Israeli doctors learn robotics, with the help of local M.D.s

Dr. Deane Penn of Alpine is flanked by visiting Israeli Drs. Jacob Borenstein, left, and Adi Lazar, who came to the United States to learn about robotic surgery. Miryam Wahrman

It has been called “Star Trek Surgery,” but California-based Intuitive Surgical makes sophisticated surgical robots for the here and now. And thanks to a program supported by the Jewish Federation of Northern New Jersey’s Partnership2Gether, Israeli doctors will learn how to use the mostly American-made devices with the intention of introducing robotic surgery into Israeli hospitals.

“They’ve sent us doctors to teach us about emergency reponse and we’ve sent them doctors to teach them about bloodless surgery,” said Dr. Deane Penn, describing earlier aspects of the P2K program. This month the program brought two Israeli surgeons to northern New Jersey for the latest initiative, to improve medical practice and technology in Israel by teaching Israeli doctors robotic surgery. Penn and his wife, Susan, hosted a reception and talk in their Alpine home on July 13, where the two sponsored doctors shared their perspectives with members of the community. Penn, a retired gastroenterologist, works as a medical stock analyst, advising hedge funds on medical technology investment strategies. He also runs The Center for Medical Weight Loss in Englewood with his partner, plastic surgeon Dr. Herbert Feinberg.

“Laparoscopic urology is less invasive than regular surgery, but robotic is even less invasive,” said Penn. “With the 3D lighting effect you can see the tissues better and the robot can get into places that human hands cannot. There is less bleeding, and the patient can leave the hospital the next day,” he added.

The four-armed da Vinci robotic apparatus (named for Leonardo da Vinci who drew and designed the first robot) has computer-controlled mechanisms that hold two or three surgical tools as well as an endoscope, i.e., a tiny camera and light. The advanced systems use algorithms to translate hand movements of skilled surgeons into fine motions of minimally invasive surgery. Since it can be used for removing tumors or repairing tissues with minimal damage, robotic surgery is particularly useful in urology as well as obstetrics. Hence the two doctors chosen for this initial visit were a urologist and an obstetrician.

One of the two doctors, Dr. Adi Lazar, 41, was born in Romania, and attended medical school there. After residency training in Israel and France, he settled in Israel and is now a senior urologist at Western Galilee Hospital in Nahariya.

“Most of the radical prostatectomy in the U.S. is done by robots,” said Lazar. When traditional prostate surgery is performed there is a significant risk of complications such as incontinence and impotence. Lazar explained that with robotic surgery, prostate cancer survival rates are better, with fewer side effects. He estimated that the systems for robotic surgery could cost between $1 million and $2 million.

Dr. Jacob Borenstein, 56, who has served as the head of obstetrics and gynecology at Western Galilee Hospital, came to the United States with the program to learn about robotic surgery for gynecology.

“Robotic surgery is very successful in the pelvic region,” said Penn. “It is a narrow area and very difficult to see, so it is hard to dissect the area.” Robotics are used to remove benign cancers of the uterus and ovaries, explained Penn.

Borenstein’s medical niche is the lower female genital tract. He practices gynecologic oncology and laser therapy and does research on the human papilloma virus, which causes cervical cancer. He said that “every day I make 25 to 50 decisions, many of them life and death.” He recalled that when he came to WGH in 2003, “laparoscopy was very minimal. We began a service of laparoscopy for ectopic pregnancies, salpingectomies [removal of Fallopian tubes], treating ovarian cysts, and now hysterectomies and other advanced laparoscopies.” However, he added, “robotic surgery helps you do surgery easier, better, preserving nerves and blood vessels. It is very successful.”

Borenstein also spoke in detail about medical education in Israel, providing information on a medical school that is about to open in the northern region of the country. He was recently appointed associate dean of the new medical school.

