Three Considerations for Businesses Looking to Grow/Sell/Distribute Hemp and Hemp Products in New Jersey

Eric Alvarez, Associate, Norris McLaughlin

This is an exciting time for cannabis law, and multitudes of individuals and businesses are finding themselves interested in or working with cannabis-related business issues.  From the purchase and sale of CBD, to the expansion of medical marijuana programs across the country, to the constant discussions and rumors swirling around pending or anticipated legislation, this truly is an interesting time to be involved in the cannabis industry.

Unfortunately, here in New Jersey, at least for now, there are voids in legislation and regulations that leave individuals, attorneys, and businesses wondering precisely what can and cannot be done with cannabis (both industrial hemp and marijuana).  The good news (hopefully) is that guidance appears to be forthcoming on both the state and federal levels relating to industrial hemp and hemp-derived products such as CBD.

As of this writing, the New Jersey Department of Agriculture is currently regulations to establish New Jersey’s Industrial Hemp Pilot Program.  Although the contours of this program are hazy right now, it would allow certain individuals and businesses to research, develop, grow, process, and distribute industrial hemp and hemp-derived products in New Jersey.  This is great news if you’re thinking of working with hemp in the Garden State.  But what can you do now to make sure you’re ready to hit the ground running once the New Jersey Industrial Hemp Pilot Program is in full swing?

Here are a couple of helpful tips to consider if you’re thinking of getting involved in the hemp business, regardless of what you intend to do:

  1. Develop a Business Plan and Form a Business EntityThe first step in any successful business venture is, well… a business. First, you need a business plan.  What do you want to do with your business?  Do you want to grow hemp? Sell hemp and hemp-derived products? Conduct research and testing on hemp and hemp-derived products?  Who is your target market?  What sets you apart from everyone else?  Depending on what you want to do, there are myriad business and legal implications on both a state and federal a level that need to be taken into consideration to get you from planning to profiting.  (Depending on what you plan to do, there may be local zoning and regulatory concerns to consider as well.)Next, you need to decide what type of business entity is right for you and how you’re going to operate that business.  Choosing the right type of business entity depends on a multitude of factors, including corporate structure; tax treatment; limitations on liability; allocation of income, loss, deductions, and credits among the owners; and many more. Once you’ve decided on the type of entity, you need to determine how that entity will operate.  Typically, businesses have some form of agreement among its shareholders/members that spells out all the details of how the business will be managed and operated by its owners, how profits and losses will be allocated and distributed, and whether the members/managers have the right to make capital calls to the shareholders/members.  These high-level crucial steps set the foundation for any successful venture and ensure that you are protected and making the most of your investments for years to come.  Consulting with an attorney and business planning professionals will help identify the best type of business entity for your goals.
  1. Consider Patent/Trademark/Domain Name IssuesDo you have a catchy name or slogan for your future business? Working on a neat logo? Any business looking to build a brand should consider intellectual property assets and enforcement.  Cannabis brand owners are no exception. Surely, you’ll be working hard on making your business a success through building brand recognition and goodwill and you should make sure that no one else capitalizes on your hard work. However, the ability to obtain a patent or trademark registration can become more complicated for cannabis businesses.  You’ll want to work closely with an intellectual property attorney who is well-versed in the United States Patent and Trademark Office’s position on cannabis registrations.
  2. Considerations for Hemp Growers/Distributors – Licenses 

Once the Pilot Program regulations are promulgated, there will likely be an accreditation or certification program that will allow individuals and businesses to grow hemp. This will likely require a lengthy application process and, if successful, strict compliance with extensive municipal, state, and federal rules and regulations. Of course, record-keeping and a robust compliance program will be essential. Setting the proper foundation through careful business planning and building a team of professionals to assist will help the application process go more smoothly.

The list doesn’t end there. There are a multitude of other factors must be taken into consideration, too many to fit into a single blog post.  For the best chance at success, any person or business looking to enter the market place should consider consulting with an attorney familiar with applicable laws and regulations.If you have any questions regarding this post or any other related matters, please feel free to email me at [email protected].

