About 15% of surgical procedures performed in the United States today are done robotically, but with rapid advances in medical technology, robotics will likely dominate the future of surgery. Recognizing this growing trend, the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell is bringing state-of-the-art robotics into the hands of its students early into their medical school careers.
During a presentation held at the Zucker School of Medicine Feb. 22, second-year medical students demonstrated their robotic surgical skills using the da Vinci Surgical System manufactured by Intuitive. The exercise is part of the standardized nine-week Surgical Skills Training Course that until now was reserved only for doctors in their later years of residency. The program is the newest addition to the school’s cutting-edge undergraduate medical curriculum, helping to prepare future surgeons for tomorrow’s operating rooms.
“We never believed that memorizing concepts and facts in huge lecture halls was the best way to learn and prepare for being a doctor – our students learn by doing,” said Dr. David Battinelli, dean of the Zucker School of Medicine and executive vice president and physician-in-chief of Northwell Health.
“We are fortunate to have a partner in Northwell Health, New York state’s largest health system,” he said. “By leveraging Northwell’s extensive resources, technology and expertise, we can provide students with an exceptional medical education that includes unique learning experiences, such as the advanced Surgical Skills Training Course and state-of-the-art robotics that we are now providing students in their second year of medical school.”
In March, the Zucker School of Medicine will celebrate 15 years since its establishment through an equal partnership between Hofstra University and Northwell Health. The school welcomed its first class in 2011 and, since then, has challenged the traditional model for training future physicians, which typically separates the basic sciences from clinical learning.
The school’s curriculum pushes the boundaries of conventional undergraduate medical education by integrating patient care and medical sciences and immersing students in both throughout their education. The school was the first in the nation to train students to become Emergency Medical Technicians beginning on their first day of medical school. The SSTC is another example of how the school disrupts the status quo by exposing its students early on to concepts and technologies they can expect to encounter further in their training.
“This course has introduced me to techniques and ideas that I might not be expected to practice or understand until I’m a surgical resident, but having the early exposure, I am more confident in my ability to develop these skills to a level required of me as a resident or attending surgeon,” said second-year medical student Christopher Copeland. He admits the skills he learned as a kid playing video games have been useful in accomplishing the training exercises on the da Vinci robot.
“The robot is not something I’m intimidated by – I view the training modules as games: having fun while also developing the rudimentary skills important for safely operating with a robot.”
The military, in a joint effort with the Stanford Research Institute, first developed robot-assisted surgery in the late 1980s. The da Vinci Surgical System became the first robotic device approved by the FDA in 2000. Today, the da Vinci system is an innovative, state-of-the-art advanced instrumentation. The robot works as an extension of a skilled surgeon by replicating the surgeon’s hand movements in real-time and aiding with greater visualization, enhanced dexterity and greater precision. Besides honing the fine motor skills needed to manipulate da Vinci’s tentacle-like arms, the training has helped the students to better communicate and work together.
“Surgery is a team sport,” said Harrison Labban, a member of the Class of 2025, who plans to pursue a surgery residency after graduation. “Over the past nine weeks, I’ve learned to communicate more efficiently with other surgical team members and become more comfortable in my role as a medical student in the operating room.”
During the robotic skills demonstration, Labban assisted classmate Alexis Benjamin, who sat at the surgeon’s console viewing a 3D image of the “patient,” in this case, a small six-inch round disc with colorful spikes. Benjamin’s task was to manipulate da Vinci’s hand controls, which correspond to the surgical instruments on the ends of the robot’s arms, to pick up and place tiny rubber rings on each of the spikes. The job may look simple, but Benjamin said it takes precision, fine motor skills and dexterity to succeed.
“I have the ability for wrist articulation between the instruments that you wouldn’t be able to do by hand, laparoscopically,” explained Benjamin, detailing the advantages the da Vinci robot provides. “This has been a unique experience and will prepare me better for the future.”
Being exposed to the SSTC early on in medical school has also helped students like Amanda Haye solidify their decision to pursue a medical career in surgery.
“It’s been wonderful to have time set aside each week to explore our surgical interests and to be mentored by some of the most experienced professionals in the field at Northwell,” said Haye. “It’s been the highlight of my career so far as a medical student, and I can’t thank everyone enough.”
Today, robotic surgery is recognized as the next generation of minimally invasive surgery, particularly for bariatric, colonic and advanced foregut procedures. Studies have shown that robotic-assisted surgery has fewer complications, minimal scarring, less blood loss and a quicker recovery for the patient than open surgery.
“At Northwell, we do 11,000 robotic procedures per year and that’s only growing, and there are technological advantages rather than open-hand surgeries,” explained Dr. Gene Coppa, chairman, and Dr. John D. Mountain, professor of surgery at the Zucker School of Medicine, and chairman of surgery at Long Island Jewish Medical Center and North Shore University Hospital.
“In medicine and, more specifically, surgery, technology is something we all look forward to. It became obvious that the earlier our trainees are exposed to these technologies, the better it is in the long term,” Mountain said.
Recognizing the benefits of advanced surgical training for undergraduate students, Coppa worked with other proponents, including Dr. Lee Richstone, professor of urology at the Zucker School of Medicine and chairmanof urology for Lenox Hill Hospital; Dr. Gainosuke Sugiyama, professor of surgery at the Zucker School of Medicine and chairman of surgery for Long Island Jewish Valley Stream; and Dr. Louis R. Kavoussi, Wald Baum-Gardner professor of urology at the Zucker School of Medicine and chair and senior vice president of urology for Northwell Health. They were instrumental in bringing the SSTC and the da Vinci Surgical System to the medical school.
“We are one of the first medical schools, if not the first, in the country to train undergraduate medical students in surgical and robotic skills, and it’s not too soon to do so,” explained Kavoussi, who heads up Northwell’s Smith Institute for Urology. “I liken it to playing in the NFL; you don’t wake up one day and step onto a football field to become the quarterback – it takes years of practice; that’s what we’re doing here, exposing our future surgeons to the ‘playing field’ early on in the process.”
The students couldn’t agree more. In demonstrating their grasp of the robotic surgical techniques and concepts, they proved that the SSTC came at the right time in their medical education.
“I think it’s incredible that we can leverage such a vast network of resources from Northwell to add to our cutting-edge curriculum and not only introduce students to clinical settings early on but now provide practical, hands-on surgical experience at such an early stage in our training,” said Lauren Milley, agreeing with her fellow students’ sentiments. “It’s been incredible to be part of an organization that invests in its students, and I’m looking forward to what’s to come.”