By P.H.I.Berroll

It’s one thing to research and develop a new surgical procedure. It’s quite another to put it into practice, over and over again. The surgeons of Mount Sinai have been leaders in the use of the DaVinci robotic system and other minimally invasive techniques. Here, three of them talk about how those innovations have impacted their work.

Dr. Eric M. Genden is no stranger to innovative surgical procedures – he was the first surgeon in the United States to perform a jaw transplant. So it’s not surprising that he has been a pioneer of robotic surgery in his field of specialty, cancers of the head and neck. “It’s made a remarkable impact on our ability to take care of patients with these cancers,” says Dr. Genden, “without making large incisions and doing surgeries that take up a huge amount of time and resources.” Dr. Genden, the Chairman of the Department of Otolaryngology and Chief of the Division of Head and Neck Oncology, performed his first robotic surgery in 2006 and has since done close to 250 such procedures. The biggest advantage of the robotic procedure, he says, is its relative simplicity: “In the typical open surgery, patients have to undergo a 12-to-14-hour procedure to get to the tumor, and they’re usually in the hospital for 10 to 12 days. Using the robot, we’re able to remove the tumor in about two hours – and patients usually go home the next day, eating and drinking and swallowing.” Dr. Genden notes that the robotic technique “is being adapted widely, not only across the U.S. but now in Europe and Asia – because people are seeing that this has a tremendous impact on both the quality of patient outcomes and the cost of care.”

As Chief of the Surgery Department’s Division of Metabolic, Endocrine and Minimally Invasive Surgery, Dr. William B. Inabnet III leads a team that has done more laparoscopic surgeries than at any other hospital in New York City. Dr. Inabnet himself performed the first robotic thyroidectomy at Mount Sinai in 2010, and is a strong advocate of both robotic and non-robotic minimally invasive procedures to remove part or all of a diseased thyroid gland. In the most common procedure, a laparoscope with a tiny, high-definition video camera is inserted into the incision made by the surgeon, so that he and his team can have a bigger, clearer view of the operation on a television screen – “which promotes teamwork,” says Dr. Inabnet, “and greatly improves patient safety.” There is also a cosmetic advantage: The patient is left with a one-to-two-inch scar on the front of the neck, as opposed to four to six inches in a traditional operation. Dr. Inabnet is so impressed with the procedure that he has posted a video of it on Facebook (www.facebook.com/msthyroid), and looks forward to its becoming more common. “Every year,” he notes, “we graduate two endocrine laparoscopic surgery fellows who know these techniques. We’re training the next generation.”

Prostatectomy – the removal of a diseased prostate gland – has long been considered one of the riskiest of medical procedures; because the prostate is surrounded by nerves which control sexual and excretory functions, the slightest error can leave a patient both impotent and incontinent. But through the use of robotics, Dr. David B. Samadi has been able to perform close to 2,200 prostatectomies at Mount Sinai, with amazing results: “97 percent of patients retain continence,” he says, “85 percent, sexual function. 95 percent stay only one night in the hospital. Pain is minimal.” As Chief of Robotics and Minimally Invasive Surgery at Mount Sinai, Dr. Samadi, a urologist, performs almost 15 robotic prostatectomies a week, using a procedure he has named with the acronym SMART (Samadi Modified Advanced Robotic Technique). The main advantages of the technique, he says, are the ability of the DaVinci system to handle the prostate without disturbing “the delicate, sensitive nerves” around it, and to give him a clear, precise view. “In open surgery, you use ‘the touch factor’ because you can’t see the detail of the procedure,” he notes. “With the SMART technique, I can see the detail – so I can perform a precise operation.”

Originally published in Mount Sinai Science & Medicine magazine, 2012.