Urologist who once held a record in number of robotics surgeries performed in Central New York talks about his new specialty — single port robotic surgeries
By Chris Motola
Q: What is single-port robotic surgery?
A: It’s exactly what it sounds like. Instead of using multiple little holes to stick the robotic instruments into the body to do surgery, it uses a single hole. With the capabilities of technology and engineering advancements, the instruments are smaller and so is the camera. Not only that, but the instruments that are introduced in the abdomen are no longer rigid. They have the ability to flex — articulate is the term the manufacturer uses. The basically move around similar to a flexible arm.
Q: What does that look like?
A: The best way I can describe this is, if you watch Spiderman, how Dr. Octopus uses his arms. With the old robot he would have a rigid arm that could go up and down but not have the ability to curve around corners. So with the new single-port robot the camera and the instruments can all articulate. They all go in through one small hole that is a little bit less than an inch, about two centimeters. Once they go in through that hole they can spread out. They can open up like an umbrella and then move around to where you need them to go.
Q: Aside from the reduced tissue damage, what are the advantages of use a single hole?
A: With the older robots that just about everybody else is using, each of these instruments has to go in through a separate hole. You have to strategically place them so that they don’t run into each other, clang into each other, and cross each other. The camera is a like fiber optic snake like what a plumber might use, so it can wrap around corners and behind things.
Q: Is anything lost by using the SP robot?
A: One of the things you do lose is at the wrist of the instrument. You still have the fingers and the elbow, but the wrist portion isn’t as good. There are only so many points of mobility that you can have. That’s something that has to do with the engineering aspects of the instrument and the material of the instrument. You can’t have everything flopping around and moving. But other than that there aren’t any real limitations. Some people say it’s not as strong. It couldn’t carry a 50-pound weight or something, but it’s used for delicate surgery so that’s really not something that’s necessarily needed. If you needed to lift that weight, though, the stiffer instruments would have the advantage. What you gain [with SP] is better visualization, a smaller hole. And you don’t always have the space to place multiple holes due to things like previous surgeries and scar tissue. Or even just the size of the person or the area you’re working with.
Q: How long have you been using it?
A: Almost two years. It wasn’t until September of 2022 that I received all my training in how to use this new technique and start doing surgeries. We’ve performed well over 250 surgeries, mostly urology, which is what I do, as well as a few very delicate ENT cancer cases.
Q: For the things you can use it on, what percentage of the time would you say you’re using it versus the older robotic platforms?
A: Almost all of my urological surgeries that were using multi-port surgeries have been converted to single-port. Things like prostatectomy and simple prostatectomy, which removes the large prostate. It’s a huge advantage and change for removing the prostate. I also use it for adrenal masses, kidney cancers, kidney repairs, bladder repairs. I could do all that through a single port.
Q: When we spoke back in 2018, you held a local record for robotic surgeries. Do you still have that record?
A: I have the record of doing the most single-port surgeries in Central New York since I’m one of maybe only two in the area that’s been trained on it. But in the case of robotic surgeries more broadly, some people have surpassed me, mainly because I do cancer surgeries. My cases tend to be longer. And a lot of surgeons now use robots for simple surgeries. They can do six, seven or eight of them a day where cancer surgeries you’re doing two or three a day. A hernia surgery can be a 30-minute surgery, where a cancer surgery is usually two to three hours. So I’ve been losing ground, but am still very prolific when it comes to cancer surgeries, and I hope to soon be introducing this technology to everyone else. Right now, myself and Dr. Marzouk are the only ones using it around here. As other surgeons become more curious and the robot gets FDA-approval for other types of surgery, I think other surgeons will be quick to pick up this type of instrument which will provide advantages to our patients in the Central New York area.
Lifelines
Name: Po N. Lam, M.D.
Position: Urologist at Associated Medical Professionals
Hometown: Dallas, Texas
Education: Medical degree from the University of Texas Southwestern Medical Center at Dallas; completed surgical training from the University of Louisville Health Sciences Center. Went on to receive urologic training at the University at Buffalo School of Medicine and Biomedical Sciences. Diplomate of the American Board of Urology. Has authored several peer-reviewed scientific publications and presented his work at national and international meetings
Affiliations: Crouse Health, St. Joseph’s Health, Auburn Community Hospital, Oneida Hospital
Organizations: American Urological Association; Society of Endourological Surgeons; Society of Urological Robotic Surgeons
Family: Wife, son
Hobbies: Travel, running, finding new restaurants (foodie)