on the program when you’re on your own.”

A Great Remedy

Toni Millas can attest to that. A 48-year-old x-ray technologist, Toni was left at home alone a lot when her husband of 28 years, a truck driver, was out on the road. About five years ago, the lack of a support system began to take a toll on her health and well-being.

“I was never thin, but I always maintained my weight pretty well,” Toni says. “Then I just got lazy. I stopped eating healthy and then, about a year ago, my health started to deteriorate because of it.

“I was getting chest pains, struggling with sleep apnea and feeling sluggish, and I was having a lot of anxiety because I just wasn’t feeling right. I was thinking, I’m going to give myself a heart attack.

Worried that her symptoms might be the byproduct of a heart condition, Toni visited a doctor who ran some tests that determined her heart health was, in fact, just fine. That eased some of Toni’s concerns, but it didn’t alleviate her symptoms.

“Then one day, a friend at work who had the robotic sleeve gastrectomy surgery suggested I see Dr. Rekkas,” Toni explains. “She said it helped her with her sleep apnea, so I checked it out because I felt like I had to do something.”

Sleep apnea is a condition that causes people who are sleeping to repeatedly stop breathing for anywhere from a few seconds to a minute. Symptoms include daytime sleepiness, fatigue and memory loss, and one of its primary causes is obesity.

At 5 feet 2 inches tall and weighing close to 200 pounds, Toni was borderline obese when her sleep apnea problems began. The suggestion that Dr. Rekkas could help by performing a robotic sleeve gastrectomy was therefore a sound one.

In fact, a series of studies involving nearly 14,000 sleep apnea patients has revealed that 75 percent of those patients experienced a profound reduction of their symptoms following a bariatric procedure such as the robotic sleeve gastrectomy.

“This surgery is a great remedy for sleep apnea, and the fact that Toni came to us on a referral from another patient is not unusual,” Dr. Rekkas states. “We get a lot of our patients that way because when you lose one hundred pounds or more, people notice.

“I feel much better about myself. I’m eating better and looking better. Even my skin looks and feels better.” – Toni

“So she came in as a person who was struggling with her weight and with sleep apnea, and like so many, she had tried diets and gym memberships and was on medications, and nothing was working for her.”

The robotic sleeve gastrectomy did. Toni had the surgery in March 2019. At the time, she weighed 197 pounds. Since the surgery, she has lost more than 60 pounds and is no longer suffering from the effects of sleep apnea.

Photos courtesy of Manatee Weight Loss Center

Toni Millas

“For about a year, I was having to use a CPAP [continuous positive airway pressure] machine for my sleep apnea,” Toni says, “but now, that machine is collecting dust. I don’t need it anymore because I’m sleeping well at night and feeling terrific all day.

“I have not felt this great since I was a teenager. And I feel much better about myself. I’m eating better and looking better. Even my skin looks and feels better. It’s amazing what this surgery has done for me, and that’s why I so highly recommend it.”

Amy recommends the surgery as well. She says that finding Dr. Rekkas has been “the most important thing I’ve done so far in my journey, because the people in his office are so encouraging and supportive. Everyone there is so knowledgeable and motivated.”

Dr. Rekkas says he and his staff are motivated by the success that patients such as Amy and Toni have had improving their health and outlook on life since undergoing the surgery and becoming a part of the lifestyle program he’s built around it.

“Most people think weight-loss surgery is this extreme, scary, crazy thing, but it’s actually one of the safest surgeries we can offer patients,” Dr. Rekkas adds. “And most people don’t realize that about a third of the population could qualify for it.

“That means that nearly a third of the population would also benefit from it because the results are very impressive. It’s important to educate people on this and let them know that it’s out there.

“It’s a great thing, and the people who are having the procedure are leaving the hospital the next day, and not only is it helping them lose weight, it’s helping them get off their blood pressure medication and helping to cure things like diabetes and sleep apnea.”

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