By: MILES Z. EPSTEIN
THE BENEFITS OF ROBOTIC surgery include a faster return to daily activities; fewer complications; shorter hospital stays; reduced hospitalization costs; reduced trauma; significantly less pain; and less scarring. Here are some examples that show how it can enhance the capabilities of trained surgeons to improve quality of life for patients and save lives, as well.
Clara Maass Medical Center, RWJBarnabas Health
By Michael J. Straker, M.D., F.A.C.O.G., OB/GYN, Minimally Invasive GYN Surgery, Director, Dept. of Obstetrics and Gynecology
Most, if not all, of the robotic surgeries I do can be considered success stories. Patient recovery time is significantly decreased with robotic surgery, as compared to open surgery, and their overall convalescence time is decreased by half. Recovery time for patients who receive open GYN surgery can be anywhere between four to eight weeks, usually averaging at six weeks. For robotic surgery, the recovery time is usually two to four weeks. For instance, I performed a robotic hysterectomy on a woman in her 70s and she was back to work in only two weeks. Patients usually appreciate the cosmetic results of smaller incisions with robotic procedures, versus open GYN surgery. In terms of advancements to the technology used in robotic surgery, a more finely articulated vessel sealer would be effective in decreasing surgical time, particularly for surgeries in the cervical area. Additionally, improvements in the technology used to map out the ureters may help to decrease the likelihood of ureteral injury.
Community Medical Center, RWJBarnabas Health
By Steven Lowry, M.D., Chair, Robotic Surgery Program, Colorectal Surgeon
I consider each of my patients who receive robotic surgery a success story. I do a lot of robotic colon surgery and comparing the recovery time between robotic colon surgery and open surgery is like night and day. As opposed to five to seven days in the hospital, patients who receive robotic surgery significantly reduce their hospital stay to just two to three days. I tell my patients who receive robotic colon surgery that at a month, you are going to feel 90 percent to 95 percent recovered. For individuals who receive open surgery, by a month you are only maybe 60 percent to 70 percent recovered. I also do a lot of hernia repairs robotically, and it is all around a much better repair structurally than doing an open surgery, and patients recover in about a third of the time that it would normally take. To advance the use of robotic surgery, there needs to be more patient and physician education about the technology and its benefits. Physicians may not be aware that robotic surgery does not sacrifice the quality of the procedure done, but in fact has increased positive patient outcomes and significantly reduces recovery time.
Englewood Hospital and Medical Center
By James McGinty, M.D., Chief of Surgery and Surgical Services
Robotic surgery has been a gamechanger, especially in hernia repair. One of our patients experienced a bulging abdominal hernia as a result of a large incision to remove her gallbladder many years ago. Traditional methods of hernia repair involve opening the full length of the scar and moving the abdominal muscles to cover the weakness. This results in a strong repair, but also involves hospitalization, significant pain and tube placement to drain fluid from the wound. In laparoscopic repair, long considered the best in minimally invasive surgery, a mesh patch is placed under the defect. However, with large defects such as this, it is difficult to maneuver small instruments effectively, and there is a high recurrence rate. Additionally, attaching the mesh is difficult because the hernia is close to the ribs and diaphragm. Using the advanced technology of robotic surgery, and through several half-inch cuts, our surgeons were able to move muscles to close the hole, as would be done in the traditional repair. Because the robotic instruments give the surgeon superior range of motion and precision, the repair was reinforced with a mesh that is smaller, attached in a way that avoids damage to surrounding structures. Our patient went home on the same day, without narcotic pain medications or drains, and returned to normal activities within two weeks. Best of all, she can expect a durable repair that will allow her to live her life without the pain and disfigurement of a large abdominal hernia. There have been significant technological advances in robotic surgery which allow surgeons to do more complex operations through reduced number and sized incisions. Miniaturization of the robotic platform and instruments allows surgeons to operate inside organs such as the stomach. Combining image guidance and robotics allows more precise removal of tumors.
Hackensack University Medical Center, Hackensack Meridian Health
By Yair David Kissin, M.D., Orthopedic Surgeon, The Orthopedic Institute
Hackensack University Medical Center successfully completed New Jersey’s first robotic-assisted total knee replacement surgery using the THINK Surgical Inc. TSolution One® System for the treatment of severe osteoarthritis. More than 30 million adults are impacted by osteoarthritis, making it the most common form of arthritis and the most common cause of disability. HackensackUMC is one of four centers in the country participating in an Institutional Review Board (IRB) and Food and Drug Administration (FDA) approved clinical trial by THINK Surgical Inc. to demonstrate that the TSolution One® System is a safe and effective surgical alternative to traditional knee replacement using manual instrumentation. The procedure was performed on a 58-year-old patient who suffered from osteoarthritis of the left knee. Six weeks after the surgery, the patient had full range of motion and was very pleased with the progress.
