Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Introduction to transoral robotic surgery

Introduction Transoral robotic surgery (TORS) has evolved from the endeavor of head and neck surgeons to perform minimally invasive targeted resection of lesions of the upper aerodigestive tract. Transoral resection of oral, oropharyngeal, hypopharyngeal, and laryngeal lesions has been performed from the 1800s. It has evolved from techniques initially crude to increasingly sophisticated headlights, the use of binocular loupes for magnification, and then to the use…

Robotic surgery for endometrial cancer and sentinel lymph node mapping

Introduction Endometrial (uterine) cancer is the most common malignancy of the female genital tract in the United States, with an estimated 66,570 new cases and 12,940 deaths in 2021. In 2019, there were an estimated 807,860 women living with uterine cancer in the United States. Approximately 3.1% of women will be diagnosed with uterine cancer at some point during their lifetime. Hysterectomy remains the mainstay in…

Robotic surgery for radical procedures: Ovarian cancer, upper abdominal debulking, and pelvic exenteration

Introduction The original robot-assisted hysterectomy was first published in the World Journal of Surgery in 2001. Nearly 4 years later, the US Food and Drug Administration (FDA) approved the use of the da Vinci Surgical System for gynecologic procedures in 2005. Following this approval, the number of robotic-assisted surgeries in gynecologic oncology has increased dramatically. Minimally invasive surgery in the field of gynecology offers known benefits…

Robotic-assisted laparoscopic approach to early-stage cervical cancer

Introduction Cervical cancer currently is the fourth most common cancer occurring in women. Worldwide, an estimated 570,000 women were diagnosed, and 311,000 women died of the disease in the year 2018. Most (99%) cervical cancers are related to an infection with the human papilloma virus (HPV), resulting in oncogenesis. The World Health Organization (WHO) has made it a goal to eliminate the burden of cervical cancer,…

Robotic-assisted laparoscopic sacrocolpopexy

Introduction Sacrocolpopexy is considered the gold standard surgical procedure for pelvic organ prolapse, with success rates estimated at 98.6% and mesh complications rates of 4.1%. Since the mid-2000s, robotic-assisted laparoscopic sacrocolpopexy has gained increased popularity due to the ease of dissection and suturing afforded by wristed instrumentation. The first laparoscopic sacrocolpopexy was described by the Nezhats in 1994. After the US Food and Drug Administration (FDA)…

Robotics for benign gynecology

Introduction Hysterectomy is the second most frequently performed surgical procedure after cesarean section for women who are of reproductive age in the United States. According to the Centers for Disease Control and Prevention (CDC), from 2011 to 2015 10.6% of women between the ages of 40 and 44 had a hysterectomy, with approximately 600,000 hysterectomies performed annually. , Hysterectomy can be performed vaginally, abdominally, laparoscopically, or…

Robotic urologic microsurgery

Introduction In the field of male reproductive surgery, optical magnification is crucial due to the microscopic anatomic structures. The microsurgeon gains advantages with tools and technology for ease of use and ergonomics. These surgical procedures had fairly poor outcomes due to the limitation of direct visualization by the naked eye prior to the 1970s when the operative microscope began being used. Beyond direct visualization without magnification,…

Augmentation ileocystoplasty

Introduction Augmentation cystoplasty is traditionally indicated for small-capacity, poorly compliant bladders, refractory to more conservative treatment strategies. Aggressive pharmacological therapies with anticholinergics or β3-mimetic drugs, intradetrusor injections of botulinum toxin, and sacral neuromodulation have reduced the need for augmentation cystoplasty over the past two decades. While ileocystoplasty with a preterminal segment of ilium is by far the most widely adopted augmentation procedure, other gastrointestinal segments such…

Ureteric reconstruction: Ureterolysis, reimplant, strictures

Introduction Ureteral strictures may arise from a multitude of etiologies including ischemia, iatrogenic trauma, noniatrogenic trauma, retroperitoneal fibrosis (RPF), radiation, malignancy, or ureteral calculi. Surgical reconstruction is necessary to preserve renal function due to the risk of prolonged hydronephrosis as well as symptomatic relief in those who have flank pain. Robotic reconstruction has been proven to be feasible with outcomes equivalent, if not better, than that…

