On the Horizon

B e s t P r a c t i c e s f r O m t H e e x P e r t s a t t H e c e n t e r f O r r O B O t i c s u r g e r y

Robotic SuRgeRy W i n t e r 2 0 1 4

robotic surgery places most surgeons at the pinnacle of technology. However, we cannot

become complacent with new advances in technology for minimally invasive surgery. Many surgeons never move on with new techniques or technology, and many residencies do not even teach robotic

surgery. As robotic surgeons, we have clearly adopted new technology, and we have to keep our eyes and ears open and try new things all the time.

Recently, we’ve seen more advances

in robotic surgery, including single-site technology in both cholecystectomies and hysterectomies. Although some features of robotic surgery are lost in single-site, such as wristed instruments, it produces less scarring than standard robotic or laparoscopic surgery. The patient and physician interest has been higher because single-site laparoscopic surgery is next to impossible. The newer generation of single-site instruments will have wristed capabilities and offer more ability to do a wider array of cases through one incision. These advances may even lead to improvements in technology for natural orifice surgeries in the future, where true scarless surgeries may be a possibility without compromising patient care.

Other new technological advancements include the use of fluorescent dyes to visualize vascularity, lymph nodes, nerves and ureters. Currently, the fluorescent dye is available for use to delineate vascular supply to the bowel as well as for visualizing the biliary tree. However, studies are underway to use these dyes to find sentinel nodes in gynecologic as well as urologic and colorectal surgeries.

Even newer dyes are being tested to visualize nerves for nerve-sparing procedures and the ureter for easy visualization during pelvic surgery. These dyes could be game changers and possibly decrease the rate of anastamotic failures, biliary injury, ureteral injury and nerve compromise during radical surgery.

So we must keep pushing the envelope and keep envisioning the perfect surgery with great results and minimal risk of complications. We will continue to strive to be leaders in this field of minimally invasive surgery.

Ricardo Estape, M.D.Medical DirectorCenter for Robotic Surgery

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this issue

tAKe A HANDS-oN APPRoAcH Arrange a case observation or simulator training by calling 786-662-8877.

RicARDo eStAPe, M.D. Medical Director Center for Robotic Surgery

Surgeons who keep pace with technological advances keep themselves in the best position to benefit their patients.

2 | R o b o t i c S u R g e R y A D v A N t A g e | W i n t e r 2 0 1 4

in 2006, surgeons from Baptist Health’s Center for Robotic Surgery helped develop a first-of-its-kind platform for performing

thoracic surgery robotically. Since then, the Center’s surgeons have remained at the forefront of this growing field, not only pioneering new surgical procedures but also training hundreds of others in how to perform them. The Center’s robotic thoracic surgery program has attracted surgeons from as far away as Colombia, France, Italy, South Korea and Taiwan.

“Closer to home, some of our local physicians still aren’t aware of the domestic and international reach of our training program,” said Mark Dylewski, M.D., director of general thoracic surgery and robotic surgery at Baptist Health Cardiac & Thoracic Surgical Group. “We have trained more than 300 surgeons from many states and numerous countries around the world.”

iNteRNAtioNAlly ReNowNeD PRogRAM

Surgeons seeking to learn the latest robotic thoracic surgical techniques flock to South Miami Hospital, where they train with Dr. Dylewski and other experts.

One innovative teaching tool used by the program is simulator training. Similar to a flight simulator for pilots, this simulator connects with a physician control console identical to the one used in actual robotic surgery. A surgeon practices using the robot for suturing, knot tying and other skills, while a computer tracks the trainee’s performance.

Once this portion of the training has been completed, the next step is cadaver lab

training. Dr. Dylewski or one of his colleagues currently conducts this training at facilities in Sunnyvale, Calif., or in Houston. However, when a new facility opens at South Miami Hospital, it will be able to host cadaver lab training on-site.

“We are in the process of building a dedicated training facility, expected to open in 2014,” Dr. Dylewski said. “It will include a large area where we can air live telecasts from the operating room, as well as a cadaveric training lab.”

AcRoSS tHe couNtRy AND beyoNDThe last step in the training process

is traveling to a hospital where a team

S u R g i cA l i N N ovAt i o N S

Training The World’sroboTic Thoracic surgeons

of newly trained surgeons is launching a robotic thoracic surgical practice. “We help them get oriented, and walk them through several cases,” Dr. Dylewski said. “It’s very rewarding to take a group of surgeons from the beginning of their robotic training all the way through to the point where they are functioning independently as robotic teams.

“It’s rare for physicians at a community hospital to have the opportunity to broadly influence the field of minimally invasive robotic thoracic surgery,” Dr. Dylewski added. “We are very proud of the role we continue to play in bringing robotic thoracic surgery to the nation and the world.”

domestic: Alabama, California, Connecticut, District of Columbia, Florida, Georgia, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, New Jersey, New York, North Carolina, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Washington. international: Belgium, Brazil, Canada, Chile, China, Colombia, Costa Rica, Czech Republic, Dominican Republic, France, Germany, India, Italy, Japan, Netherlands, Panama, South Korea, Taiwan, Venezuela.

thoracic surgery training around the World

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Pioneering a neW TreaTmenT for recurrenT ovarian cancer

surgeons at Baptist Health South Florida’s Center for Robotic Surgery are the first in the world to combine hyperthermic intraperitoneal chemotherapy (HIPEC) for ovarian cancer

with robotic surgery. Early findings indicate that this treatment extends progression-free survival time. It is a promising advance in the fight against ovarian cancer, which kills about 14,000 women in the United States each year—more than any other cancer of the female reproductive system.

