Newark Beth Israel Medical Center

Professional Journey and Role Transition

I began my career with an engineering degree from the Cooper Union, which honed my problem-solving skills and creative thinking. As a first-generation college student with parents who left school after fourth grade, I understood the value of perseverance and innovation early on.

After completing urology training at Indiana University, where I was among the first to adopt laparoscopic kidney surgery and performed extensive open surgeries for various cancers, I naturally transitioned to robotic surgery. In late 2004, I took a two-day DaVinci course and self-trained on the robot. By 2006, I helped establish the first DaVinci S training center in the Northeast. In 2007, I performed the world’s first live-streamed robotic kidney surgery, demonstrating the potential of robotics to surgeons worldwide.

Evolution of Surgical Techniques and Patient Management

Early on, I replicated open prostatectomy techniques robotically, carefully preserving critical structures. Over time, I incorporated innovations like the Rocco stitch introduced in 2007 and nerve-sparing approaches developed in Italy to optimize urinary continence and sexual function. For benign prostatic hyperplasia, I progressed from transvesical techniques to a method involving separation of the bladder from the prostate and repositioning it to streamline reconnection. This approach allowed for sameday discharge without the need for irrigation.

In the management of kidney tumors, I pioneered zeroischemia partial nephrectomies, removing tumors without clamping the renal artery to preserve renal function, even in complex cases. Throughout these advancements, my core team—consisting of my original nurse coordinator, surgical technician, and anesthesiologists—provided consistency and expertise that supported our exceptional outcomes.

Key Innovations Introduced in Robotic Urology

I was the second surgeon in New Jersey to perform robotic prostatectomy and the first in the Northeast to conduct robotic simple prostatectomy for benign prostatic hyperplasia, bladder removal and kidney surgery. In 2006 and 2007, I led the world’s early robotic retroperitoneal lymph node dissections for testicular cancer and live kidney surgeries, showcasing both technical feasibility and educational value. By integrating live broadcasts from Newark to Anaheim, I helped catalyze the broader adoption of robotics and informed the design of subsequent training curricula.

“By focusing AI training on tissue outcomes rather than instrument motions, robotic platforms will self-learn procedures like humans, ushering in supervised automation within a decade”

Mindset Shifts for Transitioning to Robotic Platforms

Robotic surgery demands foundations in both open and laparoscopic techniques. Laparoscopy teaches camera navigation, gravity utilization and remote instrument handling, while open surgery instills bimanual dexterity, tactile feedback appreciation and suturing skills. Having mastered both modalities, I rapidly reduced my operative times from two and a half hours early on to less than ninety minutes and achieved proficiency beyond many contemporaries. This diverse surgical experience remains critical for any surgeon transitioning to robotics.

Integrating AI and Machine Learning into Robotic Surgery

I have adopted OpenEvidence, a medical-grade large language model trained exclusively on peer-reviewed literature and guidelines, for accurate insights. It has vastly improved my efficiency in research, patient education and clinical decision making. Looking ahead, Intuitive Surgical’s decades of instrument motion data may give way to tissue-focused AI training so that robots learn procedures from outcome patterns alone. Within ten to fifteen years, I anticipate AI-assisted automation under surgeon supervision, similar to Tesla’s autopilot model, enhancing precision, reducing variability and improving patient safety.

Balancing Technical Precision with Patient-Centered Care

From the outset, I have demystified robotics for patients by showing them the instruments, sharing brief procedural videos and explaining that the robot mirrors my hand movements rather than acting autonomously. As robotics becomes standard care, I now focus on justifying open approaches when patients opt out of robotics. Clear, informed consent, transparent communication and empathetic dialogue remain central to building trust and ensuring patients feel informed, reassured and supported throughout their surgical journey.

Advice for Aspiring Robotic Urologists

Seek comprehensive open surgical experience to grasp the anatomy and spatial context that robotics’ magnified view lacks. Engage in cadaver labs and simulation centers to reinforce three-dimensional understanding. Embrace evolving technologies and AI as essential tools since those who integrate them early will lead the next generation. Leverage platforms like OpenEvidence for continuous learning and precise patient communication. Cultivate a collaborative team culture because consistent partnerships with nurses, techs and anesthesiologists are the backbone of successful robotic programs. These are the few pieces of advice I have for aspiring urologists.