'A Robot Operated on My Hernia'
Tarpon Springs Surgeon Debunks This & Other Myths
About Robots in the O.R.

Robotics-assisted surgery has become enormously popular, with physicians around the world performing 1.5 million procedures - from hysterectomies to heart valve repairs - in 2011.

"But myths and misconceptions about robots in the operating room still abound," says physician Dr. Keith Chisholm, MD, a Board Certified General Surgeon on staff at Florida Hospital North Pinellas, (www.fhnorthpinellas.com).

"One is that the robot performs the surgery - 'a robot operated on my hernia,' " says Dr. Chisholm. "Technically, it's not a robot because it can't perform surgery without someone controlling it - it's actually computer-assisted surgery. The surgeon guides all of the movements using finger-manipulated controls."

He and other robotics surgeons use the da Vinci Surgical System, which the U.S. Food and Drug Administration approved for minimally invasive surgeries in 2000. Nine years later, the da Vinci was being used in 80 percent of surgeries to remove cancerous prostates, according to its maker, Intuitive Surgical, Inc.

"The benefits of robotics-assisted surgery are numerous", says Dr. Chisholm, who performs several different procedures using da Vinci and became the first Pinellas-Pasco physician to use it for a single-incision cholecystectomy (gall bladder removal).

"The robotic arms hold miniaturized surgical instruments, so we can get in through very small incisions," he says. "That means there's less chance of infection, less pain, much less scarring and a quicker recovery time. Because the arms have 'wrists' that can rotate more than 360 degrees, we have far more maneuverability than we do with laparoscopic surgery, and we can get into hard-to-reach areas."

"One of the robotic arms holds a magnified 3D high-definition camera, which gives us a much better view of the surgical site than we would have with just our own two eyes."

In a 2013 FDA survey, surgeons experienced with da Vinci said their patients have less bleeding, fewer complications, much quicker recovery times and less time in the hospital - 24 hours on average. Interestingly, those who used da Vinci to remove advanced cancer in the tonsils region of the throat said half of their patients were able to avoid chemotherapy.

What are some other myths and misconceptions?

•  Myth: Robotics-assisted surgery costs much more than traditional surgery.
A study published in July 2013 found that half of the minimally invasive procedures reviewed, including robotics-assisted and laparoscopic surgeries, cost insurance providers less than the same surgeries performed in the traditional manner. Four of the six minimally invasive surgeries also resulted in fewer lost work days - sometimes several weeks fewer.

"The robotics technology is expensive and the whole surgical team has to be trained, which can add to the cost," says Dr. Chisholm. "But there's also a tremendous savings compared with traditional surgery because the patient is out of the hospital more quickly and there are fewer complications."

(Study conducted by University of Pennsylvania health economist Andrew J. Epstein and published in JAMA Surgery.)

•  Myth: Robotics-assisted surgery is riskier than traditional surgeries.
Any surgery has certain risks, but in many ways, robotics-assisted surgeries have fewer overall, Dr. Chisholm says.

"Many times, the robotics-assisted procedures can be done much more quickly, so there's less risk simply because the duration of the procedure is shorter," he says. "You also have the smaller incisions, less bleeding, etc. that reduce the risks."

In addition, the Tampa Bay area is fortunate to have the cutting-edge 2-year-old Center for Advanced Medical Learning and Simulation (CAMLS) operated by the University of South Florida.

"Our surgical teams have easy access to training, practice with simulators and continuing education, so we're extremely well-prepared," Dr. Chisholm says.

About Dr. Keith Chisholm

Dr. Keith Chisholm graduated from the University of North Carolina, Chapel Hill, Medical School and went on to residency training at the University of Florida, becoming an assistant adjunct professor and attending surgeon at the Malcolm Randall VA Medical Center in Gainesville, Fla. He's believed to have performed the first laparoscopic colon resection in the UF surgical department. From laparoscopy to robotics-assisted surgery was a natural advance for Chisholm, who has a private practice in Trinity, Fla., and is among the robotics-certified surgeons with privileges at Florida Hospital North Pinellas, (www.fhnorthpinellas.com).

4 Reasons Why Some E-Cigs Are a Safer
Alternative to Traditional Smoking
CEO Applauds FDA's Proposed Regulations

The Food and Drug Administration is trying to get a handle on new smoking products, including electronic cigarettes, with newly proposed regulations that include banning sales to minors and requiring manufacturers to register all of their products and ingredients with the FDA.

"I like these proposals; the public needs clarity on smoking alternatives because we have 42.1 million adult tobacco smokers [CDC, 2012] who may be able to benefit from them," says Anthony Sarvucci, CEO of American Heritage International, (www.americanheritageonline.com), a company that develops e-cigarettes expressly for adult tobacco smokers who want to quit but have not succeeded.

