Research & Development

ATLAS encompasses a multidisciplinary team of physicians, nurses, physician’s assistants, patient navigators, researchers, artists, and engineers who collaborate towards improving cancer care and patient safety. The program houses an engineer's lab, an artist’s studio, and surgical training facilities which are fully supported by Roswell Park and grant funding. The ATLAS program has published more than 80 publications since its initiation and filed patents for 12 different innovations. The main focus of ATLAS is advancing cancer care, patient safety, care provider and patient education, and surgical innovations.

Advances in Cancer Care:

1. International Robotic Cystectomy Consortium (IRCC): ATLAS houses the IRCC, the largest robotic cystectomy databases in the world. This is a multinational multi-institutional database comprised of 35 institutions from 13 countries. With more than 20 key publications, IRCC laid down the foundation for safety and efficacy of robot-assisted cystectomy and urinary diversion for bladder cancer.

2. Irrigation Study: We investigated the mechanism of local recurrence after bladder cancer and the effect of pneumoperitoneum on peritoneal immune response against tumor cells using Next Generation Sequencing. This work has been awarded the best poster presentation in the American Urological Association meeting in 2016, and was featured in AUA News. Determining the pathogenesis of how bladder cancer relapses despite sound surgical technique can lead to substantial improvement in patient survival and may open new horizons for bladder cancer treatment.

3. Spatial Analysis and Geomapping: We are currently investigating the spatial correlations between patients’ residential locations, and environmental parameters to identify “hot spots” of bladder cancer in Western New York (WNY) to map significant clusters of bladder cancer patients in WNY and the associated environmental risks. Such analysis may have significant implications in prevention and early detection of bladder cancer, and consequently, improve patient survival and decrease healthcare costs.

4. Art Heals: In collaboration with the Albright Knox gallery, we investigated the effect of exposure to art on the postoperative course. The study aims at studying whether exposure to art during perioperative period can improve the postoperative course for patients undergoing inpatient oncological surgical procedures.

Safety in Cancer Care:

1. TechnoFields: Introduction of robot-assisted surgery has been associated with changes in the operating room layout. Additionally, the physical separation of the surgeon (in the console), and the patient and the rest of the team, may affect communication and team dynamics in the operating room. We developed and validated a methodology, that involves changing the operating room into a laboratory that captures different team activities and non-technical attributes during robot assisted surgery. Further, we mapped team dynamics as well procedural interruptions and reviewed the different methods that can be used to optimize performance in the operating room and avoid adverse and near miss events.

2. Mind Maps: With advents in robot-assisted surgery, it became crucial to understand how human brain-robot interaction works, and how it affects learning, skill acquisition, mental and physical workload during surgery. We were the first to study the difference in cognitive function between experts and novices, how cognitive function varies during different stages of surgery. We also described the process of mentorship during robot-assisted surgery, and how this can help cognitive learning side by side with physical training.

3. Surgical Scoring Systems: We developed and validated various scoring systems for robot-assisted urological surgical procedures that can be used for objective evaluation of surgical performance. These scoring systems can provide expert-based structured feedback to trainees guiding and tailoring their training activities and shortening learning curves. They can also be valuable for surgeons’ credentialing and remediation, insurance companies, and hospital managers.

Healthcare Provider Training and Patient Education:

1. SAGES Training and Testing: The ATLAS program’s training lab houses robotic, laparoscopic and endoscopic training stations. ATLAS also facilitates testing for Fundamental Skills of Robot Assisted Surgery (FSRS), Fundamentals of Laparoscopic Surgery (FLS), Fundamentals of Endoscopic Surgery (FES), and Fundamental Use of Surgery Energy (FUSE).