Fraud, Technical Violations and/or Misrepresentation That Could Trigger H-1B Visa Refusal

Upon approval of H-1B petition by the USCIS, foreign nationals residing abroad may need to go to the U.S. Consulate/Embassy to get an H-1B visa stamped into their passport before they can travel to and enter the United States. Before going for the visa interview, it is very important for a visa applicant to understand the purpose of the visa interview, the discretionary powers vested in the Consular Officers, and most importantly the kind of fraud, technical violations and/or misrepresentation that could result in visa refusal or administrative processing.

First and foremost, it is very important to understand that although Consular Officers cannot re-adjudicate petitions approved by the USCIS, Consular Officers can certainly review the petitions to determine the eligibility of visa applicants. Consular Officers, thus, are vested with wide and discretionary powers. Till date, there is no set mechanism in-place by which a foreign national, applying for a visa abroad, can challenge a Consular Officer’s unfavorable exercise of discretion.

To be specific, Consular Officers derive such broad discretionary powers from section 221(g) of the Immigration and Nationality Act (INA). A quick glimpse at Section 221(g) provides the factors that may form the basis of visa refusals or administrative processing. In simple layman terms, the statements in the application or in the papers submitted therewith may trigger visa denial. Further, a Consular Officer may determine that the application does not comply with the INA or regulations. If that happens then Consular Officers is bound to explain clearly “… what documents or other evidence is needed, or what procedural step needs to be completed (e.g., case being submitted to the Department for advisory opinion …).”

Additionally, a Consular Officer may refuse to issue visas if s/he “knows or has reason to believe” that the foreign national is ineligible to receive a visa. Interestingly, although “Reason to believe” is an objective determination based upon facts or circumstances which would lead a reasonable person to conclude ineligibility, it can be formed through hearsay evidence.

In certain cases the final determination about visa can be placed on-hold pending “administrative processing” The Foreign Affairs Manual (FAM) defines “administrative processing” as clearance procedures or the submission of a case to the Department of State (DOS). The same FAM guidance counsels Consular Officers not to reveal to visa applicants the specific reason for administrative processing in a given case.

Further, there is no strict timeline specified for administrative processing resolution. Even though the DOS Administrative Processing webpage informs us that most administrative processing is resolved within 60 days of the visa interview, it is very difficult to confirm this statement. In other words, clients whose visa applications are subjected to administrative processing could end up waiting significant amount of time (often in excess of 60 days) until the administrative processing is completed and visa is finally issued. In some cases, the administrative processing of the case can take up to two (2) years.

Types of Fraud, Technical Violations, and/or Misrepresentation That May Trigger Administrative Processing/Visa Refusal at Consular Posts

Understanding the kind of fraud, technical violations, and/or misrepresentation may help avoid the visa refusals or administrative processing at the Consular Posts abroad. Listed below are some typical violations, fraud or misrepresentations that could trigger administrative processing/visa refusal:

• H-1B employer required the beneficiary to pay the ACWIA fee or deducted certain fees associated with filing the I-129 petition, effectively lowering the beneficiary’s wages to less than the required prevailing wage;

• Employer failed to pay the beneficiary at least the prevailing wage for the particular occupation in the specific geographical location, as noted and attested to on the LCA filed with DOL;

• Beneficiary was working in a geographical location not covered by a valid Labor Condition Application (LCA) filed with Department of Labor (DOL);

• The employer placed the beneficiary in a non-productive status, commonly referred to as “benching” (where the beneficiaries are not paid or paid less than the full hours specified on the petition), when work was not immediately or continuously available;

• Business did not exist, no evidence of daily business activity, the business location was unable to support the number of employees claimed, or there was no evidence that the employer ever intended for the beneficiary to fill the actual job offered;

• Educational degrees or experience letters submitted were confirmed to be fraudulent;

• Signatures had been forged on supporting documentation; and

• Beneficiary performing duties that were significantly different from those described on the LCA and I-129 petition.

Primary Fraud or Technical Violation Indicators

In addition to the typical violations such as fraud or misrepresentations that could trigger administrative processing/visa refusal, there are certain primary fraud or technical violation indicators (factors) that Consular Officers always remains on lookout. Results of a study conducted by the Office of Fraud Detection and National Security (FDNS) in collaboration with USCIS indicated that H-1B petitions filed for accounting, human resources, business analysts, sales and advertising occupations are more likely to contain fraud or technical violation(s) than other occupational categories. The following is a list of primary fraud or technical violation(s) indicators that potentially could contribute to administrative processing/visa refusal at a U.S. Consulate office abroad.

