Advances in Robotic Surgery for Improved Patient Care - PowerPoint Presentation

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 worksSlide6
Slide7

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