Dr. Jason Hawksworth, Dr. Tamatha Fenster, and Dr. Arnar Geirsson come from different specialties, but one thing unites them: the implementation of surgical robotics to advance their practices. In this episode, the doctors discuss how robots are revolutionizing the fields of hepatobiliary, gynecological, and cardiac surgeries–and what’s coming next for the future of medicine.
With perspectives spanning hepatobiliary, gynecologic, and cardiac surgeries, NewYork-Presbyterian’s Dr. Jason Hawksworth (Columbia), Dr. Tamatha Fenster (Weill Cornell Medicine), and Dr. Arnar Geirsson (Columbia) describe how they each came to incorporate robotics into their practices. One of the biggest takeaways: robotic surgeries allow for more accuracy in minimally-invasive approaches; so patients experience shorter hospital stays and quicker recoveries, even after major procedures. But there are some limitations to robotic surgeries that the doctors are still navigating. Dr. Fenster discusses how there are haptics limitations in robotic surgery. As a result, she shares more about her innovative smartHER 3D MRI program that is addressing this issue and details how her and her team are developing a way of holographically projecting 3D MRIs over patients to help guide surgeons while they operate.
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Dr. Hawksworth: The history of the, the development of the surgical robot is very interesting. I come from a military background, so it's all the more interesting to me.
Catherine: This is Dr. Jason Hawksworth. The surgical robot he's speaking about was developed originally by DARPA, the U.S. Department of Defense's Tech Development Agency.
Dr. Hawksworth: And what they were trying to do is trying to bring a robot forward to the battlefield and then you could have the surgeons controlling this medical surgical robot from far behind the front line -- controlling surgical robots from afar, increasing the surgical capability on the battlefields while not putting your surgeons very close to the front lines.
Catherine: The DARPA robot was eventually shuttered, but its successor would become known as the DaVinci, a surgical robot which is now transforming surgery across all medical specialties. Performing surgery with robotics may seem unconventional, but surgeons who embrace the technology [00:01:00] say they're able to perform increasingly complicated surgeries. Patients are receiving the recovery benefits of minimally invasive techniques and the precision of open procedures.
I’m Catherine Price and this is Advances in Care. Today, we’re talking to Dr. Jason Hawksworth, a liver surgeon, Dr. Tamatha Fenster, a gynecologic surgeon, and Dr. Arnar Geirsson – a cardiac surgeon. We’ll be hearing from these three physicians from NewYork-Presbyterian about how they are bringing their practices to the cutting edge by integrating robotics.
Dr. Hawksworth: You know, I've, I've always been interested in liver surgery, it was always very enticing.
Catherine: Dr. Hawksworth is the Chief of Hepatobiliary Surgery at NewYork-Presbyterian/Columbia.
Dr. Hawksworth: The liver is an amazing organ. It is influential in your immune system. It regulates your coagulation system, your metabolism. It's the only organ in the body that can [00:02:00] regenerate, which is fascinating and nobody truly understands how it can do that. So it's really an amazing organ physiologically and anatomically.
Catherine: There’s this organ of mystery just sitting there in our abdomens [laughs] mystery and peril.
Dr. Hawksworth: All true, all true.
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Liver surgery is very challenging for a lot of reasons. The liver, as it happens, is very vascular, so bleeding is an issue. You have to have good exposure to be able to control bleeding, if that occurs. You need to be able to see all the blood vessels that go in and out of the liver. And the liver is relatively inaccessible. It lives under the right rib cage. So all of that is important because to do liver surgery, at least historically, you would have to make a very large incision on the abdomen, spread the ribs to get exposure, so it's, it's a very, uh, challenging, complex type of surgery. For all the reasons I mentioned, [00:03:00] it has historically been maximally invasive surgery.
Patients not only have to recover from potentially a bloody operation, but also have to heal up a large incision that's very painful. It can be hard to breathe, which can set up pulmonary complications like pneumonia, and that, that combination of recovering from a hepatectomy and developing a pneumonia potentially is very dangerous. So there have been surgeons trying to apply minimally invasive surgery to the liver for decades.
