New minimally invasive surgery center begins training the next generation of surgeons.

Nintendo Surgery

Mary Nolan, R.N., M.S., right, executive vice president of care delivery and Hospital general director, guides minimally invasive surgical tools while assessing her deftness on a video monitor. MISCTE Director Bart Sachs, M.D., M.B.A., with glasses, and Leon Hirsch, founder of U.S. Surgical, center, watch another Procedure in the new training center.
They could not have scripted it any better. Within three hours after David Bonner, Ph.D., underwent a bilateral hernia operation under general anesthesia, he strolled into the grand opening of the Medical Center's new minimally invasive surgery training center. Dressed in sweats and sneakers, he looked liked he had just left a basketball game, not a hospital bed. But there he was, a walking, smiling, healthy advertisement for minimally invasive surgery the brand of surgery that was chiefly responsible for his mobility so soon after the procedure. And there was no script.

"I feel great," said Dr. Bonner, making his way through a crowd of supporters and media members.

The purpose of the event on J-4 on Jan. 28 was to cut the ribbon on the new center - formally called the Minimally Invasive Surgery Center for Training and Education (MTSCTE). The center is set up so residents, surgeons and students can practice the techniques of minimally invasive surgery. It is funded in part by a five-year, $1 million grant from the United States Surgical Corp. of Norwalk, Conn., whose representatives participated in the ribbon cutting.

In minimally invasive surgery, physicians perform surgery with special instruments through small, half-inch openings in a patient's body rather than through large incisions that take longer to heal and leave significant scars. Tiny high-resolution cameras permit surgeons to see inside the body in ways far superior than with the naked eye.

"Surgery will dramatically change in the 21st century," said Barton L. Sachs, M.D., M.B.A., associate professor of surgery and MISCTE director. "We are committed to be at the forefront of this devel- oping technology so that we can offer the very best surgical care to our patients."

As part of the day-long symposium and grand opening, which included brief informational speeches by many Medical Center physicians who use these surgery techniques, Dr. Bonner's surgery was broadcast live to seven other institutions over the Adirondack Area Network. Coincidentally, Dr. Bonner, The Sage College's director of technology initiatives, provided the technical expertise in establishing the network, which includes Albany Med's telemedicine network. Albany Med physicians and invited guests viewed his surgery live from Huyck Auditorium.

David Bonner & T. Paul Singh, M.D.
David Bonner, Ph.D., center, is proof of the benefits of minimally invasive surgery. Less than four hours qfter a bilateral hernia operation, he visited his surgeon, T. Paul Singh, M.D., right, at the MISCTE grand opening.

The training center houses a videoconference suite in which surgeons and students can watch procedures as they happen in the Medical Center's operating rooms on the other side of campus. At the center, surgeons, residents, other members of the operating room team and even medical students work with laparoscopic instruments and equipment, practicing new surgical techniques on a series of progressively difficult nonclinical simulators.

In addition to providing a training site for surgeons to learn these new techniques, MISCTE provides physicians and scientists from the Medical Center with a state-of-the-art facility in which to conduct joint research with U.S. Surgical. Such joint efforts are expected to result in new instruments and techniques that will provide patients with a broader range of these less invasive procedures.

It is estimated that 30 percent of the more than 27,000 surgical procedures performed at the Albany Medical Center are minimally invasive. Dr. Sachs, who often refers to minimally invasive techniques as 'Nintendo Surgery," estimates that up to 75 percent of all procedures eventually will be done through small openings in the body. Statistics show a steady yearly increase in all forms of minimally invasive surgery performed from 1995 through 1998. During the same time period, the average cost per operative procedure has significantly dropped.

"The results of this technique are comparable to open surgery, but postoperative pain and recovery time are dramatically reduced, meaning patients go home sooner and return to their normal activities much faster," said Dr. Sachs.

T. Paul Singh, M.D., Dr. Bonner's surgeon, assistant professor of surgery and MISCTE associate medical director, recently completed two laparoscopic kidney removals from a donor to a living-related transplant patient. Among the most common procedures performed at the Medical Center using minimally invasive techniques are gall bladder removal, hernia operations and a wide variety of spinal, gynecological, cardiac, gastrointestinal and urologic surgeries. Vascular procedures, cancer treatments and surgery on fetuses while in the mother's uterus will be added to the list of minimally invasive techniques.

Dr. Sachs said a patient undergoing a spinal fusion, in which a damaged spinal disk is removed and replaced by metal "spacers," would normally remain hospitalized for 10 days and typically return to work in four months. With
the minimally invasive approach, patients are discharged within one or two days and are able to return to work in two to four weeks.

Dr. Bonner was released from the Hospital later that day and was back to work the following week. With traditional hernia surgery, he would have spent several days in the hospital and would not have returned to work for two to three weeks.
"He's a bit more motivated than most patients," said Dr. Singh. "But he is certainly another example of how minimally invasive surgery has improved outcomes."

- Paige H. Sheehan
Automation Innovation

New robot a key component of MISCTE.

Engineers from Endobotics, Inc., an -engineering firm based at Rensselaer Polytechnic Institute in Troy, have developed robot technology that may eventually be used by physicians conducting minimally invasive surgery at the Medical Center.
The technology was introduced at the grand opening of the Medical Center's new Minimally Invasive Surgery Center for Training and Education (MISCTE).
With assistance from Albany Med surgeons, Endobotics has taken the kind of precision that enables robots to produce computer microchips and built a prototype robot to perform the surgical tasks of cutting, tying, clamping and suturing. The two-armed EndoBot uses endoscopic cameras, ultrasound data, and tactile measurement for guidance as it enters the body cavity through small openings - or ports.
Surgeons can manually control the robot movements, or simply program the robot to, suture a certain area and then supervise its actions.
Barton L. Sachs, M.D., M.B.A., associate professor of surgery and MISCTE director, said the EndoBot has tremendous potential to reduce surgery time, reduce costs, maintain quality and decrease post-surgical complications. The EndoBot must receive approval from the U.S. Food and Drug Administration before it is used clinically.

ERIC P. Retzlaf

Center News. March 1999