Sonnie KimAshchi MD FACOG Medical director of St Vincent Southside robotic program How many of you actually have seen and even tried daVinci robotic surgical systems Current understanding about daVinci robotic surgery with PCPs ID: 619277
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Slide1
Advances in Robotic Surgery for Improved Patient Care
Sonnie Kim-Ashchi, MD, FACOG.
Medical director of St. Vincent Southside robotic programSlide2
How many of you actually have seen and even tried daVinci robotic surgical systems?Slide3
Current understanding about daVinci robotic surgery with PCPs ; High Awareness, Fairly Positive Perception •
87-100%
are aware of da Vinci Surgery •
63-75% view it positively
Big Gaps in Knowledge of da Vinci® Surgery Among Referring
Physicians
1 in 3 PCPs
don’t
know any local surgeons who perform da Vinci Surgery
75% of PCPs
don’t
know outcomes of da Vinci Surgery vs. open and lap
surgery
50%+ OB/GYNs don’t know da Vinci procedures outside of GYN
60 % of PCPs
don’t
know da Vinci procedures for GYN, cardiothoracic, colorectal or general surgery
Slide4
daVinci Robot Assisted surgery, Minimally invasive Surgery ( MIS)
Cardiac
- mitral valve repair, revascularization
General Surgery
- cholecystectomy, colectomy, colorectal esophagectomy, trans hiatal gastrectomy, hepatectomy, lower anterior resection, Nissen fundoplication, pancreatectomy, Para esophageal hernia repair, rectopexy, splenectomy, ventral hernia repair, bariatric surgery
Head
&
Neck
- trans oral surgery
Thoracic
- lobectomy
Urology
- cystectomy, nephrectomy, partial nephrectomy, prostatectomy, pyeloplasty, ureteral reimplantation
Gynecology
- Endometriosis resection, benign and cancer hysterectomy, myomectomy, sacrocolpopexy
List of procedures are GROWING!
Plastic surgery-daVInci robot assisted latissimus dorsi flap retrieval for breast reconstruction after double mastectomySlide5
Benefits of robotic surgery
Less
blood loss- less chance of blood transfusion
Less
infection
Less
complication
Less
chance of procedure converting to an abdominal procedure
Short
hospital stay
(overnight stay vs. outpatient)
Lower
readmission rate
Less
postoperative pain = less narcotic use
Quicker
recovery-faster return to normal activities
For example, patients go back to regular work and activities with no limitation by 3 to 4 weeks after daVinci benign hysterectomy, sometimes 2 weeks if office worksSlide6Slide7
Advantage of well-organized robotic program- 46 %
less complication.
37%
lower costSlide8
daVinci robotic systems
Leonardo daVInci’s
mechanical knight robot
in 1495
daVinci Si system
daVinci Xi system
FDA Cleared for daVinci gyn surgery in 2005
daVinci
daVinci SSlide9
daVinci Surgical System; How does it work?
High Definition 3D Vision
Surgeon-controlled
Stable and immersive view
Up to 10x zoom
Precision & Dexterity
Mimics surgeon’s hands
Scales down movements
With tremor filtration
Intuitive
®
Motion
Advanced software enables intuitive control
(instead of
cross-handed)
3 cm
1cmSlide10
daVinci robot assisted benign gynecological surgeries
Hysterectomy, myomectomy, adnexal surgery, endometriosis resection
and pelvic prolapse
Please note there are non surgical options for these conditions. Slide11
St. Vincent SS robotic ORSlide12
daVinci robot assisted benign hysterectomy- 80% by
MIS
!!
TAHSlide13
Multicenter analysis comparing robotic, open, laparoscopic and vaginal hysterectomy by high-volume surgeons for benign indications
Robotic
patients
had:
•
Larger uteri
•
Fewer complications
•
Shorter hospital stay
•
Similar
conversions, readmissions & reoperation rate as other MIS
approaches
International Journal of Gynecology and Obstetrics 2016 Lim PC. Garza D.Slide14
Clinical Benefits Promote Positive Economic Value of daVinci Surgery in Gynecology
* Common misconception - Robotic surgery is too expensive !
The cost of robotics must take into the account the total cost of care and how robotic-assisted surgery affects the rate of laparotomy to prove the benefits of minimally invasive surgery without increasing costs.
Total
cost of a patient’s care includes not only instrumentation costs, but also costs based on factors such as length of stay (LOS, daVinci 0.5 vs open 2.7 vs LSC 1.8 days), Operating Time , Conversion rates ( LSC 7.2 % vs daVinci TLH 0.3 %), complications, readmissions and reoperations.
National cost average data- bed day $1,553. A conversion $3,162. Complication cost $3,632. OR time $11 per minute, Readmission $11,087
There are also societal cost savings to consider based on the patient’s quicker return to normal activities.
Surgeons’ time – outpatient !Slide15
Benefits of robotic surgery
Less blood loss-less chance of blood transfusion
Less infection
Less complication rateLess chance of procedure converting to an abdominal procedure
Short hospital stay
Less postoperative pain-less narcotic use
Quicker recovery-faster return to normal activities
For example, patients go back to regular work and activities with no limitation by 3 to 4 weeks after daVinci benign hysterectomy, sometimes 2 weeks if office worksSlide16
Adaptation of MIS in benign gyn cases such as endometriosis resection, myomectomy and hysterectomy
Abdominal (Open) Surgery
Vaginal Surgery
Laparoscopy
Robotic-Assisted
Surgery: Multi-port
Robotic-Assisted
Surgery:
Single-Site
®Slide17
Evolution of Surgical approachesSlide18
daVinci robot assisted benign gyn surgery
One Large Incision
Multiple Small Incisions
One Small
Incision
i
n the Belly Button
Open Hysterectomy
da Vinci
®
Hysterectomy:
Multi-port
da Vinci
®
Single-Site
®
Hysterectomy
or
Traditional Laparoscopic
Single
Incision
Hysterectomy
Traditional
Laparoscopic HysterectomySlide19
How to remove the specimen through 2cm umbilical incision?
Not limited
by incidence of prior surgeries, pelvic infection, large uteri or presence of single or multiple adnexal masses or/and severe endometriosisSlide20
1200 gram morcellated uterusSlide21
daVinci Single-Site benign hysterectomy or adnexal surgery
Virtually , “scarless” surgery !!! Slide22
Please Remember the Benefits of robotic surgery for your patients
Less blood loss-less chance of blood transfusion
Less infection
Less complication rate
Less chance of procedure converting to an abdominal procedure
Short hospital stay/ Lower Rate of readmission
Less postoperative pain-less narcotic use
Quicker recovery-faster return to normal activities
For example, patients go back to regular work and activities with no limitation by 3 to 4 weeks after daVinci benign hysterectomy, sometimes 2 weeks if office worksSlide23
Thank you !
St. Vincent Southside Robotic TeamSlide24
Please call me if you would like to come. 904-759-2328