Caitlin Whyte (Host): This is Crouse Healthcast. I'm your host, Caitlin Whyte. And with me is Dr. Benjamin Sadowitz, a board-certified general surgeon from Crouse Health. In this episode, we are talking all about the fascinating world of robotic surgery. Well, Doctor, start off our conversation here today. What kind of options are there in robotic surgery?

Dr. Ben Sadowitz: That's a great question. When I finished residency about 11 years ago and then went to fellowship, from a general surgery perspective, there was really no one using the robot to do basic general surgery. We did it all with conventional laparoscopy and that involves small incisions and port sites that the instruments go through to do sometimes fairly complex surgeries in a sort of a minimally invasive way.

And as I've moved through practice the past 10 years, those surgeries we were doing laparoscopically, we now use the robot to do for a multitude of reasons. But as a general surgeon, we do a wide variety of things from gallbladder surgery to appendix surgery to hernia surgery, and all of them are amenable to using the robotic platform.

Host: And who would be a good candidate for robotic surgery versus that traditional surgery?

Dr. Ben Sadowitz: Generally, we find that the bulk of our patients are actually good candidates for this surgery. And one of the biggest reasons is from a recovery perspective, it's generally a less painful way to do surgery and leads to faster recovery. So really, any patient who can undergo a general anesthetic and who doesn't have significant mitigating factors, like a significant amount of previous surgery or some other comorbidities can really undergo robotic surgery. So, there's really a small sliver of patients who wouldn't qualify. And honestly, for some patients, conventional laparoscopy is quite difficult to use as a platform for their operations. And the robotic platform makes it possible to do their operations in a minimally invasive fashion. And in the past, we would not have been able to do that. So, it actually opens the door for more patients to get minimally invasive surgery, even beyond what we do with conventional laparoscopy.

Host: And you mentioned recovery time. That brings me into my next question. I'm sure there is a range for different recovery times for different surgeries. But can you tell us-- maybe using a hernia surgery as an example-- how is recovery time different for a procedure done robotically versus traditionally?

Dr. Ben Sadowitz: That's a good question. So, one of the biggest things that myself and actually all of my partners do now from a hernia perspective is a robotic repair of what's called an inguinal hernia or groin hernia. And in the past, that was traditionally done with a groin crease incision, and that could be fairly painful. You get some swelling there, and recovery took several weeks and, you know, you weren't off your feet, but a groin crease incision is in a painful area. And doing it in a robotic fashion, you go to smaller incisions that are higher on the abdominal wall, so much less pain right off the bat, especially those first two weeks. You're getting back to daily activities faster. You're potentially getting back to work faster. You're taking something that in the past could have been fairly debilitating for people, especially if they needed two inguinal hernias repaired at once. Now you can do two at once with very low muscle and fuss, very little pain. And people, one of the biggest things they want is something that will get them back to activity in a way that's safe and in a way that's minimizing their pain. One of the biggest hot button issues for any surgery is for pain control afterwards, what are you going to do for pain control, especially when it comes to narcotic pain medication? And with robotic platform, and it's not just for inguinal hernia, but many of the surgeries we do, you can almost eliminate that as adjunct to their pain control. So, hernia is not the only one where this is important. Gall bladder surgery, appendix surgery, the bariatric surgery that our bariatric surgeons do, if you can minimize patients' need for narcotic pain meds postoperatively , they tend to do much better, recover quicker, and don't have those sort of unwanted side effects. So, from that perspective, it's such a huge adjunctive thing. And it's one of the big questions patients ask: What will the pain be like? How will pain be controlled? And can we minimize narcotic uses after surgery? And robotics really allows us to do that.

Host: Absolutely. Well, what is some of the feedback then from patients when it comes to using robotics?