• Firms with 25 or fewer employees have higher rates of fraud or technical violation(s) than larger-sized companies;

• Firms with an annual gross income of less than $10 million have higher rates of fraud or technical violation(s) than firms with an annual gross income greater than $10 million;

• Firms in existence less than 10 years have higher incidences of fraud or technical violation(s) than those in existence for more than 10 years;

• Beneficiaries with only bachelor’s degrees had higher fraud or technical violation(s) rates than did those with graduate degrees.

In conclusion, having an approved petition by the USCIS is not a guarantee that a foreign national will get an H-1B visa at the Consular Post abroad. As previously stated, Consular Officers have wide discretionary powers pertaining to visa issuance. Not only that, there is no set mechanism to challenge the Consular Officer’s unfavorable exercise of discretion.

While “Consular Non reviewability” is presently being challenged in Federal Courts, the issue is still far from being resolved.

To avoid visa refusal or elongated administrative processing, H-1B visa applicants and prospective H-1B employers should take into consideration the type of fraud, technical violations, and/or misrepresentation that could result in such decisions and prepare accordingly.

More so, because small organizations, new organizations or organizations reporting a certain level of annual gross income are always on the radar of Consular Officers as to fraud/technical violations, visa applicants should prepare well in advance and carry as many supporting financial or corporate documents as they can to prove that the petitioning company is not a shell business.

If you should have any questions or need more information about the way that the U.S. Immigration and Nationality Laws may impact you, your family, your friends or your colleagues, please feel free to contact the U.S. Immigration and Nationality Lawyers at the NPZ Law Group – VISASERVE – U.S. Immigration and Nationality Lawyers by e-mailing to us at [email protected] or by calling us at 201-670-0006 (x107) or by visiting our Law Firm’s website at //www.visaserve.com

Honoring New Jersey Companies that Care

By Anthony Russo, President, CIANJ

MORE THAN 200 New Jersey busi­ness leaders attend­ed the Sixth Annual Companies that Care Awards, co-present­ed by the Commerce and Industry Association of New Jersey (CIANJ) and COMMERCE.

Held at Nanina’s in the Park in Belleville, New Jersey, on March 19, 2019, the event recognized companies for their charitable and philanthropic programs that care for veterans; help children; feed the hungry; shelter the homeless; volunteer to help the needy; raise money for charities; protect the environment; and support employees and their families during emergencies.

Top honors were earned this year by RWJBarnabas Health, who was named the 2019 Extraordinary Good Works Champion for its Wellness on Wheels (WOW) mobile education center that includes a hydroponic greenhouse and cooking school to help reduce health disparities in vulnerable communities.

 “RWJBarnabas Health has done a tremendous job of reaching out to those in at-risk communities to address the connection between a healthy lifestyle and preventing serious health issues,” explains CIANJ Chairman Richard W. Abramson, a member of the law firm, Cole Schotz P.C. “They have a mobile education center to provide fresh vegetables for use in cooking class­es, including a hydroponic greenhouse, which is truly innovative.”

Barbara Mintz, senior vice president of healthy living and community engagement for RWJBarnabas Health, accepted the top honor on behalf of all the employees who make the WOW mobile unit program possible.

In addition to RWJBarnabas Health, 44 other companies were honored as “Champions of Good Works,” and were featured in the March 2019 issue of COMMERCE, including:

Supporting New Jersey Charities—Anheuser-Busch’s Newark Brewery; Atlantic Stewardship Bank; and Mazars USA LLP.

Community Outreach—Decusoft; LAN Associates; Nanina’s in the Park; NJMEP; Pirro Zinna Cifelli Paris & Genitempo, LLC; Stuyvesant Press; and Wells Fargo.

Global Outreach—AECOM; Celgene; ICA Risk Management Consultants; and NPZ Law Group, P.C.

Helping Children—B&G Foods; Connell Foley LLP; Deloitte; Delta Dental of New Jersey; ExxonMobil; Goya Foods; Lakeland Bank; and ZaGo Manufacturing Company Inc.

Volunteerism—AmeriHealth NJ; JCP&L; New Jersey American Water; and Stark & Stark.

Environmental Conservation— Atlantic Health System’s Overlook Medical Center; eMazzanti Technologies; Holy Name Medical Center; Riker Danzig; and Saint Peter’s Healthcare System.

