A short lecture for referring physicians about robotic surgery.

1. da Vinci®
Hysterectomy
for Benign Gynecologic
Conditions
Anthony R DeSalvo, MD
St Joseph Health
Center

2. 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 pain
1
Thomson Solucient data
2
US Department of Health & Human Services, womenshealth.gov, Hysterectomy FAQ. www.4woman.gov/faq/hysterectomy.htm
3
American College of Surgeons “About Hysterectomy” brochure.
http://www.facs.org/public_info/operation/hysterectomy.pdf#search=%2290%25%20hysterectomies%20performed%20are%20elective%22

3. 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

4. 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 abdominal4
4
2008 Thomson Solucient data

5. da Vinci® Si™ Surgical System

6. 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

7. 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 surgery1,2
3. Payne, T. N., F. R. Dauterive, et al. (2010). “Robotically assisted hysterectomy in patients with large uteri: outcomes in five community
practices.” Obstet Gynecol 115(3): 535-542.
4. Visco, A. G. and A. P. Advincula (2008). “Robotic Gynecologic Surgery.” Obstet Gynecol 112(6): 1369-1384.

8. 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
efficiency1
1. Payne, T. N. and F. R. Dauterive (2008). “A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical
outcomes 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.

9. da Vinci® Surgical System U.S. Installed Base
1999 – 2010
Alaska
Hawaii
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010- through Q2 close

10. 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