Da Vinci Robotic Colorectal Cancer Surgery [Interview][Transcript]

Guests: Dr. Jerald Wishner and Mrs. Gina Neri

Presenter: Neal Howard

Guest Bios:

Jerald D. Wishner, MD, FACS

Dr. Jerald Wishner is the Co-Director for The Institute for Robotic and Minimally Invasive Surgery and the Medical Director for the Colorectal Surgery Program at Northern Westchester Hospital. Dr. Wishner is Fellowship trained in both colorectal and minimally invasive surgery, has received advanced training in robotic laparoscopic surgery, and has been designated as a trainer for robotic general and colorectal surgery by Intuitive Surgical.

Gina Neri

Within days of learning she was pregnant with her 3rd child, Gina – a 39 year-old lawyer living in NYC – learned she had colon cancer. Her only symptom was rectal bleeding and she had no family history of cancer.  Wanting to keep the baby, she met with several surgeons who told her that she wouldn’t be able to if she underwent traditional surgery. That’s when she explored the option of robotic-assisted surgery with the da Vinci System for a minimally-invasive alternative.

Segment overview: In this segment, Dr. Jerald Wishner and Gina Neri talk about the da Vinci system robotic assisted surgery.

Transcription – Da Vinci Robotic Colorectal Cancer Surgery 

Neal Howard: Hello and welcome to Health Professional Radio. I’m your host Neal Howard, thank you so much for joining us today. March is Colon Cancer Awareness Month. In studio with us today, we have returning guest Dr. Jerald Wishner. He’s Co-director of the Institute for Robotic and Minimally Invasive Surgery and Director of Minimally Invasive and Colorectal Surgery Program at Northern Westchester Hospital. Joining him is another returning guest, this is Gina Neri. Discovered that she was suffering with colon cancer within days of discovering that she was pregnant with the third child. These two have come together and they’ve got a fascinating story about technology and hope. Thanks for coming in both of you.

Dr. Jerald Wishner: Thank you very much for having us.

Gina Neri: Thank you.

N: Gina, when you were here with us before, we talked about you being diagnosed with colon cancer almost simultaneously as discovering that you were pregnant with your third child, a devastating diagnosis to say the least, but not a deal breaker. Talk about your diagnosis with cancer.

G: I was 39 years old and it was 2015, the day after Easter, I had one instance of rectal bleeding and that instance of rectal bleeding scared me enough and I went to my primary care doctor who’d done took some rule out testing including a pregnancy test and luckily, as a precaution, sent me to a gastroenterologist. Then, he performed the sigmoidoscopy and we found the tumor and found out that I was pregnant.

N: Dr. Wishner, you’re Co-director of Institute for Robotic and Minimally Invasive Surgery. Gina is pregnant and she’s got colon cancer. This is isn’t something that you see all the time in your practice? Or is it something that’s just a routine surgery?

W: No, quite the opposite in 25 plus years of practice this combination. I’ve never seen this before. Now we do see cancer in pregnant patients, normally it would be breast cancer which poses its own set of problems but obviously, it’s not in the abdominal cavity close to the uterus, we’ll find ourselves from time to time taking an appendix out our gall bladder, out from a woman while they’re pregnant. But for the most part, we used to think of colon cancer as a disease of older patients. That’s changing now as we’re starting to see in younger and younger patient population. But this is the first time I come across a patient who was pregnant and had colon cancer at the same time. I discussed this with many of my colleagues at the time as well and really no one I spoke had ever encountered a case like this. That’s not the say that it hasn’t happen, we know it’s happened it’s just extremely unusual.

N: When it came to the initial consultation between you and Gina, sometimes it’s hard enough to get the conversation started especially when it’s something as rare as this going on about how to move forward. The sense of urgency must have been overwhelming.
W: Yes. Normally with colon cancer you have a sense of urgency but you have the time to do things right and take the proper steps and collect the proper information. But certainly in this particular case, because the tumor was in the part of the colon, it was directly behind the uterus, the bigger the uterus would get, the more problematic that would be. Once Gina decided that it was critical to her to do everything she could to not only help herself but to save her developing, her growing child then we made the decision just to proceed along those lines and get things going as could be as we could.

N: You said once Gina decided. Gina, was this an immediate decision or was there a process that led you to this decision to have the type of surgery that we’re going to talk about momentarily?

G: No, there was a decision process going on. I met with Dr. Wishner first and then I went through a slew of other doctors and consulted with them. My husband and I definitely discussed this several times. I had actually scheduled to surgery with another doctor first but the thing was is that doctor had told me that termination was necessary and inevitable. So I cancelled everything and I went back to Dr. Wishner and we discussed further detail of the da Vinci robotic assisted surgery. It was that point in time that I was convinced, that I was going to stay with Dr. Wishner and that I was going to have robotic assisted surgery.

N: Dr. Wishner, the da Vinci method of minimally invasive colorectal surgery, is this something that has been developed there are Northern Westchester Hospital? Or is this something that you’ve become an expert in not necessarily the developer of?

W: Sure. The robot was developed by Intuitive Surgical which is probably the leading company of surgical robotics. In fact this is the only robotic surgical platform approved in the United States to do this type of surgery and this was developed out in California. We’re currently on the fourth generation of the robot the ‘Xi System’ which is the one we use now and the one we used in Gina’s case. Here at the hospital however we’re one of 20 designated epicenter surgeons for robotic surgery so we are at the fore-frontier of the hospital, we train surgeons around the country who come in to see and learn how to do this. As a result, we have the most state of the art system with the most updated, every time there’s new technology that becomes available, new upgrades or new instrumentation, we bring it to our community first. When Gina came in, we have the opportunity to provide her the most current state of the art system to help her and her child.

