1. Advances in Robotic Surgery for Improved Patient Care
Sonnie Kim-Ashchi, MD, FACOG.
Medical director of St. Vincent Southside robotic program

2. How many of you actually have seen and even tried daVinci robotic surgical systems?

3. Current understanding about daVinci robotic surgery with PCPs ; High Awareness, Fairly Positive Perception • % are aware of da Vinci Surgery • 63-75% view it positively
Big Gaps in Knowledge of da Vinci® Surgery Among Referring Physicians
1 in 3 PCPs don’t know any local surgeons who perform da Vinci Surgery
75% of PCPs don’t know outcomes of da Vinci Surgery vs. open and lap surgery
50%+ OB/GYNs don’t know da Vinci procedures outside of GYN
60 % of PCPs don’t know da Vinci procedures for GYN, cardiothoracic, colorectal or general surgery

4. daVinci Robot Assisted surgery, Minimally invasive Surgery ( MIS)
Cardiac- mitral valve repair, revascularization
General Surgery- cholecystectomy, colectomy, colorectal esophagectomy, trans hiatal gastrectomy, hepatectomy, lower anterior resection, Nissen fundoplication, pancreatectomy, Para esophageal hernia repair, rectopexy, splenectomy, ventral hernia repair, bariatric surgery
Head & Neck - trans oral surgery
Thoracic- lobectomy
Urology- cystectomy, nephrectomy, partial nephrectomy, prostatectomy, pyeloplasty, ureteral reimplantation
Gynecology- Endometriosis resection, benign and cancer hysterectomy, myomectomy, sacrocolpopexy
List of procedures are GROWING!
Plastic surgery-daVInci robot assisted latissimus dorsi flap retrieval for breast reconstruction after double mastectomy

5. Benefits of robotic surgery
Less blood loss- less chance of blood transfusion
Less infection
Less complication
Less chance of procedure converting to an abdominal procedure
Short hospital stay (overnight stay vs. outpatient)
Lower readmission rate
Less postoperative pain = less narcotic use
Quicker recovery-faster return to normal activities
For example, patients go back to regular work and activities with no limitation by 3 to 4 weeks after daVinci benign hysterectomy, sometimes 2 weeks if office works

7. Advantage of well-organized robotic program- 46 % less complication
Advantage of well-organized robotic program- 46 % less complication. 37% lower cost

8. daVinci robotic systems
daVinci Si system
daVinci  daVinci S
Leonardo daVInci’s
mechanical knight robot
in 1495
daVinci Xi system
FDA Cleared for daVinci gyn surgery in 2005

9. daVinci Surgical System; How does it work?
High Definition 3D Vision
Surgeon-controlled
Stable and immersive view
Up to 10x zoom
Precision & Dexterity
Mimics surgeon’s hands
Scales down movements
With tremor filtration
Intuitive® Motion
Advanced software enables intuitive control (instead of cross-handed)
3 cm
1cm

10. daVinci robot assisted benign gynecological surgeries
Hysterectomy, myomectomy, adnexal surgery, endometriosis resection and pelvic prolapse
Please note there are non surgical options for these conditions.

11. St. Vincent SS robotic OR

12. daVinci robot assisted benign hysterectomy- 80% by MIS!!
TAH

13. Multicenter analysis comparing robotic, open, laparoscopic and vaginal hysterectomy by high-volume surgeons for benign indications
Robotic patients had:
• Larger uteri
• Fewer complications
• Shorter hospital stay
• Similar conversions, readmissions & reoperation rate as other MIS approaches
International Journal of Gynecology and Obstetrics Lim PC. Garza D.

14. Clinical Benefits Promote Positive Economic Value of daVinci Surgery in Gynecology
* Common misconception - Robotic surgery is too expensive !
The cost of robotics must take into the account the total cost of care and how robotic-assisted surgery affects the rate of laparotomy to prove the benefits of minimally invasive surgery without increasing costs.
Total cost of a patient’s care includes not only instrumentation costs, but also costs based on factors such as length of stay (LOS, daVinci 0.5 vs open 2.7 vs LSC 1.8 days), Operating Time , Conversion rates ( LSC 7.2 % vs daVinci TLH 0.3 %), complications, readmissions and reoperations.
National cost average data- bed day $1,553. A conversion $3,162. Complication cost $3,632. OR time $11 per minute, Readmission $11,087
There are also societal cost savings to consider based on the patient’s quicker return to normal activities.
Surgeons’ time – outpatient !

15. Benefits of robotic surgery
Less blood loss-less chance of blood transfusion
Less infection
Less complication rate
Less chance of procedure converting to an abdominal procedure
Short hospital stay
Less postoperative pain-less narcotic use
Quicker recovery-faster return to normal activities
For example, patients go back to regular work and activities with no limitation by 3 to 4 weeks after daVinci benign hysterectomy, sometimes 2 weeks if office works

16. Surgery: Single-Site® Abdominal (Open) Surgery
Adaptation of MIS in benign gyn cases such as endometriosis resection, myomectomy and hysterectomy
Robotic-Assisted
Surgery: Single-Site®
Abdominal (Open) Surgery
Robotic-Assisted
Surgery: Multi-port
Laparoscopy
Vaginal Surgery

17. Evolution of Surgical approaches

18. daVinci robot assisted benign gyn surgery
One Large Incision
Multiple Small Incisions
One Small Incision
in the Belly Button
Open Hysterectomy
da Vinci® Hysterectomy:
Multi-port
da Vinci® Single-Site® Hysterectomy or
Traditional Laparoscopic
Single Incision Hysterectomy
Traditional Laparoscopic Hysterectomy

19. How to remove the specimen through 2cm umbilical incision?
Not limited by incidence of prior surgeries, pelvic infection, large uteri or presence of single or multiple adnexal masses or/and severe endometriosis

20. 1200 gram morcellated uterus

21. daVinci Single-Site benign hysterectomy or adnexal surgery
Virtually , “scarless” surgery !!!

22. Please Remember the Benefits of robotic surgery for your patients 
Less blood loss-less chance of blood transfusion
Less infection
Less complication rate
Less chance of procedure converting to an abdominal procedure
Short hospital stay/ Lower Rate of readmission
Less postoperative pain-less narcotic use
Quicker recovery-faster return to normal activities
For example, patients go back to regular work and activities with no limitation by 3 to 4 weeks after daVinci benign hysterectomy, sometimes 2 weeks if office works

23. Thank you !
St. Vincent Southside Robotic Team

24. Please call me if you would like to come. 904-759-2328