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Advances in Rheumatology ADVANCES IN RHEUMATOLOGY February 2013 Osteoimmunology Research Yields Significant SPECIAL EDITION Findings Affecting Diverse Group of Diseases Weill Cornell Medical College, a teaching affiliate of NewYork-Presbyterian Hospital, is among the top-ranked clinical and medical research centers in the country. The advanced research at Weill Cornell Medical College furthers medical science and improves clinical practice, and many of the physi- cians with academic appointments at the College also practice medicine at NewYork-Presbyterian/ Weill Cornell Medical Center. Here, the Dean of Weill Cornell Medical College discusses research SAVE THE DATE that explores both the immune and skeletal systems, with wide-ranging implications. Brain Attack and Cerebrovascular Disease e are undertaking advanced research in Update 2013 “Wareas such as inflammatory arthritides March 8, 2013 and lupus, and are engaged in important research New York Academy of Medicine in skeletal biology, particularly as it relates to Osteoclasts lining scalloped edges of bone. New York, NY inflammatory diseases, cancer, osteoporosis, and Brain Tumor Biotech osteoarthritis,” Laurie H. Glimcher, MD, said. cells of the immune and skeletal systems are Summit 2013 She added, “At Weill Cornell Medical College, explored, which has led to discoveries that increase June 7, 2013 we have a very vigorous rheumatology research understanding of the basic science and eventually Weill Cornell Medical College group. I think it is very important for the academic may lead to advanced therapeutics for a range of New York, NY community to realize that we are fully committed disorders.1 Such discoveries have led to her elec- Advanced Endoscopic to strengthening our research even further, and one tion into several prominent scientific institutions, Skull Base and Pituitary way we will do that is through additional recruits.” including the National Academy of Sciences and Surgery, Hands-on As Stephen and Suzanne Weiss Dean of Weill the Institute of Medicine. Symposium Cornell Medical College, where she is also Profes- Osteoimmunology centers on the fact that the June 14-15, 2013 sor of Medicine, Dr. Glimcher is clearly well posi- skeleton is continually engaged in osteoclast-medi- Weill Cornell Medical College tioned to state these goals, but she also happens ated bone resorption coupled with osteoblast- New York, NY to be an example of this commitment herself. Dr. mediated bone deposition. “The osteoblast has been For more information and to Glimcher was recruited a year ago from her posi- shown to be the niche where hematopoietic stem register, visit nyp.org/pro or tion as the Irene Heinz Given Professor of Immu- cells emerge within the bone marrow,” Dr. Glim- e-mail [email protected] nology at the Harvard School of Public Health, cher explained. “The osteoblast creates factors and where she was Director of the Division of Biologi- provides the environment that allows hematopoietic cal Sciences. She was also Professor of Medicine at stem cells to differentiate, and supports the immune Harvard Medical School, directing its immunology system. Correspondingly, the cells of the immune program, and Senior Physician and Rheumatolo- system—T and B cells and macrophages—secrete gist at Brigham and Women’s Hospital, in Boston. inflammatory cytokines that activate the osteoclast Dr. Glimcher’s research laboratory has made sev- and lead it to resorb bone. So, for example, in rheu- eral notable discoveries, many of which have cen- matoid arthritis you find activated macrophages that tered on the pathophysiologic immune responses differentiate into osteoclasts under inflammatory Top Ranked Hospital in New York. affecting autoimmune, infectious, and malignant signals as well as signals from osteoblasts, which Twelve Years Running. diseases. In an emerging field that has been called cause bony erosive lesions.” osteoimmunology, the interrelationships between See Skeletal Biology, page 3 ADVANCES IN RHEUMATOLOGY Robotic Applications and Operating Room Technology Are Transforming the Post-Op Surgical Experience uilding on the concept of mini- minimally invasive approach to treat Weill Cornell. Dr. Tewari, who is Direc- B mally invasive procedures, robotic uterine fibroids, as well as other gyneco- tor of the Prostate Cancer Institute and surgical approaches performed at logic surgeries—reported that real-time the LeFrak Center for Robotic Surgery, NewYork-Presbyterian Hospital are imaging has been fundamental to creat- has performed more than 5,000 robotic- vastly improving the patient experi- ing the modern OR, which is capable of assisted urologic procedures, and is ence. Real-time imaging in the oper- offering minimally invasive endovascular widely recognized for this work. Data