HJAR Jul/Aug 2023

HEALTHCARE JOURNAL OF ARKANSAS I  JUL / AUG 2023 55 Scott Stern, MD Chief Medical Officer and Medical Director of Surgical Oncology CARTI A rural hospital isn’t going to go out and buy two robots, it doesn’t make sense. In central Arkansas, where we have such a big physician presence, availability is still the limiting factor. When you need the robot, the time, and the team (which must also be specially trained) — and all of the urologists, gynecologists, general surgeons, head and neck surgeons, and more want to use it — a bottleneck is unavoidable. The result? Very long wait times for nonemergent issues and scheduling issues for everybody. What happens next Every year, we push boundaries. In the first half of my career, the focus was on bigger, more complex surgery because we made reconstruction so much better. And that was great. Now, technology has evolved and leapt forward to a point where we’re asking, “What is the most minimal thing that can be done? How can we improve safety? How can we lessen the time to recover?” In the end, robotic surgery is still just a tool — but what an incredibly impressive tool it is. I can’t wait to see all the ways we use it for the betterment of our patients. n As CARTI’s chief medical officer andmedical director of surgical oncology,Scott Stern,MD, leads CARTI’s medical team in providing the highest level of care to patients across Arkansas. Stern completed a fel- lowship in head and neck surgical oncology at MD Anderson Cancer Center at the University of Texas in Houston. He attended the University of Arkansas for Medical Sciences in Little Rock, where he com- pleted residencies in general surgery and otolaryn- gology — head and neck surgery — and attended medical school. the critical structures are, what needs to be removed, ... everything . And working with a robot? It does not move until the surgeon tells it to. It does not get distracted. It is not inexperienced. There’s less to worry about, which increases confidence and allows sur- geons to relax and do exceptional work. It’s a win-win for everyone. Challenges with training An issue that deserves consideration, especially with younger graduates, is that many have only learned robotic surgery. They simply haven’t been trained on open approaches. For the most part, of course, robotic surgery is going to go smoothly. We want surgeons trained on robotic surgery. And yet there are times, the rare 1%, where you get bleeding — particularly in the abdo- men, with so many blood vessels — result- ing in blood on the lens or poor visualiza- tion, and you have to open the patient. Or some other unforeseen issue. What happens when surgeons have very little experience with open surgery? If a patient is suddenly crashing and nobody knows how to open the belly or make that transition, how do we keep the patient safe? Challenges with access Access is a huge barrier to robotic surgery, and it will continue to become a larger is- sue as more patients request robotic sur- gery. After all, this is a very, very expensive piece of equipment, and there is a limit to the number of robots that any hospital has. more. Tumors can be safely removed with incredible bleeding control and 360-degree rotations in confined spaces. This advance- ment is huge for HPV-related cancers. Why? If you can remove that positive tumor with negative margins, the patient can actually avoid radiation. More recently, the robot has been intro- duced in orthopedics, particularly for total joint and hip replacement. Highly sophisti- cated computer modeling can identify and create a truly custom prosthesis — looking at the patient’s specific bone, input into the computer. No more drawing from an X-ray. No more eyeballing it. The result goes be- yond a custom prosthetic. This is custom- ized surgery, and it’s how we go from what used to be a 10-day hospitalization to an outpatient procedure. Additional benefits for physicians Ergonomics! Seriously, it’s ergonom- ics. Think about the position surgeons are in most of the time: standing at the side of the patient, bent over at a 30-degree angle, turned or twisted. Many hours a day, mul- tiple days a week. It’s no wonder surgeons often deal with back and neck issues. With robotic surgery, surgeons are at a console working in the most ergonomically neutral position possible, which can help them op- erate over a longer period of time and ex- tend their career by years. Robotic surgery can also significantly de- crease anxiety. The incredible visualization means the surgeon can clearly see where