This June: NYU School of Medicine & Robotic Thoracic Surgery

Details about the upcoming Robotic thoracic surgery course at NYU this June.

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New York University School of Medicine has an upcoming CME course on Robotic Thoracic Surgery this June (10th & 11th).  The day and a half course will be held at NYU Langone Medical Center in New York City.

The conference covers robotic surgery basics as well as lectures on robotic esophagectomies and mediastinal surgery.  Robotic master surgeon, Dr. Robert Cerfolio will be giving two presentations.

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Dr. Robert Cerfolio with a Latin American thoracic surgeon at a conference in Orlando, Florida 2015

Dr. Inderpal Sarkaria from the renown University of Pittsburgh Esophageal & Lung Surgery Institute will be giving a presentation on esophagectomies by the robotic approach.  Dr. Sarkaria is the newest thoracic surgeon at the UPMC program run by Dr. James Luketich.

While it is a short conference, it’s a chance for interested thoracic surgery professionals to learn more about establishing a robotic surgery program.  It is also part of a larger robotic surgery conference, the Second Annual NYU Langore Multi-Specialty Robotic Surgery Course.

All robotic surgery enthusiasts, fellows and interested surgeons – can register for the course here.  Allied health professionals are encouraged to attend.

 

Robotic surgery with Dr. Ricardo Buitrago, thoracic surgeon

Robotic (thoracic) surgery comes to Clinica de Marly in Bogota, Colombia

A year and a half ago, I interviewed and spent some time with Dr. Ricardo Buitrago at the National Cancer Institute, and Clinica de Marly while doing research for a book about thoracic surgeons.  At that time, Dr. Buitrago stated he was interested in starting a robotic surgery program – and was planning to study robot-assisted thoracic surgery with Dr. Mark Dylewski.

Dr. Ricardo Buitrago in the operating room, April 2011

Fast forward 1 year – when I received a quick little email from Dr. Buitrago telling me about his first robotic surgery at the Clinica de Marly.  At that point, I sent Dr. Buitrago an email asking if I could come to Colombia and see his robotic surgery program to learn more about it.  We had several phone conversations about it and I also outlined a research proposal to gather data on thoracic surgery patients and outcomes at high altitude, to which he enthusiastically offered to assist with. Thus began my current endeavor, in Bogota, studying with Dr. Buitrago.

Now – after completing a proctoring period with Dr. Dylewski, Dr. Buitrago has more than a dozen independent robotic surgeries under his belt.  He has successfully used the robot for lobectomies, mediastinal mass resections and several other surgeries.

As part of my studies with Dr. Buitrago – I’ve made a video for other people who may be interested in robotic surgery with the DaVinci robot and what it entails.

Hope you enjoy.

 

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

Robotic Thoracic Surgery

today, we are looking at the research and case reports related to the use of the Divinci robot for robot-assisted thoracic surgery..

I’m not sure if this should be filed under the Future of Thoracic Surgery – or news, since it won’t be long before more surgeons are performing their surgeries using the DiVinci robot.

I’ve already met a surgeon here in Bogota who has been training to start performing his lung surgeries using this technology.

It’s still a pretty new application of this robot – though reports go back to 2000, but it’s been slow to catch on in this specialty. The Divinci, which has been used for several years; in urology, gynecology and cardiac surgery is an expensive, large, unweldly machine so it takes consider time, and expense to get the necessary training and skills to use it appropriately.
However, one of the surgeons I know in Fresno, at the Stanford Cardiothoracic Surgery Clinic, Dr. Randy Bolton, has been using it for his cardiac cases for years..

So, today, we are looking at the research and case reports related to the use of the Divinci robot for robot-assisted thoracic surgery..

Robotic surgery for mediastinal tumors – Japan: a review of six cases including tomography, diagrams of staff positioning, and a discussion of port placement, as well as some of the problems they encountered (a lack of speciaized instruments).

The University of Illinois experience: 32 cases from 2001 – 2009 ; this study highlights some of the problems implementing new technologies – there is a significant learning curve, and it slows you down.. (The average operating time was 209 minutes). There are some color photos, so caution to the squeamish.

There are three articles pending publication on the use of robotic surgery for thoracic cases – one by Melfi, Vita, Divini and Mussi (European J Cardiothoracic Surgery)
and another, discussing 2 cases of pneumonectomy by robot by Spaggiari and Galetta that sound pretty intriguing.

I’ll see if I can update the article when the articles are more widely available.