Joey Wahler (Host): It covers a wide range of medical procedures, so we're discussing General Surgery. Our guest is Dr. Erik Stancofski. He's a trauma surgeon and a board-certified general surgeon for Beebe Healthcare. This is the Beebe Healthcare podcast. Thanks for joining us. I'm Joey Wahler. Dr. Stancofski, welcome.

Erik D. Stancofski, MD: Thanks for having me.

Host: Great to have you aboard. So first, I'm wondering what initially inspired you to pursue this career in Surgery, and what would you say most continues to motivate you today?

Erik D. Stancofski, MD: Surgery is a fascinating field. Fortunately, I knew early on that I wanted to become a medical doctor and particularly a surgeon somewhere in seventh or eighth grade. Growing up in Beirut, Lebanon, I became fascinated by the biology, the anatomy, the physiology, and I knew I was doing that. So, I went to college in Lebanon. I went to medical school in Lebanon. And then, I came here in 1992 in Baltimore and did my surgical residency.

Host: What first brought you to the U.S.?

Erik D. Stancofski, MD: When I finished my medical school, it's understood that a U.S. residency is a superior, education in any kind of medical specialty. So, I decided to come here. I was at American University of Beirut, so it made sense to come to an English-speaking residency rather than the other Western European ones.

Host: Gotcha. And now, you've been with Beebe Healthcare for more than two decades. So, what is it about Beebe and its community that's kept you so committed?

Erik D. Stancofski, MD: Well, we came here, my wife and I-- when we were in Baltimore, we came here for one of our anniversaries and we discovered the area. We really liked it. Never thought that we would end up here. And a job opportunity opened up in 1998, right fresh out of residency. And we came here originally for two years just to have my papers in order. And 27 years later, here we are.

Host: That's great. That's great. So as a general surgeon, what procedures do you perform most these days?

Erik D. Stancofski, MD: The variety of general surgery, I mean, the whole gamut. It starts with the usual acute disease processes like acute appendicitis and acute cholecystitis, gallbladder problems, hernias. And specifically recently, since Beebe purchased the da Vinci Robot, I have transitioned, if you want, most of my practice to robotic., And that has happened since 2019. And progressively, more and more of what I do is robotic.

Host: You led me beautifully there, Doc, into my next question because I want to ask you a bit about that. You do specialize in minimally invasive and robotic surgery. So for those unfamiliar, what exactly does that mean and how do those techniques most benefit patients? We should point out, first of all, for those that don't know that robotic surgery is the term, but there are still human expert hands like yours behind it, right? Robots have not taken over the OR. Correct?

Erik D. Stancofski, MD: Oh, no, no, no. Absolutely, absolutely. We are performing the surgery. The robot is just an instrument. It's just a module, if you want. So General Surgery, we deal mostly with the abdomen, sometimes with the chest. So, these are body cavities. And to open the cavity or to access the cavity, it used to be a big, big incision right down the middle. And that was the rule for years and years and years until middle to late '80s, they came up with the first laparoscope, which is this little instrument that allows a camera to go inside the belly and look around. And it was first used by the gynecologist to do things like tubal ligation. And then, General Surgery started using it a little more. Gallbladder surgery started to be transitioned to laparoscopy and then hernias, appendicitis, then colon surgery, then more and more advanced and more complicated procedures.

The big advantage is that there's no big incision. It's two, three, four, or five little incisions. So, less pain, quicker return to function, and overall better patient satisfaction and better disease-specific numbers and statistics. In the beginning, colon cancer was a big no-no, you don't do this laparoscopic because you don't do as well of a resection for cancer. And then, in 2006, there was a huge study that showed that it's quite the opposite actually. People with laparoscopic colon resections do better than people with open colon resections. And more and more, people are doing things laparoscopically because it's just better than open. There's still certain things, certain disease entities that don't lend themselves to laparoscopic surgery, but they're less and less.

And now, we have expanded it to solid organ surgery. So, we can take a spleen out, laparoscopically, we can take a pancreas out laparoscopically. But it's more and more. And the big jump from open surgery to laparoscopic surgery was further enhanced now with the jump from laparoscopic surgery to robotic surgery. It's almost exactly the same except that instead of the surgeon and the one or two assistants playing Twister with their arms and looking at weird angles at the monitors, we just connect every instrument to an arm of the robot and I control the three or four arms of the robot and perform the surgery that way. And I'm sitting down, which is great.

Host: Okay. That's a nice added benefit. By the way, I love that you mentioned Twister. Apparently, you're aware of the game Twister, even though you're from Lebanon, right? Is that big there?

Erik D. Stancofski, MD: Absolutely. It's available. It was fun. We used to play it as teenagers.

Host: An international game indeed. Funny. So, you mentioned the da Vinci. method, the da Vinci equipment, which has basically become the gold standard in robotic surgery. And so, we hear a lot in all kinds of different robotic approaches nowadays, Doc, about the preciseness with which you can operate with that. Why is that so important?

Erik D. Stancofski, MD: The translation of the surgeon's hands to the instrument's hands can be dialed up or down. So, I can make big moves outside with very, very, very small movements inside and vice versa. So, I think there's five different settings: 3:1, 2:1, 1:1, and then 1:2 and 1:3, where it translates the magnitude of my hands' motions into the instruments motion. So when we are working on something very precise, dissecting a fine structure, we usually decrease the motion of the instruments and increase the motion of the hands. And when we are operating on something that requires less precision, we just go 1:1 or 2:1. So, there's a lot of fine tuning there. And it's a great thing to have to be able to tune, because not everything needs the same range of movements.

Host: Gotcha. So, I would imagine you have many examples, but can you maybe walk us through a recent case in which this advancement in surgery that you're discussing was really at play where it shows better than anything the difference between what you can do now and what you would've had to have gone through years ago?

