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MILESTONE OF 500 ROBOTICMILESTONE OF 500 ROBOTIC--ASSISTED ASSISTED

Professor Hextan NGAN Yuen-sheungTsao Yin-kai Professor in Obstetrics and GynaecologyClinical Professor and Head, Department of Obstetrics and Gynaecology

Professor William Ignace WEILi Shu-pui Professor in SurgeryChair Professor of Otorhinolaryngology, Department of Surgery

OPERATIONS AT OPERATIONS AT HKU/QMHHKU/QMH

Professor LAW Wai-lunClinical Professor, Department of Surgery

Dr TAM Po-chorConsultant (Urology), Department of SurgeryQueen Mary Hospital

Mr. Barry LO Sum-kinAdvanced Practice NurseQueen Mary Hospital

Rapid development of minimally invasive surgery in recent 20 yearssurgery in recent 20 yearsSmall incisions, less pain, better recovery and shorter hospital stayLong term outcome for cancer not compromisedA li i i i l i f Applications in many specialties of surgery

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2–D flat image videoS b diffi lt i d f th Surgery may be difficult in deep spaces of the body such as the pelvisRigid instruments – chopstick effectDexterous maneuvers difficult with the available instruments Long learning curve for complicated proceduresNot ergonomic to surgeons

A master and slave robotic systemSurg n’ n lSurgeon’s consolePatient side cartImaging processing equipmentDexterous instruments

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da Vinci Surgical Systemda Vinci Surgical System

da Vinci Surgical Systemda Vinci Surgical System

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Stable camera platform with 3 D stereoscopic vision and magnification vision and magnification Tremor filteringArticulated instruments with 7-degree freedom of movementErgonomic position for the surgeonTelesurgery possible

First approved by the FDA in USA in 2000I t ll d i QMH i 2007Installed in QMH in 2007Widely applied in general surgery, gynaecology, ENT(Ear, Nose, Throat), urology and paediatric surgery and a wide range of surgical procedures were performedU J l 2011 500 b i i d Up to July 2011, over 500 robotic assisted operations were performed

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Types of operations No. of operations

Gynaecology 168

Urology 167

General Surgery 100

ENT 53ENT 53

Paediatric Surgery 19

Total 507

ROBOT ASSISTED ROBOT ASSISTED GYNAECOLOGICALGYNAECOLOGICAL

Professor Hextan NganTsao Yin-kai Professor in Obstetrics and Gynaecology

Clinical Professor and Head

G CO OG CG CO OG COPERATIONSOPERATIONS

Department of Obstetrics and GynaecologyThe University of Hong Kong

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Total number of cases performed – 168

58 for cervical cancers60 for endometrial cancers14 for ovarian/fallopian tube cancers25 for premalignant conditionsp g8 for uterine fibroids

Stereoscopic visualization/HDT f i iTremor free visionArticulated instruments allows more range of motion together with filtration of tremor –dexterity and precision of surgeon are enhancedTh d b i i The advantages are more obvious in complicated operations performing in a narrow space such as the pelvis

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Radical hysterectomy is a standard treatment for most of the early stage (1a2 1b1) cervical for most of the early stage (1a2 – 1b1) cervical cancersOne of the most complicated gynaecological operations involving a lot of dissections of vascular structures in the lower part of the pelvis pelvis It is well known to be associated with surgical morbidities including bleeding and post-operative fever

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In the past 3.5 years, 58 radical hysterectomies were performed using the da Vinci Surgical were performed using the da Vinci Surgical SystemIn general, patients had less blood loss (median – 200ml) and better recovery with a shorter hospital stay comparing to an open radical hysterectomyradical hysterectomy

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The operative sites are usually the surrounding areas of the big major vessels i e the iliac vessels areas of the big major vessels i.e. the iliac vessels, aorta and vena cavaThe precision of instrumentation and tremor free 3-D vision facilitates better dissection of lymph nodes More than 100 lymph node dissections were More than 100 lymph node dissections were performed in the past 3.5 years

ROBOTIC ASSISTED ROBOTIC ASSISTED

Dr. PC TamConsultant (Urology)

Department of Surgery

O O C SS SO O C SS SUROLOGICAL OPERATIONSUROLOGICAL OPERATIONS

Department of SurgeryQueen Mary Hospital

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Types of operations No. of patientsProstatectomy 120yPartial nephrectomy 17Cystectomy 14Pyeloplasty 10Others 6Total 167

