THE DA VINCI SURGICAL SYSTEM

THE DA VINCI SURGICAL SYSTEM

By: Gianna Morrongiello

What is it?What is it?• TELEMANIPULATION SURGICAL SYSTEM THAT CONSISTS OF AN

ERGONOMICALLY DESIGNED SURGEON'S CONSOLE, A PATIENT CART WITH FOUR INTERACTIVE ROBOTIC ARMS, A HIGH-PERFORMANCE VISION SYSTEM AND PATENTED ENDOWRIST INSTRUMENTS.

• HAS BEEN USED IN MINIMALLY INVASIVE SURGERIES SINCE JUNE 2001

• CAN PERFORM SURGERY THROUGH ONE OR A FEW 1-2 CM INCISIONS ( SIMILAR TO LAPAROSCOPIC SURGERIES)

• MINIATURIZED WRISTED INSTRUMENTS AND A HIGH-DEFINITION 3D CAMERA TRANSLATE YOUR SURGEON'S HAND MOVEMENTS INTO PRECISE MICRO-MOVEMENTS OF THE DA VINCI INSTRUMENTS

• PROVIDE SURGEONS WITH ENHANCED CAPABILITIES, INCLUDING HIGH DEFINITION 3D VISION AND A MAGNIFIED VIEW.

• CANNOT ACT ON ITS OWN. THE DOCTOR CONTROLS 100% OF THE DA VINCI SYSTEM

• REUSABLE 10 TIMES ONLY "Features." Da Vinci Surgery. Web. 24 Oct. 2015. http://www.davincisurgery.com/da-vinci-surgery/da-vinci-surgical-system/features.php

OPERATING ROOM SCHEMATIC

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"Da Vinci Instruments." Intuitive Surgical. Web. 24 Oct. 2015. http://intuitivesurgical.com/company/media/images/davinci_instruments_images.html

OPERATIVE FIELD VIEW

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COMPARISON WITH A PENCIL

ERASER.

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INTUITIVE HAND MOTION CONTROLS

"Da Vinci Instruments." Intuitive Surgical. Web. 24 Oct. 2015. http://intuitivesurgical.com/company/media/images/davinci_instruments_images.html

https://www.youtube.com/watch?v=0XdC1HUp-rU

Methods

•128 PATIENTS OPERATED ON WITH THE DA VINCI™ ROBOTIC SYSTEM

•78 FEMALE, 50 MALE PATIENTS

•MEAN AGE WAS 52 (RANGE 18–78)

•SURGERIES PERFORMED BY SIX DIFFERENT SURGEONS WHO WERE EXPERIENCED LAPAROSCOPISTS (EACH WITH TRAINING WITH THE DA VINCI SYSTEM)

FIRST STUDY (TESTING THE DA VINCI ROBOT) :

SECOND STUDY (COMPARING THE ROBOT WITH TRADITIONAL

NON EVASIVE SURGERY) :

•A SYSTEMATIC LITERATURE SEARCH WAS PERFORMED INDEPENDENTLY BY TWO OF THE AUTHORS

•PARTICIPANTS OF ANY AGE AND SEX WHO UNDERWENT ROBOTIC OR LAPAROSCOPIC LIVER RESECTION FOR ALL TYPE OF HEPATIC LESIONS WERE CONSIDERED

•DATA WAS RETRACTED Johannes Bodner, Florian Augustin, Heinz Wykypiel, John Fish, Gilbert Muehlmann, Gerold Wetscher, Thomas Schmid. “The da Vinci robotic system for general surgical applications: a critical interim appraisal.” SWISS MED WKLY 2005;135:674–678. Web. 24 Oct. 2015.

Montalti, Roberto, Giammauro Berardi, Alberto Patriti, Marco Vivarelli, and Roberto Troisi. "Outcomes of Robotic vs Laparoscopic Hepatectomy: A Systematic Review and Meta-analysis." World Journal of Gastroenterology : WJG. Baishideng Publishing Group Inc. Web. 24 Oct. 2015.

