Annual Pub 2024 accessible 07262024 (1) - Flipbook - Page 45
SUMMER 2024 MAGAZINE
What specialties effectively use robotics? Typically, specialties that
are working deep in the pelvis. So urologists, colorectal surgeons,
and gynecologic oncologists, all of whom operate deep in the pelvis
like the bladder, prostate, rectum, those structures. In the past, you9d
have to have multiple retractors and multiple hands, and it would
still be very hard to see and navigate through those areas. Now, the
robot can have multiple arms doing exactly what you want them to
do, and the scope can zoom into those areas that you need to see.
What prompted your group to begin using robotics? Many of the
things we do in plastic and reconstructive surgery are based on
a need. And essentially, the need came from a challenge from
our colorectal surgeons who were incorporating more robotic
techniques and asking why our reconstruction required large
incisions and why patients were complaining more about the
reconstruction incision than about the colorectal surgery incisions.
They were able to remove a big cancer and the entirety of the rectum,
but because they did everything through small incisions, with the
robot, the patient really didn9t have a lot of pain from those areas.
It sounds like you9re using robotics more in your reconstructive
work? Well, one of the things I9m becoming known for nationally
and internationally is using the robot to perform reconstruction
after abdominal perineal resection for low-lying rectal cancer. The
colorectal surgeon has to remove the entirety of the rectum and the
patient ends up with a colostomy, as the colon is coming out from
the abdomen. Historically, we would use naps from the abdomen,
including skin, and drop that muscle from the abdomen, down into
the pelvis to oll the space where the rectum used to be. But that
was when we had the luxury of using the big open incision that the
colorectal surgeons used. Now, these days, the majority of colorectal
surgeons are using robotic techniques. Those big incisions are a
thing of the past.
Robotic surgery has become an area of great interest among
reconstructive surgeons who do these surgeries after the colorectal
surgeons onish. Because the colorectal surgeons are already
utilizing the robot, they have the crew, nurses, techs, and everyone
else already trained for the robot. You9re not adding any additional
expense or additional training to the staff. You9re actually decreasing
the morbidity and improving the outcomes for the patient.
You obtained your certiocation to use the Da Vinci Robotic System
in 2014. How many robotic surgeries have you performed since
then? We9re probably approaching about 30. Right now, I9m one of
the founding members of our American Society of Plastic Surgeons
How is Southern Nevada doing when it comes to robotic surgery?
I think we stand up pretty well with all the specialties across the
country that are typically incorporating more and more robotics.
Overall, the majority of the colorectal surgeons, gynecologic
oncologists, urologists, and general surgeons have incorporated
robotic techniques. Thoracic surgeons, otolaryngologists (ENT), and
orthopaedic surgeons are increasingly utilizing robotic techniques,
so I would say we aren9t too far behind. In general, it9s not the quality
of the doctors here but, rather, the volume of doctors. We just don9t
have enough people that can actually do these techniques. But in
plastic and reconstructive surgery, I would say that we are really
ahead and at the forefront. I base that opinion after having been
brought in to lecture at places like the University of California, San
Francisco (UCSF), Stanford, and Beth Israel (Harvard).
Are we teaching the next generation? Yes. Inside our new medical
education building, we have a simulation center where we have
a robot that is the exact same console as the one that is used in
the operating room. I9ve had fellows that I9ve taken through to get
certiocations in microsurgery, and after they do the simulations,
and then they do it on a patient, they tell me,
