Robotic Surgery Robotic Surgery Status Quo + Development Status Quo + Development

Martin KalošMartin KalošCzech Society for Robotic SurgeryCzech Society for Robotic Surgery

3rd of December 20123rd of December 2012AlmatyAlmaty

Czech Society of Robotic Surgery

da Vinci® Si HD

S M

od

el

Up

date

s

Si M

od

el

Up

date

s

• 3D HD Vision (720p) • Multi-quadrant access• Interactive video displays

• Enhanced HD Vision (1080i)• Dual Console option• Upgradable architecture

• 3D Vision• EndoWrist Instrumentation• Intuitive® Motion

Core

Tech

nolo

gy

1999

2006

2009

Current Development

da Vinci® Si™

Firefly™ Fluorescence Imaging

Skills® Simulator™

Advanced Instrumentation*

Single-Site™

*EndoWrist Stapler is pending 510(k) clearance

Single Site Surgery:

Open Surgery Single Incision LaparoscopyLaparoscopic Surgery

PN

875

26

5 R

ev A

1

1/1

1P

N 8

75

26

5 R

ev A

1

1/1

1

Single-Site™ Instrumentation has CE Mark and is FDA-cleared for cholecystectomy.

da VinciTM Single Site

SCOPE

da VinciTM Single Site

New Instruments

FluorescenceExcitation laser light from illuminator

Return signal from fluorescing ICG

Identify vessels during IMA / IMV dissection

Assess perfusion of large bowel prior to transection

Assess perfusion of rectal stump prior to transection

Fluorescence

ROBOTIC SURGERY IN THE WORLD

• Installations worldwide: 2 341– 389 v Europe– 1 707 USA– 245 Rest of the World

Installments – World Data

2 1322 341

Procedures – World Data

278 000

360 000

Abdominal Surgery Thoracic Surgery

General surgery

Vascular SurgeryGynecology

Lung Surgery

UROLOGY

Cardiosurgery

ENT

ThyreidoctomyTongue Base CA

Indications – World Data

Indications – Czech data

Urology

Most Frequent

1.daVinci Radical Prostatectomy

2.daVinci Partial Nephrectomy

daVinci Prostatectomy Results

Oncological effects of Robotic Surgery

Positive marginsRobotic x Laparo x Open

1. dVH : da Vinci Hysterectomy 2. dVSC : da Vinci Sacrocolpopexis3. dVM : da Vinci Myomektomie

Gynecology

Most Frequent

daVinci Hysterectomy Results

General

Surgery

Most Frequent

1.dV LAR : da Vinci Low Anterior Resection

2.dVTh : da Vinci Thyreoidectomy

robotic Versus Laparoscopic Low Anterior Resection of Rectal Cancer: Short-Term Outcome of a Prospective Comparative Study* from Dr. Baik. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea

Annals of Surgical Oncology. 2009.

*Baik, et al. robotic Versus Laparoscopic Low Anterior Resection of Rectal Cancer: Short-Term Outcome of a Prospective Comparative Stud. Ann Surg Oncol DOI 10.1245/s10434-009-0435-3.

191.1 ±65.3190.1 ±45.0Operative Time

0.0085.5 ±1.54.7 ±1.1Days to Soft Diet [Mean ±SD]

0.0017.6 ±3.05.7 ±1.1Length of Stay [Mean ±SD]

0.013

0.033

0.025

P

2 (3.5)0 (0.0)- Incomplete [n (%)]

0 (0.0)

4 (7.1)

52 (92.9)

1

5.4%

56

Robotic LAR

Macroscopic Specimen Judgment

57Number of Patients

6 (10.5)Conversion Rate [n (%)]

12 (21.1)- Near Complete [n (%)]

43 (75.4)- Complete [n (%)]

4- Anastomotic leakage (n)

19.3%Complication Rate (%)

Lap LAR

191.1 ±65.3190.1 ±45.0Operative Time

0.0085.5 ±1.54.7 ±1.1Days to Soft Diet [Mean ±SD]

0.0017.6 ±3.05.7 ±1.1Length of Stay [Mean ±SD]

0.013

0.033

0.025

P

2 (3.5)0 (0.0)- Incomplete [n (%)]

0 (0.0)

4 (7.1)

52 (92.9)

1

5.4%

56

Robotic LAR

Macroscopic Specimen Judgment

57Number of Patients

6 (10.5)Conversion Rate [n (%)]

12 (21.1)- Near Complete [n (%)]

43 (75.4)- Complete [n (%)]

4- Anastomotic leakage (n)

19.3%Complication Rate (%)

Lap LAR

Da Vinci Low Anterior Resection (Baik)

Other

1.ENT – Transoral

2.Cardiac

3.Lung

Thank you !