Monmouth Medical Center is First in New Jersey to Perform Two Groundbreaking Robotic Surgeries

Monmouth Medical Center, an affiliate of Barnabas Health, is the first hospital in New Jersey to perform two groundbreaking robotic surgeries taking this innovative technology to the next level: a scarless single-incision laparoscopic hysterectomy and a partial nephrectomy (kidney removal) using fluorescent imaging technology. These innovative procedures offer patients a minimally invasive alternative to traditional surgery with better results.  Monmouth Medical Center is the only hospital in the region employing two of the most advanced da Vinci robotic systems available.

Monmouth Medical Center paved the way in the urogynecology field by performing a hysterectomy utilizing a Single Incision Laparoscopic Surgery (SILS) with the da Vinci Robot. Martin P. Michalewski, M.D., F.A.C.O.G, a urogynecologist with Monmouth Medical Center, performed a SILS hysterectomy through the belly button (umbilicus), leaving no visible scar.

Rather than making three or four separate one-quarter inch abdominal incisions, SILS uses a single one-inch incision in the umbilicus.  The major advantage over traditional laparoscopic surgery is that there are no visible scars as the only scar is hidden within the umbilicus. Since there are fewer incisions, there is significantly less pain as there is less tissue trauma, less bleeding, and less risk of infection or injury from multiple port insertions. 

“We’re proud to be in the forefront of health care by offering this 21^st century procedure to patients requiring pelvic surgery,” said Dr. Michalewski.  “Laparoscopic surgery has moved to a whole new level by adding SILS and robotics, enabling us to perform even the most complex procedures previously limited to open abdomen surgery. The da Vinci Robot and SILS flexible micro-instrumentation ensure an enhanced level of surgical precision previously reserved to neurosurgery.”

Through robotics, SILS and advanced laparoscopy, surgeons can perform the most complicated surgeries more precisely.  The outcomes are better, the recovery time is shorter and patients often return home the same day.

“Despite the fact that non-invasive surgeries are the new standard of care, an astonishing 66 percent of hysterectomies in the U.S. are still conducted through ‘open’ procedures, which were first performed and standardized more than 80 years ago in the 1920s,” said Dr. Michalewski.  “As the use of minimally invasive technologies such as robotics and SILS is changing medicine dramatically, it’s critical for people to research their treatment options to be sure they are receiving the most effective approach that will yield the best results.” 

According to the Centers for Disease Control and Prevention, doctors in the U.S. perform approximately 600,000 hysterectomies a year, making it the second most common surgery for women.  Traditional hysterectomies require a vertical or horizontal incision across a woman’s lower abdomen.  The uterus is removed through the incision, which is then closed. Typically, this procedure requires a two- or three-day hospital stay and up to eight weeks of recovery.  Through laparoscopic surgery from the early 1990s, several small incisions are made on the abdomen to perform the procedure. Robotics was introduced in the early 2000s; standardized Single-Incision Laparoscopic hysterectomy followed almost a decade later.  Fast forward to SILS enhanced with the da Vinci robotic surgical system, which gives surgeons the benefit of 3-D, high-definition imaging.

“Three years ago, my first SILS patients were ecstatic with the results because they didn’t have scarring or pain,” said Dr. Michalewski.  “Now with the addition of robotics, we’ve taken hysterectomies and pelvic floor repairs to a whole new level.  More importantly, as at this time there is much controversy between doctors, FDA and industry leader surrounding vaginal mesh repairs for pelvic organ prolapse and urinary incontinence, we can alleviate patient concerns by offering other options.  We routinely offer to our patients minimally invasive laparoscopic, outpatient procedures (and the most experience in the region with hundreds of cases performed annually) in robotic pelvic organ prolapse and urinary incontinence procedures such as sacral colpopexy that do not require use of controversial vaginal mesh,” said Dr. Michalewski. 

Partial Nephrectomy Utilizing Fluorescence Imaging Technology

Urologist Pierre Mendoza, M.D., of Monmouth Medical Center’s Robotic Surgery Department, performed the first partial nephrectomy in New Jersey for a patient with kidney cancer using a new near-infrared fluorescence imaging guided system available on the da Vinci Si Surgical System.  The specially designed camera and endoscopes enable surgeons to capture images of tissue and surrounding blood vessels by injecting a unique fluorescence dye that is activated by near-infrared light. The result is more precise visualization, allowing finer assessment of tissue while using a minimally invasive approach.

Monmouth Medical Center is among a select group of hospitals in the country to first utilize this technology. “Using fluorescence imaging is revolutionary as it may allow surgeons to differentiate between malignant and normal tissue in real time as cancerous tissue fluoresces less brightly than normal kidney parenchyma,” said Dr. Mendoza.

The enhanced imaging system incorporates a green-colored dye called IndoCyanine Green (ICG) and is utilized for identification of the renal vessels allowing selective arterial clamping during surgery.  “Fluorescence Imaging Technology further advances robotic surgery by adding a tool to potentially minimize vascular complications during robotic-assisted partial nephrectomy, ” said Dr. Mendoza.  “It’s an advantage for both patients and surgeons.”

Real-time application of the technology, combined with 3D visualization, provides a more accurate identification of critical vessels and tissue during surgery.  This surgical approach enables surgeons to pinpoint and remove the diseased or “affected” portions of the kidney with more precision, without removing the entire kidney.  “By using this technology, we can perform complex kidney surgery in a more accurate, less invasive manner,” said Dr. Mendoza. 

“During surgery, it’s critical to stop blood flow to the portion of the kidney that requires dissection, allowing the rest of the kidney to maintain its critical blood supply. Through this technology, we can now confirm ischemia (held blood flow) as well as tissue perfusion (maintained blood flow),” said Dr. Mendoza.

Monmouth Medical Center is leading the way for robotic assisted kidney surgery and will continue to be at the helm with its skilled team of urologic surgeons.

About Monmouth Medical Center

Located in Long Branch, N.J., Monmouth Medical Center, an affiliate of Barnabas Health, along with the Children’s Hospital at Monmouth Medical Center, is one of New Jersey's largest academic medical centers and has been a teaching affiliate of Philadelphia’s Drexel University College of Medicine for more than 40 years. From its earliest days, Monmouth Medical Center has been a leader in surgical advancement and has introduced many technological firsts to the region, including robotic surgery and other minimally invasive techniques. The hospital is routinely recognized by HealthGrades, the nation’s largest premier independent health care quality company, for excellence in both emergency medicine and maternity care. U.S. News & World Report has recognized Monmouth as a regional leader in cancer, geriatrics, gynecology, neurology and neurosurgery. For more information on Monmouth Medical Center, visit www.barnabashealth.org.