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

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.

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