Post on 12-Jan-2016
Robotics In SurgeryRobotics In Surgery
Presented byPresented by
Gordon TravisGordon Travis
ObjectivesObjectives
1. Describe trend Robotic system, the da Vinci S HD Robotic system, the da Vinci S HD
Surgical SystemSurgical System
2. Describe hardware/software3. Assess nursing implications4. Examine related legal/ethical
issues5. Advantages/Disadvantages from
nursing perspective
Trend DescriptionTrend Description
Robotic-assisted Minimally Robotic-assisted Minimally Invasive SurgeryInvasive Surgery
Shorter recovery timesShorter recovery times Fewer complicationsFewer complications Reduced hospitalization costs Reduced hospitalization costs Reduced trauma to the patient Reduced trauma to the patient
(Intuitive (Intuitive
Surgical 2005)(2)Surgical 2005)(2)
Trend DescriptionTrend Description
Robotic-assisted Robotic-assisted Minimally Minimally Invasive Surgery Invasive Surgery has become the has become the “GOLD”“GOLD” standard-of-care standard-of-care for particular for particular surgical surgical proceduresprocedures
ExamplesExamples ProstatectomyProstatectomy HysterectomyHysterectomy Mitral valve Mitral valve
repair repair (Intuitive Surgical 2005)(Intuitive Surgical 2005)
(3)(3)
Robotic SurgeryRobotic Surgery
Robotic HardwareRobotic Hardware
Console front viewConsole front view
(Intuitive Surgical (Intuitive Surgical 2005)2005)
Robotic HardwareRobotic Hardware
Surgical cart Surgical cart with with instrumentsinstruments
(Intuitive Surgical (Intuitive Surgical
2005)2005)
Robotic HardwareRobotic Hardware
Surgeon sits at Surgeon sits at console away console away from patient from patient
((Intuitive Intuitive Surgical 2005)Surgical 2005)
Robotic HardwareRobotic Hardware
VisionVision Magnification X Magnification X
1010 HD 3-D visionHD 3-D vision
(Intuitive Surgical (Intuitive Surgical
2005)2005)
Robotic Robotic Hardware/SoftwareHardware/Software
Robotic hardware Robotic hardware driven by Intuitive driven by Intuitive proprietary proprietary softwaresoftware
Software not based Software not based on any “well-on any “well-known” operating known” operating systemsystem
Software first Software first developed in 1994developed in 1994
Software version 11 Software version 11 in use at presentin use at present
(Ken Swartzman, Intuitive (Ken Swartzman, Intuitive engineer, personal engineer, personal communication, September communication, September 22, 2008) 22, 2008)
Robotic Robotic Hardware/SoftwareHardware/Software
Robotic movements, Robotic movements, driven by Intuitive driven by Intuitive proprietary softwareproprietary software SimultaneousSimultaneous FluidFluid AmbidextrousAmbidextrous
((Intuitive Surgical Intuitive Surgical
2005)2005)
Usability of SoftwareUsability of Software
The software interface has received The software interface has received national awards for its user friendly national awards for its user friendly designdesign
40 hours of practice with interface 40 hours of practice with interface must be completed prior to use on must be completed prior to use on patientspatients
Robotic interface software was trialed Robotic interface software was trialed for 10 years prior to FDA approval 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)
Information systems Information systems used in da Vinci Robotic used in da Vinci Robotic
SurgerySurgery Dedicated system/Special Dedicated system/Special
purposepurpose
Used by Surgeons to assist Used by Surgeons to assist in surgery in surgery
Stand alone system that Stand alone system that runs on Intuitive proprietary runs on Intuitive proprietary softwaresoftware
American National Standards American National Standards Institute (ANSI)Institute (ANSI)
Would recommend for other Would recommend for other starting this trendstarting this trend
(Erik Weiker, Intuitive training engineer, (Erik Weiker, Intuitive training engineer, personal communication, October 8, 2008)personal communication, October 8, 2008)
Advantages of Robotic Advantages of Robotic SurgerySurgery
Areas that were once Areas that were once difficult to work in difficult to work in such as under the such as under the pubic symphysis for pubic symphysis for the bringing together the bringing together of the bladder and of the bladder and urethra (anastomosis) urethra (anastomosis) now become freely now become freely accessible to the accessible to the operating surgeon. operating surgeon.