The TSolution One® System is designed to cut the femur and tibia based on a pre-operative plan designed by the surgeon. The clinical trial will examine the ability of the TSolution One® System to follow this pre-operative plan and achieve desired implant alignment. HackensackUMC is on the forefront of orthopedic care, making advancements in orthopedic surgery to further improve patient outcomes and furthering our commitment to providing high-quality, patient-centered care.
Holy Name Medical Center
By Maria B. Schiavone, M.D., Division of Gynecologic Oncology, The Patricia Lynch Cancer Center
At the Patricia Lynch Cancer Center (PLCC) at Holy Name Medical Center, the daVinci® robot enables gynecologic oncologists to perform complex surgeries through a minimally invasive approach for gynecologic cancers and benign diseases. The benefits to patients include a reduction in blood loss, less pain and a shorter hospital stay. Most patients are able to return to work and other activities within just a few weeks. The robot’s utility in enabling us to perform complex surgeries—such as staging for ovarian cancer, surgery to treat recurrent disease in patients with ovarian and endometrial cancers, and upper abdominal procedures—continues to unfold. At the PLCC, each patient is a person whose name we know. A recent successful case involves a 38-year-old mother of three with early-stage cervical cancer. Her complex radical surgery was performed through five small incisions using the daVinci® robot. A technique called sentinel lymph node mapping was also performed using the robot’s fluorescence imaging capability, which allowed us to more precisely evaluate for cancer spread to the surrounding lymph nodes. Using the robot, I removed her cervix, uterus, and fallopian tubes, and repositioned her ovaries to protect them from the postoperative radiation that was needed to help prevent cancer recurrence. Saving her ovaries spared her from early menopause and preserved their ability to produce estrogen that benefits her heart and bones. After radical surgery and five weeks of radiation therapy, she has an excellent prognosis.
Jefferson Health-New Jersey
By Roy Sandau, D.O., FACOS, Chief of Surgery
Since 2011, I have used the da Vinci® robotic surgical platform to treat hundreds of patients with surgical emergencies, difficult cancer operations and outpatient, same-day procedures. I have successfully treated numerous patients who were turned away by other surgeons and told they were not candidates for laparoscopic surgery due a history of multiple abdominal reoperations. I can honestly say that, in most of these instances, the patient’s care was enhanced by robotic surgery. The da Vinci® surgical platform offers enhanced dexterity, 3D visualization, camera stabilization and fluorescent imaging to allow better identification of critical anatomy. In my personal experience, it allows for the most complex operations with better results than traditional laparoscopic surgery—with a shorter hospital stay, decreased pain, blood loss, perioperative complications and reduced ER visits. My patients have been able to return to work faster, attend family events, and enjoy planned vacations. In cancer cases, they are able to start chemotherapy and radiation faster without delays due to the shorter recovery time. To expand the use of robotics, we need reduced costs, a more reliable increase of high-speed bandwidth to provide remote surgery, miniaturization of hardware to allow mobile units, compact storage and better utilization in smaller operating rooms.
Jersey Shore University Medical Center, Hackensack Meridian Health
By Kourosh Asgarian, D.O., Cardiothoracic Surgeon
Jersey Shore University Medical Center is one of the few hospitals in the greater New Jersey region to perform robotic-assisted Coronary Artery Bypass Graft Surgery (CABG). By using the da Vinci® Xi Surgical System, the medical center is at the forefront of cardiovascular care, and provides patients with better outcomes, reduced traumatic impact and quicker recovery. The medical center’s first robotic-assisted CABG was performed in 2017 on 56-year-old Sean, who had a blockage in a major artery that was too severe for a stent. He required surgery to remove plaque buildup in the coronary arteries to improve blood flow to the heart but was fearful of undergoing a major surgical procedure (sternotomy) that traditionally requires an incision from the neck to the abdomen. Fortunately for Sean, a robotic approach was an option, requiring only four one-inch incisions. Whereas recovery from traditional sternotomy requires months of rest and healing, the robotic approach allows the patient to heal faster, with less pain and a reduced chance for infection. After his procedure, Sean spent less than 24 hours in the intensive care unit and felt minimal pain. He noticed an immediate difference in his body after surgery, such as breathing better and the ability to walk and talk at the same time. His recovery included cardiac rehabilitation as an outpatient, gaining strength every day. As the newest and most advanced minimally invasive cardiac procedure, robotic-assisted CABG is an exciting option that is improving the lives of cardiac patients.
