When Jake Sharaf, MD, graduates from The Mount Sinai Hospital’s Plastic and Reconstructive Surgery Residency, he will have a unique set of skills that few of his peers, or practicing plastic surgeons, possess.
“I have been training in robotic-assisted microsurgery,” says Dr. Sharaf, who is in his sixth and final year of residency. “Having exposure to this technology during residency has been a huge advantage, especially as the technology continues to expand in the field of reconstruction.”
Dr. Sharaf is among the first cohort of residents to receive robotic-surgery training, a source of pride for program director Alice S. Yao, MD. An alumna of the program, she introduced the technology to the division when she joined the hospital as an attending in 2016. Since then, she has watched other fields, such as urology, rapidly adopt robotic-assisted surgery to achieve improved outcomes among patients. Plastic surgeons, for the most part, have had limited involvement in, or access to, the technology’s potential.
“It did not catch on quickly in the field because surgeons do not need the robot to achieve the nuances that you want to achieve in facial or more cosmetic surgery,” explains Dr. Yao, Associate Professor of Surgery at the Icahn School of Medicine at Mount Sinai.
“As more patients ask for less invasive procedures, more surgeons are starting to request this skill. But it is almost impossible to learn if you do not do it in residency, because you have to take time off from your practice to visit one of a handful of hospitals that specialize in this surgery.”
Members of Mount Sinai’s Plastic Surgery Residency program undergoing robotic-assisted microsurgery training. From left: Arjun Nanda, MD, PGY-1; Perri Vingan, MD, PGY-1, Alice Yao, MD; Sabrina Shih, MD, PGY-2; and Jake Sharaf, MD, PGY-6 (Chief Resident)
By incorporating robotic-assisted training into the program, Dr. Yao is giving trainees an advantage when they enter the field. Each resident begins training in the hospital’s simulation lab, which offers a safe and controlled environment to gain proficiency and confidence. Residents subsequently assist in patient surgeries, initially observing and assisting with port placement and system adjustments, eventually progressing to performing robotic-assisted procedures under Dr. Yao’s supervision.
“The technology is not officially indicated for plastic surgery, so we are using it mainly for procedures I have trained on, which involve breast reconstruction,” Dr. Yao says. “The goal is that by seeing how the technology is used in these cases, they will go on to explore new ideas for its use.”
Mr. Sharaf says most of his robotic-assisted surgery training has involved latissimus dorsi muscle flaps and deep inferior epigastric perforator flaps. “Over the years, we’ve used multiple robotic techniques and have seen firsthand how much the field has advanced,” he says. “We are really fortunate to be learning from Dr. Yao, who is one of the few surgeons in the country using the robot for reconstructive procedures.”
Dr. Sharaf, Chief Resident, participates in the robotic setup and surgery.
Drs. Yao and Sharaf set up the access port for the robot.
A resident must learn to use special equipment when setting up the device.
The bedside setup and troubleshooting are some of the more difficult aspects of the surgery due to the many complex parts of the device.
The introduction of robotic-assisted training builds on a tradition of innovation that began with the foundation of the Department by world-renowned surgeon and educator Arthur Barsky, MD, in 1952, whose earlier work helped Hiroshima victims, including those with severe burns and facial disfigurement. This legacy has continued under Peter Taub, MD, MS, FACS, FAAP, the current Chief for the Division of Plastic and Reconstructive Surgery, Mount Sinai Health System, whose leadership, beginning in 2021, has shaped the Department into a leading center for craniofacial and pediatric plastic surgery.
Over the years, the program has earned a reputation for excellence through a graduated approach to training that Dr. Yao believes is unique for encouraging independent thinking. “That starts when the trainees are interns,” Dr. Yao explains. “We ask them questions such as what suture they would use in a case, so they build confidence in their decision-making, even as they are monitored and supported. The goal is they will graduate as self-sufficient, independent thinkers who are also collaborative.”
A surgeon operating on the surgeon console.
The video monitor shows a clear display to all team members of what the surgeon sees.
Training a resident on the surgeon console
The robotic device can reach remote areas of the body easily.
It is an approach to training that appealed to Sabrina Shih, MD, a PGY-2 resident. She says she has benefitted from clinical experience, managing her own panel of patients through preoperative workups, planning surgical techniques, and providing postoperative care.
“That experience helps us transition from residency to attending responsibilities,” Dr. Shih says. “We are also very fortunate to have attendings who consistently ask for our input and value our role as providers.”
Dr. Yao is exploring other opportunities to build skills that give residents an advantage upon entering the field. She is looking at the potential of virtual reality to improve surgical outcomes and is interested in adopting next-generation robotic-assisted microsurgical tools. Each innovation, she notes, is guided by a commitment to ensuring that residents are ready to deliver outstanding care.
“When it is clear that something has value for patients, we are open to embracing it and teaching it to our residents,” she says.
Featured
Alice S. Yao, MD
Program Director, Plastic and Reconstructive Surgery Residency, Associate Professor of Surgery
Jake Sharaf, MD
Chief Resident, Plastic and Reconstructive Surgery
Sabrina Shih, MD
Resident, Plastic and Reconstructive Surgery