Dr. Ben Sadowitz: So, a lot of our patients who have had previous surgery, especially in inguinal hernia space, will tell us doing it robotically is a substantially different postoperative process than doing it we sort of consider the old-fashioned way now. It's like we talked about with pain, it's much less painful. They feel like they're getting back to activities faster. They're overall very pleased with how they're feeling in that immediate sort of weak or two post-op. So, we've seen some marked differences.

Adjunctively, I would say Crouse Hospital in Syracuse here has really made it their mission to be one of the front runners in terms of robotic surgery and its technology. They're really sort of patient-centric in their approach to surgery. And I can tell you, I've been back now for 10 years. I've seen marked differences as we've transitioned over to largely robotic surgery in terms of overall patient satisfaction, pain control, getting back to their work and school faster has really been a great boon for the patients in terms of those factors that they find most important.

Host: Do you ever run into patients that have concerns with a robotic model versus that traditional old school, like you said? And how do you work around that?

Dr. Ben Sadowitz: You know, nowadays, most people come and they understand that that is the best technology out there. But in the past, when it was newer, there would always be those questions. And invariably, one of the questions becomes, "Well, if the robot's doing the surgery, what are you doing?" And there's a misconception there. The robotic platform doesn't do anything without us as surgeon. So, we have total control of it. And what it allows us to do is, number one, have better visualization of what we need to see for the operation. But two, the instrumentation is such that we can now have instruments with greater degrees of freedom and greater precision when we're doing cases.

So when I talk to patients about it, I tell them, "I can do your operation the old-fashioned way. I can do it with conventional laparoscopy. I can do it with robotics. But what I can tell you is this, the robotic way is where I can give you the best operation. And then, from a patient recovery perspective, you're going to feel the best with us doing it this way." And patients are really on board with that. They love the fact that Crouse has been at the forefront of this technology and really wants the best for their patients.

And I'll also say, Crouse, when it comes to some of the maneuvers we use both robotically and for pain control, they will incur some additional expense as a facility because they see the importance of the patient experience. And if we can make their experience better, Crouse has been very good at saying we don't mind incurring some additional expense to make sure the patients have the best experience possible.

Host: Of course. And to wrap us up, Doctor, how is the robotic surgery program different at Crouse?

Dr. Ben Sadowitz: Well, I would say if you look at hospitals, not just in the Northeast, but across the country, our program is very robust. So, we have, at this point, I believe, nine robots in our hospital. And we just upgraded the main robotic system to the newest version. So, we have two specialty systems. And then, the other, I believe six or seven are the newest version of the intuitive surgical robot. So, that's very unique.

There are very few places that have upgraded to the newest system, and this newest system has tons of new features, including instrumentation that allows you to actually feel some resistance. In the past, the robotic surgical system, one of the knocks on it was you couldn't feel tension on tissues. And the new system actually allows you to do that now, which is a huge thing, especially for surgeons who have to delicately handle bowel or even thoracic surgeons who are handling lung, it's very important to be gentle with those things. There's a whole bunch of AI-based learning material now within the system that allows you, if you're a teaching program, to teach residents and new surgeons how to do robotic surgery.

 And Crouse, like I said, has really remained at the forefront of that. They've made sure as a new technology comes out, that they are getting it as soon as it's available. Again, very few programs across the country and in the northeast have as robust a program as ours and as many robots as we have. You'd be hard pressed to find even larger hospital systems with multiple hospitals that have as many robots as we do. And we're a standalone, private community hospital. So, I think it's definitely one of those great things that administration has decided to dive into and invest in. The patient experience has been one that they've seen benefit in. And I hope, you know, as the future moves on, we continue to do this for the patients, because I think it really provides them with the best outcomes.

Host: Absolutely. Well, thank you so much for sharing with us. That was Dr. Benjamin Sadowitz. For more information, please go to crouse.org/robotics. If you enjoyed this podcast, please share it on your social channels and check out the entire podcast library for more topics of interest to you, I'm your host, Caitlin Whyte, and this is Crouse Healthcast. Thank you for listening.