Dr. Tewari and team conducting a robotic urological surgery at Mount Sinai
Robotic surgery isn’t a panacea, but it has the distinct advantage of going places human hands don’t necessarily fit.
That was part of the motivation behind New York-based Mount Sinai Health System’s recent announcement establishing the Mount Sinai Robotics Institute (MSRI) to educate surgeons, advance research and improve outcomes.
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Mount Sinai was an early adopter of the Intuitive Surgical’s da Vinci robot, which has become an important tool for urologic, gynecologic and head and neck surgeries. This approach can be particularly helpful for patients with throat tumors, which are often difficult to reach.
“The challenge has always been access,” said surgeon Eric Genden, who chairs the Department of Otolaryngology, Head and Neck Surgery and co-chairs MSRI with urologic surgeon Ash Tewari, in a phone interview. “These tumors typically exist in the back of the throat. How do you get back there? The standard approach has been making a cut through the jaw, a procedure that can take anything from 12 to 14 hours.”
The side effects of traditional surgery can be horrendous as well. Patients can spend two weeks in the hospital and have trouble swallowing or speaking. Sometimes the large incision causes facial disfigurement. Robotic surgery can offer a more humane option.
“Robotics allows us to work through the mouth to access the tumor,” said Genden. “Instead of being a 14-hour procedure, it’s usually only two hours. There are no incisions on the face, so cosmetically, it works quite well.”
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This potential to reduce side effects associated with cancer surgery carries over to urologic cancers as well. The robot’s precision can help surgeons avoid nerves associated with erectile and urinary function.
Though it’s unclear whether robotic surgery can improve cancer outcomes, its ability to reduce patient suffering helped drive the institute’s creation. Head and neck surgeons at Mount Sinai are particularly motivated by recent increases in throat cancer, many caused by HPV.
“You have guys who are 46 and have these tumors,” Genden said. “If you give them high-dose radiation, they’re going to sustain a significant hit. Robotics decreases the impact of the surgery, but it also decreases the toxicity of therapy.”
MSRI will be focused on research, developing new technologies that enhance robotic surgeries. Surgeons often have difficulty determining how much tissue to remove – where does the tumor stop? Mount Sinai is one of several institutions working on optical probes that can differentiate cancer from healthy tissue. There are also startups in the space like Lumicell that have developed optical probes to detect cancer at the margins for breast cancer patients.
New devices like these often emerge from collaboration among biologists, engineers, and physicians. Mount Sinai surgeons have been collaborating with scientists and engineers at Rensselaer Polytechnic Institute to make that happen. Genden and Tewari believe the best way to accelerate progress is to get everyone in the same room.
“Usually scientists and physicians don’t talk, so the scientists don’t understand what they should be focused on,” Genden said. “This crosstalk helps scientists and engineers understand the clinical problems: how to control bleeding; how to use optical imaging to define where tumors start and stop; how to intraoperatively monitor tumor location.”
Photo: Mount Sinai Health System