the value of da vinci surgery

The da Vinci Advantage:The Value of daVinci Surgery

Randy Fagin, MDSenior Medical Advisor – Training | Intuitive SurgicalDirector of Robotic Surgery | The Hospital at Westlake Medical Center

The da Vinci Advantage:Why Listen to Me– In 2000 I trained in LRP with Bertrand Guionneau

and Guy Valancien in Paris, France– I performed over 300 LRP• Operative Time 2 - 2½ hours• Blood transfusion rate less than 1%• Return to erections 75%

– I assumed what I was doing was “best in class”– I felt threatened by da Vinci surgery• I believed “you don’t need a fancy multimillion dollar

robot to do a good operation”

The da Vinci Advantage:Why Listen to Me:– In 2000 I trained in LRP with Bertrand Guionneau

and Guy Valancien in Paris, France– I performed over 300 LRP• Operative Time 2 - 2½ hours• Blood transfusion rate less than 1%• Return to erections 75%

– I assumed what I was doing was “best in class”– I felt threatened by da Vinci surgery• I believed “you don’t need a fancy multimillion dollar

robot to do a good operation”

The da Vinci Advantage:Why Listen to Me:

“you don’t need a fancy multimillion dollar robot to do a good operation”

TRUE

However, you do need one if you want to do a better operation

The da Vinci Advantage:Why Listen to Me

“you don’t need a fancy multimillion dollar robot to do a good operation”

TRUE

However, you do need one if you want to do a better operation

The da Vinci Advantage:Why Listen to Me:– On August 22nd, 2003 I sat down for the 1st time at

a da Vinci console– I spent the next 12 months on a mission to get my

hospital to purchase a daVinci system

The da Vinci Advantage:Why Listen to Me– Monday October 1, 2004 I performed my first dVP– Monday April 25, 2005 I performed dVP #200 – Wednesday April 27, 2005 I performed 2dVP’s– Thursday April 28, 2005 I performed 1 LRP

• some insurance would not cover da Vinci surgery back then

– Friday April 28, 2005 I decided never to perform another LRP again

As of today I have performed ≈2,000 dVP’s my patients have come from

over 30 of the United States and 12 countries

The da Vinci Advantage:Why Listen to Me– Monday October 1, 2004 I performed my first dVP– Monday April 25, 2005 I performed dVP #200 – Wednesday April 27, 2005 I performed 2dVP’s– Thursday April 28, 2005 I performed 1 LRP

• some insurance would not cover da Vinci surgery back then

– Friday April 28, 2005 I decided never to perform another LRP again

As of today I have performed ≈2,000 dVP’s my patients have come from

over 30 of the United States and 12 countries

The da Vinci Advantage:Why Listen to Me– Monday October 1, 2004 I performed my first dVP– Monday April 25, 2005 I performed dVP #200 – Wednesday April 27, 2005 I performed 2dVP’s– Thursday April 28, 2005 I performed 1 LRP

• some insurance would not cover da Vinci surgery back then

– Friday April 28, 2005 I decided never to perform another LRP again

As of today I have performed ≈2,000 dVP’s my patients have come from

over 30 of the United States and 12 countries

The da Vinci Advantage:Why Listen to Me– Monday October 1, 2004 I performed my first dVP– Monday April 25, 2005 I performed dVP #200 – Wednesday April 27, 2005 I performed 2dVP’s– Thursday April 28, 2005 I performed 1 LRP

• some insurance would not cover da Vinci surgery back then

– Friday April 28, 2005 I decided never to perform another LRP again

As of today I have performed ≈2,000 dVP’s my patients have come from

over 30 of the United States and 12 countries

The da Vinci Advantage:Why Listen to Me– Monday October 1, 2004 I performed my first dVP– Monday April 25, 2005 I performed dVP #200 – Wednesday April 27, 2005 I performed 2dVP’s– Thursday April 28, 2005 I performed 1 LRP

