1. JANUARY 17, 2013SHANNON ADAIR, DIETETIC INTERN Robotic Surgery

2. Outline What is robotic surgery? DaVinci robots Indications Procedures available Treatment Limitations/ Contraindications Risks/Side effects Results Recovery time Nutrition

3. What is robotic surgery? A minimally invasive alternative to standard or laparoscopic surgery Surgeon performs surgery by using a computer that remotely controls tiny instruments attached to a robot Less invasive than traditional surgery, more precise than laparoscopic surgery.

4. DaVinci Robots Named after Leonardo DaVinci, student of anatomy and inventor of the first robot Robotic surgery started to grow through the 80’s and 90’s. First robotic surgery marketed in 1985 First DaVinci robot marketed in 1999 with FDA approval in 2000 Gold standard of robotic surgery

5. PHYSICIAN CONSOLE FOUR-ARMED TOWER Standard DaVinci Set up

6. Indications Urology Gynecology Cardiothoracic General Surgery Colorectal Head and Neck Used for both simple and complex procedures. Possible surgery specialties include:

7. Indications Common conditions treated: Bladder Cancer Colorectal Cancer Coronary Artery Disease Endometriosis Gynecologic Cancer Heavy Uterine Bleeding Kidney Disorders Kidney Cancer Lung Cancer Mitral Valve Prolapse Obesity Prostate Cancer Throat Cancer Uterine Fibroids Uterine Prolapse

8. Procedures Available Coronary artery bypass Cutting away cancer tissue from sensitive parts of the body such as blood vessels, nerves, or important body organs Gallbladder removal Gastric Bypass Hip replacement Hysterectomy Kidney removal Kidney transplant Mitral valve repair Pyeloplasty (surgery to correct ureteropelvic junction obstruction) Pyloroplasty Radical prostatectomy Tubal ligation

9. Treatment Pt placed under general anesthesia 1-2 cm incisions made for robotic insertion into the abdomen Surgeon sits at a station nearby to control the robot High definition 3D camera attached to robot to enable surgeon to see better and more fully than possible laparoscopically Robot reduces surgeons movements, moving 1/2 inch for every 1 inch the surgeon moves (decreases tremors, increases precision) and gives higher range of motion than laparoscopy

10. Difference between standard and robotic Prostate removal surgery

11. Limitations/ Contraindications May take longer, as the robot takes time to set up Expense limits availability Not available for certain complex surgeries that require greater ability to move instruments (i.e. some heart surgeries)

12. Risks/Side Effects Standard anesthesia risks (reactions to medication, breathing problems) Standard surgery risks (bleeding, infection) Risks may be lower than for open or laparoscopic surgeries

13. Results Results are the same as standard/laparoscopic results, depending on the procedure Results may have fewer negative consequences than with standard/laparoscopic surgeries Dr. Marshall at OSF says gastric bypass outcomes are the same whether done laparoscopically or robotically Some physicians prefer robotic surgery

14. Recovery Time Depends on specific surgery performed. Pts typically able to walk within 1 day Because robotic surgical cuts are typically smaller, robotic surgery may lead to: Faster recovery Less pain and bleeding Less risk of infection Shorter hospital stay Smaller scars

15. Nutrition NPO for 8 hours prior to surgery Depending on procedure performed, pt may be required to take an enema or laxative the day prior to surgery Increased calorie and protein needs for healing Ten days before surgery, pt must stop taking aspirin, blood thinners (coumadin), and supplements (vitamins & minerals)

16. Nutrition Prescription Standard post-surgery diet initiated: Clear liquids Advance diet as tolerated Avoid fatty foods initially Avoid constipation by consuming enough fiber and water

17. Future Possibility Telesurgery Major obstacle is latency (surgeon to robot time)

18. Questions?

19. References Bonsor, Kevin, and Jonathan Strickland. "How Robotic Surgery Will Work." HowStuffWorks. N.p., n.d. Web. 15 Jan. 2013..http://www.howstuffworks.com/robotic- surgery1.htm "The DaVinci System." Intuitive Surgical. N.p., n.d. Web. 15 Jan. 2013..http://www.intuitivesurgical.com/company/history/system.html "Robotic Surgery." Robotic Surgery Benefits. Mount Sinai School of Medicine, n.d. Web. 15 Jan. 2013..http://www.roboticoncology.com/robotic-surgery/ "Robotic Surgery." U.S National Library of Medicine. U.S. National Library of Medicine, n.d. Web. 16 Jan. 2013..http://www.nlm.nih.gov/medlineplus/ency/article/007339.htm "Surgery Enabled by Da Vinci." Da Vinci Surgery. N.p., n.d. Web. 15 Jan. 2013..http://www.davincisurgery.com/da-vinci-surgery/