Thank you Frank for the introduction of our new Epicenter surgeons and hosts. Again, thank you for taking the time to come out here for this meeting. My name is Debbie Choy and you probably know me from all the emails that I’ve been sending you. For the last few months I have been working with a lot of you on the Epicenter program, to onboard the new Epicenters, planning this meeting, and taking your feedback about what we can do better with the processes of this program.
Robin, need to show Pfannenstiel incision with red line in addition to vertical laparotomy. I prefer the phrasing of the asterisk line.
Over the last five years the installed base of da Vinci Surgical Systems has grown significantly.
Referring physicians presentation short
da Vinci®Hysterectomyfor Benign GynecologicConditions Anthony R DeSalvo, MD St Joseph Health Center
Hysterectomy Facts Approximately 525,000 hysterectomies are performed each year in the U.S.1 By age 60, 1 in 3 women in the U.S. will have had a hysterectomy2 90% are performed for elective benign indications 3 Fibroids Abnormal uterine bleeding Endometriosis Chronic pelvic pain1 Thomson Solucient data2 US Department of Health & Human Services, womenshealth.gov, Hysterectomy FAQ. www.4woman.gov/faq/hysterectomy.htm3 American College of Surgeons “About Hysterectomy” brochure.http://www.facs.org/public_info/operation/hysterectomy.pdf#search=%2290%25%20hysterectomies%20performed%20are%20elective%22
Complex Hysterectomy Pelvic Adhesive Disease (PAD) Prior pelvic surgery Endometriosis A significant Prior pelvic infection portion of benign Large Uteri hysterectomies High BMI Patient (BMI ≥ 30) are complex. Presence of single or multiple adnexal masses
Evolution of Hysterectomy Total abdominal (TAH) & vaginal hysterectomy (TVH) Laparoscopic-assisted vaginal hysterectomy was introduced by Reich in the late 1980s (LAVH) Laparoscopic supracervical hysterectomy (LSH) Total laparoscopic hysterectomy (TLH) >50% of all hysterectomies performed in the U.S. are abdominal44 2008 Thomson Solucient data
da Vinci Hysterectomy da Vinci overcomes the limitations of conventional laparoscopy by enabling gynecologists to treat complex pathology minimally invasively, 5 cm minimizing conversions and the need for total abdominal hysterectomy. Tremor filtration, motion scaling, 3D vision and robotic precision improve the technical quality of reconstruction EndoWrist® instruments provide 7 degrees of freedom and added dexterity Using the da Vinci System’s 4th arm to perform traction and retraction tasks provides the surgeon with enhanced control of the surgical site Net result: Improved technical capabilities for quality reconstruction When compared to the open approach, da Vinci offers the patient and surgeon numerous potential benefits 1 cm
Patient Expectations and Benefits Less need for pain medication2,4 Less blood loss and fewer transfusions1,3,4 Fewer complications and lower conversion rate1 Shorter hospital stay1,3,4 Quicker recovery and fast return to normal daily activities1,4 Small incisions for improved cosmesis Better clinical outcomes and patient satisfaction as compared to open surgery1,23. Payne, T. N., F. R. Dauterive, et al. (2010). “Robotically assisted hysterectomy in patients with large uteri: outcomes in five communitypractices.” Obstet Gynecol 115(3): 535-542.4. Visco, A. G. and A. P. Advincula (2008). “Robotic Gynecologic Surgery.” Obstet Gynecol 112(6): 1369-1384.
Surgeon Benefits Compared to conventional laparoscopy, the unsurpassed visualization, dexterity and control allow surgeons: To treat more pathology minimally invasively — safely, reproducibly and following open surgical technique1 —including patients with: Adhesive disease1 Large pathology1 Obesity2 Greater access, precision and control for improved dissections1 Quicker, easier suturing during vaginal cuff closure1 Control of the camera and all three operative arms for the ultimate in surgical autonomy and efficiency11. Payne, T. N. and F. R. Dauterive (2008). “A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgicaloutcomes in a community practice.” J Minim Invasive Gynecol 15(3): 286-291.2. Piquion-Joseph, J. M., A. Nayar, et al. (2009). “Robot-assisted gynecological surgery in a community setting.” Journal of Robotic Surgery: 1-4.
da Vinci® Surgical System U.S. Installed Base 1999 – 2010 AlaskaHawaii 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010- through Q2 close
The Future is Robotic Surgery Robotic surgery is here to stay The advantages to our patients with MIS are significant Robotic surgery allows almost all patients to benefit from the advantages of MIS – especially those with >BMI