Catherine: A lot of the development of laparoscopic liver surgery techniques happened in Japan and Korea, particularly because in those countries, hepatitis B and C are more common, which can lead to liver cancer. And so Japanese and Korean surgeons have gotten very good at laparoscopic liver surgery. They get a lot of practice. But the same can't be said for the United States.
Catherine: When Dr. Hawksworth was training in 2010, [04:00] only 1 percent of liver surgeries in the United States were done laparoscopically.
Dr. Hawksworth: There has been a lot of reluctance, in particular in North America for doing complex liver surgery laparoscopically. One of the fears of doing laparoscopic liver surgery is that if there's a bleeding complication that, um, you just may not be able to control it laparoscopically. And the limitations of laparoscopy are a couple. One is that you're, you're typically using a 2D camera. So you're looking at a 2D monitor trying to do a 3D operation which is very challenging, when you're trying to see around corners, for example, you're trying to see deep into the upper abdomen, and when you're trying to suture. So if you get into trouble, during a laparoscopic liver surgery, you need to be able to suture a bleeding blood vessel very quickly before you lose too much blood. and that's very difficult with laparoscopic instruments, [00:05:00] which don't articulate, meaning they're straight sticks. With no depth perception, it's just extremely difficult to suture quickly and well and be able to get out of trouble.
Catherine: And here, Dr. Hawksworth is talking about simple liver surgeries. More complex surgeries, like say a liver transplant? Dr. Hawksworth says that's nearly impossible to accomplish laparoscopically.
Dr. Hawksworth: You need to be able to dissect out the hepatic artery and the portal vein branches to the side of the liver that you're removing, for example. And doing that dissection very precisely with straight instruments and a 2D monitor is like almost impossible. We call them chopsticks, right? So you're operating with chopsticks, Mr. Miyagi or something, you know, trying to catch a fly with chopsticks.
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Dr. Hawksworth: And it's like almost impossible for, you know, most mortal surgeons. Even the, the so called masters of laparoscopic liver surgery, these surgeons in Japan and Korea that have done [00:06:00] thousands and tens of thousands of cases, if you look at their data, the conversion rate from laparoscopic to open surgery is fairly high.
Catherine: Even though it was hard, Dr. Hawksworth built his practice doing what he calls hand-assisted laparoscopic liver surgery, but it was really only safe for simple cases. This hybrid approach was mostly laparoscopic, with the addition of one larger incision where he could insert his hand.
Dr. Hawksworth: And that way, if there was a bleeding problem, at least I could put my finger on it, while I figured out what to do and then basically would just do the extraction of the part of the liver that I was, um, removing through that hand port.
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Dr. Hawksworth: In early 2018, I had enough laparoscopic experience where I felt like I could take on some bigger cases. And I had a young patient with a benign liver mass that needed to come out and my plan was to do a laparoscopic right hepatectomy. I was able to mobilize the liver, which is [00:07:00] fairly easy to do laparoscopically with a hand in but I just wasn't able to dissect out the blood vessels that go into the liver and just didn't feel like I could do that operation safely. So I had to convert that to open, which was really frustrating in a young, in a young patient to have to, you know, put a liver incision on them. The patient recovered uneventfully, but stayed in the hospital for about a week recovering from that incision. You know, in my head, I thought I could do this case laparoscopically, and what I found is that I just, I felt like I couldn't give that level of safety that I could open, but ultimately that's what led me at least partly down a robotic path.
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Catherine: One of the first disciplines to really integrate the surgical robot was urology.
Dr. Hawksworth: And they quickly realized that the robot was able to give [00:08:00] them the optics and the articulating instruments that they could work in a tight space like the pelvis and be able to suture very well. It completely changed not only their field, but almost every surgical field.
Catherine: Very, very few liver surgeons were using robotics at that time, but to Dr. Hawksworth, it seemed like a viable option for his patients. A win-win, as safe and controlled as open procedures, but minimally invasive. So he hopped on a DaVinci console and began training.
