Specialty: Robotic & Minimally Invasive Surgery, Colon & Rectal Surgery
Practice: CareMount Medical Group
Hospital: Northern Westchester Hospital
When Jerald Wishner, MD, FACS, graduated from medical school in 1988, surgery was still being done the same way it had been done for generations: with a scalpel and sutures. “There was no minimally invasive surgery when I was beginning,” Wishner says. “But after completing a five-year residency in surgery, minimally invasive surgery emerged, so I spent two additional years specializing in minimally invasive surgery.”
Wishner explains that there are two types of surgery: open surgery and minimally invasive. Within the field of minimally invasive surgery, there is laparoscopic and robotic surgery, and robotics is the next frontier. Today, there is only one robotics company in the country, Intuitive Surgical, which makes all of the robots and machinery for general and colorectal surgery. And last year, Wishner and the entire Westchester community received a huge boon when he was designated an “epicenter surgeon” for robotics colorectal surgery, one of only 20 in the entire US. “This means surgeons from all around the country come to observe my surgeries,” says Wishner, “and the minute a new technology comes out, Northern Westchester Hospital can bring it to our community first.”
Is open colon surgery becoming a thing of the past?
Yes. It’s inevitable, given the dramatic improvements in visualization and precision because of the robot. Simply put, the two main advantages of robotic surgery versus laparoscopy are better visualization and more precision. In the United States right now, approximately 42 percent of colon surgery is done minimally invasively. In our area, that number is much higher and growing rapidly.
We are at the infancy right now. In another 10 years, surgery is going to look nothing like it looks right now.
Does the high cost of the robot ever outweigh the benefits?
Everyone always talks about the cost of the equipment, but the hospital is not going to go bankrupt because we do things robotically, and I think hospital administrators are starting to see this. When you look at the value, the amount of time patients stay in the hospital is shorter, and the length of the case is shorter, requiring less operating-room time and fewer hospital resources. This saves the system money. And, at the end of the day, people are going back to their lives and to work faster, too. So there is both clinical and financial value.
How much recovery time do you save patients when you use the robot?
For an open colon surgery, the length of stay in the hospital is seven to eight days. Laparoscopically, the length of stay is about 3.5 days. Robotically, the length of the stay is 1.6 days.
What’s the most memorable surgery you’ve ever performed with the robot?
About a year ago, I had a 39-year-old patient who was diagnosed with colorectal cancer at the same time she found out she was pregnant. She was at nine weeks and wanted to keep the baby but had consulted several other surgeons who told her she would have to terminate the pregnancy. I was able to safely remove the tumor using the robot, and she now has a beautiful 1-year-old daughter. That’s one I’ll never forget!