School of Medicine Alum Is a ROBODOC
Gerald Matthews, M.D. '86, calls on a 7-foot robot to assist in laparoscopic surgery.
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Only about 30 urologists in the country are able to treat complex cases where use of a robot is helpful, according to Gerald Matthews, M.D. '86. He is chief of urology at two College affiliates - Metropolitan Hospital Center in Manhattan and Our Lady of Mercy Medical Center in the Bronx. |
Gerald Matthews, M.D. '86, is your average soccer dad. He's also one of only a few dozen surgeons in the United States who specialize in reversing male infertility through microsurgery, enabling patients who may have given up on having a child of their own to do so.
After graduating from Emory University in Atlanta in 1979, Dr. Matthews, who grew up in the New York area, decided to return to familiar surroundings. He chose New York Medical College because of its reputation and diversity. Looking back on his medical school days, Dr. Matthews says he remembers his clinical rotations most fondly, specifically his surgical rotation.
"I was fascinated with the ability to decisively act at one stage in the course of a disease process and improve clinical outlook with a procedure," he says. "Not only did I find that my interests were surgical, but also my time with the urology service was when I decided what I wanted do." Dr. Matthews credits the late Joseph Addonizio, M.D., then professor and chairman of the Department of Urology, with influencing his decision.
Urology beckons
"What crystallized things for me was that urology seemed to be such a multifaceted specialty - surgical skills were required, endoscopic skills were required, a strong textbook knowledge was required. It really allowed me to practice what I felt was a broad scope of medicine," he says.
Shortly thereafter, Dr. Matthews became drawn to the treatment of male infertility, intrigued by the microsurgical techniques that were being developed and perfected. In 1993 he secured a prestigious fellowship in male reproductive medicine and microsurgery at what was then called The New York HospitalCornell Medical Center in New York City. Two years later he returned to Valhalla as assistant professor of urology and director of male reproductive medicine and sexual dysfunction. He became chief of urology at Metropolitan Hospital Center in 2000 and chief of urology at Our Lady of Mercy Medical Center in the Bronx in the summer of 2003.
Now Dr. Matthews belongs to a very small fraternity of urologists. "There are probably 25 to 30 physicians in the country who specialize in these microsurgical techniques for male infertility," he says. "We're talking about very complicated surgeries to reconstruct the male reproductive tract." While these are not common place procedures, they are not as rare as some might think. He estimates that a male factor is identified in up to 50 percent of all infertility cases.
Robotic repair
The complex techniques that drew him to a career in surgery in the first place have presented Dr. Matthews with his present challenge of repairing and reconstructing the male reproductive tract. A case in point is hernia surgery, which is now performed successfully via laparoscopic surgery rather than an open surgical procedure. However, a little-known pitfall of the laparoscopic procedure is the potential for injury to the vas deferens, the narrow tube that carries sperm from the testis to the prostate and through the penis. It turns out there is a trade-off for not having to perform open surgery; the tight space within the abdominal cavity where the laparoscopic instruments are placed increases the chance that a surgeon could inadvertently cut the vas deferens and not even know it. The result: an accidental vasectomy.
"Your first thought as a surgeon is, if it were laparoscopy that created this problem, then let's do something laparoscopically to help undo what was done," Dr. Matthews says. "Unfortunately, the area in the pelvis where the vas deferens is located is fairly small and not readily accessible with conventional laparoscopic techniques."
But in June 2003, help arrived in an unlikely form. Dr. Matthews enlisted the services of a 7-foot robot to reverse an accidental vasectomy. It was the first time that the robot, known formally as the da Vinci Surgical System, had been used to help restore male fertility. Now it is mainly used for suturing inside the body in a variety of surgical situations.
Surgical slip
One of his first cases was puzzling at first glance; the patient was married and in his late thirties, and had already fathered a child. When he and his wife began having trouble conceiving, they consulted a urologist and discovered his sperm count was zero - perplexing and worrisome news for a man who already had a child and should have at least had registered some sort of sperm count, however low.
"The one thing that stood out when he came to us was that he had undergone hernia surgery since his child was born. We were able to identify that, in fact, there had been accidental ligation of his vas deferens during the surgery," Dr. Matthews explains.
Using the da Vinci robot, Dr. Matthews and his colleague Albert Samadi, M.D., were able to perform precision microsurgery to repair the damaged structure. The difference between the robot and typical laparoscopic equipment is that the arms of the robot are fully articulated and provide a range of motion and dexterity that are impossible to match laparoscopically. Sitting at a separate console with a 3-D image of the surgical area, the surgeon controls the deft movements of the robotic arms, utilizing a minimally invasive procedure while simultaneously having access to a wider visual field that is comparable to what a surgeon would see in a traditional open procedure.
Looking back on it, Dr. Matthews is modest in describing his first robotic adventure. Dr. Matthews says he hopes to hear soon that the patient and his wife are expecting another child. As for his "assistant," Dr. Matthews says he looks foward to making use of the robot again when appropriate. He plans to publish a case history detailing the complex repair they achieved with the robot's assistance. In the meantime, to his wife Ellen and their children Maggie, Jack and Owen, he is still just another soccer dad.