Dr. Hawksworth: When you, when you get on the console and let's say the first time you try to throw a suture with the robot, it's truly intuitive. The way that the instruments are set up, the way they articulate is totally analogous to your own hand. It's really easy for your brain to kind of understand visually what you're trying to do and be able to do it with your hands.
Catherine: Those robotic arms are inserted into the patient via tiny incisions, much like laparoscopy. There's an additional small incision for the robot's high definition camera. [00:09:00] All of this is controlled by a surgeon sitting a few feet away.
Dr. Hawksworth: The robot is attached to the console where the surgeon sits. The console is a sort of viewing box, where the surgeon sits down. It's a binocular camera, so you get 3D optics, which gives you vision like you were operating open and it's a 10X camera. So it's like operating with a microscope. You have pedals on both feet where your left foot controls the camera, you also control all four arms. You put your hands into these, almost like paddles that you can control the robot arms with. It has hands that articulate, seven degrees of freedom, just like the human hand does. Once I sort of got used to the robotic platform and the technology I was able to go from sort of low to medium complexity liver surgery cases, to medium to high complexity cases very quickly. [00:10:00]
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Dr. Hawksworth: I was able to do these cases robotically that I, that I just couldn't do laparoscopically.
Catherine: Soon, Dr. Hawksworth came across another patient needing a right hepatectomy: the exact same surgery that he couldn’t get through the year prior.
Dr. Hawksworth: The concept of a robotic major hepatectomy might as well have been science fiction to me. I just didn't think that that was actually possible. And I was able to basically breeze through that case, did it all minimally invasive with the robot. Patient was very happy, went home in three days, which is at the, at the time, basically unheard of.
Catherine: Compare that to the typical hospital stay for a patient after an open hepatectomy, which is 7 to 10 days.
Dr. Hawksworth: So just a night and day change in outcomes.
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Dr. Hawksworth: And that was really a confidence booster as a surgeon. Now with robotics, I felt like I could do the operation very close to the way I would do it open. And for me, I felt like that was the way to offer a safe operation to a patient minimally invasively [00:11:00] with the benefits of minimally invasive surgery: you know, smaller incisions, lower complications, less infections, faster return to work, less narcotics, all of those advantages... While still providing a safe operation. It completely changed my practice.
Catherine: After a few years of performing robotic liver surgery, Dr. Hawksworth was able to convert 90 percent of his practice to minimally invasive surgery.
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Catherine: The use of robotics is clearly transforming surgery for the better, especially when it comes to less invasive procedures and faster patient recovery. But what can’t robotics do? And how can roadblocks lead to even more innovation?
Dr. Fenster: So I was finishing my residency. And I think we had one robot in the hospital that was really used for oncologists. And an attending came back to our residency program. And she did, it may have been a robotic [12:00] endometriosis resection, I mean, it may have been a quite simple case. But, I was changed forever. Totally and completely flipping-medicine-on-its-head-way of doing surgery.
Catherine: This is Dr. Tamatha Fenster. A gynecologic surgeon at NewYork-Presbyterian/Weill Cornell Medicine.
Dr. Fenster: When I trained, almost exclusively, our surgeries were done open or vaginally. I mean the surgery, would include, usually, more blood loss. You know, trying to pull back bowel and push back fat and omentum and try to find this tiny uterus sometimes it deep into the recesses of the pelvis and you'd use retractors and you can get nerve injuries and all these different things. Presumably the patient would have more pain, more risk of infection. And after the surgery, sometimes you admitted the patient for two weeks or more. And if the uterus was bigger than say 10 or 12 centimeters, sometimes we would do vertical incisions-- you know, that's an incision from the umbilicus down to the pubic symphysis. [13:00] And that has higher risk of dehiscence and other issues that can happen postoperatively. Never in my wildest dreams did I think you could do surgery almost remotely, you know, with someone sitting on the other end of the room. And I was smitten.
