An Exclusive Interview With Dr. Ash Tewari,
Weill Medical College of Cornell University
“If We Can Think About It, It May Happen”
For Dr. Ash Tewari, it’s all about “bits and bytes,” blood and guts being, for him, signs of surgeries past. For nine years now, Ash Tewari, M.D., M.Ch. [Magister Chirugiae, Master of Surgery], the Director of Robotic Prostatectomy and of Prostate Cancer-Urologic Oncology Outcomes at the Brady Urology Foundation of The Department of Urology at Weill Medical College of Cornell University (just one of several titles and affiliations), has been performing robotic surgery on patients diagnosed with prostate cancer. It’s a field that the thoughtful and quietly articulate doctor says attracted him some years ago when he determined that he wanted to have more precise information about the prostate and be able to perform surgery under less invasive conditions. The result was Dr. Tewari’s decision to learn about and, subsequently, train and perform on a surgical system consisting of a console, robotic cart with arms, and high-definition 3D vision system.
Education Update caught up with Dr. Tewari, soon after he emerged from two operations, but not to worry--he had had a comfortable chair, just a few feet away from his surgical team and, of course, his patients. He also had confirmation once again of why he had switched from “open” (traditional) surgery to robotic surgery. He was able to get a multi-dimensional perspective of the prostate, and he knew he was using a procedure that reduced blood loss. Though he has performed hundreds of such operations, he modestly considers himself still a “student of the field.” But what a field, and how it is growing.
Dr. Tewari points out that the 20-year old field of robotic surgery emerged in response to two main concerns: 1) the need of NASA to know that if an astronaut had an attack of appendicitis, for example, there would be an expedient and efficient way to deal with it; and 2) the need of the military to know that a battlefield injury to a vital organ could be dealt with remotely in the absence of an on-site specialist.
Before becoming interested in robotic surgery, Dr. Tewari had been performing numerous open prostatectomies, and he is respectful of the majority of surgeons who still perform operations in traditional ways. Not everyone is a candidate for robotic surgery, he notes, but those for whom the outcomes are most favorable include patients with early-stage prostate cancer, those who are motivated to do what they can to facilitate recovery and those whose sexual and urinary dysfunctions reverse in a few months’ time. As for data comparing the overall health of patients who undergo robotic surgery as compared with those who opt for open surgery, studies are not complete.
If robotic surgery seems so promising, why aren’t more doctors using it? Dr. Tewari, an “early adopter” suggests that they may come on board, but at the moment we are in a “transition” period, and the technique is still catching on. Inertia is hardly peculiar to medicine. It takes time for professionals in any field to feel comfortable with new procedures. Surgeons want to be excellent at the get go, Dr. Tewari says, but think that their initial cases will not be up to speed and so they may hang back a bit, want more preparation---read more of Dr. Tewari’s numerous articles, perhaps, or watch training videos. But of the future, Dr. Tewari has no doubt: it belongs to robotic surgery.
Increasing numbers of medical schools now include “The Da Vinci System,” ™ as the robotic system is known, in their curricula, and more and more interns are involved in computer simulations--working first on inanimate structures, then animal models and finally on humans, assisting in teams. The machines are expensive ($l.6 million each) but Weill, which has two, is now expecting a third, and schools across the country are acquiring them.
Further refinements are in the works, Dr. Tewari says--smaller and less expensive machines, more portable, with a higher degree of magnification and more integrative of the senses, this last of particular interest to him. He is looking to technology that will provide “tactile” as well as visionary information, enabling doctors to “feel” as well as see better.
The true future of minimally invasive surgery is telesurgery with the surgeon and patient being in different cities or countries, thereby allowing a greater number of patients access to experts in a more cost-effective way. For example, doctors in the United States removed a gall bladder from a patient in eastern France by remotely operating a surgical robot arm. Meanwhile, Dr. Tewari continues in what remains of his so-called spare time to indulge other interests--cricket, reading, listening to music and courteously responding to interviews, with clarity and humor. #