Fistulae of the urinary tract: Vesicovaginal, ureterovaginal, and rectourethral

Fistulae of the urinary tract: Vesicovaginal, ureterovaginal, and rectourethral A fistula is an epithelialized or endothelialized connection between two or more organs. Frequently, it will be named after the organs or systems affected. Some fistulae can be made intentionally to treat a condition, others develop as a consequence of a noxious event, most of the time in the treatment of a condition. Urogenital fistulae are among…

Robotic gender-affirming surgery

Introduction With increasing social acceptance of the transgender community, the number of trans-identifying patients is increasing in the United States, with an estimated 0.39% to 2.7% of the US population identifying as transgender or gender nonbinary. Expanding insurance coverage of gender-affirming surgery (GAS) will likely lead to a rapid rise in the number of these procedures being performed in the coming years. A testament to this…

Complex bladder neck reconstruction and posterior urethroplasty

Robotic reconstruction Bladder neck reconstruction and posterior urethroplasty have posed a major challenge in surgical reconstruction for urologic surgeons. Often, these patients present with a previous history of radiotherapy or ablative interventions for other pathologies that have resulted in obstructive or damaged function of the lower tracts. These complications can be devastating to the patient’s quality of life, Prior to the advent of laparoscopy, upper tract…

Retroperitoneal lymph node dissection for metastatic testicular cancer

Introduction Retroperitoneal lymph lode dissection (RPLND) forms an integral part of the multidisciplinary management of testicular cancer. , Cisplatin-based chemotherapy regimens have revolutionized the treatment of testicular cancer, and consequently the role of surgery has changed. However, their combined role has resulted in overall survival rates over 90%. Robot-assisted RPLND is increasingly being used in selective cases for stage 2 disease in both the primary and…

Partial cystectomy

Introduction Partial cystectomy is an uncommonly performed procedure with oncologic and functional indications that determine surgical approach. Because of the risk of tumor spillage with urothelial cancers, it is rarely indicated in the management of this malignancy, but the approach can be utilized for less common bladder tumors or the excision of bladder diverticula for functional reasons. The robotic approach is particularly suited to partial cystectomy…

Extended lymphadenectomy in robot-assisted radical cystectomy

Radical cystectomy for the treatment of muscle-invasive or high-risk non–muscle-invasive bladder cancer must include extended lymphadenectomy to improve pathological staging and surveillance. When we refer to extended lymphadenectomy, it includes internal, external, and common iliac artery stations. An anatomical understanding of the lymphatic drainage of the bladder and the definition of appropriate boundaries is crucial to perform an appropriate extended lymphadenectomy in robot-assisted radical cystectomy (RARC).…

Urinary diversion

Introduction Use of robot-assisted radical cystectomy (RARC) has significantly increased over the past decade in favor of open and laparoscopic approaches. Robot-assisted Radical Cystectomy Versus Open Radical Cystectomy in Patients with Bladder Cancer (RAZOR), an open-label noninferiority study, has further confirmed the oncologic safety of the robotic approach up to 3 years after surgery. , Nevertheless, all the patients underwent extracorporeal urinary diversion (ECUD) in this…

Robotic-assisted radical cystectomy for men and women

Background The treatment for muscle invasive bladder cancer (MIBC) and some high-risk superficial bladder cancers (in patients who may or may not have had intravesical immunotherapy) is radical cystectomy (RC), customarily through an open lower midline abdominal incision. This is a major physiological insult causing high morbidity and a clearly defined mortality. There is an accepted complication rate of up to 60%, a 25% readmission rate,…

Robot-assisted kidney transplantation

Introduction Open kidney transplantation (OKT) is considered the gold standard treatment for end-stage renal disease as it is able to achieve a greater survival rate and a better quality of life in comparison to hemodialysis. The introduction of this surgical technique, in the second half of the last century, is considered a milestone in the history of surgery. The first successful cadaveric kidney transplantation was performed…

Adrenalectomy

Introduction Prior to recent advancements in surgical technology, open adrenalectomy was the gold standard for benign and malignant adrenal diseases. With the introduction of laparoscopy, surgeons began to transition to minimally invasive surgery. When compared to open adrenalectomy, laparoscopic adrenalectomy (LA) has been shown to have lower intraoperative blood loss, lower postoperative pain scores, shorter length of stay, and better longer-term cosmesis. On the contrary, laparoscopic…