Advocates for the Homeless—CarePoint Health; Hackensack Meridian Health; McCarter & English, LLP; and Terrie O’Connor Realtors.

Combating Hunger—AtlantiCare; Eastwick College; NAIOP New Jersey; and Plast-O-Matic Valves Inc.

Caring for Veterans—A.J. Perri; AnythingIT; Columbia Bank; Jefferson Health New Jersey; and Peapack-Gladstone Bank.

Thank you to the major sponsors: Silver Sponsors—Columbia Bank; ExxonMobil; Hackensack Meridian Health; McCarter & English, LLP; Nanina’s in the Park; Park Château; RWJBarnabas Health; The Park Savoy. Bronze Sponsors—AmeriHealth NJ; Atlantic Stewardship Bank; Lakeland Bank; New Jersey American Water; UnitedHealthcare; and Wells Fargo. Caring Circle Sponsors—Atlantic Health System; CarePoint Health; Connell Foley, LLP; JCP&L; Mazars USA.

And thank you to the Supporting Sponsors—AECOM; A.J. Perri; Celgene; COMMERCE; Deloitte; Delta Dental; Holy Name Medical Center; ICA Risk Management Consultants; LAN Associates; LG Electronics USA; New Jersey City University; NJMEP; Piro Zinna Cifelli Paris & Genitempo, LLC; PKF O’Connor Davies, LLP; Plast-O-Matic Valves, Inc.; PSE&G; Saint Peter’s Healthcare System; Stuyvesant Press; Terrie O’Connor Realtors; Triangle Manufacturing; Villani Bus; ZaGo Manufacturing. Photography Sponsor—Eastwick College.

 CIANJ is proud to honor New Jersey’s most caring companies and their employees, who make our state a great place live, work and raise a family.

NJII’s NJ Health Information Network Master Patient Index

Compiled by John Joseph Parker, Contributing Editor

THE NEW JERSEY INNOVATION Institute (NJII), an NJIT corpora­tion, has teamed with the New Jersey Department of Health to field new technology called the Master Person Index, to securely connect and share patient information under the New Jersey Health Information Network (NJHIN).

NJHIN—which offers the ability to seamlessly connect medical records across any and all healthcare providers, ensuring the information is accurate, up-to-date and secure—employs a two-tiered Master Person Index that identi­fies an individual with multiple records, even when they’re maintained by differ­ent providers and health systems.

This is accomplished through a verifi­cation process that separates such re-cords and then matches them to a single person by assigning them a “common key.” Interoperability, or the capacity to share patient information across electronic health records and networks, is the goal of this statewide index, with nationwide expansion being the ulti­mate objective.

“This data exchange network has successfully identified patients and maintained data quality and security,” says New Jersey Health Commissioner Dr. Shereef Elnahal. “The Master Person Index gives medical professionals the ability to accurately identify patients and link critical medical information to their records, regardless of where care is provided. This improves safety, reduces medical errors and duplicative testing, helps prevent fraud and reduces healthcare spending.”

Interoperability has been a high prior­ity in the healthcare industry for nearly a decade and is one of the main objec­tives of the NJHIN based on its benefits to the overall population. Simply put, interoperability will help save lives. By promoting healthcare delivery through an efficient exchange of patient data, the end result is the added benefit of higher quality care at a lower cost.

For example, if one needs emergency care while on vacation and is unable to remember their current list of med­ications, through interoperability-driven technology, providers could access and review the individual’s medical history, and quickly determine the best course of action to take. This secure data shar­ing reduces duplicate testing and could prevent potentially life-threatening drug interactions.

Two recently launched initiatives, the Common Key Service and Master Person Index Use Cases, are part of NJHIN’s objective of connecting a per­son’s identity across different systems. Bergen New Bridge Medical Center is in a unique position to participate due to its specialized service line in Behavioral Health. If a patient arrives in the emergency department requiring acute behavioral health services and is subsequently admitted for inpatient care, having access to their complete medical records ensures treatment deci­sions are made based on the patient’s medical history. This prevents a patient from receiving care that could negatively impact them or run counter to treatment received by other providers. Being one of the first to adopt this technology affords Bergen New Bridge Medical Center an advantage in promoting interoperability throughout the state, thus providing better quality care to its patients.

