New Masters: Dr. Mark Dylewski, Robotic Surgery

Talking with Dr. Mark Dylewski, one of the new masters of thoracic surgery in the area of robotic surgery

Most of us never had the opportunity to meet or talk to some of the ‘masters’ of thoracic surgery like Dr. Hermes Grillo (1923 -2006), the ‘Father of Tracheal Surgery’ but as we have discussed before, thoracic surgery is not static.  New technologies and new techniques are emerging all the time, and with these developments – new masters of thoracic surgery.

Dr. Mark Dylewski, may look too young to be the father of anything, but he is certain to be remembered in thoracic surgery history as one its new masters, and as one of the ‘fathers of robotic-assisted thoracic surgery’.   While he is not the only surgeon doing robotic surgery, he is certainly one of the most prolific robotic / thoracic surgeons and has trained a large number of his peers.

Dr. Garrett Walsh and Dr. Mark Dylewski, thoracic surgeons

Talking to Dr. Dylewski about robotic surgery

At the recent conference, Advances in Lung Cancer and Mesothelioma, we had the opportunity to sit and talk with Dr. Dylewski about the state of robotics in thoracic surgery.   Dr. Dylewski is one of the foremost experts on the topic and teaches robotic surgery techniques at the South Miami Hospital Center for Robotic Surgery.  Since he started performing robotic surgery in 2006, he estimates that he has taught over 200 thoracic surgeons how to perform surgery utilizing the DaVinci robot.

In comparison to other minimally invasive techniques (specifically VATS), Dr. Dylewski believes that robotic surgery has greater potential for use in thoracic surgery, due to its easy adoptability.  He reports that unlike VATS, robotic surgery techniques utilize traditional surgical skills so that surgeons are usually proficient at robotic surgery after performing 30 – 40 cases.  There are no counter-intuitive movements or altered visibility/surgical perspectives which are two of the things inherent in video-assisted thoracoscopy.  He attributes both of these issues with the failure of more wide-spread adoption of VATS despite the availability of this technology for over twenty years.  According to Dr. Dylewski, less than 30% of all thoracic procedures in North America are currently done using VATS.

Simply put, even some of the best thoracic surgeons may have trouble adapting to VATS techniques and as many as 20% will never fully adjust to video-assisted surgical techniques.

However, in his experience, robotic-assisted thoracic surgery such as complete portal robotic lobectomy ( aka CRPL-3 or CRPL-4, depending on the number of arms used) has a greater potential for widespread use.  He explains that despite the initial hefty price tag, the robotic technology easily justifies its equipment costs, in terms of subsequent savings and benefits from decreasing the length of stay, less patient discomfort and greater patient satisfaction.  He reports that these benefits have led to the adoption of robotic surgery as the standard of care in other specialties such as gynaecology despite the relative newness of this technology.

Dr. Dykewski also presented data regarding surgical outcomes from 355 cases, which includes a wide variety of thoracic procedures such as lobectomies, esophagectomies and mediastinal surgeries.  Surgical outcomes were comparable to VATS procedures with a markedly shorter length of stay.

Dr. Mark Dylewski, MD

Thoracic Surgeon

Director of General Thoracic & Robotic Surgery

Baptist Health of South Florida

Miami, Florida

OR live with Dr. Dylewski

Spanish news story about Dr. Dylewski on YouTube

Selected publications

Dylewski MR, Ohaeto AC, Pereira JF. (2011).  Pulmonary resection using a total endoscopic robotic video-assisted approach.  Semin Thorac Cardiovasc Surg. 2011 Spring;23(1):36-42.

Ninan M, Dylewski MR. (2010).  Total port-access robot-assisted pulmonary lobectomy without utility thoracotomy.  Eur J Cardiothorac Surg. 2010 Aug;38(2):231-2. Epub 2010 Mar

Additional References and Resources

Meyer M, Gharagozloo F, Tempesta B, Margolis M, Strother E, Christenson D. (2012).  The learning curve of robotic lobectomy.  Int J MId Robot. 2012 Sep 18. doi: 10.1002/rcs.1455.   The authors of this publication report that it takes 18 – 20 complete portal robotic lobectomies to obtain competency.

Talking with William Serpa about the da Vinci robot

a sit down interview with William Serpa of Intuitive Surgical to discuss RATS (robot-assisted thoracic surgery) with the da Vinci robot.

As we look towards the future of thoracic surgery, at emerging technologies and procedures – one technology stands apart from the rest: robot-assisted surgery.  Love it or hate it – all thoracic surgeons have heard of it. So you can imagine my excitement this week when I had the opportunity to sit down and talk to one of the representatives of Intuitive Surgical, the makers of the best-known robotic surgery device, the da Vinci robot.