"The bottom line is that we know how terrible traditional cigarettes are for people, but there has been a vacuum of information about e-cigs, which leads to a great deal of misinformation, some fear-mongering, and even simply making stuff up."

Sarvucci gives four reasons why some e-cigarettes are easily a better alternative.

•  According to the American Lung Association, the average cigarette contains acetone, found in nail polish remover; acetic acid, an ingredient in hair dye; ammonia, a common household cleaner; arsenic, used in rat poison; benzene, found in rubber cement; butane, used in lighter fluid; cadmium, active component in battery acid; carbon monoxide, released in car exhaust fumes; formaldehyde, embalming fluid; hexamine, found in barbecue lighter fluid; lead, used in batteries; naphthalene, an ingredient in moth balls; methanol, a main component in rocket fuel; nicotine, used as insecticide; tar, material for paving roads; and toluene, used to manufacture paint.

•  "Adult consumers of e-cigarettes deserve to know what they're smoking," says Sarvucci, who adds that minors "absolutely should not be smoking or vaping, period." American Heritage's vapor fluid contains water and three food-grade quality ingredients - kosher vegetable glycerin and vegetable propylene and natural flavoring, and the nicotine is derived naturally. "We're the only e-cigarette company for which all of the e-juice ingredients are sourced and mixed in the United States," he says. "Fluid for most other e-cigarettes is sourced and mixed in China and it often contains dozens of ingredients."

•  According to the Centers for Disease Control and Prevention, cigarettes harm nearly every organ in your body and cause dozens of diseases. Cigarette smoke causes more deaths - combined - than HIV, illegal drug use, alcohol consumption, motor vehicle injuries and gun incidents. "We've made significant progress against cigarette smoke in recent decades, but it's not only a problem of the past," he says. Almost half a million Americans will continue to die each year, even though they know the statistics as well as anyone, because they are severely addicted. "Mimicking an authentic smoking experience, like my company tries to do, at least gives these people a better option that's also healthier for the people around them," Sarvucci says.

•  Smokers deserve hope ... In American culture, we have a can-do attitude that is unique to the world, which largely accounts for our influence. We often have a tough time, however, admitting that an individual has a problem that's beyond his or her control. Smoking cigarettes is that problem for more than 40 million of our friends, family and neighbors.

"Look – I wouldn't have gotten into this business if it were to create new smokers," Sarvucci says. "I went this route because, yes, it's a highly profitable space, but it's also an extremely helpful alternative for traditional smokers. If you're a nonsmoker, ask yourself: What would you rather have in your body, a few edible compounds, water and naturally sourced nicotine, or nicotine accompanied by the chemical used to exterminate rats?"

About Anthony Sarvucci

Anthony Sarvucci is the CEO of American Heritage International, (www.americanheritageonline.com), a publicly traded company that manufactures, distributes and sells disposable premium electronic cigarettes. The product uses ingredients that are exclusively sourced and mixed in America, and is designed strictly as an alternative for tobacco smokers and chewers. Sarvucci is past president and co-founder of Prairie West Oil and Gas Ltd. and serves as an investment banking consultant.

After the economy crashed in December 2007, nascent online peer-to-peer lending platforms quickly grew. They've since evolved into an increasingly popular investment alternative to Wall Street and other traditional options.

Peer-to-peer lending isn't new and it's no passing fad, says P2P pioneer Brendan Ross, president of Direct Lending Investments LLC, (www.dirlend.com), which runs a short-term, high-yield small business loan fund.

"It's a rebirth of the simplest and oldest way of making money: one individual loaning money to another and getting paid back with interest," Ross says.

What makes this new incarnation different is accessibility.

"Online lenders like IOU-Central and Prosper.com make it easy for prospective lenders to find and fund borrowers through a website," Ross says. "These platforms have automated the underwriting process, including checking credit and looking at applicants' bank accounts, so they can vet borrowers based on reliable information."

Each online lending platform operates differently, but all vet applicants. The lender posts qualifying requests on its website, and private investors decide which to fund, either in their entirety or in part. At Lending Club, for instance, investors can choose to lend the entire amount requested by a borrower, or as little as $25 to multiple borrowers, which adds protection if one defaults.

Investors can manually choose which loans to fund, or they can ask the platform to choose within certain parameters. Yields on a portfolio of loans can be 10 percent or more, Ross says.

He offers these tips for investors in three tiered financial levels:

•  Investing $10,000 to $24,000: Visit the Lending Club and Prosper.com websites, and choose the one that most appeals to you, Ross says.

"Open an account in a tax-deferred IRA and shift a portion of your investments out of stocks and into lending," he says.

