Dr. Michael Stifelman, director of robotic surgery and minimally invasive urological surgery.

The Four-Armed Surgeon

With Help From a Robot Named DaVinci, Experts in Urological and Gynecological Surgery Have Become Virtuosos

“We’re on the clock now,” says one of the OR nurses. Michael Stifelman, MD, director of robotic surgery and minimally invasive urological surgery at NYU Langone Medical Center and assistant professor of urology, is removing a kidney tumor. Instead of standing over the patient, however, he sits 10 feet away, peering into an eyepiece as he manipulates the world’s most advanced surgical robot, the DaVinci SI.

The robot looms above the operating table, its four mechanical arms inserted into the patient’s abdomen through cylindrical ports. One arm holds a camera, giving Dr. Stifelman a magnified, high-definition 3-D view. The other three arms hold miniature surgical instruments that precisely replicate the surgeon’s actions, but with a greater range of motion.

This is the most delicate phase: the kidney’s artery has been clamped off while the tumor is excised, and the team must move quickly to avoid kidney damage from lack of blood. As the team watches on an overhead screen, Dr. Stifelman maneuvers tiny scissors to swiftly cut out the tumor while his other hand operates a cauterizing instrument. “Sutures,” he calls. The assisting surgeon slides a needle and thread through a port, and Dr. Stifelman guides the mechanical hands, deftly sewing up the gap where the tumor had been.

The DaVinci is just one example of how NYU Langone is breaking ground in minimally invasive surgery. Unlike open surgery, performed through a large incision, minimally invasive procedures use one or more small incisions, sparing the patient wear and tear and shortening recovery time significantly. Gynecological and urological surgeons pioneered this approach, and that trend continues at NYU Langone.

“Gynecologists were the first to do laparoscopy 30 years ago,” explains David Keefe, MD, professor and chairman of the Department of Obstetrics and Gynecology. Today, he estimates, gynecologists at the Medical Center employ the technique—in which the surgeon manipulates camera-guided surgical tools through ports—for 60% of routine procedures, including most operations to remove the uterus, ovaries, fibroid tumors, and polyps, as well as repairs of problems related to incontinence and infertility.

Robotic surgery is also being used for hysterectomies and other basic procedures, but it has proven particularly valuable in the field of gynecological oncology. “In my practice, it has completely replaced laparoscopy for most cases,” says Bhavana Pothuri, MD, assistant professor of obstetrics and gynecology, who specializes in cancer-related procedures. “I use it to operate on ovarian, endometrial, and cervical cancer.”

The Department of Urology is using robotic surgery even more extensively. “Procedures that were being done only as open surgery because they were too difficult to do laparoscopically are now also being done robotically, including prostatectomy and complex urinary tract reconstruction,” reports Dr. Stifelman. Overall, three urological and four gynecological surgeons are now employing robotic surgery. Their goal is to develop and define the role of robotics in the surgical arena, as well as to create standardized teaching techniques. “The technology will only get better,” notes Dr. Stifelman. “This represents the future of surgery.”