Thank you for joining us today for this gynecology patient education seminar. I ’m Dr. ____ and I’m a board-certified ____ Ob/Gyn ____ here in area __. I appreciate the opportunity to talk to you today, because there have been some exciting new advances in the treatment of many common gynecologic conditions. The primary advance that I want to talk to you about today is robotic-assisted surgery with the da Vinci Surgical System. From my experience incorporating robotic surgery into my practice, I hope to give you a feeling on the many benefits of minimally invasive surgery.
During the course of our program today, I will discuss different gynecologic problems, their symptoms and their treatment options, including surgical options. I will provide an overview of da Vinci Gynecologic Surgery, which in many situations is your most effective, least invasive surgical option. Common operations now available with robotic-assisted surgery include: da Vinci Hysterectomy, da Vinci Myomectomy and da Vinci Gynecologic Cancer Surgery.
Some important things to know about hysterectomy are that it ’s the most common surgical procedure performed on women. This is because it is the definitive solution for many types of common gynecologic conditions. About 650,000 hysterectomies are performed annually in the United States alone. Most of these are still performed through abdominal incisions, either up and down between the belly button and the pubic bone or across, what many women refer to as a bikini incision. Due to recent advances in minimally invasive approaches to hysterectomy, more and more gynecologic surgeons are performing these types of procedures either vaginally or using what ’s called a laparoscopic approach.
Myomectomies are also quite common. About 40,000 procedures are performed in the United States every year. Most of these procedures are performed through abdominal incisions. Sometimes if there are many fibroids or the fibroids are very large, a hysterectomy maybe required. Some gynecologic surgeons have begun performing myomectomies with minimally invasive surgical approaches. Myomectomies are indicated if you are still trying to get pregnant and a minimally invasive surgical approach offers many advantages for a shorter recovery.
Now that we have talked about some common gynecologic conditions and their various treatment options, let ’s discuss some of the approaches that are available when surgery is needed. As I alluded to earlier, if you need a hysterectomy, it can be done with a traditional approach, an open abdominal incision; this incision maybe vertical or transverse. Now, however, many physicians are offering minimally invasive surgery for hysterectomy. A minimally invasive approach could be vaginal with conventional laparoscopy or robotically with the da Vinci Surgical System.
There are many advantages to minimally invasive surgery. These include reduced blood loss, fewer complications, a shorter stay in the hospital, a faster recovery, and less scarring.
Vaginal surgery maybe appropriate for you for certain gynecologic problems. The pros of vaginal surgery include that it is less invasive. There is no scar on the abdomen and often you spend only one night in the hospital. There is also significantly less pain with a vaginal approach than there is with an abdominal hysterectomy. Cons to vaginal surgery are that it can be difficult to perform. The physician may not be able to see as well and it may be difficult to control bleeding from the vascular tissues that give blood supply to the pelvic organs. In addition, vaginal surgery may not be indicated for certain types of patients. If you have never had children or have large fibroids or other types of large masses, you may not be able to have the surgery performed vaginally. Cancer operations are rarely performed vaginally as they usually require much more extensive surgery than a vaginal approach could offer. Finally, if you have significant adhesions or scar tissue from endometriosis or prior surgeries, this could make vaginal surgery unfeasible.
On the other hand, laparoscopic surgery is performed through very small keyhole incisions in the abdomen rather than one long continuous incision. One advantage to laparoscopic surgery is that the surgeon ’s view is magnified. Laparoscopic surgery begins with the surgeon inserting a video telescope or camera through a small incision, usually in the belly button. This camera will often magnify the areas that the surgeon is examining and provide better visualization than open surgery. With conventional laparoscopic surgery, after the surgeon has placed the camera, several additional small keyhole incisions are made. Through these small incisions cannulas or trocars are inserted. Through these trocars different types of instruments can be inserted that perform various functions like grasping, cutting or cauterizing.