“Bergen New Bridge Medical Center has been a pioneer in several NJHIN projects, including being the first organization to transmit data through the system,” says Van Zimmerman, executive director of the NJHIN. “Joining 62 of the 71 hospitals in the state, they have stepped up to move New Jersey forward in the interoperability movement by signing on to participate in the Master Person Index and Common Key Service Use Cases.”

From Cancer to Joint or Knee Replacement, Robotic Surgery is a State-of-the-Art Option

WHETHER IT’S A CANCEROUS tumor or a hernia or a joint or knee replacement, surgical precision determines success and quali­ty of life—and that creates a huge role for robotic surgery in today’s patient care. Robotic surgery enables surgeons to perform complex surgeries in a mini­mally invasive manner. The robot acts as an extension of the doctor’s hands, allowing him or her to perform surgery with pinpoint accuracy and very little damage to surrounding tissue. Here are some case studies the showcase the capabilities of robotic surgery.

 Atlantic Health System, Morristown Medical Center By Tom Thomas, M.D., MPH, Director, Head and Neck Reconstructive Surgery and Transoral Robotic Surgery, Leonard B. Kahn Head and Neck Cancer Institute at Morristown Medical Center’s Carol G. Simon Cancer Center; Leader, Atlantic HPV Center

A 60-year old veteran came to me for a mass in his right neck. He had a tooth extraction and sore throat and was treated with antibiotics for 10 days. When he did not improve, he was referred to an ENT and diagnosed with Human Papilloma Virus (HPV)-positive squamous cell carcinoma. There are 4 HPV strains that cause cancer. The virus can be dormant for decades and appear as cancer later. HPV causes 70 percent or more of oral, head and neck cancers. The patient was referred to me for minimally invasive Trans Oral Robotic Surgery (TORS) using the da Vinci® robot. Traditional surgery accesses the back of the throat by splitting the lip and the jaw, which causes severe func­tional and cosmetic deficits. Or, a sur­geon can go through the mouth with a laser to remove the cancer, but it limits the surgeon’s line of vision. TORS using the da Vinci® robot allows me to see tumors that are tucked in the back of the tongue or side wall of the throat. It is imperative that we use minimally invasive natural orifice approaches such as TORS, especially in the younger population with HPV- associated throat cancers.

Atlantic Health System, Overlook Medical Center By Ronald P. Benitez, M.D., Board-Certified Neurosurgeon; Chief of Endovascular Neurosurgery at Overlook Medical Center’s Atlantic Neuroscience Institute

One of the biggest benefits of robotic technologies is precision. A robot’s abili­ty to semi-automate surgical proce­dures—with pinpoint accuracy—comple­ments the exactness of even the most highly skilled surgeons. Patients are liv­ing proof of this. Along with a team of doctors, I recently treated a young woman in her late 20s who was suffer­ing from epilepsy. She was a candidate for responsive neurostimulation (RNS), which is essentially a pacemaker for the brain. RNS requires implanting depth electrodes in the brain. These electrodes detect the abnormal electrical activity that signals the onset of seizures and quickly deliver stimulation to reduce the occurrence of epileptic episodes. We used robotic navigation to help ensure the precise insertion of these electrodes. The combination of our medical profi­ciency with this technology successfully improved this patient’s quality of life by drastically reducing the frequency of her seizures. Additionally, new robots like the Zimmer Biomet ROSA Brain robot, are helping doctors identify exactly where seizures are stemming from in the brain, without requiring open brain surgery. New at Overlook Medical Center, the ROSA is a game changer for both treatment and recovery.

CarePoint Health By Richard Boiardo III, M.D.

CarePoint’s team of lead­ing-edge experts have per­formed hundreds of mini­mally invasive robotic-assisted proce­dures utilizing both the da Vinci® robot and the IntelliJoint HIP system. Robotic Surgery, conducted at Christ Hospital and Hoboken University Medical Center, is a less-invasive procedure which allows surgeons to have greater control, vision and precision. With this advanced tech­nology, CarePoint’s patients experience less pain, a small incision, minimal scar­ring and a quicker recovery. Our surgical team allows them to perform a variety of robotic surgeries including but not limited to gynecology, joint replacement and other general surgeries. Earlier this year, I successfully performed Hoboken University Medical Center’s first same-day anterior hip replacement surgery using the IntelliJoint system. IntelliJoint technology offers cutting-edge control of component position and length in total hip arthroplasty. This could effec­tively be a solution for mechanical com­plications and aid in the initiative for same-day Total Hip Surgery—the latest and greatest for patients with arthritic hips.

