Robotics in gynecology lite

Robotics in GynecologyAnthony R. DeSalvo, M.D.

1842 E Market StWarren, OH 44483

330.856.7212warren-obgyn.com

Anthony R. DeSalvo, M.DBachelor of Science – Kent State

UniversityMedical Degree – Northeastern Ohio

Universities College of MedicineResidency – Beth Israel Medical

Center, New York, NYBoard Certified – American Board of

Obstetrics and Gynecology

Why am I here?

Introduce the concept of robotic surgery to the public

Dispel some common myths about robotic surgery

Hysterectomy factsApproximately 525,000 hysterectomies are

performed each year in the U.S. for non-cancerous conditions

By age 60, 1 in 3 women in the U.S. will have had a hysterectomy

90% are performed for elective benign indicationsFibroidsAbnormal uterine bleedingEndometriosisChronic pelvic pain

Route of SurgeryAbdominalRequires a

large abdominal incision

Usual hospital stay is 2 to 4 nights

6 to 8 weeks of recovery

Vaginal hysterectomyThe entire operation is performed

through the vaginaRequires good access to the uterusMore challenging in patients with prior

abdominal surgery or previous cesarean section

More challenging if the uterus is enlargedLimited visualization of the pelvis and

ovaries

Laparoscopic hysterectomyBetter visualizationShorter hospitalizationShorter recoveryGood visualization of the pelvic

organsCan be performed in a wide variety

of patientsTraditional laparoscopy requires a

unique skill set and commitment to the procedure

US Hysterectomy Modalities 2005 vs. 20124

Vag – 22%

Lap – 14%

2005Jan 1,

The Impact on Hysterectomy

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

2012

0%

10%

20%

30%

40%

50%

60%

70%

80%

Adoption of MIS for Hysterectomy

Laparoscopy

da Vinci

Vaginal

Open

Year

Ad

op

tio

n

Farquhar et al. "Hysterectomy Rates in the United States: 1990–1997" Obstet Gynecol 2002;99:229 –34Becker et al. "Inpatient Surgical Treatment Patterns for Patients with Uterine Fibroids in the United States, 1998-2002" Journal of the National Medical Assn.

Vol. 97 (10) October 2005Wu et al. "Hysterectomy Rates in the United States, 2003" Obstet & Gyn VOL. 110, NO. 5, NOVEMBER 2007Solucient data through 2010 for Lap, Open and Vaginal Trends

Natural Evolution of Technology

Evolution of Technology

Konrad Zuse’s Z1 (1938)First binary computerMechanical calculator

UNIVAC I – UNIVersal Automatic Computer (1951)First commercial computer

U.S. Census BureauOriginal price: $159,000

Ultimate price: $1.5 million46 systems built and sold

IBM 701– (1953)First commercial IBM computer

$15,000/month rental feeOnly 19 systems built and sold

Evolution of Technology

Altair (1974)Scelbi (1974)

First personal computerKit that user had to put together, make it work,

and write software256 Byte RAM

$400

IBM 5100 – First IBM PC (1975)50 pounds

Programming language (APL or BASIC)64K storage version

$19,975

Which would you rather have?

Versus

RoboticsCurrent applications

Auto industrySpace industryMultiple other industriesMilitaryLaboratory test processingAutomated research equipmentRadiation therapyToys

What’s the difference?

The natural evolution of computers into the operating room

Minimally Invasive SurgeryBenign hysterectomy in the US 2003

Wu JF. Et al. Obstet Gynecol 2007;110:1091-1095.

Mean LOS=1.7 days*

Mean LOS=2.0 days*

Mean LOS=3.0 days*

*P-value<0.001

da Vinci® S Robotic Platform

da Vinci® Surgery (Minimally Invasive)

Robotic PlatformGeneral thoughts

A tool Not new surgery or procedure

A tool that makes minimally invasive surgery easier

Advantages of robotic surgeryMuch improved 3D visualization over

traditional laparoscopyKeep in mind, that traditional laparoscopy

was still better than open surgeryFull wristing instruments with 7 degrees

range of motionComplete surgical control of the operative

instrumentsMimics the hand movements of open surgery

da Vinci® Awareness

President Obama(Cleveland Clinic)

The Doctors

Private Practice

The Daily Buzz

Jeopardy

Law & Order

CNN

SummaryThe addition of computer technology into the

operating arena is a natural evolution and progress

The addition of robotic platform for surgery is a continuation of this progress

Man’s tools continue to add great value to our lives

This tool will greatly reduce or nearly eliminate the need for open surgery

The societal benefits of a surgical platform are vast and numerous