Cutting Edge Advances for Male Infertility and Testicular or Groin Pain.
By Nancy Devault, Staff Writer
Male infertility and chronic groin or testicular pain are conditions that inflict a great deal of angst and frustration for patients. There is a great deal of difficulty and trepidation in openly discussing these issues. The effective care and management of these patients requires a sensitive, dedicated multi-disciplinary team approach led by a specialized type of urologist – an Andrologist. Sijo Parekattil, MD is the only dual fellowship (Cleveland Clinic Foundation) trained andrologist and robotic microsurgeon in the country and is the Director of Urology and Robotic Surgery at Winter Haven Hospital. He is also a Clinical Assistant Professor at the University of Florida. Dr. Parekattil is an award winning researcher, innovator and physician who has earned numerous honors including America’s Top Urologists (2009).
Male Infertility, Vasectomy Reversal & Groin / Testicular Pain Program
In 2010, Dr. Parekattil established the Winter Haven Hospital Robotics Institute, in affiliation with the University of Florida, with the launch of the male infertility and groin / testicular pain program. According to Dr. Parekattil, approximately fifteen percent of all couples trying to conceive a child face fertility issues. Among those, up to fifty percent of conception problems may be attributed to male infertility factors. He reports the causes of male infertility can range from genetic and physiologic issues to environmental causes. To find the most appropriate solutions, the Male Infertility Program at Winter Haven Hospital offers a comprehensive diagnostic workup as well as a full array of treatment options to ultimately achieve conception. For Dr. Parekattil, helping couples achieve a successful pregnancy is one of the most rewarding aspects of his work.
Until the recent use of robotics, Dr. Parekattil says surgical treatments for male infertility had remained unchanged for decades. Over the past several years, Dr. Parekattil has conducted a controlled trial to analyze robotic assisted vasovasostomy (RAVV) and vasoepididymostomy (RAVE) in comparison to standard microsurgical vasovasostomy (MVV) and vasoepididymostomy (MVE). His findings, to be published in the September issue of the Journal of Reconstructive Microsurgery, illustrated that the robotic assisted procedures decreased operative duration and improved the rate of recovery of post-operative total motile sperm counts. This is the first prospective cohort database study of its kind clearly showing advantages to the use of robotics in microsurgical vasectomy reversal and congenital obstruction reconstruction. Optimum outcomes for vasectomy reversals are typically achieved within three years of the initial vasectomy; however Dr. Parekattil has achieved favorable results in patients thirty years out from their vasectomy procedure. Patients and their surgeon can also pre-operatively use the Vasectomy Reversal Predictor, an algorithm developed by Dr. Parekattil that calculates the likelihood of requiring a more complex vasectomy reversal called vasoepididymostomy (www.RoboticInfertility.com). Dr. Parekattil was the first to perform this kind of complex bilateral vasectomy reversal robotically in 2007, and continues to achieve an impressive ninety-seven percent success rate for bilateral vasovasostomy (vasectomy reversal) cases.
Groin or Testicular Pain
In addition to male infertility interventions, Dr. Parekattil regularly treats chronic groin and/or testicular pain, a symptom identified in about 100,000 men annually. “This type of pain is attributed to hypersensitive nerves in the groin, perhaps activated from a prior trauma to the area. It’s difficult to treat this dysfunction because unlike a tumor, we are not removing a mass, but instead working to eliminate pain by targeting specific nerves. We have developed a unique Winter Haven Groin Pain Classification System to identify the type, location and potential root cause of the pain,” he explained. This group is also the first to identify three specific nerve fiber branches of the ilioinguinal and genitofemoral nerves in the spermatic cord that have Wallerian degeneration as a possible cause for this pain. This work was recently presented by Dr. Parekattil as a key plenary session presentation at the Annual 2012 American Urology Association Meeting in Atlanta.
“The groin and/or testicular pain treatment goal is to desensitize the problematic nerves which may start with physical therapy, pain management and non-invasive urology treatment options. When these fail, we have developed a targeted robotic assisted microsurgical denervation procedure to target these nerves in a minimally invasive manner without affecting the bulk of the nerves and function of the spermatic cord and testicle. In 2008, we performed the first such successful procedure for the treatment of this condition. It’s an effective fifteen to thirty minute outpatient procedure.” describes Dr. Parekattil. Dr. Parekattil has now performed over 400 of these procedures since then: 85% of these patients have a fifty percent or greater reduction in pain and 72% have complete elimination of pain. Female patients with groin pain are also treated.