• some insurance would not cover da Vinci surgery back then

– Friday April 29, 2005 I decided never to perform another LRP again

As of today I have performed ≈2,000 dVP’s my patients have come from

over 30 of the United States and 12 countries

The da Vinci Advantage:Why Listen to Me

– IF you believe that your current surgery is “as good as it gets”

– THEN you are performing • yesterday’s standard of care• maybe today’s standard of care• but DEFINITELY NOT tomorrow’s standard of care

The da Vinci Advantage:Why Listen to Me

– IF you believe that your current surgery is “as good as it gets”

– THEN you are already behind

The da Vinci Advantage:

• The Vision-Precision Advantage• The Consistency Advantage

The da Vinci Advantage:The Vision – Precision Advantage• Vision

– Stereoscopic view (better depth AND detail)– 10x magnification– High definition– You place the camera EXACTLY where you want it

If I can see it better I can do a better operation

• Precision– Scaled motion

• Allows for more precise movements than my own hands are capable of

– With improved ergonomics comes improved precision

If I have a more precise tool I can create less collateral damage

The da Vinci Advantage:The Vision – Precision Advantage

• Better Vision and Improved Precision:– IS NOT a replacement for skill– IS an advantage for ALL SURGEONS no matter

what their skill level

The da Vinci Advantage:The Consistency Advantage

• What do YOUR LAP surgeons believe

The da Vinci Advantage:The Consistency Advantage

• What do YOUR LAP surgeons believe

“my outcomes are as good as they get”

“I’m at the TOP of my game”

The da Vinci Advantage:The Consistency Advantage

• What do YOUR LAP surgeons believe

“my outcomes are as good as they get”

“I’m at the TOP of my game”

• and if they never convert to dVP they are right

The da Vinci Advantage:The Consistency Advantage

• What do YOUR LAP surgeons believe

OUTCOMES LAP

best

worst

The da Vinci Advantage:The Consistency Advantage

• What do YOUR LAP surgeons need to know

OUTCOMES LAP

dVbest

best

worst

worst

The da Vinci Advantage:The Consistency Advantage

• What do YOUR LAP surgeons need to know

OUTCOMES LAP

dVeasy

easy

hard

hard

The da Vinci Advantage:The Consistency Advantage

YOUR LAP surgeons need to know

• They are STUCK at their current level if they continue with LAP

• There is a level above LAP, but to get there they need to transition to daVinci

The da Vinci Advantage:The Consistency Advantage

• daVinci surgery– Improves the best outcomes A LITTLE– Improves the worst outcomes A LOT– Reduces the distance between • BEST-WORST • EASIEST-HARDEST

The da Vinci Advantage:The Consistency Advantage

• daVinci surgery

Reduces Variability in the Difficulty of an Operation

Reduces Variability in Outcomes

The da Vinci Advantage:The Consistency Advantage

• daVinci surgery– Reducing Variability in Outcomes• Better Vision• Improved Precision• 4th Arm

– Improved control over your operation

• Reduced Fatigue

The da Vinci Advantage:The Consistency Advantage

• Reduced Fatigue– Ergonomic Advantage of daVinci surgery• 87% of surgeons who regularly perform standard

laparoscopic surgery experience discomfort/pain neck, hand, and lower extremities– J Am Coll Surg 2010

• Standard Laparoscopic Surgery increases surgeon fatigue and reduces performance – Surgery 2010;147:318-30

The da Vinci Advantage:The Consistency Advantage

• Reduced Fatigue– Ergonomic Advantage of daVinci surgery

Improve ergonomics of performing an operation

Improve Performance of the Surgeon

Improve Consistency of Patient Outcomes

The da Vinci Advantage:

• Surgery today is NOT as good as it gets

• Better Vision and a More Precise tool is an advantage for ALL surgeons

• Reducing Variability in Difficulty Reduces Variability in Outcomes