By Victoria Stern
In 2015, as her endocrine surgery fellowship at the National Institutes of Health came to a close, Joanne Glanville, MD, began contemplating her next move. She already had applied to an MIS fellowship, but was not sold on that option yet. She reached out to her mentor, Stephen Pereira, MD, for guidance.
Dr. Glanville had no idea how perfect her timing was. For the past year, Dr. Pereira, who heads the private practice Stephen G. Pereira, M.D. and Associates, and is chief of robotic general surgery at HackensackUMC, both in New Jersey, had been designing a general surgery fellowship program in robotic surgery. Recently, he had received institutional support for the yearlong fellowship from HackensackUMC surgery chairman Martin Karpeh Jr., MD, and was looking for his first fellow.
Dr. Pereira told Dr. Glanville he had an idea but needed a day or two to iron out the details. When they spoke on the phone a few days later, Dr. Pereira offered Dr. Glanville the fellowship position. She accepted without hesitation.
In July, Dr. Glanville started the one-year, robotic-focused program. Initially, she did simpler cases, simpler elements of more complex cases, and received training on port placement and robot positioning, all under the guidance of Dr. Pereira or his partner Adam Rosenstock, MD. “For instance, during a colon resection, Dr. Pereira would let me take down the colon and then he would complete the rest of the operation, walking me through each step,” Dr. Glanville said.
As Dr. Glanville gained more experience, she was able to complete these complex cases from start to finish, with Drs. Pereira or Rosenstock at the bedside ready to assist if needed. “By the end of the year, I had completed a high volume and diverse mix of robotic cases on my own,” Dr. Glanville said.
More specifically, she performed more than 200 cases robotically from routine cholecystectomies to more complex abdominal wall hernias, inguinal hernias, fundoplications, splenectomies and colectomies. Reflecting on Dr. Glanville’s progress, Dr. Pereira said, “Her development—the proficiency, ease and comfort she acquired—was unbelievable. The entire process became second nature to her.”
He used Dr. Glanville’s case variety and volume to apply for accreditation through the Fellowship Council. “We just received accreditation approval last year and are officially on the fellowship match list,” Dr. Pereira said.
As the first person to fill the role, Dr. Glanville played a big part in designing the program to suit her needs and anticipate those of future fellows. Dr. Glanville, for instance, did not want to lose her open or laparoscopic skills over the year, so she shaped her training to incorporate laparoscopic and open cases at the practice and the two affiliated hospitals—HackensackUMC and HackensackUMC at Pascack Valley.
“I could be involved in as much laparoscopic or open surgery as I wanted, which kept those skills sharp,” she said.
Anusak Yiengpruksawan, MD, FACS, agreed that it’s important for surgeons not to limit their training to one area. “In surgical training, you want to have skills in every aspect, not just robotic surgery. I think the robot should be part of a more comprehensive surgical training program.”
In addition to surgery, Dr. Glanville participated in the full spectrum of patient care from pre-op to post-op. As the fellowship progressed, she also gained experience teaching residents robotic skills, guiding them through simpler cases in much the same way that Drs. Pereira and Rosenstock did when her fellowship began.
Ultimately, the mark of a successful fellowship is how well a surgeon transitions to practice. Now at Surgical Associates of Richmond, in Virginia, and equipped with a range of new technical, teaching and patient care skills, Dr. Glanville has found the transition to be a smooth one.
“It was an amazing year that prepared me robotic-wise and patient care–wise,” she said. “I learned so many technical tricks on the robot, and I felt so confident when I went off on my own.”
Currently, the fellowship is in its second year and the team is receiving applications now for 2017-2018. Given the recent fellowship accreditation, “we’ve seen an uptick in interest, with about two dozen applicants so far,” said George Mazpule, MD, who joined the practice in August. Dr. Mazpule also noted that HackensackUMC recently purchased three new Xi robots (Intuitive Surgical), installed in January, which brings the total to four robots, including the Si model that Dr. Glanville trained on during her fellowship.
This robotic fellowship is not the only option for surgeons interested in intensive robotic training. Erik Wilson, MD, professor and vice chair of surgery at the University of Texas Medical School, in Houston, has run a robotic-specific fellowship program for many years, as has Vincent Obias, MD, at George Washington University, in Washington, D.C. Shorter robotic courses and MIS fellowships, which include robotic training, also are available throughout the United States. Back in 2010, for instance, Dr. Yiengpruksawan created a one-year Advanced GI Surgical Fellowship Program, which provides extensive training in open, laparoscopic and robotic surgery.
“Robot training is necessary because it offers different advantages, opportunities and skills to open or laparoscopic surgery,” said Dr. Yiengpruksawan, director of the Valley Hospital Institute for Robotic and Minimally Invasive Surgery, in Ridgewood, N.J. Given that robotic surgery relies on visual, not tactile, facility, “when you perform robotic surgery, you need expert knowledge of anatomy and imaging,” he said. “That is also why training for complex cases must focus extensively on preoperative planning.”
Regarding the importance of robotic fellowships, Dr. Pereira sees robotics as the leading edge in surgery, much like laparoscopic surgery was in the 1980s and 1990s.
“The robot opens up a whole new frontier of advances, which is why training is so important,” he said. “Surgeons as humans can improve, but there will always be certain limitations to what we can do. I think robotics takes those limitations and improves or eliminates them.”