CentraState Medical Center By Troy Sukkarieh, M.D., Board-Certified Urologic Surgeon; Central Jersey Urology Associates

I recently diagnosed a man with a rare type of kidney cancer. He had been seeing another urologist for several months with urinary difficulties, including urinating blood at times. He was told the blood in his urine was from his prostate and ultimately had prostate surgery. Despite this, he continued to bleed and came to me for a second opinion. After reviewing his medical history and records, I found that he had a slowly enlarging left kidney. This was a sign that something else was going on and I ultimately found an aggressive cancer of the lining of his left kidney. The patient was counseled on his options and elected to undergo surgical treatment which offered him the best chances of a complete cure. Again, his relatively uncommon cancer was from the lining of the kidney and not the “meat” of the kidney. His specific treat­ment involved not only removal of the kidney, but also the entire kidney drainage tube, called the ureter, all the way down to the bladder as well as the associated lymph nodes. This was a multi-quadrant surgery. With tradi­tional “open” surgery this would have required two painful incisions, one in the flank near the ribs and one in the lower belly near the pubic bone. With robotic technology that helps facilitate complex surgeries like this one, I was able to access multiple quadrants of the abdomen and pelvis through a few small incisions. The kidney was removed through an incision made where there would be the least amount of muscle damage done and therefore minimize post-operative pain. The patient did great and left the hospital in two days. He is expected to make a complete recovery.

Englewood Health By Mazyar Ghanaat, M.D., Program Director, Urologic Oncology, The Lefcourt Family Cancer Treatment and Wellness Center

After suffering from chronic pain, one of my patients was diagnosed with a large renal mass that appeared cancer­ous. Rather than performing open sur­gery and making a large incision, we used MIS, minimally invasive surgery—specifically robotic surgery, to remove the kidney through a smaller incision. The patient recovered quickly and was able to return home the next day. Had she undergone open surgery, we would have had to go through the mus­cle, and the large incision would have likely caused significant pain. The patient also would have faced a longer recovery, requiring more pain medica­tion and possibly several days in the hos­pital. With technological innovations such as robotic surgery, trained urologic surgeons like me can use 3D imaging and robotic assistance for much greater visibility and maneuvering during very intricate surgery. This advantage makes a world of difference.

Hackensack Meridian Health, JFK Medical Center By Michael Lasser, M.D., FACS, Medical Director of Robotic Surgery Program

The use of robotic surgery enhances a surgeon’s ability to view the anatomy via high-definition 3D images and per­form with a precision often not possible with other minimally invasive methods. The benefits to the patient are signifi­cant (i.e., less pain, less blood loss, quick­er recovery, reduced risk of complica­tions) and in some cases include the preservation of an organ that may have needed removal. A particular case that comes to mind is a 71-year-old female patient referred to me by her primary care physician. She had a large mass on her left kidney that was likely cancerous and would require large open surgery to remove both the tumor and the entire kidney. Using robotic surgery, I performed a Robotic Partial Nephrectomy to remove only the tumor and save the rest of the kidney. The 10-fold magnification that our da Vinci® robotic surgical system gave me—versus the 3-fold magnification from traditional laparoscopic surgery—allowed me to precisely excise the tumor without damaging the surrounding healthy tis­sue. The patient had several small inci­sions from the procedure and was cured of her cancer, with minimal impact on the overall function of that kidney. Complex urologic, colorectal, thoracic, general surgical, and gynecologic condi­tions like this are often well treated with robotic surgery here at JFK Medical Center.