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Dr. Fenster: I went to art school many years ago, trained as an artist. We were always thinking of new techniques and new technologies. I was always trained to, to push limits and think about how things can be done in a different way, potentially a better way. And so the robotic surgery was completely up my alley because it was taking a conventional way of doing something that had limitations and completely redesigning it. And it was like, exhilarating, you know, I got butterflies in my belly. I couldn't sleep at night because I, I just kept thinking like “Oh my god, where is this gonna go? Think about the surgeries we can do.” [14:00] I started thinking - these big fibroid uteri -- Imagine, imagine if this technology allows us to take those tumors out of people's belly buttons and let those ladies go back to work the next day. I mean, that would really be groundbreaking.
Catherine: Dr. Fenster's training coincided with a surge in laparoscopic gynecologic surgery. Suddenly, surgeries that were done maximally invasively were possible to do through small ports in the abdomen, assisted by high definition cameras.
Dr. Fenster: At that time, when I was first introduced to laparoscopic surgery, I didn't see limitations. I saw, you know, an incredible world of opportunity and growth and, and to see these women that we had been admitting for two weeks with pain and narcotics and PCA pumps and all this, to go home the next day, you know, and go back to their jobs two weeks later, you can't even, I mean, it's incredible. [15:00] It's like a horse drawn carriage to, you know, all of a sudden a car within a month.
Catherine: But of course, laparoscopy has its limitations too. Just imagine you had to sew with, like Dr. Hawksworth said earlier, chopsticks. But, when robots came onto the scene, it was absolutely undeniable that suturing with the robot was much, much smoother.
Dr. Fenster: Sometimes I tell patients, to simplify it, I tell them it's a giant sewing machine. It allows your hands to move in 360 degree rotation. So these complicated layers of suturing that we need to do to close these fibroid defects in the uterine muscle, to prevent things like uterine rupture-- because my hand can rotate 360 degrees, I can very efficiently, seamlessly do these artist-like closures of a uterus almost effortlessly.
Catherine: But it wouldn't be long before Dr. Fenster found there were limitations of robotic gynecologic surgery, too. [16:00]
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Dr. Fenster: You start with smaller cases. So the technology works really well, but then as you get more sophisticated and you take on harder, more complex cases, you find the weaknesses in the technology you're using, and hence comes innovation. And that's exactly what happened with my team and myself. The one deficit of the robot is you don't have haptic feedback. You can't feel the tumors in the muscle. So if I'm trying to dissect out tumors deep in muscle, and there's blood, and there's maybe fat I'm pushing back, and there's other limitations, you can not see the tumors. You can actually lose the tumors or make incorrect incisions. What we do when we work up these women with fibroids is we do an MRI, and the MRI gives you slices of where the fibroids are, but you kind of lose that panoramic gestalt perspective of other organs and where exactly the fibroids are in space.
Catherine: Dr. Fenster [17:00] found that her ability to offer complicated robotics procedures was being limited by two factors. First, the fact that robotics surgery doesn't allow you to physically feel the tumors with your hands. And second, that 2D MRIs provide a limited picture of where the tumor sits in the anatomy.
Dr. Fenster: So I found as I was doing more and more complicated myomectomies, The robot and the 2D MRI was really a limit in knowing where all my tumors were. I found that I was telling women who had more than say 2 or 3 fibroids, you know what, you need to have open, you need to have laparoscopic, or another iteration because I can't find your fibroids.
Catherine: Dr. Fenster was a skilled laparoscopic surgeon. Her patients would still get great outcomes and great recovery times. But to her, that simply wasn’t good enough.
