Background
The practice of surgery has been transformed by the availability of laparoscopic technology, video imaging capabilities, new energy sources for cutting and coagulation, and an ever-expanding base of surgical experience with minimally invasive techniques. When compared with open surgery, studies have shown that these procedures reduce impairment of pulmonary function, reduce blood loss, and decrease suppression of the immune system--a potentially important factor in the surgical treatment of cancer. Patients experience less pain and scarring, and can resume normal activities much more quickly than with conventional surgical approaches.

In 1985, laparoscopic cholecystectomy was first performed to remove a diseased gallbladder and it has since become the standard of care. The procedure was made possible by the computer chip TV camera which can fit easily into the palm of a hand. Improvements in technology and techniques have now enabled surgeons to perform many other types of surgery. Today, minimally invasive surgical procedures are employed routinely in many surgical subspecialties including general surgery, gynecology, pediatric surgery, thoracic surgery, urology, and colorectal surgery.

New York Presbyterian Hospital's new Minimal Access Surgery Center (MASC) is established not only to facilitate the application of these techniques to patient care, but also to serve as a center for research and development of innovative technology and new techniques. Advanced training opportunities in minimally invasive techniques are being offered to practitioners as well as resident physicians-in-training. MASC is a joint program of New York Weill Cornell Medical Center and Columbia Presbyterian Medical Center, and is supported by the outstanding faculty and resources of Columbia University College of Physicians & Surgeons and Weill Medical College of Cornell University. Collaboration between the pre-eminent medical schools and the two highly respected centers of New York Presbyterian Hospital results in a strong program for patient care, training, and research.

Leadership
The Minimal Access Surgery Center is under the direction of Dennis L. Fowler, M.D., a nationally known authority in laparoscopic surgery. He has performed over 3.000 cases to date, and pioneered a number of surgical procedures and techniques that had not previously been performed laparoscopically.

Richard L. Whelan, M.D., a specialist in laparoscopic colorectal surgery, and Director of the Section of Colorectal Surgery at Columbia Presbyterian joins Dr. Fowler in this major initiative. Dr. Whelan serves as Site Director of MASC at the Hospital's Columbia Presbyterian campus. Dr. Whelan has a large experience with laparoscopic colorectal surgery, and studies from his research laboratory have defined much of our understanding about the physiologic benefits of laparoscopy.

What is Minimal Access Surgery?
Minimal access surgery is completed with one or more small incisions instead of a large incision. The surgeon passes a telescope with video camera through a small incision (usually only ¼" long) into a body cavity. He/she then views the surgery on a TV monitor. Surgical instruments are then passed through other similar little incisions. The surgeon examines and operates on the area in question by viewing magnified images projected on a video screen. When the telescope is used to operate on the abdomen, the procedure is called laparoscopy. When used in the chest, the procedure is called thoracoscopy, and when used in a joint, it is called arthroscopy.

Surgical Services at a Glance
The Minimal Access Surgery Center offers the extensive experience of the Hospital's surgeons in a variety of clinical specialties as well as state-of-the-art equipment and facilities. Equipment in operating rooms includes FDA-approved, voice-activated surgical robots that help to position the instruments as well as to control, hold and move the telescope. In addition, operating room systems have been integrated so that the surgeon can control all of the devices with a touch screen panel.

Surgeons from at least six subspecialties are involved in the practice and development of minimal access surgery. These areas include general surgery, gynecology, pediatric surgery, thoracic surgery, urology, and colorectal surgery.

Research and Innovation
The Minimal Access Surgery Center supports the development of innovative technology as well as research studying the outcomes and consequences of minimal access surgery. Some of the current research and development within MASC includes the following:

· Enhancing video imaging technology
· Evaluating the best prosthesis for hernia repair
· Identifying new energy sources for cutting and coagulation
· Evaluating and developing the role of robotics in surgery
· Studying the effects of surgery on the immune system
· Identifying better diagnostic methods in the emergency department or intensive care unit using laparoscopy

An example of this work is in the area of robotics. MASC surgeons are now evaluating robots that control the surgical instruments. These robots are expected to function as an extension of the surgeon's hands, manipulating the instruments as directed by the surgeon. From a console, the surgeon controls the robotic arms that are at the patient's bedside. Unlike current laparoscopic instruments that do not bend, those connected to the robotic arm are designed to mimic the movement of the surgeon's hand and wrist. With this articulation, scaling of the motion, and absence of surgeon tremor, very fine movements can be made in small areas not accessible previously with laparoscopy or thoracoscopy.