Last spring was a discouraging time for Billy Mickle. He was diagnosed with liver cancer and his course of treatment seemed unsure.
Then he was referred to Nelson Royall, M.D., a Tulsa-based OU Physicians surgeon who was the first to bring major robotic liver surgery to Oklahoma. Royall used the robot to perform minimally invasive surgery on Mickle, removing the left lobe of his liver, in which the cancer was confined, and sent him home only three days later.
For Mickle, who lives in Sand Springs, Royall’s expertise was a godsend. The cancer had not spread, his small incisions healed quickly, and he’s back to his daily life.
“Dr. Royall and his staff are just amazing,” Mickle said. “I give him the highest praise.”
Royall brings a unique service to Oklahoma. He is one of only a handful of robotic liver and pancreas surgeons in the United States and is the first in Oklahoma to use the robot to perform surgery for liver and pancreatic cancer. He is fellowship-trained in surgery of the liver, bile duct and pancreas, bringing years of surgical oncology experience to patients in Oklahoma and around the region.
With robotic liver surgery, patients bleed less, meaning they don’t require blood products or transfusions, Royall said. They face a lower risk for complications, leave the hospital faster, and recover more quickly than those who undergo traditional open surgeries. Incisions are five to eight millimeters, which leads to less pain and scarring. In addition, the robot makes surgery possible for many patients who couldn’t tolerate open surgery or aren’t candidates for laparoscopic surgery because of other issues.
Patients also enjoy a good prognosis after robotic liver surgery because of Royall’s skills in performing more precise and advanced maneuvers than would be possible with laparoscopic surgery.
“The robot allows me to have 360-degree range of motion, which lets me get around difficult areas and structures,” he said. “I can perform more delicate suturing, and I can do complex movements without any difficulty. We also remove lymph nodes from the area to make sure the cancer hasn’t spread, and the robot allows me to remove them safely while protecting sensitive blood vessels and organs in the area.”
The robotic system provides additional tools to enhance the safety of the surgery. Three-dimensional imaging allows Royall to see where structures are in space. The robot also offers what is equivalent to X-ray vision – allowing him to see inside the liver and bile duct system.
“It allows me to quickly find the bile duct and blood vessels feeding the different parts of the liver,” he said. “I can make sure the ones that need to be protected are not injured during the surgery. It also helps to prevent leaks from areas like the bile duct.”
Royall finds it gratifying to provide a safer surgery that results in outcomes at least as good or better than traditional and laparoscopic surgery. His patients are grateful to have the option in Oklahoma.
“I was very blessed to have this surgery,” Mickle said. “I knew I was going to be alright.”

Agency Adds to Compassionate Allowances List
Andrew Saul, Commissioner of Social Security, today announced four new Compassionate Allowances conditions: CDKL5 Deficiency Disorder, Pitt Hopkins Syndrome, Primary Peritoneal Cancer, and Richter Syndrome. Compassionate Allowances is a program to quickly identify severe diseases and medical conditions that meet Social Security’s standards for disability benefits.
“Social Security’s highest priority is to serve the public and we are committed to ensuring Americans with disabilities receive the benefits they are eligible for,” said Commissioner Saul. “For over a decade, our Compassionate Allowances program has helped us accelerate the disability process for people who are likely to get approved for benefits due to the severity of their condition.”
The Compassionate Allowances program identifies claims where the applicant’s condition or disease clearly meets Social Security’s statutory standard for disability. Due to the severe nature of many of these conditions, these claims are often allowed based on medical confirmation of the diagnosis alone. The list has grown to a total of 237 conditions, including certain cancers, adult brain disorders, and a number of rare disorders that affect children. To date, more than 600,000 people with severe disabilities have been approved through this fast-track policy-compliant disability process.
The agency incorporates leading technology to identify potential Compassionate Allowances and make quick decisions. When a person applies for disability benefits, Social Security must obtain medical records in order to make an accurate determination. Social Security’s Health IT brings the speed and efficiency of electronic medical records to the disability determination process. With electronic records transmission, Social Security is able to quickly obtain a claimant’s medical information, review it, and make a determination faster than ever before.
For more information about the program, including a list of all Compassionate Allowances conditions, please visit:
www.socialsecurity.gov/compassionateallowances.
To learn more about Social Security’s Health IT program, please visit:
www.socialsecurity.gov/hit.
People may apply online for disability benefits by visiting www.socialsecurity.gov.
To create a my Social Security account, please visit:
www.socialsecurity.gov/myaccount.

Game Warden Jay Harvey, based in Atoka County, was honored by the National Wild Turkey Federation as the Oklahoma Law Enforcement Officer of the Year for 2018 during a regular meeting of the Oklahoma Wildlife Conservation Commission on Aug. 12 in Durant.
Presenting the award were Don Chitwood, eastern Oklahoma regional director for NWTF, and Terry Bourne, president of the Little Dixie Chapter of Durant.
Harvey, who won the same honor from NWTF in 2004, began his career as a Game Warden in 1992. He has been involved with various NWTF activities, especially with Jakes events. He has volunteered with the weeklong Wildlife Youth Camp for 20 years, serving seven years as camp director. In 2005, Harvey started a wildlife law enforcement class at Southeastern Oklahoma State University. And in 2017, his proficiency in airboat operations allowed the rescue or evacuation of more than 200 people as he volunteered for disaster relief in the wake of Hurricane Harvey in the Houston area.