Dr. Fenster: Mediocracy is not acceptable. Like, I'm sorry, but surgery is not perfect. We are not there [18:00] completely. And it is up to us every single day to challenge what we do and say, hold on, is there a safer, better way to do this? I do this with every aspect of surgery. There are aspects of surgery that we just traditionally do, so you don't even notice the inherent danger or the inherent limitation in what we're doing because it's just what's been taught and we've all been doing it and then sometimes you take a step back and you're like, “it needs to be better, it needs to be improved.” So you, you could sit there and complain and kind of, you know, throw instruments at the end of the case and be grumpy. Or you could go home and be like, I'm going to make this better. If, if I'm not going to do it, who's going to? I mean, I'm at the premier institution in the world with incredible ancillary schools that can actually help me bring these ideas to life. What excuse do I have to not try to make medicine better for women and all people?
Catherine: So rather than ditching the robot, Dr. Fenster invented a 3D MRI, to solve [19:00] the robot's haptics problem, which she named Smart-H-E-R: SmartHER.
Dr. Fenster: The wonderful thing about Cornell is we have all these fantastic schools that we're all affiliated with. So you can think of an idea and then you call some colleagues and they connect you to another and another another and all of a sudden you find yourself working up with brilliant folks at Ithaca or, you know, brilliant folks in the biomedical engineering division who can help you create a vision in your head into reality. So I was so fortunate to find a Dr. Bobak Mosadegh who has a lab at Cornell. He's actually an engineer and a radiologist. He's a PhD and I told him about this vision I had to have these three dimensional MRIs guide us in surgery and he was completely on board. We really decided smartHER was a solution for the haptics limitations in robotic surgery. We thought we need to take these two dimensional MRIs and make them [20:00] three dimensional, make them come to life so that I can rotate the image in space and really understand where all the fibroids were. In relation to other structures on the uterus and other organs, I could find all the tumors and therefore be able to do more complicated cases on the robot.
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Dr. Fenster: We had the surgeons working on the console doing robotic surgery and adjacent to them was an iPad with the MRI loaded with the three dimensional smartHER MRI scans and they could just, they don't have to unscrub, they're already unscrubbed so there was no contamination issues. They would just lean to the right, scroll through the iPad, pick out what image they wanted to look at, turn back to the console where they could do the surgery and dissect out whatever tumor they saw on the screen that they wanted to target. So it was definitely a way to guide them other than touch to find the fibroids. Because as we've shown with smartHER we can see if a fibroid is exophytic, if it's broad ligament, [21:00] if it's, if it's pedunculated, because we can rotate it in space and understand it in relation to other structures. Ideally in the future, we would integrate the iPad into the console that the surgeon is using and all they'd have to do is simply click a button and these big green spheres in three dimensional reality would project onto the actual anatomy that they're working on. So they wouldn't even have to turn their head.
Catherine: Dr. Fenster isn't done with smartHER. She and her team are adapting the technology so that, in laparoscopic cases, the 3D MRI can be holographically projected on top of the patient's body to help guide surgeons as they operate. And eventually, the team hopes to analyze the imaging with machine learning in order to assist surgeons in planning their operations.
Dr. Fenster: And so we've been making a catalog of imaging. And our ultimate goal is to have the MRIs automatically translated to these three dimensional imaging. And then a step forward [22:00] to do deep learning. So what that means is we want the technology to not only translate the two dimensional imaging to three dimensional, but then give the surgeon predictions. Tell the surgeon this case should take you an hour based on other cases. This case you'll lose 300 cc's of blood loss based on other cases. This case you should do minimally invasive, and you should do a cut here, here, and here. That will be your most seamless approach based on other cases. So training the technology to give predictions and actually improve outcomes.
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Catherine: The surgical robot and the 3D-MRI that Dr. Fenster and her team are building to support it – are improving accuracy in gynecologic surgery. But not all fields have been as quick to adopt the robot. Take, for instance, cardiology: 20 years ago, there was a lot of optimism that robotics would be the future of cardiac surgery. But it didn't exactly pan out that way. In its infancy, the robot wasn't [23:00] technologically advanced enough to tackle complicated cardiac procedures, so surgeons left the robot behind. But in recent years, the DaVinci has evolved, making it more appropriate for cardiac procedures.
Dr. Geirsson: Patients were requesting less invasive procedures and that certainly I think had sparked some interest, among especially younger generations and kind of mid career cardiac surgeons to really start to offer this and train and maybe push the envelope a little bit of how we do things.
