By now, surgery and robotics are old friends. Robotic-assisted surgery got its start as a proposed method for surgeons to operate on the battlefield without being there. Over the last 25 years, the technology has evolved to enhance minimally invasive surgery across urology and other surgical specialties.

Robotic platforms are now widely used around the world, including at Novant Health New Hanover Regional Medical Center in Wilmington, said Novant Health surgeon Dr. Ibardo Zambrano.

But the word “robot” can be misleading, he added. These sophisticated devices don’t act alone, and are operated by trained surgeons. The da Vinci Surgical System, the first such platform cleared by the FDA, is equipped with four interactive arms moved by a surgeon using a remote console. The system delivers high-performance visuals and precise incisions.

Known as “minimally invasive” surgery, the incisions are far smaller than traditional “open surgery,” which can mean less pain, less risk of infection, and less scarring for patients.

“It also makes everything faster with recovery,” said Zambrano, 40, who’s treated prostate cancer and other genitourinary cancers at Novant Health Urology—Wilmington and Brunswick Forest since 2022. “That’s the idea behind doing things with robotics.”

In short, robotics simplifies surgery for patients. And today many specialty operations, from orthopedic to gynecological, are possible because of this technology.

Get the world-class cancer care you need.

Start here

Hungry for opportunity

Zambrano was 16 when he left his native Colombia and moved to the U.S. with a dream of a fresh opportunity. He couldn’t speak a word of English, but was determined to learn it when he moved in with his aunt in Queens, New York. (“I’m still learning,” he jokes today.)

Opportunity came knocking at Skidmore College, three hours north of the city, where he received a full scholarship and majored in neuroscience. It wasn’t long before Zambrano took an interest in research and surgery.

“I had a goal, and the goal was medical school,” he said.

All things seemed possible when he received a research scholarship to spend time at the National Institutes of Health (NIH) in Maryland as a post baccalaureate student. He studied molecular pathways linked to Parkinson’s disease, and in 2008 met fellow research student Lindsey Buckingham, now a gynecologic oncologist at Novant Health Zimmer Cancer Institute. Today they are married and have three children.

Early days

After his stint at the NIH, Zambrano transitioned to Walter Reed National Military Medical Center, where he worked as a research tech and was exposed to surgery while working on animal models of hemorrhagic shock. He also had the opportunity to shadow trauma surgeons in the operating room.

Zambrano took his interest in surgery to the Perelman School of Medicine at the University of Pennsylvania. Early on, he stumbled “serendipitously” into urology, he said, while on a rotation treating cancer patients.

Last year, Zambrano became the first Society of Urologic Oncology fellow at the University of North Carolina. He and UNC Urologic Oncology Director Dr. Ray Tan were recently awarded a grant to fund their research into reducing disparities in prostate-cancer counseling.

When to start screening

Prostate cancer is the most common cancer and the second leading cause of death among men in the U.S. Prostate-specific antigen (PSA) levels in the blood are used to screen men, but this has become a much-debated subject. Years ago, the United States Preventive Services Task Force arrived at the consensus that PSA-screening was resulting in over-diagnosis and over-treatment.

Medical guidelines advise men to have regular conversations with their doctors.

If you have a strong family history of prostate cancer, you should start screening in your 40s, Zambrano said. The idea is to catch prostate cancer early, when it is treatable and there is the highest likelihood for success. Additional tests can help determine cancer aggressiveness and guide treatment decisions.

Zambrano works with patients to help minimize cancer recurrence and progression and outlines for them the available treatment options.

“I tell them that we are going to have a long-term relationship,” Zambrano said. “It’s a tough conversation, but I often frame prostate cancer as something that you can live with.”

Many of those conversations are with Zambrano’s Hispanic and Latino patients, who are immediately put at ease by a urologist whose first language is Spanish.

“Spanish is very handy here in North Carolina, which means I can take better care of my patients,” said Zambrano, among the 5% of Hispanic and Latino urologists in the U.S.

He said many patients struggle to book appointments, which often means they are diagnosed with cancer late. Many also struggle with making a decision about treatment, which can lead to further delays. Addressing these barriers, Zambrano said, relies on establishing research partnerships between Novant Health and UNC. One such project he is leading with Dr. Hung-Jui (Ray) Tan at UNC Urology focuses on improving communication tools to deliver prostate-cancer counseling.

Partnerships and trials are on the way

In October, Novant Health Zimmer Cancer Institute will open a multidisciplinary genitourinary oncology clinic to improve health care delivery and strengthen clinical collaborations among specialists treating prostate, kidney, bladder and testicular cancers. Zambrano will work to expand Novant Health’s research partnership with UNC to improve the way surgeons communicate the risks and benefits of operations and treatments to patients.

“This will ultimately help patients and their doctors make the right decisions around surgery,” he said. “Being a surgeon, you see patients early and that’s very rewarding. As a urologist, I am with them all through their journey.”