As modern medical technology continues to see exponential growth, the Crouse Institute for Robotic Surgery remains a leader in the industry, largely due to its pioneering spirit and team-centered approach.
Crouse Robotics Team
Since its inception in 2008, the Crouse Institute for Robotic Surgery has evolved to become the largest multispecialty robotic surgery program in Central New York. Crouse Health has a sizable team of highly skilled, experienced surgeons, each committed to the use of the newest, most advanced surgical technology available today. Surgeons at Crouse Health continually enhance their minimally invasive surgical skills in order to offer their patients the highest level of care possible.
Surgeons and administrators at Crouse, particularly those who were instrumental in laying the initial foundation for the program’s infrastructure, share their perspectives on how Crouse became the market leader in this highly competitive and continually evolving field of modern medical technology.
James Sartori, MD, member of Crouse Robotics Team
History of Robotic Surgery
Central New York was not the birthplace of robotic surgery, and the da Vinci Surgical System was certainly not the first robot designed to assist in performing surgical procedures. According to the American Journal of Robotic Surgery, a robot was used for the first time in a procedure over 30 years ago, when the PUMA 200 was utilized for needle placement during a CT-guided brain biopsy. There have been many advances in robotic technology since that first robotic-assisted procedure back in 1985. Each improvement led to the first da Vinci Surgical System, which was approved by the Food and Drug Administration in 2000. This early da Vinci model broke new ground as the first robotic surgery technology approved for general laparoscopic surgery.
The Making of a Leader
Eventually, the Crouse Health team began to contemplate what it would take to establish a successful robotic surgery program of its own. When approached by its highly skilled staff of surgeons who had learned about the many benefits of robotic surgery, administrators at Crouse saw the promise of such a program and committed the resources to building it, in partnership with its surgeons.
Po Lam, MD, a board-certified urologist at Crouse Health, performs close to 200 robotic procedures each year. His fellowship training included endourology, laparoscopy and minimally invasive surgery at the University of Oklahoma Health Sciences Center. Dr. Lam was instrumental in getting Crouse Health’s robotic surgery program off the ground.
“In 2006, Crouse did not have a robotic surgery program. I met with Paul Kronenberg, MD, [CEO of Crouse Health at the time] to ask him if we could start a program,” Dr. Lam says. “Since then, the Crouse program has grown significantly.”
Dr. Lam, as well as GYN/oncology surgeons Mary Cunningham, MD, and Douglas Bunn, MD, conducted much of the initial research to learn about program start-up costs. They also estimated the number of cases it would take to make the investment in the technology, training and other expenses worth the initial expenditure.
“At that time, the technology cost between $1.2 million and $1.4 million,” Dr. Lam says. “This was a significant investment, but adding the technology made sense because of the tremendous service we would be able to offer to the community.”
After Dr. Lam and the other Crouse surgeons presented data on how and why the hospital should consider a new robotic surgery program, hospital administration gave the technology their stamp of approval, fully supporting the surgeons’ vision of bringing the leading-edge technology to Crouse.
The purchase of the hospital’s first da Vinci robot in 2008 was just the beginning.
“It’s vital to undergo the right preparation and training before using robotic surgical technology. Crouse Health provides great training for the surgeons, both the experienced surgeons and the new surgeons and residents, as well as the rest of the team.”
— Po Lam, MD, board-certified urologist at Crouse Health
John Nicholson, MD, colon and rectal surgeon at Crouse Health, graduated with honors from SUNY Upstate Medical University in Syracuse in 1973. As a highly skilled surgeon, Dr. Nicholson was one of the first in the area to be trained on the da Vinci system.
“Crouse Health’s state-of-the-art technology wouldn’t be what it is today if it hadn’t been for the efforts of the staff and the support of the administration,” Dr. Nicholson says. “When the robotics program first launched, it was considered a badge of honor for nurses to be on the robotics team, so those who were selected worked very hard to ensure that the program was successful.”
While the robotic technology is the same at every hospital, the quality of the surgeons using the technology is what really matters.
“Crouse Health has the right staff and the right surgeons with the right training,” Dr. Lam says. “That is the recipe for success.”
The Crouse Institute for Robotic Surgery has continued to progress since its inception.
“Every few years a newer version of the technology is available,” Dr. Lam says. “Our administration helps us stay up to date on the newest technology, which allows us to offer the most advanced care possible to our patients.”
“Our robotic surgery program is physician driven, with an active steering committee and talented physicians, PAs, nurses and technicians, all trained to perform optimally as a team. The robot technology is just another tool for the staff. The physicians’ talent and engagement is what really drives the program, creating an environment where the staff providing patient care can really excel.”