Catherine: This is Dr. Arnar Geirsson, the director of the Surgical Heart Valve Program at NewYork-Presbyterian/Columbia. He's a mitral valve specialist who is interested in harnessing the power of robotics for cardiac surgery.
Dr. Geirsson: I felt that this was an excellent way of doing truly minimally invasive surgery.
Dr. Geirsson: There are obviously different ways of repairing the valve. In the surgical procedure, it involves [24:00] putting the heart of the patient on a heart lung machine and, and, and stopping the heart briefly and then doing some reconstruction.
Catherine: When Dr. Geirsson began his surgical training, there were two common approaches to mitral valve repair. The first is sternotomy, where the heart is accessed through an incision in the center of the breast bone.
Dr. Geirsson: Some of the drawbacks of sternotomy is primarily you do have to go through the bone in the front of the chest through the sternum. And, you know, you do have to rewire or put it back together. There are some issues and, uh, longer healing related to that and higher risk of infection, and it takes longer for patients to recover. It does take about six to eight weeks for the bone to heal up adequately, because it's a little bit more invasive way of doing heart surgery.
Catherine: The other approach is a thoracotomy.
Dr. Geirsson: Which involves usually an incision that is somewhere between three to four inches. And, uh, and you go in between the ribs and you separate the ribs a little bit. That can also be [25:00] painful the first few days. Some of the challenges with that is that primarily the instruments you use were long shafted straight instruments-- just the ability to repair the valve effectively with these longer instruments is a little bit more challenging, I think. And the visualization can sometimes be challenging. But with the newest generations of robot, this becomes a much more user-friendly operation.
Catherine: A robotic mitral valve repair would be much less invasive than both sternotomies and thoracotomies. The incision would be about one inch, with smaller holes for robotic arms. Dr. Geirsson trained on the robot and developed a plan to change his practice.
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Dr. Geirsson: I obviously wanted to make sure that was done in a safe manner and I think that's why it took me a while to make sure that I could do this very well. You know, we put together how we were going to do the operation in a very choreographic manner, [26:00] simulating the way that we would have done it exactly. And then we did some dry lab in the O.R. with the whole team to kind of go through every single step of the operation. To identify the first patient is always challenging. How do you tell the patient that you're going to be the first patient that I'm going to do a robotic operation on? So yeah, that can be tricky and I think you have to be very honest to the patient that you're doing this for the first time but we've trained, we got the team trained. We feel that you're a good candidate for this and then, you know, we always had this kind of fallback option of doing this through a right thoracotomy or sternotomy if we have problems. And there was a lot of interest. Like there were, I don't know how many people showed up in the operating room at that time, seeing us do the first operation.
Catherine: No pressure!
Dr. Geirsson: It was, it was, uh, it was intense a little bit. And I have to say, once we were able to do it successfully, there was a certain relief that we were able to do a good job. Operation went very well. And I certainly remember the first time I [27:00] talked to the patient and, you know, we had the breathing tube out and she was doing great. The patient was very thankful and very happy and certainly made me feel pretty good about myself and the team. Uh, yeah, it was. It was good feeling. That makes it, what makes it worth coming to work every day. We ensured that we reviewed all the cases – Where could we do better? You do the first few cases, there are a lot of people coming in to see this operation and kind of later on, it becomes of a, just a regular operation. I think once you get used to the ability of doing things with the robot, you don’t really go back to the other way of doing it.
Catherine: For the next several years, Dr. Geirsson would grow his robotics practice. He was the only surgeon doing robotic mitral valve operations in the region. And his outcomes were impeccable.
Dr. Geirsson: So we did a study -- we looked at seven years and compared, basically three groups of patients: traditional sternotomy, [28:00] right thoracotomy, and then robotics surgery for patient undergoing a mitral valve repair for mitral valve prolapse.
