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Anthony R. DeSalvo, M.D.        1842 E Market St     Warren, OH 44483            330.856.7212      warren-obgyn.com
Anthony R. DeSalvo, M.D Bachelor of Science – Kent State University Medical Degree – Northeastern Ohio Universities    C...
Why am I here? Educate the public some common gynecologic  conditions that may require an operation Discuss the types of...
Common conditions treated byhysterectomy Heavy menstrual bleeding Pelvic pain Fibroid uterus Endometriosis Prolapse ...
Heavy menstrual bleeding Defined as bleeding that lasts for longer than 7 days  per month or greater than 80 mL per cycle...
Pelvic pain Chronic pelvic pain refers to pain of at least six  months duration that occurs below the belly button  and i...
Fibroid uterus Fibroids are tough balls of muscle that form in the uterus People sometimes refer to fibroids as “tumors....
Endometriosis Endometriosis occurs when tissue normally found in a  woman’s uterus grows outside of the uterus . This ti...
Prolapse When tissues that support the organs in the lower belly relax. The  organs drop down and press against or bulge ...
Cancer As a benign gynecologist, I do not treat women with  gynecologic cancers These women are best served by a referra...
Procedures Hysterectomy – removal of the uterus Total hysterectomy – removal of the uterus and  cervix Sub-total hyster...
Hysterectomy facts Approximately 525,000 hysterectomies are performed  each year in the U.S. for non-cancerous conditions...
Route of SurgeryAbdominal  Requires a large   abdominal   incision  Usual hospital   stay is 2 to 4   nights  6 to 8 we...
Vaginal hysterectomy The entire operation is performed through the  vagina Requires good access to the uterus More chal...
Laparoscopic hysterectomy Better visualization Shorter hospitalization Shorter recovery Good visualization of the pelv...
US Hysterectomy Modalities 2005 vs. 20124                                    Jan 1,               2005          Lap – 14% ...
The Impact on Hysterectomy       Adoption of MIS for Hysterectomy             80%             70%             60%         ...
Natural Evolution of Technology
Natural Evolution of Technology
Evolution of Technology Konrad Zuse’s Z1 (1938)  First binary computer      UNIVAC I – UNIVersal Automatic Computer (1951)...
Evolution of Technology         Altair (1974)         Scelbi (1974)  First personal computer  Kit that user had to put    ...
Which would you rather have?                    Versus
RoboticsCurrent applications       Auto industry       Space industry       Multiple other industries       Military  ...
What’s the difference?
The natural evolution of computersinto the operating room
Minimally Invasive SurgeryBenign hysterectomy in the US 2003                             Mean LOS=1.7 days* Mean LOS=2.0 d...
da Vinci® S Robotic Platform
da Vinci® Surgery (Minimally Invasive)
Robotic PlatformGeneral thoughts    A tool    Not new surgery or procedure    A tool that makes minimally invasive     ...
Advantages of robotic surgery Much improved 3D visualization over traditional laparoscopy   Keep in mind, that tradition...
da    Vinci®          Awareness President Obama                     Jeopardy                 CNN (Cleveland Clinic)       ...
Summary The addition of computer technology into the    operating arena is a natural evolution and progress   The additi...
DaVinci Hysterectomy Public Lecture
DaVinci Hysterectomy Public Lecture
DaVinci Hysterectomy Public Lecture
DaVinci Hysterectomy Public Lecture
DaVinci Hysterectomy Public Lecture
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DaVinci Hysterectomy Public Lecture

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A public presentation given about the robotic surgical platform. There were several video slides that were removed due to space limitations.

