2016-11-16 / Front Page

Mount Sinai Establishes Robotics Institute (MSRI)

Since the first minimally invasive robotic surgery to treat head and neck cancer at Mount Sinai in 2008 surgeons at Mount Sinai have been on the forefront of pioneering robotic surgery techniques.  Showcasing the cumulative experience of these surgeons and our multidisciplinary teams, The Mount Sinai Robotics Institute (MSRI) has been established at the Icahn School of Medicine at Mount Sinai to advance patient care and augment research and training.    
Surgeons at Mount Sinai have employed robotic surgery as a treatment for a variety of conditions including urological disease, oral and throat cancers, obstetrical conditions, cardiovascular disease and neurological conditions.  Groundbreaking work such as new techniques and refinements, and complication reduction programs in these areas has distinguished MSRI as an international leader in robotic and minimally invasive surgery.  Educational programs and clinical research programs have been instrumental in achieving outstanding outcomes.
“The purpose of MSRI is to achieve the best results for patients through optimization of robotic technology and multidisciplinary care,” says Ash Tewari, MBBS, MCh, the Kyung Hyun Kim Chair of the Milton and Carroll Petrie Department of Urology at Mount Sinai, co-chair of the Institute.  “At our Institute, we will focus on patient education, clinical research and collaboration, and the study of health care outcomes, as well as training, and development of new technology.”
Eric M. Genden, MD, MHA, FACS, the Dr. Isidore Friesner Professor and Chair of the Department of Otolaryngology—Head and Neck Surgery at Mount Sinai and co-chair of the Institute performed the first transoral robotic surgery (TORS) in New York in 2008 in advance of the U.S. Food and Drug Administration’s approval of the technique for head and neck cancer surgery in 2010. “We were an early adopter of the da Vinci® Surgical System and we have been studying robotic oropharyngeal cancer treatment since then.  We have found robotic surgery—for a variety of disease conditions—minimizes our patients’ recovery time and maximizes their outcomes.”  Since then, Dr. Genden and his team have enhanced the TORS technology for removing tumors in the throat, tonsils, and base of the tongue to improve patients’ recovery, cosmetic appearance, and ability to speak and swallow.
“In the past, these tumors presented a significant challenge to reach, and traditionally were removed by surgeons through a large incision stemming from the top of the lip to the throat.  However, the advent of robotic technology brought about a momentous paradigm shift in the removal of tumors and the benefits it delivers to patients,” says Dr. Genden.  “Our studies have shown that minimally invasive robotic surgery has resulted in fewer days in the hospitals and fewer complications for patients.”  
For robotic surgery in head and neck patients, Mount Sinai sends frozen sections of tumors at the time of surgery to pathology, which conducts a rapid turnaround of results while the patient is still asleep.  If the cells are positive, the surgeon resects more to ensure margin accuracy.  Additionally, the Head and Neck Cancer Research Program has a history of evaluating and utilizing new optical technologies for increased margin control and more precise tumor identification.  For example, Mount Sinai was selected as the exclusive site for the Advaxis immunotherapy clinical trial for patients diagnosed with HPV-related oropharyngeal cancers, which is now entering Phase II.  
Dr. Tewari developed the robotic prostate surgery technique called Advanced Robotic Technique prostatectomy or ART. ®   It is a highly individualized technique that reflects a patient’s unique anatomy, cancer location, and neural structure while removing cancer and minimizing side effects in select patients.   Through ART, Dr. Tewari delicately removes the prostate while preserving sexual and urinary function.    
In treating patients, Dr. Tewari and his team use a combination of precision medicine approaches including advanced imaging, genomics, and translational research.  In addition, Mount Sinai has pioneered the use of NeuroSAFE, an advanced procedure that lets the surgeon know if all the cancer has been excised during the operation itself.  It is the only institution in the United States currently using this technology.  He also designed athermal and reconstruction techniques to minimize nerve damage during prostate cancer surgery and catheter-less surgery to minimize pain and discomfort for patients.  
“The robotic urological cancer surgery program reflects almost two decades of experience and research into mastering and refining the robotic technique in order to ensure we achieve the highest levels of cancer control for patients while preserving nerves responsible for erectile function and continence,” says Dr. Tewari.
Other pioneering surgeons at Mount Sinai have also introduced significant innovations in the field of robotics.  The first assistant sparing technique (FAST) robotic partial nephrectomy was developed by Ketan Badani, MD, Vice Chair of Urology and Robotic Operations at the Mount Sinai Health System.  It specifically aims to reduce warm ischemia time to the kidney, preserve maximal normal renal function while removing the tumor, and minimize complication risk.  The FAST approach has been taught and demonstrated throughout the United States at national meetings and internationally in twelve countries. Dr. Badani has published over 100 peer-reviewed manuscripts on the advancement of robotic technology and improvement in patient outcome.
Mount Sinai is also one of the only locations in the country dedicating a da Vinci Surgical System solely to teach residents and fellows robotic surgery techniques.  The majority of users are urological, gynecological, head and neck and general surgeons.   In addition, first-year medical students at the Icahn School of Medicine at Mount Sinai have the ability to take a Robotic Anatomy Training Day where students perform robotic surgery on cadavers.  The course began eight years ago as the first of its kind in the United States, and Mount Sinai is still one of the only schools in the world to do it.    
The MSRI is one of more than 20 institutes at the Icahn School of Medicine, part of the Mount Sinai Health System.  The Institutes are hubs of scientific and clinical enterprise, drawing on one of the largest and most diverse patient populations in the nation.
About the Mount Sinai Health System The Mount Sinai Health System is an integrated health system committed to providing distinguished care, conducting transformative research, and advancing biomedical education. Structured around seven hospital campuses and a single medical school, the Health System has an extensive ambulatory network and a range of inpatient and outpatient services—from community-based facilities to tertiary and quaternary care.
The System includes approximately 7,100 primary and specialty care physicians; 12 joint-venture ambulatory surgery centers; more than 140 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. Physicians are affiliated with the renowned Icahn School of Medicine at Mount Sinai, which is ranked among the highest in the nation in National Institutes of Health funding per investigator. The Mount Sinai Hospital is in the “Honor Roll” of best hospitals in America, ranked No. 15 nationally in the 2016-2017 “Best Hospitals” issue of U.S. News & World Report.  The Mount Sinai Hospital is also ranked as one of the nation’s top 20 hospitals in Geriatrics, Gastroenterology/GI Surgery, Cardiology/Heart Surgery, Diabetes/Endocrinology, Nephrology, Neurology/Neurosurgery, and Ear, Nose & Throat, and is in the top 50 in four other specialties. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 10 nationally for Ophthalmology, while Mount Sinai Beth Israel, Mount Sinai St. Luke's, and Mount Sinai West are ranked regionally. Mount Sinai’s Kravis Children’s Hospital is ranked in seven out of ten pediatric specialties by U.S. News & World Report in "Best Children's Hospitals."
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