Catherine: The study showed that patients who underwent robotic surgery had shorter hospital stays. Sternotomy patients typically spend 7 to 10 days in the hospital. And it usually takes 2 to 3 months before they are fully recovered. But robotic surgery?
Dr. Geirsson: Most people do stay 3 to 4 days in the hospital and vast majority of people is fully recovered about 3 to 4 weeks after the operation. There's less use of blood products, lower rates of atrial fibrillation. And as good of a repair as it was measured by the degree of mitral regurgitation and less conversion to replacement or failed repair. I think it suggests that at least it's as safe as standard sternotomy. In some degrees, better. I think it is difficult to say that it's really better, but it's at least equivalent. What remains to be seen is the long term [29:00] outcome of results of robotics the same.
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Dr. Geirsson: So I think the first year after we developed the program, we did somewhere around 30 to 40 robotic mitral valve operations. But, you know, here at NewYork-Presbyterian/Columbia we're on a trajectory to do, I think, over a hundred mitral valve operations. Because the robotic surgery is really a team sport. And that's what we've developed here at Columbia very rapidly, a really excellent team of nurses, anesthesiologists, first assistants. This is really, you know, the cream of the crops.
Catherine: This year, Dr. Geirsson will be single handedly responsible for performing approximately 10% of all robotic mitral valve repairs in the United States.
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Catherine: Robotic surgery has already transformed these surgical disciplines and the care that surgeons are able to offer to their patients. But there’s even more innovation on the horizon:
Dr. Geirsson: I think there is a lot of exciting things that can be done with robotics [30:00] in general, I mean there will probably be involvement of kind of artificial intelligence and machine learning and kind of help you choose exactly how you want to approach it. I think it's part of, uh, you know, advancing care in general. I think we do need to, uh, continue to push the envelope and, and do advanced things.
Dr. Hawksworth: Now at Columbia, I, I feel like we've taken robotic liver surgery to the next level. We've been able to offer robotic minimally invasive surgery to living liver donors. And we're one of the only programs in the entire country that's offering this to donors. So right now only 5 percent of liver transplants in the U. S. are living donor liver transplants. And so if we can make the living donor surgery easier, safer. with a better recovery, better quality of life outcomes, then we can maybe push that 5 percent to let's say [31:00] 15 or 20%. So I think that this will be a real game changer in liver transplant. Even a very small number of surgeons around the world are starting to transplant livers robotically and I think that that is going to be a reality probably in the next 10 to 20 years where we as surgeons will be able to offer solid organ transplant minimally invasively with robotics and other technology safely and with dramatic improvements in outcomes.
Dr. Fenster: I do think telemedicine surgeries or completely remote surgery will be a thing of the future and I know it's already been done in certain parts of the world, but that surgery with the surgeon not even in the hospital themselves-- they're, they're at home, they're in another facility, they're in another country, and they're helping conduct a surgery in another hospital. [32:00] Now you may have a hospital that couldn't afford to have as many robotically-trained surgeons or perhaps the patient can't travel to another setting and now a surgeon in another country is offering their expertise to help a patient remotely with a robotic instrument. I mean, that would just be phenomenal if that was standard of care.
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Dr. Fenster: I can't wait in 10 years if we play this podcast back and it's going to be like, yes, there are robots being operated from spaceships and we are, you know, doing underwater surgery and we're going to like laugh at me that we were using five ports. You know, it's just, so I can't wait to see what the future holds with this field.
Catherine: Thank you to Dr. Jason Hawksworth, Dr. Arnar Geirsson, and Dr. Tamatha Fenster for joining us today and for sharing how Robotics is transforming their practices.
I'm Catherine Price. Advances in Care is a production of NewYork-Presbyterian Hospital. [33:00] As a reminder, the views shared on this podcast solely reflect the expertise and experience of our guests.
To listen to more episodes of Advances in Care, be sure to follow and subscribe on Apple Podcasts, Spotify, or wherever you get your podcasts. And to find out more amazing stories about the pioneering physicians at NewYork-Presbyterian, go to nyp. org slash advances.
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