Victoria Cohen

Dr. Charles: a setback and a comeback

I met Dr. Anthony Charles on a flight to Atlanta. We were both headed to his robotic training, and I had just inherited him from a rep who had left. I hadn’t been involved in his training up to that point, but our experience working together would ultimately change the way I approached surgeon development.

Our first goal was to establish after-hours robotic access at UNC Chapel Hill, something the hospital had never done. I worked closely with Dr. Charles to navigate the approval process, helping him approach hospital leadership and draft the emails needed to move things forward. We eventually secured the first after-hours robotic case in the hospital’s history.

Unfortunately, that case had a bad outcome. The hospital conducted a review and determined that the outcome was unrelated to Dr. Charles’s technical skill on the robot. Nevertheless, after-hours robotic privileges were revoked, and he stepped away from robotic surgery for more than a year.

Getting back to the robot

When Dr. Charles told me he wanted to return, I was determined to help him do it successfully. We spent eight to ten sessions practicing on the Xi, and I arranged for proctors to support his first cases back. I wanted to be certain he was technically prepared before advancing him through each stage of training.

Improving Tissue Tension Awareness Through Hands-On Training

Dr. Charles struggled with tissue tension on the robot. Without haptic feedback on the Xi, surgeons rely on visual cues like blanching to gauge how much force they’re applying. I developed hands-on exercises to help him connect what tissue tension felt like with what he was seeing at the console.

I had him handle double-ply tissue with his hands, then perform the same task on the robot, repeating the exercise with different materials. I also set up a wood block with two screws and a rubber band beside the console, with a matching setup inside the abdominal model, so he could feel the tension by hand and then reproduce it robotically.

These exercises helped Dr. Charles become more confident and consistent in managing tissue tension, improving his comfort and technique on the robot.

He went on to operate consistently again. Today, he is Division Chief of Trauma/Critical Care and Acute Care Surgery at the University of Vermont, where he is developing an after-hours robotic program of his own. Just under two years after UNC lost its after-hours privileges, the hospital began restoring them.

Working with Dr. Charles had a lasting impact on how I train surgeons. I learned the importance of recognizing when someone needs more time, even when that means slowing down a training pathway. It’s an approach I still follow today.

A GYN surgeon who had never used the robot

Dr. Seshadri had never operated on the robot when we started working together at WakeMed Cary. I took him through the training pathway and tracked his outcomes in laparoscopic and robotic cases so he could compare the two using his own patient data. He made the decision based on those results.

From the time he completed training until I left, he did not perform another laparoscopic hysterectomy or myomectomy. He performed all of his benign cases robotically and became a sustainable surgeon in the first quarter after training.

A surgeon working toward robotic liver transplant

When I started working with Dr. Ravindra, he was using the robot occasionally, and only for cholecystectomies. In patients with liver cirrhosis, the gallbladder can be severely adhered to the liver bed, and the robot gave him better visualization and control. He wanted to build on that and eventually perform both donor and recipient liver transplants robotically.

I arranged case observations at UVA, where donor transplants were being performed. We identified suturing as a critical skill, so he built it through hernia repairs, and I tracked his outcomes to keep those cases on the robot. I also arranged hands-on suturing practice in the lab at Duke, since the Pringle maneuver makes dependable suturing especially important during a liver transplant.

By the time I left, he had completed four donor transplants on the robot. He had gone from occasional use to sustainable robotic practice.

UNC Hillsborough: expanding the purchase

When I began working with UNC Hillsborough, the hospital had already budgeted for one Sonata system. Because UNC directed its fibroid patients to that location, I believed the patient volume justified a second system.

I worked with surgeon and operational champions to build the case for the additional investment. Together, we presented the clinical need, procedure volume, and financial justification to hospital leadership. UNC ultimately purchased two Sonata systems instead of the one originally planned.

Elam Surgery Center: a first for Hologic

At the time, no Sonata system had been sold to an ambulatory surgery center in the United States, largely because reimbursement made it difficult to justify the investment.

I worked with surgeons who wanted to bring Sonata to the outpatient setting but struggled to secure hospital block time. Rather than focus on reimbursement alone, we showed surgery center leadership how offering the procedure could bring additional patients and surgical volume to their facility. That approach resulted in Hologic’s first Sonata capital sale to an ambulatory surgery center in the country.

Good Samaritan Medical Center: Winning a Competitive Trial

At Good Samaritan Medical Center in Brockton, Stryker went head-to-head with Karl Storz in a competitive trial that I managed from start to finish.

I led all surgeon and staff in-servicing, supported every case performed on the system, and remained on call throughout the trial, including overnight cases. My priority was making sure the OR team felt confident using the technology and always had the support they needed.

After each case, I collected feedback from surgeons and staff through structured surveys, then quantified the results to demonstrate the system’s performance in their own operating rooms. This gave hospital leadership measurable data alongside firsthand feedback from the clinicians using the technology.

I presented those findings to the hospital’s executive leadership team, helping secure a $1.6 million capital purchase for Stryker.