Now doctor you’ve presented papers at national and international hernia societies on tailoring the hernia so this surgical technique is something that you do it with the patient so how do you do that well I think it’s very important when one decides which hernia procedure to do is the the most important thing is to have the skill and the procedure that you select so I don’t do robotic hernia surgery or even laparoscopic hernia surgery I don’t have the expertise and years ago even though I do only hernias I didn’t see the advantage of doing those I still praise a lot of the doctors who do them they’re very skilled I think sometimes robotic repair of hernias might be a little much in terms of what needs to be done and there’s some concern about costs so I basically select the patient and I examine the patient and see what the patient needs and there are some patients for instance one of the possible problems after hernia surgery is the ability to go out and lift and do normal activities if someone is elderly and they’re really not very active I might choose a procedure that might not be as strong for that patient compared to a 28 year old man who’s a Mason or where it works as a carpenter who I know is going to be needing that extra strength right most hernias have very significant strengths most of the repairs have significant strength after they’re completed but we don’t like to see a hernia come back which we call a recurrence and so if you select the proper technique according to your skill as a surgeon and then according to what the needs of the patient are and then sometimes you have to assess other comorbidities in the patient for instance you don’t you may not want to do a deep general anesthesia in a patient that has significant heart disease so you tried to do that under local so there are many many factors that go into selecting the procedure for the patient again according to the skills and abilities of the surgeon you