Changing the Face of Surgical Intervention
see, as well as the most malignant. Historically, surgeons have used technologies such as intraopera- tive MRI, ultrasound and/or CT for guidance during the removal of complex tumors. However, in the case of glioblastomas, where mar- gins are small and require precision due to surrounding tissue, fluores- cence guidance—a recent addition to Englewood Health’s armamen- tarium—has proved most effective. For procedures using this ap- proach, the fluorescent compound is administered orally two to four
hours prior to the induction of an- esthesia. Essentially, it causes cancerous tissues to “glow in the dark,” explains Kevin Yao, MD, chief of neurosurgery at Englewood Health. “Bathing them in bright pink, fluorescent light enables sur- geons to clearly differentiate the cancer from surrounding cells and structures. “When you look at these tumors with the naked eye, much of the tu- mor tissue looks like normal brain. This can make resection very chal- lenging for surgeons and potential-
ly leave patients with devastating deficits postoperatively,” he adds. “Fluorescence guidance enables us to remove more cancerous tis- sue without compromising normal tissue.”
Englewood Health expanded its ro- botic surgery program with the ac- quisition in 2023 of a third da Vinci Surgical System—the robotic plat- form from Intuitive Surgical. The da Vinci robot is the most advanced platform for minimally invasive surgery available today. This technology acts as a natural extension of a surgeon’s eyes and hands, while offering enhanced dexterity and visualization of pa- tients’ anatomy. At Englewood Health, this fourth generation da Vinci technology (the Xi model) accommodates an increasing volume of robotic cas- es, as well as a growing number of robot-certified surgeons across colon and rectal, gynecologic, uro- logic, and thoracic surgery. The health system’s robotic volume has increased over 200% since 2017, when Englewood Health had just one da Vinci surgical system. With the use of the da Vinci robot, Maz Ganat, MD, chief of urology at Englewood Health, performs increasingly complex urologic on- cology procedures, including par- tial and radical nephrectomies for kidney cancer and radical cystec- tomies for bladder cancer. “The Xi is an excellent tool to allow us to continue to provide great care to our patients,” he says, “There is much better vision and mobility for surgeons and faster recovery for patients.” Anna Serur, MD, chief of colon and rectal surgery at Englewood Health, agrees. “For me, the Xi is
like driving a new-model Porsche,” she says. “It is a much better piece of equipment.” Dr. Serur now does oncologic re - sections almost entirely robotically and reports that these patients nor- mally stay just one to two days in the hospital and return to normal activ- ities within one to two weeks. The reduction in postoperative pain is a significant advance and, according to Dr. Serur, very few patients require narcotics during their recoveries. Christos Stavropoulos, MD, director of thoracic oncology at The Lefcourt Family Cancer Treatment and Well- ness Center and chief of thoracic surgery at Englewood Health, says that robotic surgery eases the post- operative course, particularly for pa- tients of advanced age. “In the past, an elderly patient who is frail would not be cleared for a major lung resection,” he says. “But now, because we can do the procedure robotically and very minimally inva- sively, we can operate on this type of patient, and they have good results.” In all these surgical endeavors, the reduction in bleeding from the use of robotic technology is central to En- glewood Health’s focus on bloodless surgery. “We haven’t needed blood transfusions, which allows for a bet- ter and quicker recovery,” Dr. Stav - ropoulos notes. The health system’s early adoption and expansion of robotics has been recognized by Intuitive Surgical, which designated Englewood Health as one of two gynecologic and gy- necologic oncology case observa- tion sites on the east coast.
Fluorescing tissue “lit up” by Gleolan™ facilitates maximal and safe removal of glioma cells from brain tissue during surgery.
Robotic surgeons from specialties in urology, bariatric surgery, colon and rectal surgery, thoracic surgery, gynecology and gynecologic oncology, and endocrine and general surgery.
Nimesh Nagarsheth, MD, medical director of gynecologic oncology and robotic surgery at Englewood Health, has been named a key opin- ion leader by the company. “What that means is surgeons from around the U.S. come to observe our program, watch us operate and learn how we efficiently arrange our patient workflow,” said Dr. Nagar - sheth. “These visitors are seeking to replicate our model at their insti- tutions. When it comes to robotics, Englewood Health is recognized as a regional and national leader.”
Brain Tumor Removal Enhanced by Fluores- cence-Guided Surgery
The Lefcourt Family Cancer Treat- ment and Wellness Center at En- glewood Health is using the latest image-guided technology in the re- section of glioblastomas, the most common type of brain tumor they
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