Here is a chart showing the correlation between the decline in open hysterectomy and an increase in da Vinci surgery. It’s also worth noting that since the first laparoscopic hysterectomy in the US was performed in 1989, the adoption has been rather slow (18% penetration in 2010) and fairly stagnant since 2004. In just 5 years of clinical use, the da Vinci system has been used in more procedures than laparoscopy has been used over 20 years. Lap and vaginal approaches have remained relatively flat or have declined over this same time period. Why?Laparoscopic Surgery (Drawbacks of conventional laparoscopy – use only if needed during presentation.)Lack of MIS penetration in complex pelvic procedures is due to technical limitations of conventional laparoscopy:2D visualization lacks depth perception & rigid instruments limit the surgeon’s precision and accuracy – both make complex surgical maneuvers difficult.Counter-intuitive movement (to move left the surgeon needs to move the instrument right), which is difficult to sustain over long, complex procedures… and even more difficult for a novice to learn.Vaginal Surgery is also difficult to perform:Limited access to uterine structures: uterus must be pulled out of the vagina to ligate the uterine arteriesLimited workspace (surgeon, assistant and nurse are working in the same space)Limited view of the anatomy (vascular structures and Comorbidities are very unlikely to be seen or addressed)Difficult to determine the source of intraop bleedingWould you agree these are limitations to both approaches? And with the rise of da Vinci adoption, the benefits of MIS extend to all women facing surgery for pelvic conditions– not just hysterectomy.
1. Anthony R. DeSalvo, M.D. 1842 E Market St Warren, OH 44483 330.856.7212 warren-obgyn.com
2. Anthony R. DeSalvo, M.D Bachelor of Science – Kent State University Medical Degree – Northeastern Ohio Universities College of Medicine Residency – Beth Israel Medical Center, New York, NY Board Certified – American Board of Obstetrics and Gynecology
3. Why am I here?Introduce the concept of robotic surgery to the publicDispel some common myths about robotic surgery
4. Hysterectomy facts Approximately 525,000 hysterectomies are performed each year in the U.S. for non-cancerous conditions By age 60, 1 in 3 women in the U.S. will have had a hysterectomy 90% are performed for elective benign indications Fibroids Abnormal uterine bleeding Endometriosis Chronic pelvic pain
5. Route of SurgeryAbdominal Requires a large abdominal incision Usual hospital stay is 2 to 4 nights 6 to 8 weeks of recovery
6. Vaginal hysterectomy The entire operation is performed through the vagina Requires good access to the uterus More challenging in patients with prior abdominal surgery or previous cesarean section More challenging if the uterus is enlarged Limited visualization of the pelvis and ovaries
7. Laparoscopic hysterectomy Better visualization Shorter hospitalization Shorter recovery Good visualization of the pelvic organs Can be performed in a wide variety of patients Traditional laparoscopy requires a unique skill set and commitment to the procedure
8. US Hysterectomy Modalities 2005 vs. 20124 Jan 1, 2005 Lap – 14% Vag – 22%
9. The Impact on Hysterectomy Adoption of MIS for Hysterectomy 80% 70% 60% 50% Adoption Laparoscopy 40% da Vinci 30% Vaginal Open 20% 10% 0% YearFarquhar et al. "Hysterectomy Rates in the United States: 1990–1997" Obstet Gynecol 2002;99:229 –34Becker et al. "Inpatient Surgical Treatment Patterns for Patients with Uterine Fibroids in the United States, 1998-2002" Journal of the National Medical Assn. Vol. 97 (10) October 2005Wu et al. "Hysterectomy Rates in the United States, 2003" Obstet & Gyn VOL. 110, NO. 5, NOVEMBER 2007Solucient data through 2010 for Lap, Open and Vaginal Trends
10. Natural Evolution of Technology
11. Evolution of Technology Konrad Zuse’s Z1 (1938) First binary computer UNIVAC I – UNIVersal Automatic Computer (1951) Mechanical calculator First commercial computer U.S. Census Bureau Original price: $159,000 Ultimate price: $1.5 million 46 systems built and sold IBM 701– (1953) First commercial IBM computer $15,000/month rental fee Only 19 systems built and sold
12. Evolution of Technology Altair (1974) Scelbi (1974) First personal computer Kit that user had to put together, make it IBM 5100 – First IBM PC (1975) work, and write software 50 pounds 256 Byte RAM Programming language (APL or BASIC) $400 64K storage version $19,975
13. Which would you rather have? Versus
14. RoboticsCurrent applications Auto industry Space industry Multiple other industries Military Laboratory test processing Automated research equipment Radiation therapy Toys
15. What’s the difference?
16. The natural evolution of computersinto the operating room
17. Minimally Invasive SurgeryBenign hysterectomy in the US 2003 Mean LOS=1.7 days* Mean LOS=2.0 days* Mean LOS=3.0 days* *P-value<0.001 Wu JF. Et al. Obstet Gynecol 2007;110:1091-1095.
18. da Vinci® S Robotic Platform
19. da Vinci® Surgery (Minimally Invasive)
20. Robotic PlatformGeneral thoughts A tool Not new surgery or procedure A tool that makes minimally invasive surgery easier
21. Advantages of robotic surgery Much improved 3D visualization over traditional laparoscopy Keep in mind, that traditional laparoscopy was still better than open surgery Full wristing instruments with 7 degrees range of motion Complete surgical control of the operative instruments Mimics the hand movements of open surgery
22. da Vinci® Awareness President Obama Jeopardy CNN (Cleveland Clinic) The Doctors The Daily Buzz Private Practice Law & Order
23. Summary The addition of computer technology into the operating arena is a natural evolution and progress The addition of robotic platform for surgery is a continuation of this progress Man’s tools continue to add great value to our lives This tool will greatly reduce or nearly eliminate the need for open surgery The societal benefits of a surgical platform are vast and numerous