1. Robotics In Surgery Presented by Gordon Travis

2. Objectives 1. 1. Describe trend  Robotic system, the da Vinci S HD Surgical System 2. 2. Describe hardware/software 3. 3. Assess nursing implications 4. 4. Examine related legal/ethical issues 5. 5. Advantages/Disadvantages from nursing perspective

3. Trend Description Robotic-assisted Minimally Invasive Surgery  Shorter recovery times  Fewer complications  Reduced hospitalization costs  Reduced trauma to the patient (Intuitive Surgical 2005)(2)

4. Trend Description  Robotic-assisted Minimally Invasive Surgery has become the “GOLD” standard- of-care for particular surgical procedures Examples  Prostatectomy  Hysterectomy  Mitral valve repair (Intuitive Surgical 2005)(3) (Intuitive Surgical 2005)(3)

5. Robotic Surgery

6. Robotic Hardware  Console front view (Intuitive Surgical 2005) (Intuitive Surgical 2005)

7. Robotic Hardware  Surgical cart with instruments (Intuitive Surgical 2005) (Intuitive Surgical 2005)

8. Robotic Hardware  Surgeon sits at console away from patient ( Intuitive Surgical 2005) ( Intuitive Surgical 2005)

9. Robotic Hardware VVVVision MMagnification X 10 HHD 3-D vision (Intuitive Surgical 2005)

10. Robotic Hardware/Software  Robotic hardware driven by Intuitive proprietary software  Software not based on any “well-known” operating system  Software first developed in 1994  Software version 11 in use at present (Ken Swartzman, Intuitive engineer, personal communication, September 22, 2008) (Ken Swartzman, Intuitive engineer, personal communication, September 22, 2008)

11. Robotic Hardware/Software  Robotic movements, driven by Intuitive proprietary software  Simultaneous  Fluid  Ambidextrous ( Intuitive Surgical 2005) ( Intuitive Surgical 2005)

12. Usability of Software  The software interface has received national awards for its user friendly design  40 hours of practice with interface must be completed prior to use on patients  Robotic interface software was trialed for 10 years prior to FDA approval (Erik Weiker, Intuitive training engineer, personal communication, September 26, 2008) (Erik Weiker, Intuitive training engineer, personal communication, September 26, 2008)

13. Information systems used in da Vinci Robotic Surgery  Dedicated system/Special purpose  Used by Surgeons to assist in surgery  Stand alone system that runs on Intuitive proprietary software  American National Standards Institute (ANSI)  Would recommend for other starting this trend  (Erik Weiker, Intuitive training engineer, personal communication, October 8, 2008)

14. Advantages of Robotic Surgery Areas that were once difficult to work in such as under the pubic symphysis for the bringing together of the bladder and urethra (anastomosis) now become freely accessible to the operating surgeon. Areas that were once difficult to work in such as under the pubic symphysis for the bringing together of the bladder and urethra (anastomosis) now become freely accessible to the operating surgeon.  Increased visualization, due to 10X magnification  Hand movements of the surgeon are transmitted precisely to the working instruments (Dean 2006) (Dean 2006)

15. Disadvantages of Robotic Surgery Possible Risks and Complications  Pressure on nerves due to positioning  Blood loss  Injury to other structures  Bowel, Bladder, Rectum  Prolonged procedure  Robotic surgery can take 1 ½ to 2 times longer then open procedure  Conversion to open procedure (Intuitive Surgical 2005)(2)

16. Ethical issues related to Robotic Surgery  The surgeon is in complete control of the robots movements  The da Vinci system cannot be programmed, nor can it make decisions (Intuitive Surgical 2005) (Intuitive Surgical 2005)

17. Informatics competencies required for nurses in Robotic Surgery Nurse requirements prior to doing Robotic surgery  Must complete two four hour training programs given by Intuitive representatives  Required to watch Robotic surgery DVD and take competency exam  Required to complete minimum 5 case observation of Robotic cases

18. Responsibilities of the informatics nurse in Robotic surgery  Set-up and preparation of Robot  Hardware and software check with pre- case checklist  Sterile draping  Correct positioning of robot during surgery  Always with attention to patient safety (robot in correct position as to not injury patient)

19. Summary  Cutting edge technology  Hardware/software proprietary to Intuitive  “Gold” standard surgery for certain cases  Requires proper training and in-service for both nurses and surgeons  Robot only works under surgeon control  Developing technology, limits of its use are still unknown

20. References Intuitive Surgical, Inc. (2005). The da Vinci® Surgical System. Retrieved September 18, 2008, from http://www.intuitivesurgical.com/products/davinci_surgicalsystem/index.aspx http://www.intuitivesurgical.com/products/davinci_surgicalsystem/index.aspx Intuitive Surgical, Inc. (2005)(2). The da Vinci® Surgical System. Retrieved September 19, 2008, from http://www.intuitivesurgical.com/products/robotic/index.aspx http://www.intuitivesurgical.com/products/robotic/index.aspx Intuitive Surgical, Inc. (2005)(3). The da Vinci® Surgical System. Retrieved October 2, 2008 2008, from http://www.intuitivesurgical.com/products/fdaclearance/index.aspx http://www.intuitivesurgical.com/products/fdaclearance/index.aspx Dean, Md, William. (2006). Dr. Dean explains the robotic advantage. Retrieved September 26, 2008, from Intuitive Surgical: http://roboticadvantage.com/ http://roboticadvantage.com/