For this treatment, the surgeon first performs robotic debulking surgery to remove all traces of tumors. Then chemotherapy drugs, which have been heated to 103 to 105 degrees Fahrenheit, are administered directly into the abdominal cavity. “Heating facilitates passage of chemotherapy into the cells,” said Ricardo Estape, M.D., medical director of the Center for Robotic Surgery at Baptist Health. The drugs are delivered through tubes inserted into the same small incisions used for the surgery.

KeePiNg cANceR At bAy loNgeRResearchers at the Center for Robotic Surgery are conducting

the first-ever study of robotic surgery with HIPEC for recurrent ovarian cancer. They’ll present their findings in March at the Society of Gynecologic Oncology’s annual meeting on women’s cancer.

“Ovarian cancer often recurs multiple times,” said gynecologic oncologist John Diaz, M.D., the lead author of the study. His collaborators on the research are Dr. Estape, Johanna Kreafle, Kristina Angel, R.N., Richard Andrew Estape, and Eric Schroeder, M.D. Early data indicates that robotic surgery with HIPEC may extend the time between treatment and the next recurrence.

“With standard treatment, the median progression-free survival time is only six to seven months,” said Dr. Estape. “For the 22 women in our trial, we have a median follow-up of 14 months, and we still haven’t reached the median progression-free survival time yet. That means the time to progression is already twice as long as with standard treatment, and it could become even longer as the data matures.”

MAKiNg SubSequeNt SuRgeRy SAfeRIf the cancer does recur, women who were previously treated with

robotic surgery have another advantage. “With traditional surgery,

the more times you open the patient, the more complications you have,” Dr. Estape said. “With robotic surgery, you have far fewer adhesions, so this is less of a problem.”

At this time, robotic surgery with HIPEC is indicated only for women with recurrent ovarian cancer who have a relatively small volume of disease restricted to the surface of abdominal organs.

“It’s not for everyone,” Dr. Diaz said. “But for the right patients, it gives them another option for the management of their disease.”

A patient undergoes heated chemotherapy for ovarian cancer at Baptist Health South Florida’s Center for Robotic Surgery. After robotic debulking, heated chemotherapy drugs are administered through tubes inserted into the same small incisions used for the surgery.

Do you HAve A gReAt Robotic SuRgeRy PAtieNt StoRy? eMAil DetAilS to coRPoRAtePR@bAPtiStHeAltH.Net.

South Miami Hospital, inc.baptist Health South florida6200 Sw 73 StreetMiami, fl 33143

ceNteR foR Robotic SuRgeRy locAtioNSSouth Miami Hospital6200 sW 73 st.south miami, fl 33143

baptist Hospital of Miami8900 north Kendall dr.miami, fl 33176

Doctors Hospital5000 university dr.coral gables, fl 33146

robotic surgery advantage is published by Baptist Health south florida to provide general health information. it is not intended to provide personal medical information, which should be obtained directly from a physician. © 2014.

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The use of robotic technology is offering a completely new world to surgeons. Watch the latest procedures and techniques Thursday, Feb. 27, as surgeons from the Center for Robotic Surgery broadcast three LIVE cases in real time on the Web. Viewers can watch a

myomectomy, lung surgery and urologic surgery on their computer, iPad or iPhone beginning at 9 a.m. Questions can be e-mailed during the webcasts. Look for more information at baptistHealth.net/Robotics.

real-time cases from the center for robotic surgery

Find previous articles about robotic surgery online. The Center’s newsletter for physicians features expert surgeons discussing the latest advancements in and benefits of robotic procedures.

To view archived issues, visit the For Physicians section at baptistHealth.net/Robotics.

stay informed

Experts in robotic surgery will discuss advances in technology at a symposium in April.

lo o K i N o N u S

This April in Miami, world-renowned experts in minimally invasive robotic surgery will present their approaches to surgical cases in a multidisci-plinary symposium.

The event will highlight advances in robotic surgery, with sessions on gynecology, gynecologic oncology, urology, thoracic, bariatric, and colorectal surgery. Attendees will learn strategies for launching and growing a successful robotics program—from a single-robot center to a multirobot, world-leading institution.

The symposium also offers a track geared specifically to allied health professionals.

mark your calendar for the miami robotics symposium

foR MoRe iNfoRMAtioN: MiamiRobotics.baptistHealth.net

when: April 25–26, 2014where: Eden Roc Hotel 4525 Collins Ave. Miami Beach, FL 305-531-0000 edenrocmiami.comHosted by: Symposium Director Ricardo Estape, M.D.