Many people may know that UPMC has long been a pioneer in robotic surgery and is recognized as one of the world’s top medical centers in robotic surgery experience. In fact, UPMC surgeons performed nearly 12,000 advanced robotic surgical procedures at 10 different hospitals across Pennsylvania in just the past five years.
What people may not know, however, is that UPMC also is one of the key centers for training surgeons to use advanced robotic surgical techniques — not only at UPMC hospitals, but at other medical centers across the country and around the globe.
In the mid-2000s, UPMC surgical oncologists began looking for better ways to achieve the same results of traditional open surgeries with less-invasive surgical techniques. They found that they could achieve good patient outcomes from complex procedures by performing them with the assistance of robots.
Robotic-assisted surgery does not mean that robots perform the surgery. Rather, it means that human surgeons can access hard-to-reach places and perform surgery with unmatched precision using the assistance of robotic equipment.
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Robotic-Assisted Surgery for Complex Procedures
Since its inception in 2008, more than 190 surgeons have trained at the UPMC Center for Robotics Training (CART). Included among them is surgeon Amer Zureikat, MD, chief of surgical oncology at UPMC Hillman Cancer Center and director of the UPMC Pancreatic Service Line. He is the director of CART’s surgical oncology track and is highly skilled in the area of robotic pancreaticoduodenectomy, also known as the Whipple procedure, a complex surgery of the pancreas.
“The UPMC Center for Advanced Robotics Training offers proctorship and mentorship for surgeons who want to enhance their robotic surgery skills,” Dr. Zureikat says. “In the proctorship, we physically show the surgeon how to do the surgery hands on, play-by-play. In the mentorship, we guide them through the process, providing support, feedback, tips and tricks, and discussion.”
Surgical oncology is surgery to remove cancer in the body. Dr. Zureikat teaches other surgeons how to use the robot to access cancerous tumors in hard-to-reach spots – such as at the head of the pancreas or in the liver – that previously would have required long incisions in an open procedure.
He believes the robot is the answer to most – but not all – complex surgeries. “The open procedure is still preferable for people who have had multiple prior abdominal surgeries with lots of scar tissue and for cases in which cancer has involved critical blood vessels,” he says. “That’s one disadvantage of the robot: that it lacks tactile feedback essential for handling fragile blood vessels near tumors.”
But for most others, he believes, the robot is an option.
“When the complexity of the procedure is higher – that’s when the robot shines,” adds Dr. Zureikat. “At UPMC, we believe robotic surgery is applicable to about 70% to 80% pancreatic cases. It’s a safe and effective way to treat both cancerous and benign diseases.”
Dr. Zureikat also notes that many patients with obesity are considered poor candidates for robot-assisted pancreatic surgery at other centers and are denied that option.
“Many centers will not consider patients with a body mass index (BMI) of 30+ for robotic surgery since these cases can be difficult to perform and need significant expertise with the robotic platform,” he says. “At UPMC, we routinely perform robotic surgery for patients with BMI 30+. We published a study which found that patients with obesity had less wound infection and faster recoveries with robotic surgeries versus open surgeries.”
UPMC is among the world’s most experienced centers in pancreatic resections. UPMC surgeons have performed more than 1300 robotic pancreatic procedures, including more than 800 Whipples and more than 100 robotic liver resections.
“The more experience we gain using the robot and the more surgeons we train, including our own, the more we’re able to expand our selection criteria, which opens up robotic surgery as an option for whole new groups of candidates,” he adds.
Benefits of Robotic Surgery
Robotic surgery has benefits for the surgeon and the patient, alike.
For the surgeon
The benefits of robot-assisted surgery include enabling the surgeon to:
- Access hard-to-reach areas of the body, such as the throat or pancreas.
- Access areas that would normally require large open incisions, such as internal organs.
- Perform the most complex procedures, such as the Whipple, with improved visualization and dexterity.
For the patient
From the patient’s perspective, benefits of robotic surgery may include having:
- A minimally invasive procedure instead of an open procedure.
- Smaller keyhole-type incisions rather than a longer incision.
- Less blood loss.
- Less scarring.
- Reduced pain.
- Fewer complications.
- A quicker recovery.
As it relates specifically to surgery of the pancreas, however, outcomes for cancer survival are the same for both the open and the robotic (minimally invasive) surgery. “The biology of the cancer is more important to the patient’s survival than the surgical approach,” Dr. Zureikat explains.
Surgical Oncology Robotics Training Program
Robotics training for surgical oncologists covers a variety of techniques to ensure proper skills development and reduce learning curves. Training surgeons acquire a level of familiarity with the robotic system that supports easier, more effective implementation of robotic surgery systems within their own hospitals.
Training includes use of CART’s:
- Robotic surgery simulator, which allows surgeons to master the manipulation of the robotic controls before operating on a patient.
- Biotissue and cadaver labs to practice technique.
- Observation of surgical cases to learn by watching.
The proctorship may also include video reviews, on-site visits by faculty, and a host of online resources to help training surgeons establish their own programs.
Paying it Forward
Although he recognizes that much about the real-world practice of medicine is competitive, Dr. Zureikat believes CART is one altruistic way UPMC contributes to the body of medical knowledge in a way that can tangibly and measurably improve lives.
“By increasing the number of surgeons trained to perform advanced robotic surgical techniques, UPMC is helping to reduce inequities in and expand the safety of and access to robotic surgery for more people across our state, across our country, and around the world,” he says. “The goal of the CART program is to take the learnings of UPMC’s vast robotic surgery experience and distill them down so that training surgeons can understand the information and replicate the techniques in a compressed timeframe.”
In addition to the surgical oncology program Dr. Zureikat oversees, the UPMC CART also offers training programs in:
- Ear, nose and throat (ENT) surgery under the direction of Umamaheswar Duvvuri, MD.
- Thoracic surgery, which is surgery of the thorax or organs of the chest, under the direction of Inderpal S. Sarkaria, MD, FACS.
Headquartered in Pittsburgh, UPMC is a world-renowned health care provider and insurer. We operate 40 hospitals and 800 doctors’ offices and outpatient centers, with locations throughout Pennsylvania, Maryland, New York, West Virginia, and internationally. We employ 4,900 physicians, and we are leaders in clinical care, groundbreaking research, and treatment breakthroughs. U.S. News & World Report consistently ranks UPMC Presbyterian Shadyside as one of the nation’s best hospitals in many specialties and ranks UPMC Children’s Hospital of Pittsburgh on its Honor Roll of America’s Best Children’s Hospitals. We are dedicated to providing Life Changing Medicine to our communities.