Some of the drawbacks of conventional laparoscopic surgery include that the surgeon is operating while looking at a two-dimensional image usually on a flat screen monitor. The instruments themselves are rigid and can only be moved in a few directions in space. The instruments are controlled at a distance with the surgeon ’s hand outside of the patient’s abdomen. This results in reduced dexterity, reduced precision, and reduced control of the instruments. It also results in greater surgeon fatigue. Assistance from the surgeon on the other side of the operating room table can also be difficult to coordinate. With conventional laparoscopic surgery, very complex operations can be quite difficult or impossible to perform. However, conventional laparoscopic surgery is an excellent option for minor or straightforward surgical procedures like tubal ligations or removal of small ovarian cysts.
How can we overcome some of these drawbacks of conventional laparoscopic surgery? Many surgeons around the country like myself now have access to the da Vinci Surgical System. This system provides state-of-the-art robotic technology and allows me to be completely in control of the operation. My assistant also has direct access to the patient through traditional laparoscopic trocars or ports.
Rather than a two-dimensional flat image, I am immersed in a three-dimensional image of the surgical field.
I direct the instruments at all times while controlling the arms on the console. Even small or very precise movements of my hands are transmitted to the instruments inside the patient ’s abdomen in real time.
Conventional laparoscopic instruments are rigid and do not have the ability to rotate like a human wrist. The EndoWrist instruments, part of the da Vinci Surgical System, move like a human wrist with seven degrees of freedom. This allows me to operate with increased dexterity and precision.
These EndoWrist instruments fit through small dime-sized incisions or keyhole incisions. A wide range of instruments are available to perform almost any type of task that might be required.
In addition to the number of many benefits to the patient, there are many benefits to me the surgeon as well. These include improved visualization, better control of the instruments, improved surgical dexterity for complex aspects of the operation, easier and faster suturing, and I ’m more comfortable while I’m operating.
This slide shows a picture of the typical configuration of these small keyhole incisions that might be used for access to perform a robotic-assisted surgery.
When you compare the benefits of different surgical approaches, you can see that the da Vinci Surgical System offers many advantages. In general, smaller incisions result in less scarring, less pain, a shorter hospital stay, shorter recovery, and quicker return to normal activities.
da Vinci Gynecologic Surgery is not indicated for everybody. It does allow me to perform a broader range of surgeries for different gynecologic conditions and for different patient situations than was ever available before. For example, radical hysterectomy done with conventional laparoscopy has not been widely accepted by gynecologic oncologists. The concern is that the lack of surgical precision results in a less than adequate cancer operation. However, the da Vinci radical hysterectomy is being performed by a large number of gynecologic oncologists around the United States with excellent surgical results. Endometrial cancer has been treated with conventional laparoscopy for sometime now with good surgical results, but it can be technically difficult to perform and quite exhausting for the surgeon. The da Vinci surgical approach offers better ergonomics for the surgeon and better precision. Surgery for vaginal or uterine prolapse can be performed with conventional laparoscopy, but as we discussed before the laparoscopic suturing may not be reliable. da Vinci laparoscopic suturing is reliable and easy. In addition, surgery for endometriosis can be quite complex and the da Vinci System provides the increased precision often required to perform these surgeries safely. Surgery for large uterine fibroids can be difficult or impossible to perform with conventional laparoscopy, but now they can be performed by experienced robotic surgeons. Finally, surgery on obese patients can be difficult for a number of reasons. However, these are the patients that benefit the most from a minimally invasive approach due to a decreased risk of wound infection and decreased risk of wound healing problems. The da Vinci Surgical System allows me to offer minimally invasive surgery to a much greater number of obese patients.
Now, let ’s talk in more detail about some of the goals of da Vinci Hysterectomy. This allows a minimally invasive approach for hysterectomy. It ’s much easier to learn than conventional laparoscopy and enables the gynecologist to perform the surgery for more advanced types of gynecologic problems. Again, the benefits to you include a shorter hospital stay, less pain and scarring, and a quicker return to normal activities.