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DaVinci Hysterectomy Public Lecture

  1. 1. Anthony R. DeSalvo, M.D. 1842 E Market St Warren, OH 44483 330.856.7212 warren-obgyn.com
  2. 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 Personal information Professional information
  3. 3. Why am I here? Educate the public some common gynecologic conditions that may require an operation Discuss the types of operations that are available Introduce the concept of robotic surgery to the public  Dispel some common myths about robotic surgery
  4. 4. Common conditions treated byhysterectomy Heavy menstrual bleeding Pelvic pain Fibroid uterus Endometriosis Prolapse Cancer
  5. 5. Heavy menstrual bleeding Defined as bleeding that lasts for longer than 7 days per month or greater than 80 mL per cycle Difficult to estimate the true amount of blood loss Bleeding that soils clothes, bed sheets or requires the significant planning Very subjective but usually a person knows it when it happens to them
  6. 6. Pelvic pain Chronic pelvic pain refers to pain of at least six months duration that occurs below the belly button and is severe enough to cause functional disability or require treatment. In the United States, this problem accounts for approximately 10 % of all visits to a GYN. It is considered the principal indication for approximately 20 % of hysterectomies performed for benign disease.
  7. 7. Fibroid uterus Fibroids are tough balls of muscle that form in the uterus People sometimes refer to fibroids as “tumors.” But fibroids are not a form of cancer. They are simply abnormal growths in the muscle of the uterus Fibroids often cause no symptoms at all. When they do cause symptoms, they can cause:  •Heavy periods  •Pain, pressure, or a feeling of “fullness” in the belly  •The need to urinate often  •Too few bowel movements (constipation)  •Difficulty getting pregnant
  8. 8. Endometriosis Endometriosis occurs when tissue normally found in a woman’s uterus grows outside of the uterus . This tissue, which does not belong outside the uterus, can then break down, bleed, and cause symptoms Some women with endometriosis have no symptoms. But most have pain in the lower part of the belly that can occur:  •Before or during monthly periods  •Between monthly periods  •During or after sex  •When urinating or having a bowel movement (often during monthly periods)
  9. 9. Prolapse When tissues that support the organs in the lower belly relax. The organs drop down and press against or bulge into the vagina. If the bladder bulges into the vagina,, this is a“cystocele.” If the rectum bulges into the vagina, it’s a “rectocele.” Uterine prolapse means the uterus has bulged into the vagina. Many women with this problem have no symptoms. But some women with pelvic organ prolapse have symptoms that include:  •Fullness or pressure in the pelvis or vagina  •A bulge in the vagina or coming out of the vagina  •Leaking urine when they laugh, cough, or sneeze  •When they use the toilet, some women need to press on the bulge in the vagina with a finger to get out all their urine or to finish a bowel movement.
  10. 10. Cancer As a benign gynecologist, I do not treat women with gynecologic cancers These women are best served by a referral to a GYN oncologist We are very fortunate to have several world class cancer centers within a 1 hour drive
  11. 11. Procedures Hysterectomy – removal of the uterus Total hysterectomy – removal of the uterus and cervix Sub-total hysterectomy (Supracervical) – removal of uterus only with the cervix left in place Oophorectomy – removal of the ovaries Confusing terms – complete , partial and total
  12. 12. 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 hysterectomy2 90% are performed for elective benign indications  Fibroids  Abnormal uterine bleeding  Endometriosis  Chronic pelvic pain
  13. 13. Route of SurgeryAbdominal  Requires a large abdominal incision  Usual hospital stay is 2 to 4 nights  6 to 8 weeks of recovery
  14. 14. 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
  15. 15. 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
  16. 16. US Hysterectomy Modalities 2005 vs. 20124 Jan 1, 2005 Lap – 14% Vag – 22%
  17. 17. 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
  18. 18. Natural Evolution of Technology
  19. 19. Natural Evolution of Technology
  20. 20. 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
  21. 21. 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
  22. 22. Which would you rather have? Versus
  23. 23. RoboticsCurrent applications  Auto industry  Space industry  Multiple other industries  Military  Laboratory test processing  Automated research equipment  Radiation therapy  Toys
  24. 24. What’s the difference?
  25. 25. The natural evolution of computersinto the operating room
  26. 26. 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.
  27. 27. da Vinci® S Robotic Platform
  28. 28. da Vinci® Surgery (Minimally Invasive)
  29. 29. Robotic PlatformGeneral thoughts  A tool  Not new surgery or procedure  A tool that makes minimally invasive surgery easier  Very rare to have “robotic” complication if used properly  Surgeon who’s using the robot has a complication as with any other tool
  30. 30. 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
  31. 31. da Vinci® Awareness President Obama Jeopardy CNN (Cleveland Clinic) The Doctors The Daily Buzz Private Practice Law & Order
  32. 32. 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

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