Increased Increased visualization, due to visualization, due to 10X magnification10X magnification
Hand movements of Hand movements of the surgeon are the surgeon are transmitted transmitted precisely to the precisely to the working instruments working instruments
(Dean (Dean 2006)2006)
Disadvantages of Disadvantages of Robotic SurgeryRobotic Surgery
Possible Risks and ComplicationsPossible Risks and Complications Pressure on nerves due to positioningPressure on nerves due to positioning Blood lossBlood loss Injury to other structuresInjury to other structures
Bowel, Bladder, RectumBowel, Bladder, Rectum Prolonged procedureProlonged procedure
Robotic surgery can take 1 ½ to 2 times Robotic surgery can take 1 ½ to 2 times longer then open procedure longer then open procedure
Conversion to open procedureConversion to open procedure(Intuitive Surgical 2005)(2)(Intuitive Surgical 2005)(2)
Ethical issues related Ethical issues related to Robotic Surgeryto Robotic Surgery
The surgeon is in The surgeon is in complete control complete control of the robots of the robots movementsmovements
The da Vinci The da Vinci system cannot be system cannot be programmed, nor programmed, nor can it make can it make decisionsdecisions
(Intuitive Surgical 2005)(Intuitive Surgical 2005)
Informatics competencies Informatics competencies required for nurses in Robotic required for nurses in Robotic
SurgerySurgery
Nurse requirements prior to doing Robotic Nurse requirements prior to doing Robotic surgerysurgery
Must complete two four hour training Must complete two four hour training programs given by Intuitive representativesprograms given by Intuitive representatives
Required to watch Robotic surgery DVD and Required to watch Robotic surgery DVD and take competency examtake competency exam
Required to complete minimum 5 case Required to complete minimum 5 case observation of Robotic casesobservation of Robotic cases
Responsibilities of the Responsibilities of the informatics nurse in Robotic informatics nurse in Robotic
surgerysurgery
Set-up and preparation of RobotSet-up and preparation of Robot Hardware and software check with Hardware and software check with
pre-case checklistpre-case checklistSterile drapingSterile draping
Correct positioning of robot Correct positioning of robot during surgeryduring surgeryAlways with attention to patient Always with attention to patient
safety (robot in correct position as safety (robot in correct position as to not injury patient)to not injury patient)
SummarySummary
Cutting edge technologyCutting edge technology Hardware/software proprietary to Hardware/software proprietary to
IntuitiveIntuitive ““Gold” standard surgery for certain Gold” standard surgery for certain
casescases Requires proper training and in-service Requires proper training and in-service
for both nurses and surgeonsfor both nurses and surgeons Robot only works under surgeon controlRobot only works under surgeon control Developing technology, limits of its use Developing technology, limits of its use
are still unknownare still unknown
ReferencesReferences
Intuitive Surgical, Inc. (2005). Intuitive Surgical, Inc. (2005). The da Vinci® Surgical SystemThe da Vinci® Surgical System. Retrieved . Retrieved September 18, 2008, from September 18, 2008, from http://www.intuitivesurgical.com/products/davinci_surgicalsystem/index.asphttp://www.intuitivesurgical.com/products/davinci_surgicalsystem/index.aspxx
Intuitive Surgical, Inc. (2005)(2). Intuitive Surgical, Inc. (2005)(2). The da Vinci® Surgical SystemThe da Vinci® Surgical System. Retrieved . Retrieved September 19, 2008, from September 19, 2008, from http://www.intuitivesurgical.com/products/robotic/index.aspxhttp://www.intuitivesurgical.com/products/robotic/index.aspx
Intuitive Surgical, Inc. (2005)(3). Intuitive Surgical, Inc. (2005)(3). The da Vinci® Surgical SystemThe da Vinci® Surgical System. Retrieved . Retrieved October 2, 2008 2008, from October 2, 2008 2008, from http://www.intuitivesurgical.com/products/fdaclearance/index.aspxhttp://www.intuitivesurgical.com/products/fdaclearance/index.aspx
Dean, Md, William. (2006). Dean, Md, William. (2006). Dr. Dean explains the robotic advantageDr. Dean explains the robotic advantage. Retrieved . Retrieved September 26, 2008, from Intuitive Surgical: September 26, 2008, from Intuitive Surgical: http://http://roboticadvantage.comroboticadvantage.com//