On the cutting edge

The machines are the latest addition to the operating rooms there and Kilkenny-born Dr. Christine Whyte, an expert in pediatric robotic surgery, is working side by side with them.
The 40-year-old surgeon has been at Montefiore Medical Center in Woodlawn since January, working at the cutting edge of what is known as minimally invasive surgery.
Her specialty is the application of this revolutionary means of operating to children’s medicine. Her reasons are clear.
“What I love about children’s surgery is that it’s very rewarding,” she said. “They tend to bounce back quickly, to recover very quickly.”
Whyte spoke last week while in a room at Montefiore filled with complex, multi-armed machines that look more menacing than medical. Pointing to an operating table upon which were three sci-fi-like claws, she said: “We use the robotic arms to operate on the patient and to get access to areas that would otherwise be very difficult without open surgery.”
It surely sounds futuristic, but robotic surgery and surgeons have become a reality. In fact, staff at the new Children’s Hospital at Montefiore hope that the techniques being developed and tested there will soon be used to help children. Whyte is at the forefront of these exciting prospects. She was recruited for that purpose a year ago by CHAM’s chief of pediatric surgery,Dr. Burton Harris.
“I always wanted to be a doctor,” Whyte said. “There were no other doctors in my family. My dad ran a car repair shop, but my parents sent me to college.”
Whyte trained at University College Dublin and her surgical training was supervised by the Royal College of Surgeons in Ireland.
“I quickly developed an interest in pediatric medicine and chose to do most of my training in that field,” she said.
Part of that training involved working in Our Lady’s Children’s Hospital in Crumlin and then a year working in Memphis, Tenn., an experience Whyte said she found particularly useful. “They had a great pediatric department and I learned a lot there,” she said.
She later spent a year working in Colorado before she was headhunted by the Children’s Hospital in Montefiore. “I got a call and they were looking for a pediatric laparoscopist and I wanted to work more in the field of minimally invasive surgery,” she said.
Laparoscopy is a term given to a group of operations that are performed with the aid of a camera that allow a surgeon to perform minimally invasive surgery. Regular laparoscopies require someone to hold the camera while the surgeon stands over the patient doing keyhole surgery. The robotic assisted laparoscopy is much easier. One of the robotic arms holds the camera and can be voice controlled by the surgeon. The surgeon can sit at the surgeon console and operate from there instead of standing over the patient.
Whyte lives in New York with her husband and two children, a son and a daughter who are 3 and 2, respectively. Her husband works in the computer software business.
“My husband got the green card visa, which meant we could all move over to the United States with him,” Whyte said, adding that her family is happy here and her husband has relatives in the Bronx with whom they spend a lot of time.
The Children’s Hospital at Montefiore was designed by avant-garde architect David Rockwell to look as little like a hospital as possible. The lobby is a riot of color and design with a glass tank containing an ecosphere, a Foucault pendulum and various pictures and tiles depicting planets and stars.
Staff members, many of whom are from the Albert Einstein College of Medicine, are some of the best in their fields. Some even wear child-friendly uniforms of pink pants and brightly designed smocks.
“I think that it is an ideal place in which to work with robotic surgery and to make full use of the staff’s knowledge, all the available resources and the hands-on attitude to training,” Whyte said.
Residents must complete training in minimally invasive surgery to prepare them for the difficult techniques and complex machinery in the years ahead.
One of Whyte’s colleagues is Dr. Alan White, director of the Montefiore Institute for Minimally Invasive Surgery. He is the mastermind behind many of the hospital’s innovations.
“He was one of the team of surgeons who performed the operation, which took place in Mexico, that was required for the [Federal Drug Administration] to give regulatory clearance to the robot,” Whyte said.
Whyte is keen to talk about this fast-evolving field of medicine.
“Robotics is changing very fast,” she said. “It is a very new area still. One of the differences between open surgery and minimally invasive surgery with the assistance of the robot is that surgeons must learn new techniques. Using the robotic arms means a loss of feeling and it takes practice to get used to that sensation.”
The residents practice using consoles where they have to manipulate metal arms to tie knot sutures on a sponge. Whyte demonstrated the painstaking exercise. They must complete the intricate task of suturing while looking at their progress on a screen. Dr. Scott J. Boley, the chief of pediatric surgical services, emeritus, calls Montefiore “the premier training center on the East Coast for these techniques.”
Perhaps not surprisingly, NASA is interested in this technology. “NASA has put a lot of money into the development of robotic surgery,” Boley said, “because if a person is up in a space station and that person needed his appendix removed, it could cost several hundred million dollars to bring him back to earth. Whereas they can be hooked up to a robot and operated on.”
Exceedingly complex procedures have already taken place with the help of this technology. A surgeon in New York, for example, has operated on a patient in Paris with the help of ZEUS, as Montefiore’s new robotic surgical system is known, and a surgeon in Paris who inserted the robotic arms.
“We could be sitting here and discuss an operation as it is happening with a surgeon in Ireland,” Boley said. “Other hospitals are following suit and investing in their own robot. However, they’re expensive, with a robotic surgical system costing approximately $1 million. The instruments are delicate and parts that need replacing could cost up to $4,000 or 5,000 apiece. The company who sells the robots provides the hospital with an engineer for one year to deal with any teething problems.”
The move from open surgery to minimally invasive surgery means diminished physical and psychological trauma for the patients.
“Rather than making big incisions, big cuts in people, the thrust of surgery these days is to less invasive methods,” Whyte said.
“You can work in very tiny spaces,” she added. “ZEUS was developed to work on cardio surgery, on the beating heart.”
In fact, a robot has already successfully performed closed-chest coronary bypass surgery on a beating heart.
Computer Motion in Santa Barbara sells the system and insists that surgeons have 40 hours of practice before they can use the machine. “From normal operating to minimally invasive, that’s a major step,” Whyte said. “You go from two dimensional to three dimensional.”
ZEUS consists of three robotic arms that are individually mounted on the operating table and the surgeon console. The surgeon sits at the console, in front of a screen, while moving the console controls with her hands. These hand motions are translated into precise microsurgical movements inside the patient’s body via robotic instruments.
The surgeon must wear 3D glasses for the screen. The camera position and system settings can be voice controlled. Even the steady hands of any surgeon have a natural tremor, but this is absorbed by the robot so that all movements are perfectly controlled. ZEUS is smaller than other robots on the market and fits more easily into an operating room.
Because the images are very clear, Whyte routinely uses the camera to carry out gall bladder operations and laparoscopies.
“I complete maybe up to half of my workload using the robotic camera,” she said. “It is my method of choice for everything from reflux, gall bladder, spleen and appendix.”
At the moment, robot-assisted procedures take longer than traditional surgeries, but Whyte hopes that ultimately that patients will spend less time on the operating table.
Her patients range in age from newborns to 21 and she says that whatever technique is used to operate, “the focus is always on the safety of the patient.”
Both Whyte and Boley say they think that more sophisticated robots will soon be on the market. One potential difficulty is making surgical instruments that are small enough for the robot but also sturdy enough for frequent use. “We need small telescopes for light, but, unfortunately, the smaller the telescope, the fuzzier the picture,” Whyte said.