this was the firsts robotic case done by me in Indore and was present in ASI, Indore meeting . Video can be found on youtube.

1. Robotic assisted Laparoscopic
Nephrectomy
Dr. Santosh Agrawal ,MCh
Robotic training at Roswell Park Cancer Institute, Buffalo, Newyork, USA
Dr.Saurabh Chipde
Dr.Jaisukh Kalathia/Dr Udit Mishra
SRI AUROBINDO INSTITUTE OF MEDICAL SCIENCE and Mohak Hospital, Indore

2. The Da Vinci Surgical System

3. Da Vinci Surgical System
• Master-slave system – the surgeon directly initiates all the movements of
the robotic instruments in real time.

4. Da Vinci Surgical System
• Since 2000, 1,370 U.S. hospitals have purchased at least one of the
$1.5 million-to-$2.2 million robots, known as the da Vinci Surgical
Systems, made by Intuitive Surgical Inc. of Sunnyvale, Calif
• In US, <1% of the radical prostatectomy were done by robots in 2001,
>40% of the radical prostatectomy were done by robots in 2006
• India – 27 robotic centers
Product of the Intuitive Surgical & the most famous robotic surgery apparatus in world.
FDA approved in human operations On July 11 in 2000.

5. Da Vinci Surgical System
Human eye vision & beyond
• Double lenses laparoscope
• 3D, high definition, binocular
view
• 10-15X magnification
Da Vinci system consists of 2 primary
components:
• A viewing & control console
• A surgical arm unit - 3 or 4 arms
(depends on the model)

6. Types of instruments used by dVSS
3 arms for tools that hold objects, act as a scalpel,
scissors, bovie, or unipolar or dipolar electrocautery
instruments.
4th
arm - for a camera with two lenses - surgeon full
stereoscopic vision from the console .
Surgeon looks through two eye holes at console ,a 3-D
image of the procedure, while maneuvering the arms
with 2 foot pedals & 2 hand controllers.

7. Endowrist Instruments
EndoWrist Instruments provide dexterity, precision and control:
•7 degrees of freedom
•90 degrees of articulation
•Intuitive motion and finger-tip control
•Motion scaling and tremor reduction

9. DDa Vinci
Surgical System

10. ROSWELL -PARK
HOSPITAL

11. Index case
• 45/M
• C/C - On/ off Right flank pain x 3 mnths
- H/O High grade fever before 1 mnth
• Past H/O - No medical / surgical illness
• Pers. H/O - Chronic alcoholic & smoker
• O/E - Obese with BMI – 30.5 kg/m²
• Vitals - Tº - Afebrile , P- 78/min , B.P.- 130/80 mmhg
• P/A - Soft , Non-tender
• Blood Investigations & Urine C/S - Normal
• USG - Rt. Grossly hydronephrotic kidney with thinned out parenchyma
- Lt kidney normal in position, shape & size
• IVP - Non visualization of the right kidney
- Left kidney normal excretion & function
• DTPA -NON VISUALIZED right kidney, left kidney GFR 55ml/min

12. IVP

13. NCCT

14. Port- Placement
CC
R
R
LivLiv
AA
Head
end

16. Result
Total operating time 180 minutes
Docking – 40 minutes
Blood loss – 200 ml
Posoperative period – uneventful
Drain removed on day2
Discharged on day 3

17. Thank