Holy Name Medical Center By Yitzhack Asulin, M.D., FACOG, FACS, Director of Female Pelvic Reconstruction and Robotic Surgery

Holy Name Medical Center’s respect for individuals and innovation has enabled surgeons here to transform ways that robotic surgery can be used to elevate the quality, safety and benefits of patient care while treating many medical conditions. Using a mini­mally invasive approach, we use the surgical robot to operate through dime-sized incisions that often require no stitches. Patients benefit with a same-day or overnight hospital stay; minimal blood loss; reduced risk of infection; and a quicker return to work and activities compared to traditional “open” surgery. We have extensive experience in robotic gynecologic surgery, especially in com­plex fibroid removal. Fibroids are com­mon, non-cancerous pelvic tumors that cause difficult symptoms that significant­ly impact quality of life. In a younger woman, we often remove only the fibroids, a procedure called myomecto­my, so she retains her fertility. In older patients, we remove the entire uterus during a hysterectomy. Essentially “bloodless surgery,” robotic fibroid surgery is an incredible option for patients who are Jehovah’s Witnesses and cannot accept blood transfusions. In one patient, I removed about 15 fibroids that had expanded the uterus to equal a 24-week pregnancy. She went home the next morning with several incisions the size of M&M can­dies, and with minimal blood loss. She went back to work in two weeks. The Surgical Review Corporation and the American Association of Gynecologic Laparoscopists have named Holy Name a Center of Excellence in minimally invasive gynecology and robotic surgery, which ensures our commitment to patient care, education and cost- efficiency.

Rutgers Cancer Institute of New Jersey By Eric A. Singer, M.D., M.A., FACS, Director of the Kidney Cancer Program, Urologic Oncologist

As the state’s only National Cancer Institute-designated Comprehensive Cancer Center, Rutgers Cancer Institute of New Jersey in partnership with RWJBarnabas Health has the ability to offer unique surgical expertise for the treatment of cancer. This ranges from conventional open and laparoscopic pro­cedures to minimally invasive techniques utilizing a robotic approach. A rare but challenging problem that is especially well suited to robotic surgery is that of bilateral, multifocal kidney tumors. In this situation, a patient has more than one tumor in each kidney. Our Kidney Cancer Program at Rutgers Cancer Institute successfully uses the surgical robot to perform staged bilateral, multi­ple partial nephrectomies (removing the tumors but leaving the rest of the good kidney behind). The wristed instru­mentation and magnified, stereoscopic vision makes the robot an especially valuable tool to use when performing the fine dissection and renorrhaphies (putting the kidney back together) needed in these complex cases. This approach, which our team performs at Robert Wood Johnson University Hospital New Brunswick, a RWJBarnabas Health facility, has allowed us to render patients cancer-free and keep them off of dialysis while helping them recuper­ate faster. (Dr. Singer receives research support from Astellas/Medivation.)

RWJBarnabas Health, Monmouth Medical Center By Robert Graebe, M.D., Chairman and Program Director of the Dept. of Obstetrics and Gynecology and Chief of Reproductive Endocrinology

As one of the pioneers of minimally invasive gynecological surgery, I’ve witnessed firsthand how robotic surgery has drastically increased our ability to shorten operative time, reduce blood loss, and reduce a patient’s hospital stay and at home recovery time. At Monmouth Medical Center, we utilize the most advanced robotic platform available, which allows us to treat more complex cases with the least amount of risk and recovery time for patients. I recently performed a robotic procedure on a woman experiencing uterine bleeding. As the only caregiver for her hus­band, her ability to quickly return to her everyday activities and her role as care­giver was just as important as a positive surgical outcome. Utilizing robotic sur­gery for her procedure, we were able to complete the surgery in less time with minimal bleeding. She was able to leave the hospital the same day and recovered more quickly at home compared to other surgical methods. Most important­ly, we were able to effectively treat her condition and she was able to quickly return to caring for her husband.

RWJBarnabas Health, The Bristol-Myers Squibb Children’s Hospital at Robert Wood Johnson University Hospital, Rutgers Robert Wood Johnson Medical School By Joseph Barone, M.D., MBA, Chief, Pediatric Urology

Working closely with my colleague, robotic surgeon Sammy Elsamra, M.D., we used the da Vinci® XI Surgical System to treat a 14-year-old girl who suffered from incontinence for most of her life due to a rare condition known as ectopic ureter. With this condition, the patient’s ureter drained directly into the vagina instead of the bladder, so she was constantly wet for her entire life. The patient had many treatments with no success and was referred to us after finally being diagnosed with the condi­tion. Using the da Vinci® XI, the most advanced robotic surgical technology of its generation, we removed part of the patient’s kidney that was draining into the vagina, which addressed the issue. She no longer experiences wetness after having to wear pads throughout her life. The entire procedure took three hours and the patient was home in one day. Using the XI robot allowed us to see the surgical area better since it was magnified and there was no large incision contributing to a faster recov­ery. Having a pediatric urologist and a robotic surgeon work together gives the patient the best of both worlds.