Robotic assisted prostatectomy is the preferred operative treatment for prostate canceroperative treatment for prostate cancerThe procedure is associated with a less blood loss, quicker recovery and a shorter hospital stayA better preservation of urinary continence can be achievedbe achieved

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open robotic P value p

Blood loss (ml) 1166 527 < 0.01

Intra-op transfusion 8 (16%) 1(2%) < 0.01

Post-op transfusion 3 (6%) 2 (4%) 0.79

Duration (minutes) 294 450 < 0.01Duration (minutes) 294 450 0.01

Hospital stay (days) 13.2 5.9 <0.01

Reduced blood lossLess transfusionLess transfusionBetter nerve preservationReduced length of hospital stay

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Robotic Assisted Radical Robotic Assisted Radical ProstatectomyProstatectomy

robotic laparoscopic p values

Operating room time (min) 376 361 .722

Estimated blood loss (mL) 329 328 .994

Warm ischemic time (min) 31.3 39.9 .032( )

Hospital stay (day) 7.2 14.1 .213

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ROBOTIC ASSISTED OPERATIONS ROBOTIC ASSISTED OPERATIONS

Professor WL LAW Chief, Division of Colorectal Surgery

Director Surgical Skills Centre

O O C SS S O O SO O C SS S O O SIN GENERAL SURGERYIN GENERAL SURGERY

Director, Surgical Skills CentreDepartment of Surgery

The University of Hong Kong

Types of operations No. of operationsTypes of operations No. of operationsColorectal surgery 63Surgery for the stomach and esophagus 24Thyroidectomy 6Hepatobiliary pancreatic surgery 5Adrenalectomy 2Total 100

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Surgical technique is important in cancer clearance and preservation of bowel urine and clearance and preservation of bowel, urine and sexual functionLaparoscopic surgery for rectal cancer is a complicated procedure with a long learning curveProcedure is performed in a deep space and is Procedure is performed in a deep space and is difficult in a deep narrow male pelvis Instrument manipulation in the pelvis can be challenging

More popular in recent years in areas with robotic surgeryrobotic surgeryBetter view, articulated instrument and stable camera platform for precise pelvic dissectionPotential benefit of better cancer clearance and preservation of functions of patientsM h 60 d f d i h More than 60 procedures performed with satisfactory outcomes

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EosphagealA condition with tight lower esophageal tight lower esophageal sphincter leading to dysphagia and esophageal dilatation

Robotic assisted Heller Robotic assisted Heller myotomy can be performed very precisely and esophageal perforation can be avoided

ROBOTIC ASSISTED ENT ROBOTIC ASSISTED ENT OPERATIONSOPERATIONS

Professor William WEILi Shu-pui Professor in Surgery

Chair Professor of Otorhinolaryngology, Department of SurgeryThe University of Hong Kong Li Ka Shing Faculty of Medicine

OPERATIONSOPERATIONS

The University of Hong Kong Li Ka Shing Faculty of Medicine

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T pes of operations No of operationsTypes of operations No. of operationsTonsillectomy 25Nasopharyngectomy 8Other transoral procedures 10Total 53

Southern China, Hong Kong15 24 per 100 00015 - 24 per 100,000

Other regions <1 per 100,000

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Moss 1950-60 5-yr LC: 34%

Lee et al. 1976-85 5-yr LC: 61%

Chua et al. 1989-91 5-yr LC: 76%

Leung et al. 1990-98 5-yr LC: 81%

Lee et al. 1996-2000 5-yr LC: 85%

Dept of Surgery, HKUJan – June 2011TORS for recurrent NPC 8 patients

Primary treatment ChemoRTMale / female 4 / 4

Age 34 – 85 years oldAge median 59 years old

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Stage rT1 disease 8Removal of anterior wall of sphenoid sinus with endoscopic instruments 2Clear resection margins 7Follow up 6 – 18 months (median) 9 months(median) 9 monthsRecurrence 0

A wide variety of operationsVarious surgical teams are involvedNovel procedures: robotic single port hysterectomy, transoral robotic proceduresSurgery by different specialties

Synchronous hysterectomy and rectal resectionSynchronous prostatectomy and hernia repair

Clinical research: randomized trial comparing laparoscopic and robotic rectal resection

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Credentialing Committee of the Hong Kong West Cluster: to overlook the clinical West Cluster: to overlook the clinical privileging of medical procedures and to confer the privilege of medical practitioners to perform new/high risk proceduresRobotic surgery is one of the procedures requiring credentialing in Hong Kong West requiring credentialing in Hong Kong West ClusterCredentialing criteria were set and credentialed doctors in robotic procedures are listed

The End

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