— Seth Kronenberg, MD, Chief Medical Officer and Chief Operating Officer, Crouse Health
Expanding the Team
Benjamin Sadowitz, MD, FACS, a board-certified general surgeon, joined CNY Surgical Physicians (now known as Crouse Medical Practice – General Surgery) in 2015. He completed his fellowship in advanced gastrointestinal and hepatopancreaticobiliary surgery at Florida Hospital Tampa. Currently, Dr. Sadowitz largely specializes in robotic general surgery, which includes gallbladder, hernia, colon, appendix and anti-reflux procedures.
Dr. Sadowitz has firsthand experience of just how efficient the teamwork is at Crouse.
“About 18 months ago, we grew from two to four robotic systems at Crouse. Logistically, we needed to train a significant number of staff members to get all four systems up and running,” Dr. Sadowitz says. “We had a large group of OR staff — technicians, nurses and physician assistants — undergo training. Our robotics coordinator, Lisa Miller, our Director of Perioperative Services, Jill Hauswirth, and our head physician assistant, Cathy Burkett, were instrumental in identifying and eliminating training roadblocks.”
“The expansion was a huge initiative for Crouse,” says Dr. Sadowitz. “All four robotic systems were up and running by January 2019.”
“There used to be limitations when the robotic technology first came out. For example, patients with scar tissue from previous surgeries may have been disqualified. Now, there are fewer limitations because the technology is much better.”
— Po Lam, MD, board-certified urologist at Crouse Health
Crouse Institute for Robotic Surgery Today
Presently, Crouse Institute of Robotic Surgery providers perform over 1,750 robotic surgery procedures each year.
“Our four robots are not only in use full-time during the weekdays, but the robotic technology is also used after hours and on weekends,” Dr. Sadowitz says.
Seth Kronenberg, MD, Chief Medical Officer and Chief Operating Officer at Crouse Health, continues to support the legacy that his father, former CEO Paul Kronenberg, MD, started in 2008.
Dr. Seth Kronenberg has been a member of the senior administration at Crouse Health since 2014. He chose Crouse because of its culture of collaboration with the medical staff.
“Physicians here have a voice in the decision-making process, a focus which I believe differentiates Crouse Health from other hospitals and health systems in the region,” Dr. Seth Kronenberg says.
While Crouse Health may have been the last in Central New York to implement the infrastructure needed to perform robotic surgery, the hospital has surpassed all other programs when it comes to patient volume and availability of clinical applications. Today, in addition to having four state-of-the-art da Vinci Xi multispecialty robots, Crouse partners with Intuitive, the company that provides the robotic technology. Through the work of the surgeons, OR staff and the unique partnership with Intuitive, Crouse Health has become the regional leader.
“Crouse Health has the highest number of robotic surgeons in the area, including 25 multi-specialty surgeons, each providing the highest level of quality to our patients by using the robotics technology,” Dr. Lam says.
“When using the robot platform for cholecystectomy, a special imaging system [Firefly fluorescence imaging] helps to highlight the bile duct. Such illumination helps minimize the risk of injury to this fragile structure during dissection.”
— Benjamin Sadowitz, MD, FACS, board-certified general surgeon at Crouse Medical Practice – General Surgery.
Considering recent advances in robotic technology and the accomplishments of Crouse’s robotics team, it’s exciting to imagine what more the future might bring. Dr. Sadowitz believes Crouse may increase the number of robotic surgical systems it uses to five.
“Robotic surgery is fast becoming the standard of care for many surgical conditions,” Dr. Sadowitz says. “More than 40 companies are vying to get into the robotic surgery market, so it makes sense that there will be a role for robotics in every operating room in the country. There will be very few places or areas of surgery where robotics won’t be involved.”
Dr. Lam also sees an exciting future involving the next generation of robotic surgical systems.
“I think the new technology will be more intuitive, with many alert signals to notify surgeons when a situation during a procedure may require additional attentiveness, such as moving in the proximity of adjacent blood vessels. The launch of the newest technology may occur within the next 12 to 18 months,” Dr. Lam says. “At Crouse, we’re prepared to be one of the first to successfully adopt new generations of robotic surgical system technology.”
“We perform a procedure called a total proctocolectomy and ileal-anal pouch — sometimes referred to as j-pouch or an s-pouch. With robotic-assisted surgery, this procedure can be done sparing the anal sphincter, which means the patient will usually not need a permanent ostomy. With traditional surgery, these patients were hospitalized for one week to 10 days. After a robotic-assisted total colectomy, the patient can typically go home in three to five days.”
— John Nicholson, MD, colon and rectal surgeon at Crouse Health
For more information about robotic-assisted surgery services offered at the Crouse Institute for Robotic Surgery, visit Crouse.org/robotics.