N: Gina, talk just a bit about your journey through surgery recovery as it relates to the cost-effectiveness of it. Is this something that if someone finds themselves in your position or the position that you were in? How much support is out there for such an advanced technology to be effective?

G: Well, I think that first, you have to know about robotic assisted surgery. I think more and more people are learning about having a surgery performed through this procedure. But I think people initially hear, ‘Oh, you had robotic surgery’. I think some people think that a robot performed the surgery. So I think first and foremost, there needs to be awareness that there is this particular option out there, a robotic assisted surgery meaning a surgeon is performing it with the machine. But then there needs to be awareness of whether or not this is the type of procedure for you. I believe Dr. Wishner did say that, it may not be for everyone and that it’s something that people should consult to see whether or not this is a good fit for them. In my particular case, as I stated before, I can imagine it wouldn’t be a fit for anyone when you hear about the fact that it allows for a 3D HD view inside the body which to me would be a better of view from a surgeon’s point of view. For some other doctors I can’t speak to them. The precision of the cut being better than a surgeon’s cut. I’m just saying that I probably moving forward if I ever needed surgery again and there was a robotic assisted surgery machine that was available for whatever surgery I was needed, I would go with that hands down.

N: Dr. Wishner, this da Vinci method, very effective in this particular case both Gina and her daughter doing extremely well. When it comes to other types of cancers in different locations, is this good for any type of cancer?

W: Certainly, virtually any infra abdominal operation whether it be colon cancer, prostate cancer, bladder cancer, uterine cancer, renal cancer, cancer in the small intestines and stomach, these operations can all be done in many different ways. They can be done with the big incision, they can be done with traditional laparoscopic incisions or the robotic laparoscopic incisions. They’re all options, it’s not a one size fits all proposition. That being said, as the technology has evolved, we’re finding more and more patients or candidates, and in my practice, I’m at a point now where better than 90% of the abdominal surgery I do is done with the robotic assisted approach because as Gina pointed out, you see so much more clearly, you get a much better image and you get a 3D image rather than looking at a regular flat TV screen. The level of precision, instead of just putting kind of straight sticks and that open and close like a scissors, or a clamp, or a pliers, it’s like putting tiny little hands inside of the patient. At the end of the day, seeing much more clearly and being much more precise can only be a good thing when we’re talking about something as important as surgery. More and more, the vast majority of things we do in the abdomen can now be done robotically.

N: Gina, as far as your hospital stay, were you in there as long as you expected to be? Or were you surprised at how long you were in there? Or were you told prior to being admitted that you were going to be there for a certain period of time?

G: Well Dr. Wishner initially told me, usually his patients are in for possibly 2-4 days depending on their surgery. But I felt comfort in the fact that he kept me in close to a week as a precaution. Under my circumstances with the pregnancy and the delicate portion of that, to me I felt safe, I felt cared for and I felt like it was the right move. I don’t know if I would felt as good being released home so soon after having such serious surgery and being in such a delicate state, being so concerned about the baby. For me it was a good thing to be in the hospital. I thank you Dr. Wishner.
W: Yes. I also remember you were a full time moms with two little ones at home that you have to go home and take care of them so you can have an extra day or two of rest, really workout and many reasons.

N: Gina, as far as your recovery and being so young diagnosed with cancer that is mainly in the minds of folks for us older folks, you become an advocate for getting the aged which people are screened lowered. Obviously, very good in your case. Talk about your advocacy and what steps you’re taking to get the word out to raise awareness?

G: Well I joined many colon cancer foundations that are already in existence. I’ve been trying to use my story in any way I can to help spread awareness because I really think that it’s important for people to understand that colon cancer I think us the second leading cancer that’s related to death yet it’s the most preventable cancer with early detection and treatment. If you get out there, and you get tested, and you get treatment, you can survive. But if you don’t get tested and you don’t get treatment that you need, your chances of survival are much lower. With respect to the under age 50 crowd, I really believe that my story resonates with so many people because there is a lot of people out there that know at least one other person who’s been diagnosed with colon cancer who’s been under the age of 50. They feel probably as compassionate as me, ‘Hey, let’s do something about this.’ I’m so glad that, that study by the American Cancer Society came out because I believe that 30 year study showed this trend rising. It’s not just a one year study or a two year study, it’s a 30 year study that’s been going on for a long time and I think it’s finally going to hopefully get the attention that it needs. From my perspective, not only telling my story, I’m trying to open up a foundation in the name of my daughter called ‘Gianna’s Hope’ and I’m in the process of starting it now. I’d like to help and support all people under the age of 50 who’s been diagnosed with colon cancer specifically women who find themselves pregnant with colon cancer. I was so lost during my process and my journey, I don’t want it to be that complicated for other people. I’m not saying that it’s complicated for everybody, but it was complicated for me. I had to go running around with my husband talking to all sorts of doctors and getting all sort of different opinions and then, sorting them out and making such difficult decisions about my health and the health of my baby and not really having a consensus to go with – it was very, very difficult. I just hope by telling my story and hopefully, my foundation one day will help save lives.

N: I’m certain that you’re doing just that today and I thank you both for coming in. You’ve been listening to Health Professional Radio, thanking Dr. Jerald Wishner, Co-director for the Institute for Robotic and Minimally Invasive Surgery and the Medical Director for the Colorectal Surgery Program at Northern Westchester Hospital, joined by Mrs. Gina Neri.

G: Thank you for having us.

W: Thank you so much for having us in.