The reason for that is interest income is taxed at a higher rate than the capital gains from stocks. Deferring those taxes until you begin spending from the IRA will help keep a lid on your current tax bill.

•  Investing $25,000 to $100,000: At $25,000, you have enough money to start getting professional advice about which loans to choose and how much to invest in each.

"I recommend going to www.lendacademy.com/invest because it's run by Peter Renton, who's very knowledgeable," Ross says. "You choose between a conservative or balanced portfolio - I recommend balanced for higher yield -- and they'll choose the loans for you and put them in your account."

The fee is just 0.95 percent.

•  Investing more than $100,000: Accredited investors have privileged access - they can shop around for private fund pools, Ross says.

"As P2P matures, borrower categories that have always had the highest yields, such as small businesses, become available as private fund pools that are managed to deliver the highest yields," he says.

These pools form mutually beneficial relationships with the P2P lending platforms, allowing the platforms to serve a larger volume of borrowers. The private funds get well-vetted borrowers from the platforms and manage the funds to the maximum benefit of all their investors.

"Everybody wins," Ross says, "including the borrowers, who get fast loans at reasonable rates."

About Brendan Ross

Money manager Brendan Ross is a peer-to-peer lending first adopter who has become an expert in this non-traditional transaction. The president of Direct Lending Investments LLC, (www.dirlend.com), which runs a short-term, high-yield small business loan fund, he previously ran a number of other companies, including ReserveAmerica, the world's largest outdoor recreation reservation company.

You have insurance on your home, your car, your health.

How about your retirement plan?

"People have homeowners insurance to protect against fires and floods," notes independent financial planner Stephen Ng, founder and president of Stephen Ng Financial Group, (www.stephenngfg.com). "They buy insurance to replace their car if it gets wrecked and they buy health insurance to protect themselves from medical costs.

"But for many people, their biggest material asset is their retirement portfolio. When I look at a new client's portfolio and ask, 'Where's your insurance?' they look at me like I'm crazy!"

Insure your retirement fund by taking steps to safeguard at least a portion of it, Ng says. As you get closer to retiring, the amount you safeguard will be what you need to rely on for your retirement income.

"Your retirement income should be derived from guaranteed sources, such as Social Security benefits and your pension plan," says Ng, a licensed 3(21) fiduciary advisor, certified to advise companies about their 401(k) and other retirement plans. "It's the amount you need to pay the bills and do the other things you hope to do in retirement, so your retirement income needs to be a guaranteed source of income.

"Then you look for your 'play checks.' That's the money you don't absolutely have to have, so you can still try to grow it, and take risks with it, in the market."

Ng offers these tips for insuring your retirement plan:

•  Invest a portion of your portfolio in annuities.
Annuities are long-term investment options through insurance companies that guarantee you payments over a certain rate of time, which could be the rest of your life or the life of your spouse or other survivor. Note: The guarantee is subject to the financial strength and claims-paying ability of the issuing insurance company.

•  If you leave your job, quickly roll your employer-sponsored 401(k) into an IRA.
While 401(k)s are a great tool for saving, particularly if your employer is providing matching funds, if you were to die, the taxes your survivors would pay on your 401(k) would be much higher than on an IRA. That's because they would have to inherit the money in a lump sum - that could easily take 35 percent right off the top. The lump-sum rule does not apply to IRAs. While your spouse would have the option to inherit your 401(k) as an IRA, your children would not. So, take advantage of your employer-sponsored 401(k), but if you leave the company, convert to an IRA or ROTH IRA. You can also begin transferring your 401(k) funds to an IRA at age 59½.

•  Consider converting your IRA to a ROTH IRA.
For protection from future income tax rate increases, you should consider slowly converting your tax-deferred IRA funds into a ROTH IRA. Yes, you'll have to pay the taxes now on the money you transfer, but that will guarantee that withdrawals in your retirement are not taxed - even as the money grows. If you plan to leave at least part of your IRA to your children, they'll benefit from a fund that continues to grow tax-free.

About Stephen Ng

Stephen Ng is the founder and president of Stephen Ng Financial Group™ (www.stephenngfg.com). Since 1992, he has helped pre-retirees and retirees preserve and increase their wealth by, in part, helping them avoid common mistakes. He regularly holds financial management, retirement investing and insurance planning seminars at businesses, churches and non-profit organizations. Ng is a Chartered Life Underwriter, Chartered Financial Consultant and a Certified Estate Planner. He is also an Investment Advisor Representative with SagePoint Financial, Inc., member FINRA/SIPC.  He brings a national and international perspective to his financial advice, with professional and educational roots in Australia and Asia, and certifications in 19 states.