Sijo Parekattil, MD: Central Florida‘s Andrologist and Global Robotic Microsurgeon
Dr. Parekattil is pioneering the use of robotic assisted treatments in microsurgical urologic procedures. He has published well over one hundred scientific abstracts, delivered over a hundred presentations at major meetings, nearly thirty peer reviewed publications and three medical books: Robotic Prostate Cancer Surgery (2010), Male Infertility: Contemporary Clinical Approaches, Andrology, ART & Antioxidants (2012), and TeleMicrosurgery (late 2012). His educational path began with electrical engineering when he began college at the age of 15. After completing his bachelor’s of engineering degree at the University of Michigan, he became interested in the world of medicine and decided to apply for medical school. This has given him a unique background to be able to apply his engineering knowledge in the area of robotic surgery.
“I was working with various chips and microscopes and thus my interests evolved into surgical techniques incorporating technology, robotics and microsurgery. I knew I wanted to invest in developing solutions and apply my skills to the unique tools of urology,” explains Dr. Parekattil. He completed his urology residency training at Albany Medical Center, followed by two fellowships at the Cleveland Clinic Foundation in Laproscopy/Robotic Surgery and Male Infertility/Microsurgery. Dr. Parekattil says his motivation within ‘this less sexy medical field’ is in part due to his extensive training and background, but more so due to his own personal experience. “I’ve been on the receiving end of such care, so I can relate to my patients, especially since many forgo medical intervention due to fear of broaching the topics of male infertility and groin or testicular pain.”
Winter Haven Hospital Robotics Institute – A Global Leader
The Winter Haven Hospital Robotics Institute has pioneered cutting edge treatment procedures using an advanced one-of-a-kind five arm robotic unit to perform urology related microsurgeries. The initial financial investment of is up to eight or ten times the expense of conventional equipment. However, Dr. Parekattil feels that the benefits of using the robotic equipment so positively impact both the medical team and the patient that it outweighs the increase in investment. “We have improved magnification (up to twenty times) and have two additional camera views (three views compared to one with standard microscopy). One of the camera views allows us direct communication to work in unison with the lab. We’re able to work more efficiently as a team since we can also use 3 instrument arms, instead of just two, thus reducing reliance on a skilled assistant. Surgeon tremor and fatigue is eliminated. Most importantly, patients experience an improved result, which is our first priority. The improved surgical efficiency has actually led to decreased out of pocket costs to the patient.” Additionally, the Winter Haven Hospital Robotics Institute offers some new imaging technology for patients: the smallest Doppler and ultrasound technology available for refined diagnostic assessment.
Robotic Assisted Microsurgical & Endoscopic Society (RAMSES®)
Medical advances through robotic assisted surgery are on the rise worldwide, especially among microsurgeons who practice urology, plastics, reconstructive and hand surgery. In 2010, the Robotic Assisted Microsurgical and Endoscopy Society (RAMSES®) was founded with an international board of directors (www.roboticmicrosurgeons.org). The mission of RAMSES® is to further develop and study surgical outcomes and establish best practice guidelines regarding management of conditions utilizing robotic assisted microsurgery. Dr. Parekattil is one of the founding board of directors for this society.
Enhancing nurse and surgical training for Robotic Assisted Surgery
Dr. Parekattil has performed a total of over one thousand robotic assisted surgeries, serving patients seeking these effective high-tech treatments from throughout the United States and many countries abroad. He has performed more robotic assisted microsurgical procedures than any other surgeon in the world. The comprehensive team performing the various complex robotic procedures is comprised of the surgeon, surgical assistant, anesthesiologist, operating room technician, and several nurses. The nursing team has always and will always continue to play an integral role in the robotics program. However, there has been a paucity of formal external credentialed operating room nurse or technician training for these team members. Due to this need, Winter Haven Hospital has recently aligned with Polk State College to offer the first of its kind robotic surgery certification course, especially designed for operating room nurses and technicians. Launched earlier this month and to be held quarterly, the course will offer “didactic hands-on, one-on-one training in the setup, operation, positioning and technical problem solving for robotic assisted surgical procedures.” The next upcoming session will be held in November 2012 (www.roboticnursing.org).
Continuing to establish themselves as the global leader in the expanding field of microsurgical robotics; Winter Haven Hospital along with University of Florida examined alternative robotic microsurgical training models to decrease surgical learning curves for trainees. “Existing training models (rodent and cadaver) are quite tedious and expensive,” says Parekattil. “We have developed a Lego® construction model approach to create the challenge of using multiple robotic arms (at least three) to accurately build structures such as the Empire State Building with robotic assistance.” A small preliminary study actually demonstrated that this technique could provide an equivalent teaching model for the development of robotic assisted microsurgical skills. The program is in the process of enrolling a multi-institutional study to further assess this methodology.