Now, let ’s take a look at the goals of da Vinci Myomectomy. Again, it enables the surgeon to offer a minimally invasive approach to the removal of uterine fibroids while preserving the uterus for fertility. Most myomectomies are currently performed through open incisions and conventional laparoscopy can be very difficult to learn and perform, particularly due to the difficulty of conventional laparoscopic suturing. da Vinci Myomectomy enables you to retain your uterus and therefore your ability to have children. In addition, you can reap the many benefits of a minimally invasive approach.
I ’d like to say a few words about how the da Vinci Surgical System can be used for different types of gynecologic cancer surgery. Traditionally, surgery for gynecologic cancers like many other types of cancers have involved large incisions with extensive operations that can result in a feeling of disfigurement. By employing a minimally invasive surgical technique even for cancer operations, patients can maintain a greater self-esteem and quality of life. In the past, conventional laparoscopy has fallen short of being an adequate surgical approach for complex cancer operations. In addition, conventional laparoscopic surgery can be difficult to learn and perform. With the da Vinci Surgical System, more advanced operations can be performed with a minimally invasive approach. The benefits we discussed before of shorter hospital stay, minimal pain and scarring, and quick recovery can also apply to women with conditions as serious as cancer.
I appreciate you spending some time with me today to learn more about da Vinci Surgery. I hope this program was helpful and stimulates you to think about different options that are available for your patients if they need surgery.
Da Vinci Gyne Surgical Assistant role
Da Vinci RoboticGynecologicSurgeryPresented by:Luis F. Aragon, RSAAmerican Surgical Assistants, Inc. / Surgbill, Inc. Advances in Minimally Invasive Surgery daVinciSurgery.com
Program Gynecologic Conditions Benign Cancerous Symptoms & Treatments Surgical Options da Vinci® Gynecologic Surgery da Vinci® Hysterectomy da Vinci® Myomectomy da Vinci® Sacrocolpopexy da Vinci® Hysterectomy for CancerLuis F. Aragon, RSA daVinciSurgery.com
Utilized Across Key Surgical Specialties General Gynecology Urology Cardiovascular ThoracicLuis F. Aragon, RSA daVinciSurgery.com
Hysterectomy Facts Most common female surgery Definitive solution for many uterine conditions 600,000 procedures annually Most performed through abdominal (open) incision Advances in minimally invasive surgery (MIS) for hysterectomy More GYN surgeons performing MIS for hysterectomyLuis F. Aragon, RSA daVinciSurgery.com
Myomectomy Facts 40,000 procedures performed annually Most performed through abdominal (open) incision Number and size of fibroids may require complete removal of uterus (hysterectomy) Advances in minimally invasive surgery (MIS) for myomectomy More GYN surgeons performing MIS for myomectomy If uterine and/or fertility preservation is desiredLuis F. Aragon, RSA daVinciSurgery.com
Surgical Approaches to Hysterectomy Open (abdominal) surgery Minimally invasive surgery (MIS) Vaginal surgery Conventional laparoscopic surgery da Vinci® Hysterectomy (robot-assisted surgery)Luis F. Aragon, RSA daVinciSurgery.com
Minimally Invasive Surgery (MIS) Reduced blood loss Fewer complications Shorter Hospital stay Faster recovery Less scarring Circa. 1991Luis F. Aragon, RSA daVinciSurgery.com
Vaginal Surgery Pros Minimally invasive Minimal scarring Short hospital stay Less pain compared to abdominal hysterectomy Cons Difficult to perform Reduced visualization Not indicated for many patients Nulliparious (women who have not given birth) Multiple fibroids (or large masses) Cancer Adhesions, e.g., endometriosis, prior pelvic surgeryLuis F. Aragon, RSA daVinciSurgery.com
Laparoscopic Surgery Minimally invasive Ability to operate through small, keyhole incisions Better visualization than open surgery Open Vertical Incision Open Transverse Incision Laparoscopic or da Vinci® IncisionLuis F. Aragon, RSA daVinciSurgery.com