2. Robotic Training: Trainees in the ATLAS program at Roswell Park Comprehensive Cancer Center develop their skills under the close guidance of Roswell Park’s robotic surgery experts. The easy-to-navigate curriculum builds the foundation for comprehension and the development of basic skills. It emphasizes directed observations to increase familiarity with procedures, and hone skills and techniques. The program centers on comprehensive knowledge of robot-assisted surgeries in a variety of specialties through an all-inclusive curriculum aimed at transforming even a novice into a fully capable robotic surgeon. With more than a decade of experience, ATLAS surgeons and staff can help you become capable and confident in performing robot-assisted surgery. Surgical teams from around the globe come together at ATLAS to develop their skills under the guidance of Roswell Park’s robotic surgery experts. Teams from Egypt, Germany, Great Britain, Hungary, Japan, India, Saudi Arabia, Scotland, and Switzerland, as well as trainees from the University of Michigan, University of Miami, Duke University, and University of Pittsburgh are among those who have participated in Roswell Park's robotic surgery training and mentoring programs. By developing and enhancing capabilities, these training programs equip surgeon trainees to provide their patients with better clinical outcomes so they can return to active, productive lives faster.

3. Applications: ATLAS has developed various interactive applications for patient education that cover a wide range of diseases, treatments, and other related healthcare information. These applications include “BCG Treatment: Everything You Need to Know” patient self-education application for patients with non-muscle invasive bladder cancer undergoing BCG immunotherapy, and the “Pelvic rehabilitation” application for pelvic muscle training to help patients regain their urinary control following radical prostatectomy for prostate cancer, and neobladder creation in bladder cancer patients.

4. Bladder Cancer Book: ”A patient’s Guide to Bladder Cancer” is a patienteducation book developed at ATLAS with multidisciplinary efforts of surgery, medicine, pathology radiation, social work, nutrition, and nursing staff. The book offers bladder cancer patients and their families the information needed to understand their disease and the treatment process. It simplifies complex scientific concepts and follows the natural history and course of disease and treatment. Readers can trace the path of a patient from diagnosis through recovery and survivorship. Partners in the creation of this book are experts in every field involved in care of patients diagnosed with bladder cancer: anesthesiology, medical oncology, nursing, physical therapy, psychology, nutrition, and social work. A majority of the chapters are no more than 3 pages, and all chapters include detailed illustrations to accompany the concepts and offer clarity.

5. Buffalo Healthcare Exploration (BHE): formerly known as the Junior Robotic Surgery Challenge, is an exciting 3- week summer program that offers high school students the opportunity to learn and innovate in a hightech, fast-paced medical environment at Roswell Park Comprehensive Cancer Center.

Surgical Innovation in Cancer Care:

1. Surgical techniques: Dr. Guru, Director of the ATLAS program, is one of the early fellowship-trained robotic surgeons (2004) with an experience of over 10,000 surgical console hours and has performed over 2,500 procedures. Dr. Guru pioneered the Robotic cystectomy program at Roswell Park Comprehensive Cancer Center and performed the first Robotic cystectomy in Western New York in November 2005. His “Technique of Spaces” for bladder cancer divided the procedure into well-defined steps simplified the procedure and facilitated teaching. He also developed the “Marionette” technique for ileal conduits, and the modified Hautmann “W” neobladder for robot-assisted urinary reconstruction after cystectomy.

2. Investigational treatments: In collaboration with our basic science team and our animal facility, ATLAS is running several animal studies looking at innovative treatment options for bladder cancer, including the use of newer immunotherapeutic agents and photodynamic therapy.

3. Surgical devices: ATLAS developed and patented several surgical devices, including a new laparoscopic suction device that’s capable of breaking down suctioned blood clots. We also developed a laparoscopic stitching device that facilitates intracorporeal suturing. Other innovations includes a device for segmental compression of the kidney during partial nephrectomy. This device reduces bleeding during tumor removal while minimizing ischemia to the kidney. Another innovation is the development of a specialized operating room cart that stores and sterilizes surgical instruments in the operating room. This cart aims at avoiding delays and minimizes procedural interruptions during robot-assisted surgery.