Joshua A. Tyler
Chief, Colorectal and Robotic Surgery, Keesler Medical Center
Assistant Professor, Dept of Surgery, Uniformed Services University of the Health Sciences
Director of Robotic Surgery, Merit Health Biloxi
Founder/Director, Institute for Defense Robotic Surgical Education (InDoRSE)
Where do you practice?
I am active duty Air Force, but also have a Training Affiliation Agreement (TAA) which allows me to practice in the private sector (in a volunteer capacity). My military practice is at Keesler Air Force Base Medical Center (Biloxi, MS), and my civilian practice is at Merit Health Biloxi.
Why I am a member of ASCRS:
ASCRS provides a wonderful community of colon and rectal surgeons for networking, mentorship, and continual learning/self-improvement. We tend to be a small close-knit community in this specialty, and ASCRS provides the perfect forum for academic, military, and community colorectal surgeons.
Tell us something about yourself that we might not otherwise know:
I am very excited about two aspects of my practice: our community involvement to serve the colorectal surgery needs of patients in South Mississippi, as well as the robotic surgery training site I founded, which is also located at Keesler.
Military colorectal surgeons tend to be fairly low-volume compared to our civilian peers. Training Affiliation Agreements (TAAs) help us have more volume, as well as serve in the off-base medical community. All of our downtown work is in a volunteer capacity. Mississippi is very underserved for colorectal surgery, with only four board-certified CR surgeons serving the entire state. My partner (Dr. Ramon Brown, another active duty AF surgeon) and I are the only two in the southern half of the state. The TAA arrangement accounts for approximately 90 percent of our practice/volume and enables us to be high-volume surgeons while serving the needs of our local community given the underserved nature of the population here for our specialty.
An additional aspect of my practice is serving as the founding director for the Institute for Defense Robotic Surgical Education (InDoRSE), located at Keesler Air Force Base (see article link below). The federal government has invested nearly a quarter of a billion dollars in robotic technology between the DoD and VA, but often these surgeons have difficulty attending courses at Intuitive’s own training sites, which are cost-prohibitive for federal surgeons. InDoRSE was founded as the federal government’s DaVinci Xi training facility for Army, Navy, Air Force, and VA surgeons to directly address this and enhance access to training/education in robotic surgery. In addition to training surgeons, we train the entire OR team including the circulator nurse and OR technicians. Personnel turnover is a significant obstacle to successful robotic implementation in federal healthcare, and our team-based approach helps ensure safe and efficient care for our patients. We have two Xi robots and now teach both basic and advanced robotics courses. We recently trained our 100th surgeon (300 personnel total), and this has spanned 37 different facilities across the DoD and VA. Those surgeons have gone home to do 1500 robotic procedures, and the educational cost savings to the government exceed one million dollars. This is explained in more detail in this article.