Drawbacks with Conventional Laparoscopic Surgery Surgeon operates from a 2D image Rigid instruments Instruments controlled at a distance Reduced dexterity, precision & control Greater surgeon fatigue Surgical assistance is limited Makes complex operations more difficult to performLuis F. Aragon, RSA daVinciSurgery.com
How can we overcome these drawbacks? da Vinci® Surgical System State-of-the-art robotic technology Surgeon in control Assistant has direct accessLuis F. Aragon, RSA daVinciSurgery.com
Vision System Surgeon immersed in 3D image of the surgical fieldLuis F. Aragon, RSA daVinciSurgery.com
The Surgeon Directs the Instruments Surgeon directs precise movements of the instruments using Console controlsLuis F. Aragon, RSA daVinciSurgery.com
Wrist and Finger Movement Conventional minimally invasive instruments are rigid with no wrists EndoWrist® Instrument tips move like a human wrist Allows surgeon to operate with increased dexterity & precisionLuis F. Aragon, RSA daVinciSurgery.com
Small Instruments, Small Incisions EndoWrist® Instruments fit through dime-sized incisions A wide range of instruments are availableLuis F. Aragon, RSA daVinciSurgery.com
da Vinci® Surgery Surgeon has… Improved visualization Better instrumentation, surgical control & precision Better surgical dexterity for complex aspects of procedure Double-click to view video Easier & faster suturing Better ergonomicsLuis F. Aragon, RSA daVinciSurgery.com
Robot-Assisted Surgery Access Open Vertical Incision Open Transverse Incision da Vinci® Surgical IncisionLuis F. Aragon, RSA daVinciSurgery.com
Potential Patient Benefits Benefit Open Surgery da Vinci® Surgery Incision size Long incision with 4-6 dime-sized visible scaring incisions with minimal scaring Pain or discomfort Weeks Days Hospital stay 3-5 days 1-2 days Recovery 4-6 weeks 1-3 weeks Return to normal Weeks Days activitiesLuis F. Aragon, RSA daVinciSurgery.com
da Vinci® Gynecologic Surgery Indications da Vinci® Surgery appropriate for a broader range of gynecologic conditions & patient situations compared to conventional laparoscopy • Cervical cancer Conventional laparoscopy not widely accepted • Endometrial cancer Conventional laparoscopy accepted, but technically difficult to perform • Vaginal or uterine prolapse Conventional laparoscopic suturing not reliable • Endometriosis • Uterine fibroids • Obese patientsLuis F. Aragon, RSA daVinciSurgery.com
Goals of da Vinci® Hysterectomy Enable minimally invasive surgery (MIS) approach – Easier to learn & perform compared to conventional laparoscopic surgery – da Vinci (robotic-assisted) Surgery will enable: More Gynecologists to perform minimally invasive surgery Gynecologists to perform more advanced operations & more types of procedures using a minimally invasive approach Provide benefits of MIS to hysterectomy candidates – Short hospital stay – Minimal pain & scarring – Quick recovery & return to normal activitiesLuis F. Aragon, RSA daVinciSurgery.com
Goals of da Vinci® Myomectomy Enable minimally invasive surgery (MIS) approach Most myomectomies performed through open incision Conventional laparoscopy for myomectomy is very difficult to learn & perform Enable women to retain their uterus* Provide means for women to preserve their fertility Provide benefits of MIS to myomectomy patients Short hospital stay Minimal pain & scarring Quick recovery & return to normal activities *Assumes patient is a candidate for myomectomy.Luis F. Aragon, RSA daVinciSurgery.com
Goals of da Vinci® Gynecologic Cancer Surgery Traditional open approach resulted in large incisions da Vinci enables minimally invasive surgery (MIS) approach – Conventional laparoscopy may fall short in adequately removing & treating gynecologic cancers – Conventional laparoscopic (minimally invasive) surgery is difficult to learn & perform – With da Vinci, Gynecologic Oncologists can perform more advanced operations using a minimally invasive approach Provide benefits of MIS to cancer patients – Short hospital stay – Minimal pain & scarring – Quick recovery & return to normal activitiesLuis F. Aragon, RSA daVinciSurgery.com