1. Robotic Surgery Student Watch “Taking surgery beyond the limits of the human hand”™ Stuart Graham RN Robotic Surgery Coordinator

2. Evolution of Surgery –Open surgery: mid-19 th Century –Minimally invasive surgery: Began in late 1980’s (Laparoscopic Surgery) –Computer Assisted (Robotic) surgery with da Vinci: 1999

3. 1987 Advantages of Minimally Invasive Surgery (MIS) –Faster recovery –Shorter hospital stay –Quicker return to work –Less postoperative pain –Better cosmesis –Patient Expectation

4. Minimally Invasive Surgery Access Open Surgical Incision da Vinci ™ Prostatectomy Incision

5. Laparoscopic Surgery Minimally invasive surgery Ability to operate through small keyhole incisions Camera and instruments fit through the keyhole incisions Better visualization than open surgery

6. Conventional Laparoscopic Surgery Drawbacks 2–D flat image video Rigid instruments - chopsticks Instruments controlled at a distance - fulcrum effect Decreases your surgeon’s precision, dexterity and control Higher surgeon fatigue Makes complex operations more difficult How can we overcome these drawbacks?

7. Technical Concepts Robotic Surgery Computer- enhanced Surgery

8. AESOP Lineage (Automated Endoscopic System for Optimal Positioning) AESOP 1000 (1993) First CMI product AESOP 2000 (1996) Incorporates voice recognition control AESOP 3000 (1998) Adds: –Double-jointed elbow –3-D manual mode button

9. Early AESOP Robotic Scope Positioner with remote control – no voice

10. FREFLEX Force-Reflecting Exoskeletal Arm Master (1994)

11. Nuclear Telemanipulation Central Research Labs

13. Superior 3-D imaging ‘Open’ surgery orientation InSite TM 3-D Vision System

14. da Vinci TM Surgical System Intuitive Movement

15. Robotic Freedom Of Movement

16. Surgical Benefits Improved vision with a true 3 dimensional view magnified up to 10x. Scaled surgeon movement. Ratios vary from 1:1, 3:1 and 5:1. This allows for very fine work and offers great benefits in pediatric laparoscopic surgery. Improved surgical dexterity with wristed instruments allows for 6 degrees of surgical freedom rather than the 4 in traditional laparoscopic surgery. Improved surgeon comfort – Surgeon seated at console during the majority of the surgery.

17. Robotic Prostatectomy

18. So What’s Next? High Resolution Display – Multiple Inputs

19. da Vinci system placements 1999 2000 2001 2002 2004 Alaska 2003 2005 2006-through Q1 close

20. da Vinci Surgical Network

21. OR Integration: Concepts

22. Predicting the future… “I think there is a world market for about five computers” Thomas Watson Chairman IBM, 1943

23. Thank You

24. For more info go to www.davincisurgery.com