“There are big problems with the number of physicians in Israel,” said Borenstein. “In the ‘90s there was immigration from Russia and many physicians came,” he said. However, now the country is faced with a shortage of doctors, as the four medical schools — Hebrew University’s Hadassah Medical School in Jerusalem, Tel Aviv University’s Sackler School of Medicine, Ben Gurion University Medical School in Beer Sheva, and Technion Medical School in Haifa — do not produce enough doctors for Israel’s needs.

“Each medical school produces about 80 to 100 graduates per year, but we need at least twice that number,” said Borenstein. He reported that some Israelis go to Europe to study, for instance to Hungary and Italy. “But the tuition in Hungary is three to four times that of Israel. So we needed another medical school.

“There was a big fight as the deans of the other schools did not want a new one. But the decision was made to fund a new medical school and put it in the Galil, since there was fear that [the region had] less and less Jews,” said Borenstein. Where in the Galil would the school be situated? “This led to another fight. Every hospital [in the north] wanted it nearby,” he said. Although Western Galilee Hospital was the largest in the region, with 700 beds, the decision was made to build the new medical school in Safed, at the Rivka Ziv Hospital. “But it could not be the main teaching hospital as there were not enough patients for students to be exposed to,” said Borenstein. So WGH in Nahariya, which was already affiliated with Technion for training medical students, became a teaching hospital for the new medical school as well.

The school, which will be part of Bar Ilan University, does not have an official name yet, but Borenstein reported that it may be called “Ilan BaGalil,” which means tree of the Galil. “The campus is in a beautiful place in Safed,” he said “It has two classes … a total of 110 to 120 students, registered to start in October.” Borenstein reported that about half the entering class is female. “The students are excellent, but we were surprised that there are very few non-Jews, perhaps four or five, in the class.” This was surprising since the hospital serves about 50 percent Jewish and 50 percent non-Jewish (Druze, Muslim, and Christian) patients.

Borenstein also spoke of the economics of the medical profession in Israel. “The salary became lower and lower, so that a doctor who works full time in a hospital can’t make a living. You need a private practice in addition.” As a result, said Borenstein, “Now there is an ongoing strike of physicians in Israel.” Because they cannot completely suspend the practice of medicine throughout the country, “every week somewhere else they are not operating. It is already in the courts.”

While Israeli medicine had been proud to be at the forefront of medical science, “We now feel that we are a little behind. It has deteriorated,” said Borenstein. “To buy equipment back home, we need donations.”

Borenstein was scheduled to spend a day in the department of obstetrics and gynecology at Englewood Hospital and Medical Center with Drs. Theodore Tobias and Michael Vardy, observing procedures and learning about the technology. Dr. Adi Lazar visited Mount Sinai Medical Center, together with Penn, where he met with and observed urologist Dr. David Samadi, a pioneer of the SMART system for robotic surgery of the prostate.

Lazar also joined Drs. John Scheuch, urologist, and Penn, Partnership2Gether’s Medical Task Force chair, at Holy Name Medical Center in Teaneck that day.

Bernard Hammer of Teaneck has been involved with Partnership 2000 from the beginning. “The exchange with doctors has been very meaningful to those doctors and their patients,” said Hammer. Hammer explained that the original partner community was in the south, at Ofakim, but it did not work out, and was soon changed to Nahariya, where the hospital served a more diverse community. “Overall, it’s been an interesting and successful project,” he said.

Dr. Ted Tobias, who has also been very active in the Partnership 2000 bloodless surgery program, spoke about the success of that training initiative in Israeli hospitals. “Western Galilee Hospital is one of the major hospitals for bloodless medicine. It is outstanding in bloodless medicine, which has led to saved finances and increased health of patients. The Jewish Federation of Northern New Jersey has made a tremendous contribution in that area.” He continued, “Englewood Hospital has the best machines and we hope to bring Israeli surgeons there, in order to export robotic surgery to Israel.”

For more information on JFNNJ’s Partnership 2000, go to www.jfnnj.org/section.aspx?id=59, or call Sarit Ron at JFNNJ at (201) 820-3907.

Miryam Z. Wahrman is professor of biology at William Paterson University, where she is also director of the Federal Department of Education Math and Science Teachers Project.