Erik D. Stancofski, MD: Yes. I mean, a quick example is colon surgery that we do a lot of, whether it's for benign disease or for cancer. When I was in residency, so from '92 to '98, everything was open. And patients would come in the night before, get prepped, and then would have the surgery, and then spend anywhere from five to eight days routinely for surgery afterwards. Now that we do this robotically, the average is 48 hours. Sometimes they go home after 24. I have not jumped yet to sending patients home the same day, but some people do that.

Host: Wow, that's amazing, isn't it?

Erik D. Stancofski, MD: It is. Patients feel less pain. Patients go home earlier. They recover better at home than they do at the hospital, and it's perfectly normal. Yeah, a big, big, big difference. They take less pain medication. They're up on their feet faster. They're back to work faster. It's a huge difference.

Host: I'm sure. I'm sure. So, switching gears a little bit, Doc, you've served in leadership roles in your career. You even at one point own your own surgical practice. You've had a very, not just successful obviously, but eclectic career in many ways. So, how have those experiences shaped your approach to patient care overall, would you say?

Erik D. Stancofski, MD: Yeah, I've been through a variety of practice models. I was first employed when I came here. Then, I went on my own for a year and a half. And then, I joined one other surgeon year and we created Cape Surgical Associates for, I don't know, 15 years or so. And then, I joined Beebe seven years ago. I'm now currently an employee of Beebe Medical Group. And I have been a vice chair of the Department of Surgery for four years and the Medical Director of our outpatient surgery center. And all of this makes the patient as the center of the whole care. As when you first start in practice, you're a general surgeon, you provide episodic care to patients, and a patient comes in, has an acute illness, you fix it. That's it. When you own your practice, you start trying to build relationship with other surgeons, with other specialties to try to get a better overall care of the patient, which is not just episodic care, but more holistic care, if you want. Cancer screening, wellness initiatives, anything that can make the patient better, not just acutely for what we treat, but in general better.

And there's a big drive now in healthcare for these kinds of initiatives where we try to keep the patient healthy, instead of trying to fix their acute problem. And that includes all the cancer screenings and all the wellness screenings and wellness initiatives, alternative methods to care, whether it is mindfulness and yoga and all sorts of things. My wife happens to be a yoga instructor, so I have to throw that there.

Host: Absolutely. Get the plug in.

Erik D. Stancofski, MD: Yep.

Host: That's great. I'll bet she's really good at Twister, huh?

Erik D. Stancofski, MD: Oh yeah.

Host: Very flexible.

Erik D. Stancofski, MD: Very.

Host: A couple of other things before we let you go. What do you wish more people knew or understood about what you do in the world of general surgery? Maybe a common misconception you can clear up for people.

Erik D. Stancofski, MD: The biggest misconception is that, "Oh, I need surgery. It is going to be bad." That's the biggest misconception. And while this was true years ago, with all those new methods and laparoscopy and robotic, it is less and less and less invasive. It affects people less. The pain is less, the downtime is less. The return to daily activities is faster. And the complication rate is less. So, it's not a big, big thing to need surgery. It's very common. I've had seven surgeries in the last five years. It's fine. you know, it needs to be done, it needs to be done. It's not the end of the world. People realize that after the operation very often that, "Oh, that was not so bad. That was fine. I'm glad I did it. Thank you, Doc." The initial response is usually, "Oh my God, I need surgery," and this should not be the case.

Host: Do you sometimes share with your patients that you yourself have had seven surgeries and kind of tell them, "Listen, I've had seven. You only need one. You're ahead of the game here"?

Erik D. Stancofski, MD: Absolutely. Absolutely. And they love that.

Host: I'm sure they do.

Erik D. Stancofski, MD: Yeah. Yeah.

Host: In summary here, Doctor, when you're not in the OR and treating patients, how do you like to unwind? What else do you like to do? Anything in particular in the area? Any favorite spots or things along those lines?

Erik D. Stancofski, MD: Yeah. There's a lot of things to do here. What I absolutely love to do is to ride my bike. All the trails, all the side roads, the little roads here and there. I have two or three groups of people I bike with. We even started recently to bike at night, the night riders. It's fun, it's good, it's outdoors. Love doing that. Swimming. I love swimming. It's good for my neck. It's good for the body in general. It makes me feel good. Essentially, these are the two things we do, biking and swimming.

Host: Sounds like a great way to stay in shape. It covers a lot of, if not all, the bases physically, right?

Erik D. Stancofski, MD: Yeah, it does. It does. It does.

Host: And then, before we let you go, one last one for you being Lebanese, what's the one thing that you can get here that you can't get over there? Or maybe vice versa too.

Erik D. Stancofski, MD: What we have there that we don't have here is Lebanese food. We have to make it ourselves here. It's available everywhere there. A Lebanese restaurant here would be nice, which by the way, my wife is thinking about maybe opening one or delving into one, into the possibility of opening a Lebanese restaurant.

Host: Hey, Lebanese restaurant, a yoga studio in the back and a bike trail nearby. What else do you need, right?

Erik D. Stancofski, MD: That's it.

Host: Excellent. Well, folks, we trust you are now more familiar with the world of General Surgery. Dr. Stancofski, keep up all your great work. Say hi to your wife for us, and thanks so much again.

Erik D. Stancofski, MD: Thank you. Thank you for having me.

Host: We appreciate the time. And keep in mind, folks, that surgery can be life changing and so is picking the right surgeon. So, tell your doctor you want a Beebe surgeon. And please remember to subscribe for more episodes of this podcast. Well, if you found this episode helpful, we hope you'll share it on your social media. I'm Joey Wahler. And thanks again for being part of the Beebe Healthcare podcast.