William ‘Al’ Serpa sat down with me to discuss robotic technology and the growing use of robotic technology in thoracic surgery.  While the da Vinci robot is used fairly frequently in urological and gynecological surgery, it is just now making inroads into other specialties.  The robot, which costs in excess of one million dollars, is more than a financial investment; it is an investment into the future of modern surgery – and Intuitive Surgical understands this.  The company maintains a long term mentoring relationship with surgeons trained on the da Vinci, and they take the training process seriously.

Interested surgeons of facilities with da Vinci equipment participate in multiple in-services, high-level on-site observations, and on-line training modules prior to beginning actual training on the robot in a 1 to 2 day skills lab.  After completing this initial training, surgeons are mentored through several cases, increasing in complexity as they become more familiar with the robot.

Mr. Serpa reports that most surgeons demonstrate surgical proficiency with the da Vinci system after completing about twenty cases.  This is also the minimal volume of annual cases required to be listed on the da Vinci website as a specialty provider.

Mr. Serpa and I discussed the perceptions that many physicians have of the difficulty of the learning curve for robotic surgery.  We discussed multiple published reports that robotic surgery lengthens case times, and the realities behind robotic surgery.  “Actually, after surgeons become familiar with using the robot, it doesn’t take more than a moment to re-position it.”  That’s sounds similar to what several previous surgeons [using the robot] have reported – so I guess the only way to find it is to see for myself.

Hopefully, my next post about the da Vinci robot will come to you from the OR.

Additional References

Giulianotti PC, Buchs NC, Caravaglios G, Bianco FM.  Robot-assisted lung resection: outcomes and technical details.  Interact Cardiovasc Thorac Surg. 2010 Oct;11(4):388-92.

Ninan M, Dylewski MR.  Total port-access robot-assisted pulmonary lobectomy without utility thoracotomy.  Eur J Cardiothorac Surg. 2010 Aug;38(2):231-2.

Kajiwara N, Kakihana M, Usuda J, Uchida O, Ohira T, Kawate N, Ikeda N. Training in robotic surgery using the da Vinci® surgical system for left pneumonectomy and lymph node dissection in an animal modelAnn Thorac Cardiovasc Surg. 2011 Oct 25;17(5):446-53.

Palep JH.  Robotic assisted minimally invasive surgeryJ Minim Access Surg. 2009 Jan;5(1):1-7.  Indian article – gives nice overview of robotic surgery.

Bodner J, Augustin F, Wykypiel H, Fish J, Muehlmann G, Wetscher G, Schmid T.  The da Vinci robotic system for general surgical applications: a critical interim appraisal.  Swiss Med Wkly. 2005 Nov 19;135(45-46):674-8.

Obasi PC, Hebra A, Varela JC.  Excision of esophageal duplication cysts with robotic-assisted thoracoscopic surgery.  JSLS. 2011 Apr-Jun;15(2):244-7.

Schmid T, Augustin F, Kainz G, Pratschke J, Bodner J.  Hybrid video-assisted thoracic surgery-robotic minimally invasive right upper lobe sleeve lobectomy.  Ann Thorac Surg. 2011 Jun;91(6):1961-5.

Melfi FM, Viti A, Davini F, Mussi A.  Robot-assisted resection of pulmonary sequestrations.  Eur J Cardiothorac Surg. 2011 Oct;40(4):1025-6.

Spaggiari L, Galetta D.  Pneumonectomy for lung cancer: a further step in minimally invasive surgery.  Ann Thorac Surg. 2011 Mar;91(3):e45-7.  Case reports of two pneumonectomies with the daVinci robot.

Kajiwara N, Kakihana M, Kawate N, Ikeda N.  Appropriate set-up of the da Vinci Surgical System in relation to the location of anterior and middle mediastinal tumors Interact Cardiovasc Thorac Surg. 2011 Feb;12(2):112-6. [this article has been cited in previous articles on the da Vinci robot.

Augustin F, Bodner J, Wykypiel H, Schwinghammer C, Schmid T.  Initial experience with robotic lung lobectomy: report of two different approaches.  Surg Endosc. 2011 Jan;25(1):108-13.

Al-Mufarrej F, Margolis M, Tempesta B, Strother E, Najam F, Gharagozloo F.  From Jacobeaus to the da Vinci: thoracoscopic applications of the robot.  Surg Laparosc Endosc Percutan Tech. 2010 Feb;20(1):1-9. Review.

Campos JH.  An update on robotic thoracic surgery and anesthesia.  Curr Opin Anaesthesiol. 2010 Feb;23(1):1-6. Review.

In-press:

Kajiwara N, Taira M, Yoshida K, Hagiwara M, Kakihana M, Usuda J, Uchida O, Ohira T, Kawate N, Ikeda N.  Early experience using the da Vinci Surgical System for the treatment of mediastinal tumors.  Gen Thorac Cardiovasc Surg. 2011 Oct;59(10):693-8. doi: 10.1007/s11748-010-0790-9.

History of Robotic Surgery – link to website

More about robotic surgery and the da Vinci surgical system

History of Intuitive Surgical and the da Vinci robot