ating suite combined with continually procedures, as well as radiologic-guided from a recently published meta-analysis advancing robotic systems offer the interventional, cardiothoracic hybrid, of 79 studies suggested robotic-assisted potential for greater precision with less and robotic procedures. prostatectomies are at least as effective by trauma, less scarring, less blood loss, “ORs for minimally invasive endo- essentially any measure, particularly in and quicker healing. Surgeons are driv- vascular procedures provided a head regard to the proportion of patients who ing the advances, and there are pro- start because they were set up for real- achieve cancer-free margins, but generate grams at both NewYork-Presbyterian/ time imaging and had the structure fewer complications.1 Columbia University Medical Center and size to accommodate the equip- “Robotic surgery was initially attrac- and NewYork-Presbyterian/Weill Cor- ment and connectivity that we need tive because of the visualization,” nell Medical Center that create an envi- for robotic procedures,” explained Dr. Dr. Tewari explained. “While the pre- ronment that encourages their rapid Evanko, who works to assist OR innova- cision of robotic excisions is an impor- implementation. tion at NewYork-Presbyterian/Columbia. tant advantage, the ability to visualize “Our surgeons are the ones driving “Minimally invasive surgery overall and the anatomy in the structural context robotic applications. My goal is simply robotics in particular are now being used that can be lost in an open approach has to ensure we are setting up our operating effectively across specialties, including been the most important attribute. There rooms [ORs] to facilitate these innova- gynecology, urology, otolaryngology, and is also significantly less bleeding, which tions,” said John C. Evanko, MD, MBA, thoracic and general surgery.” can also obscure the anatomy when per- who is Medical Director of Periopera- forming a reconstruction.” However, tive Services at NewYork-Presbyterian/ Urology other advantages, such as reduced blood Columbia and a gynecologic surgeon. In urology, Ashutosh K. Tewari, loss, have followed. Dr. Evanko—whose expertise with the MD, led much of the pioneering work The work by Dr. Tewari has greatly da Vinci Surgical System includes a in robotics at NewYork-Presbyterian/ advanced the use of robotic proce- dures for a broad array of urologic sur- gical procedures, including resection of benign hypertrophy, and he has now assembled one of the most important facilities in the world for this approach. NewYork-Presbyterian/Weill Cornell’s LeFrak Center for Robotic Surgery has several unique features. In addition to a large endowment that has permitted the Center to upgrade imaging capabilities and to employ multiple robotic systems, a comprehensive therapeutic program includes a multidisciplinary team to focus on recovery with emphasis on sus- taining a good quality of life. “There are several exciting develop- ments that will generate further evolu- tion in the field,” Dr. Tewari said. “For example, I think there will be synergy between the technological advances made NewYork-Presbyterian Hospital is improving its patient care by implementing new, advanced r obotic in robotics and genomic advances, which systems that help to improve the patient experience. will allow us to provide individualized 2 www.nyp.org NEWYORK-PRESBYTERIAN HOSPITAL care to the characteristics of the malig- able to debulk a patient’s ovarian cancer “Increasingly, imaging such as CT [com- nancy. However, robotic-assisted surgery robotically. She was rendered in complete puted tomography] scanning is an intra- in urology is a mature platform at our clinical remission with a surgery that operative tool to guide the procedure. Center. Our outcomes validate that this lasted about 2 hours and she didn’t have The modern OR has to be large enough approach provides advantages over an to stay in the hospital overnight. I think to accommodate the imaging systems, open approach.” that is a huge benefit and it isn’t being the displays, the robotic devices, as well offered in many places.” as the monitoring equipment that would Oncology be found in a conventional OR. This “A major focus for us at Weill Cor- Orthopedic, Gastrointestinal, requires planning and the infrastruc- nell Cancer Center is working to improve Neurologic ture that allows the OR to function effi- the quality of our patients’ lives, leav- At NewYork-Presbyterian/Colum- ciently.” Simply running the wires to ing them with less morbidity from our bia, robotic-assisted surgery is now being an increasingly complex and sophisti- treatments so they go on to live fruit- employed for some common orthope- cated array of devices limits the degree to ful lives
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