Which is better, robotic or laparoscopic inguinal hernia repair?

In this Part Two episode, Dr. Randy Lehman is joined again by Dr. Amy Vertrees, founder of the BOSS Business of Surgery Series and a career coach for surgeons, for an in-depth technical breakdown of both approaches.

They compare every step of the operation, from port placement and mesh selection to managing seromas and preventing recurrence. You’ll hear practical pearls on landmark-based dissection, handling intraoperative bleeding, and the subtle but meaningful advantages of robotic tools.

This episode zeroes in on the practical decision making behind robotic and laparoscopic hernia repair, highlighting how small technical choices can have outsized effects on outcomes.

0:00 Intro

0:40 Laparoscopic vs. Robotic TAPP

3:37 Port Placement Strategies & Access Tips

5:34 Mesh Types, Fixation Methods & Cost Considerations

9:38 Landmark-Based Dissection Tips

16:06 Managing Bleeding Near Cooper's & Iliac Vessels

21:38 Mesh Orientation & Securing Techniques

24:08 Peritoneal Closure & Tack Pitfalls

27:09 Post-op Seroma Management

28:05 Managing Massive Hernias

37:13 Financial Corner

39:58 Classic Rural Surgery Stories

47:11 Resources for the Busy Rural Surgeon

Resources Mentioned:

Connect with Dr. Vertrees:

https://www.bosssurgery.com/

🎙️ BOSS Business of Surgery Podcast:

https://www.bosssurgery.com/podcasts/boss-business-of-surgery-series

🌐 Connect with The Rural American Surgeon:

https://www.youtube.com/@ruralAmericanSurgeon

Join us on Facebook:

https://www.facebook.com/profile.php?id=61564305936854

Today, Dr. Randy Lehman sits down with a surgeon who traded stability for autonomy.

Dr. Amy Vertrees, an Army-trained general surgeon who built a thriving private practice covering three hospitals, breaks down the challenges and victories of modern rural surgery.

They explore what makes rural practice unique, why fellowship isn’t always necessary, and how to build a surgical team that lasts.

Plus, a candid conversation on hernia repair (when to go open vs. laparoscopic vs. robotic) and the complications that keep rural surgeons up at night.

Surgeons at any stage will find practical insights into training choices, private practice, and long-term sustainability in rural surgery.

0:00 Intro

0:13 Dr. Vertrees’ Background

2:12 Inside Private Practice

5:58 Building a Multi-Hospital Rural Surgery Group

9:26 Hub-and-Spoke Models & Surgeon Recruitment

16:10 Inguinal Hernia Volume

20:14 How I Do It: Inguinal Hernia Repair Philosophy

32:48 Confidence, Training, and Choosing the Right Operation

Resources Mentioned:

Connect with Dr. Vertrees:

https://www.bosssurgery.com/

🌐 Connect with The Rural American Surgeon:

https://www.youtube.com/@ruralAmericanSurgeon

Join us on Facebook:

https://www.facebook.com/profile.php?id=61564305936854

Is it possible to build a surgical practice from scratch…on your terms…in the hometown you dreamed of serving?

Dr. Randy Lehman is proof that it is, and he’s an open book about his journey with the next generation of surgeons.

In this special Q&A episode, Dr. Lehman sits down with two med students from Baylor College of Medicine's Student Surgical Society to share the story of his path into rural surgery and how he’s built his practice.

They discuss training with intention, avoiding common early-career pitfalls, choosing high-value skillsets, and navigating the hidden politics of hospital privileges.

If you're a med student or resident eyeing rural surgery (or just want a brutally honest look at what it takes), tune in and join the community.

0:00 Intro

0:41 Baylor Student Surgical Society

5:06 Choosing Surgery vs. ER Medicine

11:35 Owning Your Training as a Future Rural Surgeon

17:55 What Rural Surgeons Actually Do Day-to-Day

25:59 Building a Multi-Hospital Rural Practice

31:47 Compensation, Value, and Why Rural Surgery Pays

42:37 High-Value Skills

1:01:21 Making High-Stakes Decisions in Isolation

1:04:34 Practical Surgical Insights and Risk Management