Intuitive Surgical

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Robotics in Surgery
Curtis Peery, M.D. Sioux Valley Hospital
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Why Robotic assisted Surgery?

• Limitations of Open surgery
• Pain
• Increased cost
• Blood loss
• Scarring

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Why Robotic assisted Surgery?

• Limitations of Laparoscopic surgery
• Loss of depth perception
• Increased hand tremor
• Decreased Range of motion
• Compromise precision
• Ergonomically uncomfortable
• Difficult to learn

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Why Robotic assisted Surgery?

• Advantages of Open surgery
• Precision
• Ergonomic
• Intuitive

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Is there a way to maintain the minimally invasive
approach without losing the advantages of Open
surgery?
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Robotics

• Hand-eye alignment
• 3D vision
• Motion scaling
• Tremor filtration
• Ambidexterity
• Restore the feel of open surgery in a minimally
  invasive environment
• Improved ergonomically

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This vastly simplifies tasks such as suturing,
tying, and complex dissection, all of which are
extremely challenging for most surgeons with
standard laparoscopic equipment. The promise of
this approach is that it will put within reach of
all surgeons complicated operations using
laparoscopic technology.
Mark A. Talamini, M.D.Assoc. Professor of
SurgeryDirector, Minimally Invasive
SurgeryJohns Hopkins Hospital
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How does the da Vinci Surgical System work?
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da Vinci Surgical System

• Surgeons Consule
• Surgical Cart
• Insite Vision System

da Vinci Surgical System
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Superior Visualization

• Revolutionary 3-channel vision system
• High resolution 3-D image
• Panoramic view of the surgical field
• Surgeon is immersed in operative field
• Open surgery orientation

da Vinci Surgical System
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Surgical Cart And EndoWrist Instruments

• 1 camera arm
• 3 working arms
• Mobile base
• Robotic ports

da Vinci Surgical System
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Intuitive Surgery
da Vinci Surgical System
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Doctor is this experimental surgery?
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Clinical Validation
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US Hospital Installations As of July 31, 2004
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Current Applications
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Versatility in General Surgical Applications

General Surgery
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Biliary and Pancreatic Surgery

• Cholecystectomy
• Biliary diversions
• Liver Resections
• Pancreatic surgery

General Surgery
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Forgut Surgery

• Nissen Fundoplication
• Paraesophageal Hernia
• Gastric Bypass
• Gastric surgery
• Vagotomy and pyloroplasty
• Esophagectomy

General Surgery
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Colorectal and Small Bowel Surgery

• Right Hemicolectomy
• Left Hemicolectomy
• Sigmoid Colectomy
• Lower Anterior Resection
• Abdominal Perioneal Resections
• Colostomy take downs

General Surgery
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Other Surgery

• Lung
• Mediastinal
• Hernia
• Adrenalectomy
• Vascular
• Splenectomy

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Does Robotics improve patient outcomes?
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da Vinci Heller Myotomy

• Increased precision
• Improved visualization
• Better patient outcomes

General Surgery
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da Vinci Heller Myotomy
Comparison of Laparoscopic and da Vinci Heller
Myotomy
Sharp KW, et al. 100 consecutive minimally
invasive Heller myotomies lessons learned. Ann
Surg 235(5) 631-638, 200 Santiago Horgan, M.D.
University of Illinois, Chicago. 1999 data used
the values for the reference standard (open RP)
were considered the index value, with values in
each row (n) referenced to the index value
General Surgery
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Multidisciplinary Surgical Applications

Multidiscipline
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Urology dVP (da Vinci Prostatectomy)
As a trained surgical oncologist, da Vinci has
allowed me to offer my patients a better cancer
operation with improved clinical outcomes.
Thomas E. Ahlering, M.D.Associate Professor of
Urology Director, Urological Oncology
University of California Irvine Medical Center
Urology
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Gynecology

• Myomectomy
• Radical Hysterectomy
• Tubal Anastamosis
• Sacrocolpopexy

Gynecology
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Cardiac - Revascularization
the da Vinci Surgical System is now available to
facilitate a broad range of minimally invasive
cardiac surgery, from procedures such as vale
repair to cardiac revascularization. I am
confident that the da Vinci System will become an
important part of every cardiac surgeons
technical arsenal, ultimately improving the way
we treat patients suffering from cardiovascular
disease. Michael Argenziano, M.D.
Assistant Professor of Surgery Columbia
University College of Physicians and
Surgeons New York Presbyterian Hospital
Cardiac Surgery
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Cardiac Mitral Valve Repair
The da Vinci System makes it possible to offer
a wider range of patients a minimally invasive
open-heart procedure to repair the mitral valve.
This will allow more patients to benefit from
both shorter hospital stays and reduced recovery
times. W. Randolph Chitwood, Jr. M.D.
Professor and Chairman Department of Surgery
Chief of Cardiothoracic Surgery East Carolina
University School of Medicine
Cardiac Surgery
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Pediatric Surgery

• 31 Different da Vinci Pediatric Procedures
  Performed
• Urology
• Pyeloplasty Adrenalectomy
• Nephrectomy Orchiopexy
• Ureter Neocystostomy Abdominal Testicular
  Resection Ureter Implant Bladder Neck
  Suspension
• Ureterectomy Varicocele
• Bilateral Heminephroureterectomy Mitrofanoff
  (Appendicovesicostomy)
• Bilateral Transvesical Ureteral Reimplantation
• (Cohen Technique)
• Urethral Sling Placement
• Mace (Malone Antegrade Continence Enema)
  Procedure
• General Surgery
• Splenectomy Colectomy

Pediatric Surgery
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What is the experience here at Sioux Valley?
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Sioux Valley Hospital Robotic Experience98 cases
as of August 9 2005

• Prostatectomy-36
• Nissen-26
• Hysterectomy-16
• Cholecystectomy-3
• Splenectomy-2
• Adrenalectomy-2
• Colon resection-2
• Heller Myotomy-2
• Pyeloplasty-1

• Paraesophageal hernia repair-1
• Highly selective Vagotomy-1
• Inguinal Hernia repair-1
• Pericardial window-1
• IMA harvest-1
• Bronchgenic cyst excision-1
• Esophagectomy-1

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What developments are occurring in robotic
surgery?
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Future Innovations

• New Instrumentation
• New techniques
• Investigational surgery
• Training tools

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This is modern medicine at its very best
Dr. Michael Irish, Pediatric Surgeon at Blank
Childrens Hospital in Des Moines, Iowa
following the removal of a mediastinal mass from
a five day old, eight-pound infant using the da
Vinci Surgical System.