FOR IMMEDIATE RELEASE:
March 22, 2007

Philanthropic Foundations Help RPCI Develop National Center
for Robotic-Assisted Surgical Training

The nationwide demand for surgical teams experienced in robotic-assisted techniques is growing almost faster than the need can be met, says Khurshid Guru, MD, Director of Robotic Surgery at Roswell Park. But that dilemma has bred invention for Roswell Park—as the Institute has announced plans to fill the current training void, while entirely redefining the teaching tool.

Armed with a $370,000 matching grant from the John R. Oishei Foundation, a generous $150,000 grant from the Margaret L. Wendt Foundation, and an additional $66,000 from the James H. Cummings Foundation, RPCI has developed a Center for Robotic Surgery. The Center will provide training to strengthen the expertise of surgical teams from across the country. A partnership with the University at Buffalo also will help develop new and more sophisticated technology for both training and real-world applications. The initiative will thereby help improve patient safety while extending the advantages of robotic surgery to patients in more communities. 

Bridging a Growing Gap

The need for the Center is clear. To date, approximately 150 U.S. medical centers have purchased surgical robots, and that number is rapidly growing; today nearly half the prostatectomies performed in North America are done robotically. But according to James Mohler, MD, Chair of the Department of Urologic Oncology and Co-Leader of RPCI’s Prostate Program, Roswell Park recognized a need for more comprehensive training.

"Many robotic surgical programs have not developed fully and that occurs for a variety of reasons," says Mohler. "A trained surgeon may struggle in a less than supportive environment. A poor initial experience may lead one to abandon this technology. Some surgeons may find the new approach difficult to learn. We will provide more intensive training for entire surgical teams that allows for a longer term relationship with the training organization."

Mohler says that Roswell Park has been able to capitalize on its own investment of time, ideas and research to develop its approach for others. The Institute has become a leader in the field in just over two years since the launch of its robotic surgery program. Roswell Park surgeons have performed more than 325 robotic prostatectomy operations since August 2004. RPCI is also one of only several centers in the world offering the procedure for bladder cancer. And Dr. Guru is among few physicians nationwide who have completed a fellowship in robotic surgery.

One-on-one training

RPCI’s training center will feature a week-long program that provides one-on-one training, not just for individual surgeons--but for every member of the surgical team. The new RPCI training program will offer ongoing education to medical students, residents and fellows at the physician level; as well as physician assistants, operating room nurse trainees from D’Youville College and nurses and operating room technicians at RPCI. 

"The goal is to create a well-trained workforce for Roswell Park and other institutions to help continue advances in the field," explained Guru, adding that Roswell Park sees the robotic-surgical technique being used in the future for non-urological cases including gynecological, gastrointestinal and cardiac diseases.

A more focused remedial program will be offered for hospitals that have had difficulty fully establishing a robotics program, despite having the technology in-place. Teams in the remedial program will undergo three days of training at RPCI before returning to their home institutions, where one of the robotic surgeons from RPCI, along with RPCI’s head robotic surgical nurse, Marlene Bienko, RN, will spend two additional days advising them and assisting with two robotic surgeries.

Building a better robot through new virtual applications

As Roswell Park welcomes surgical teams to its training center, Guru and collaborators from the University at Buffalo's Department of Engineering and Applied Sciences also will be working behind the scenes to develop a revolutionary new training tool.

Using haptics technology--the science of making computer-rendered objects "touchable" through the mechanical production of virtual force--Thenkurussi Kesavadas, PhD, Director of UB's Virtual Reality Lab and Associate Professor of Mechanical and Aerospace Engineering, is co-leading the effort to eventually build a better robot for both training and real-world applications. According to Kesavadas, the Roswell Park collaboration's short-term goal is to create a basic simulator that will help surgeons master the skill sets required for robotic-assisted surgery, well before they even touch the actual console. 

"It's like becoming an artist," said Kesavadas. "You have to hold a brush and start making some paint strokes before you're ready to create a painting."

Kesavadas explained that a basic computer simulator console--modeled after the actual device used in a minimally invasive operating suite--will be ready within six months thanks to a combination Roswell Park's robotic surgery expertise and UB's virtual reality know-how. The simulator will offer trainees a computer-rendered 3D world of objects they can manipulate by using hand-held controls similar to those found in a robotic surgical environment. The device will allow its students to gain greater proficiency in routine tasks, for example, such as suturing--threading virtual wires through virtual beads with the slightest thumb and finger movements. Trainees will see a virtual robotic surgical arm on the computer screen performing the task. Subsequent, more advanced simulators will include virtual body organs and tissues. 

"If you look at the experts in the world who use this technology, they learned it the hard way--on a real robot for a very long time," said Kesavadas. "If you have to train a lot more surgeons to do this, some kind of training technology has to be there, because it is too expensive to provide hours of time on the actual machines, and they are simply not available to most surgeons to learn from. A good example is how pilots train for flying--almost every pilot goes through flight simulation exercises, and it has definitely improved the quality of our safety of flight. What we’re doing will have a similar effect in improving patient care...and improving the healthcare system."

Within a five year period, Mohler, Guru and Kesavadas plan to incorporate haptics into the console--so that surgeons can feel a sense of tactile feedback when the console's virtual robotic "hands" touch the computer-rendered body parts. The group's long-term goal is to perfect and commercialize the technology so that robotic console manufacturers can apply it to new surgical robots used on patients.

"Robotic-assisted procedures already offer superior benefits to traditional ‘open’ surgeries, such as smaller incisions, less bleeding, and faster recoveries," said Guru. "This will allow us to expand the scope of what is currently possible, allowing surgeons to 'feel' more of the sensations they are used to feeling in a traditional surgery--for example, whether a tissue is soft, slippery or hard. It's a completely new concept that could greatly improve robotic-assisted procedures."

Kesavadas adds that very few research groups in the world are exploring artificial sensory robotic applications--some with non-haptics methods--largely because the field of robotic-assisted surgery is so new. "We are right at the leading edge in terms of what we are doing." 

For Robert D. Gioia, President of the John R. Oishei Foundation, the Foundation's investment is an example of funding a regional collaboration with high potential for global applications and local spin-off economic benefits. "With the Center at Roswell working with several of our local institutions, Western New York will be able to move quickly to expand this technology into broader and more effective uses for patients eveywhere," said Gioia. "We see this as just the beginning."

###