Morristown Medical Center, Atlantic Health System
By Tom Thomas, M.D., MPH, Director, Head and Neck Transoral Robotic Surgery, Leonard B. Kahn Head and Neck Cancer Institute
In 2016, I met a 56-year-old man who noticed a large lump on the right side of his neck while shaving. He did not think much of it until it did not go away, and he went to his doctor. He was given antibiotics, but the lump never went away. He went to his ENT doctor and after imaging and testing, he was diagnosed with cancer. He was referred to me for Transoral Robotic Surgery (TORS) with the da Vinci® robot. His cancer was associated with human papilloma virus (HPV) infection. HPV is a sexually transmitted disease. Most individuals become exposed to HPV when they become sexually active, but usually our immune systems clear the virus from our bodies. In others, it remains dormant and develops cancer decades later. The development of TORS coincided with an epidemic in HPV-related throat cancer. Until recently, head and neck surgeons had limited surgical options and in many cases were required to split the lip and jaw, causing severe functional and cosmetic deficits. TORS enabled surgeons to see tumors tucked in the back of the tongue or side wall of the throat. The patient underwent TORS to remove the cancer from his tonsils. His neck lump was removed in the same setting. He did very well after surgery. It is imperative that we consider TORS in the era of HPV, especially in the younger population.
Overlook Medical Center, Atlantic Health System
By Jeffrey Leary, M.D., Orthopedic Surgeon
Albert Abdemur from Roselle Park is in his late 50s, but he never misses an opportunity to dance. He’s part of a social group who meet on weekends for dancing to everything from pop, rock and Latin. He’s also an operating room nurse who spends a lot of time standing. When he needed partial knee replacement last year, he didn’t have to miss a beat for long, in the club or in the OR. Like Albert, people suffering from osteoarthritis in the knee can quickly get back on track with the Mako Robotic-Arm Assisted Surgery System, which allows surgeons at Atlantic Health System’s Overlook Medical Center to perform minimally invasive partial knee replacements with greater precision. The Mako technology allows surgeons to create a 3-D model of the knee based on CT scan images. We digitally superimpose the patient’s knee into the computer program, and the robotic software determines the exact alignment for the implants to be placed. The system’s robotic arm helps keep the surgeon to that model, ensuring greater accuracy, and reduced pain, minimal hospitalization and faster recovery for the patient. Looking forward, expanding this procedure to treat other joints and allow more customization would be useful advancements.
Rutgers Cancer Institute of New Jersey
By Eugenia Girda, M.D., FACOG, Gynecologic Oncologist, Assistant Professor of Obstetrics, Gynecology and Reproductive Sciences at Rutgers Robert Wood Johnson Medical School
Computer-aided surgical systems involving robotic tools that are directed by surgeons can be useful in operations requiring extreme precision. Robotic technology incorporates three-dimensional stereoscopic vision and wristed instrumentation that allows better dexterity and precision, using incisions smaller than the diameter of a dime. With such a less-invasive approach, fewer complications, less pain and faster recovery time are often seen when compared with conventional approaches—enabling patients to resume regular activities at a quicker pace. At Rutgers Cancer Institute of New Jersey, the Gynecologic Oncology Program has been using robotic surgery for both benign and malignant conditions since the technology was introduced.
Robotic technology is now frequently used to complete staging surgery for endometrial cancer, debulking surgery for ovarian cancer, radical hysterectomy for cervical cancer, as well as intricate pelvic dissections for benign complex indications. In the future, as our society becomes further connected through technology, and with growing need for surgical specialists, there may be a unique role for robotic surgery in telemedicine.
Valley-Mount Sinai Comprehensive Cancer Care
By Melanie Ongchin, M.D., Medical Director, Surgical Oncology
The Valley Hospital was the first in the country to use the da Vinci® System to perform the Whipple procedure, a highly technical surgery for the management of pancreatic cancer. Since that time, it’s been at the forefront in utilizing the robotic technology in gynecologic cancers, as well as colorectal cancer, prostate and gastrointestinal tract malignancies. The benefits of the robotic platform are that through smaller incisions, patients have less intraoperative blood loss, experience less pain postoperatively and have a shorter length of stay. As compared to traditional laparoscopy, the robot enhances the surgeon’s ability to operate minimally invasively through the three-dimensional, high-resolution images, as well as the ability to articulate instruments to perform fine dissection. It also offers image-guidance technology that enables surgeons to detect vital anatomical structures. This is integral in complex surgical procedures involving the pancreas, liver, esophagus and stomach, and especially for the prostate and rectum where the operative field is limited due to the pelvic cavity. With further advances in the future with robotic instrumentation, hemostasis and coagulation devices and staplers, there will be improved overall procedural efficiency and the application of the robot may be expanded beyond its current applications.