Robotic Assisted Surgery training to inspire our youth
Dr. Parekattil is also engaging with those that might have just recently grown out of using these Lego® blocks simply for fun! Showcasing the da Vinci© Si High Definition Robotic Surgical System, Dr. Parekattil has launched a new program called “Scholarobotics” (www.scholarobotics.org). This ‘hands-on’ and ‘sit-on’ educational experience is geared toward presenting students, parents and the community at-large with the basic concepts of robotic assisted surgery. Held in the Grande Lobby at Winter Haven Hospital, attendees can explore the da Vinci© Robot equipment and learn about the microsurgical tools utilized during robotic assisted microsurgery.
Another youth focused opportunity is the ScholaRobotics Academy, open to high school students who have an interest in a science career. This student internship program, sponsored by the Winter Haven Hospital Robotics Institute and Polk State College, offers dual enrollment college credit hours with exceptional exposure to research projects, science and technology labs, and robotic surgery studies. The highlight of this program is that these high school students get to learn actual robotic microsurgical skills and present a project on robotic microsurgery at the International Annual Robotic Assisted Microsurgical and Endoscopy Society (RAMSES®) meeting (www.RoboticMicroSurgeons.org).
The future of the Winter Haven Hospital Robotics institute & Center for Urology
The expert team at Winter Haven Hospital also includes Kevin Lee, M.D., a Urologic Surgeon specializing in aspects of female urology, kidney stones, male erectile dysfunction, incontinence and oncology. In addition, there are two fellows – Ahmet Gudeloglu, M.D., a Robotic Microsurgery Research Fellow; and Jamin Brahmbhatt, M.D., a Robotic Microsurgery Clinical Fellow. Mathew Oommen, M.D. will join the Winter Haven Hospital Robotics Institute & Center for Urology this September. He will bring the very unique combination of being trained both as a Gynecologist as well as a Urologist, having completed two residencies. He will offer focused specialty care to include robotics in female urology, incontinence and oncology. “Though our current patient population does include a small percentage of female patients diagnosed with groin pain, I anticipate that Dr. Oommen’s emphasis on female urology will expand our reach among prospective female patients,” states Dr. Parekattil.
The Winter Haven Hospital Robotics Institute will be relocating to a new 7,200 square foot clinical space on September 1, 2012 in the 610 Corporation/Inland Fiber and Data building in downtown Winter Haven. 1,000 square feet of this clinic space is dedicated to a one-of-a-kind “robotics research and education center”– to facilitate training and education for the robotics nursing and ScholaRobotics programs. “In our new medical facility, we’ll have access to the LambdaRail – one of the world’s fastest Internet network links. This will allow expansion of our global outreach programs by enhancing communication with patients and providing educational webcasts for the robotics medical community,” says Dr. Parekattil. In fact, the Winter Haven Hospital Robotics Institute is slated to host a live webcast to present a robotic assisted microsurgery case during the next Robotic Assisted Microsurgical & Endoscopy Society (RAMSES®) meeting. Hundreds of international microsurgeons from diverse medical fields will attend the conference to be held November 9-11, 2012 at the CAMLS center at University of South Florida in Tampa. Plans are already underway for Dr. Parekattil and his team to also broadcast for the 2013 meeting, to be held at the IRCAD facility in Strasbourg, France, and the 2014 meeting planned for Sao Paolo, Brazil. “Winter Haven Hospital may be perceived by some as a small, community hospital, but our Robotics Institute is truly a global leader in building the movement of robotic assisted microsurgery,” says Dr. Parekattil.
Want to Learn More?
Winter Haven Hospital Robotics Institute
200 Avenue F, N.E. • Winter Haven, FL 33881 • Call for appointments: (863) 292-4652
Fax: (863) 292-4653 • Email: Info@RoboticInfertility.com
199 Ave B N.W. Suite 310 • Winter Haven, Fl 33881
Male Infertility & Testicular/Groin Pain Program • Website: www.RoboticInfertility.com
Robotic Surgery Certification for Nurses /Techs • Polk State College & Winter Haven Hospital
Next session: November 2012 • Register at: www.RoboticNursing.org or call 863-292-3769
A student Internship sponsored by Winter Haven Hospital Robotics Institute and Polk State College
For additional information, visit: www.ScholaroBotics.org or Call (863) 293-1121 x1465
RAMSES® (Robotic Assisted Microsurgical & Endoscopy Society)
Register for the 2nd Annual Meeting at CAMLS, Tampa, Nov 9-10th, 2012