Saint Peter’s University Hospital By James E. Gervasoni Jr., Ph.D., M.D., FACS, Surgical Oncologist

Saint Peter’s University Hospital recently performed a liver resection using robot-assisted surgery. Using the da Vinci® SI surgical system, the left lobe of a patient’s liver was removed in a proce­dure called “robot-assisted left hepatec­tomy,” giving the patient another chance at life. This particular surgery using a robotic assist tech is rare in New Jersey and can only be performed by highly trained surgeons. The patient had a history of colorectal cancer and then presented with a lesion of the left lobe of the liver. While initial biopsies came back negative for cancer, the patient’s medical oncologist made the referral for a surgical consultation at Saint Peter’s. The first-of-its-kind surgery at Saint Peter’s, in which about a third of the patient’s liver was removed, revealed a recurrence of metastatic colon cancer. Robot-assisted surgery offers the ability to perform complex procedures with unmatched precision. For the patient, it offered multiple ben­efits including less scarring, less blood loss, significantly less pain and a shorter recovery time. During the two-hour pro­cedure, the patient required only five small incisions compared to a ten-cen­timeter incision that would have been required during traditional open sur­gery. The patient was in the hospital for only two days and recovered in about a week, as compared to four to eight days of hospitalization and a month’s recov­ery time. Because of robot-assisted sur­gery, the patient’s prognosis is excellent.

St. Joseph’s Health, St. Joseph’s University Medical Center By Vincent McInerney, M.D., Associate Chairman, Department of Orthopedic Surgery

As a caregiver to both her 89-year- old mother and legally blind husband, Carmen Rivera needs to stay healthy and active. When her debilitating knee pain caused her to lose the ability to perform simple tasks around her home, she became terrified at the thought of becoming impaired. There is no other option for Rivera—she needed relief from her knee pain, with little downtime. That’s when she consulted with me and discussed robotic-assisted surgery—an innovative, less-invasive option that means quicker recovery and less pain. Within six months, Rivera underwent two robotic-assisted double knee replacements, using the MAKO surgery system, a new approach to joint replacement that offers the poten­tial for a higher level of patient-specific implant alignment and positioning. In just six weeks, Rivera returned to work, increased her exercise levels daily and challenges herself to continue to strive for maximum health. MAKO has changed the way we perform joint replacements and has significantly enhanced our patients’ quality of life. We are constantly evolving with tech­nology to bring patients better, faster relief.

Trinitas Regional Medical Center By Sergio Baerga, M.D., General Surgeon

Robotic surgery has been a great leap forward for the world of minimally invasive surgery. It has been so revolutionary that almost every aspect of surgical specialty has a use for it—and this has to do with the ease of use and the dexterity it imparts the user. In two instances, robotics helped with the management of a diffi­cult case. Both cases were hernia recur­rences in patients already with a hernia mesh placed several years ago. One case was a conventional open hernia repair with mesh, the other a laparoscopic ventral hernia repair with mesh. Though difficult as they were to tackle, the robotics approach permitted great visu­alization, maneuverability within the abdominal cavity and dexterity to lyse the numerous adhesions, including bowel, removing the crimpled old mesh and allowing adequate deployment of a new mesh using simple sutures. This approach permitted a quicker recovery and a minimal hospital stay to the patient due to less pain and a faster return to function than any other approach.

Valley-Mount Sinai Comprehensive Cancer Care By Robert Korst, M.D., Chief, Oncology Surgical Section, and Director, Thoracic Surgery

Thoracic surgeons at Valley-Mount Sinai Comprehensive Cancer Care are committed to employing safer, more effective approaches to treatment. Valley Health System uses the da Vinci® Surgical System—the latest in robotic surgical technology—to perform mini­mally invasive surgeries for both routine and complex lung and esophageal con­ditions, including cancer. The robot allows for more delicate surgical maneu­vers to be easily performed compared to the standard thoracoscopy (VATS). Its 3D optics allow for better depth perception, which further enhances the surgeon’s technical capabilities. The state-of-the-art technology can lead to shorter lengths of stay and decreased postoper­ative pain.