The document discusses robotic assisted laparoscopic nephrectomy using the da Vinci surgical system, highlighting its development, adoption in hospitals, and advanced functionalities. It details the system's components, including a viewing console and surgical arms, and describes a clinical case of right flank pain leading to a nephrectomy. The report concludes with procedural specifics, such as operating time and postoperative outcomes.

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