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Lee Farber, DO, and Dr. Choi are skilled, compassionate and dedicated robotic-surgery specialists who use the most advanced technology at Vassar Brothers Medical Center. When choosing a surgeon, patients should employ the attention to detail put into constructing a pyramid. level of dexterity similar to that of the human wrist. "Operating on the pelvis with lapa- roscopic instruments, for example, is difficult because the curved sacrum and pelvic bone obstruct your ability to reach certain tissues," Dr. Choi says. "In this case, you have to essentially bend the tissue to the will of your instrument by placing your laparoscopic apparatus near the tissue and then grasping the tissue and pulling it toward your tool. With the surgical robot's wristed instrumenta- tion, you can move your tools around the curve to reach tissues in difficult-to-access areas, which allows you to be gentler on the tissue." These advances allow Dr. Choi to perform minimally invasive colorectal surgery and ventral, inguinal and complex hernia repair. These procedures are much less feasible — and in the case of complex hernia repair, impossible — using laparo- scopic equipment. Dr. Choi also utilizes the robotic surgical system to complete complex colon and rectal tumor resection. "Successfully treating cancer takes pre- cedence over using a minimally invasive approach," Dr. Choi says. "If I have to perform open surgery to make sure I've removed the entire tumor, I will open the patient. Because the visualization and instrument articulation are so much better using the surgical robot, however, I rarely have to convert to an open surgery. This is important because open surgery can cause wound infections and other complications that delay the onset of chemotherapy and other treatments, which can ultimately impact overall survivorship." Advances in Robotic Surgical Equipment The da Vinci Surgical System is not a static technology. Since it was unveiled in 1999, it has undergone several enhance- ments. The third- and fourth-generation robotic surgical systems — the da Vinci Si and Xi surgical systems — represent significant advancements over the first- and second-generation systems. A new feature of the da Vinci Si Surgical System is the specialized instrumenta- tion that allows for single-site surgery performed through the patient's umbi- licus. The da Vinci Xi Surgical System, a relatively new technology that Vassar Brothers Medical Center acquired in December 2014, was designed especially for bariatric, general and colorectal sur- geries and affords surgeons the ability to seamlessly perform multiquadrant abdominal surgery. "The da Vinci Xi Surgical System is a game changer," Dr. Choi says. "Robotic surgery really started to make sense for me as a general surgeon when I began using the da Vinci Xi Surgical System." The beauty of the system lies in its newly redesigned surgical arms and overhead upper-arm instrument architecture, which allow for greater range of motion and anatomical access within the abdomen. "The da Vinci Xi Surgical System gives surgeons more mobility," Dr. Choi says. "With the older versions of the robot, physicians operating on both the left and right quadrants had to undock the robot, move it to the patient's other side and reconnect the equipment, which requires an entire operating team and forces us to pause surgery for five to 10 minutes. With the da Vinci Xi Surgical System, we no longer have to move the robot — the platform's mobility allows us to easily reposition the surgical arms as needed." Minimally Invasive Colorectal Surgery Colectomy and lower anterior resection to treat colorectal cancer and diverticulitis are among the most common procedures Dr. Choi performs using the da Vinci Xi Surgical System. Though the intricacies of each surgery differ depending on whether surgeons are removing a colorectal tumor or treating diverticulitis, the overall approaches are similar. During robot-assisted colorectal surgery, the surgical ports are placed and camera inserted through several keyhole-sized incisions in the patient's abdomen. Once the surgical tools are in place, Dr. Choi visualizes the ureter to prevent damage to the structure and visualizes and dissects the blood supply. The artery supplying blood to the related area of the colon or rectum is then transected using the COV ER FE AT UR E 8 | Mid Hudson MD NEWS ■ M D N E W S . CO M