• 122 OF 128 PROCEDURES (95%) WERE SUCCESSFULLY COMPLETED WITH THE DA VINCI™ ROBOT. (OPEN CONVERSION WAS NECESSARY IN FOUR CASES POSING SURGICAL PROBLEMS)

• THERE WAS NO RELEVANT (>50 ML) BLOOD LOSS IN ANY PROCEDURE.

• 30-DAY MORTALITY IN ALL 128 PATIENTS WAS 0%.

• THE ROBOTIC APPROACH IS SIGNIFICANTLY MORE EXPENSIVE THAN CONVENTIONAL MINIMALLY INVASIVE SURGERY, DUE TO LONGER PROCEDURE DURATION

Results:FIRST STUDY (TESTING THE DA VINCI ROBOT) :

SECOND STUDY (COMPARING THE ROBOT WITH TRADITIONAL NON

EVASIVE SURGERY) :• LAPAROSCOPIC HAD A SIGNIFICANT REDUCTION IN BLOOD LOSS AND LOWER OPERATIVE TIME

• NO DIFFERENCES WERE FOUND WITH RESPECT TO CONVERSION RATE, R1 RESECTION RATE, MORBIDITY, OR HOSPITAL STAY.

• BOTH SHOWED SAFETY AND EFFECTIVENESS

Johannes Bodner, Florian Augustin, Heinz Wykypiel, John Fish, Gilbert Muehlmann, Gerold Wetscher, Thomas Schmid. “The da Vinci robotic system for general surgical applications: a critical interim appraisal.” SWISS MED WKLY 2005;135:674–678. Web. 24 Oct. 2015.

Montalti, Roberto, Giammauro Berardi, Alberto Patriti, Marco Vivarelli, and Roberto Troisi. "Outcomes of Robotic vs Laparoscopic Hepatectomy: A Systematic Review and Meta-analysis." World Journal of Gastroenterology : WJG. Baishideng Publishing Group Inc. Web. 24 Oct. 2015.

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PROCEDURAL COST (DOLLARS)

DURATION OF PROCEDURE (MINUTES)

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FUNNEL PLOT OF MORBIDITY (A) AND

HOSPITAL STAY (B) IN ALL INCLUDED

STUDIES.

Montalti, Roberto, Giammauro Berardi, Alberto Patriti, Marco Vivarelli, and Roberto Troisi. "Outcomes of Robotic vs Laparoscopic Hepatectomy: A Systematic Review and Meta-analysis." World Journal of Gastroenterology : WJG. Baishideng Publishing Group Inc. Web. 24 Oct. 2015.

Johannes Bodner, Florian Augustin, Heinz Wykypiel, John Fish, Gilbert Muehlmann, Gerold Wetscher, Thomas Schmid. “The da Vinci robotic system for general surgical applications: a critical interim appraisal.” SWISS MED WKLY 2005;135:674–678. Web. 24 Oct. 2015.

Why is this important?Why is this important?• FURTHER SYSTEM DEVELOPMENT AS WELL AS A DRASTIC

REDUCTION OF COSTS.

• “HYBRID OPERATIONS”- PROCEDURE WOULD BE DONE AS TRADITIONAL MINIMALLY INVASIVE SURGERY AND THE ROBOT WOULD BE USED ONLY FOR MOST CHALLENGING PARTS OF THE OPERATION, IN ORDER TO INCREASE EFFICIENCY AND DECREASE HUMAN ERROR

• IMAGE FUSION- RADIOLOGIC IMAGING SYSTEMS PERMITS MORE PRECISE AND DETAILED SURGICAL PLANNING SO THE SURGEON CAN MORE EASILY DETECT AND IDENTIFY HIDDEN ANATOMICAL STRUCTURES

• SURGICAL TRAINING PROGRAMS- SURGEONS IN TRAINING WILL PERFORM OPERATIONS ON PATIENTS ONLY AFTER PERFORMING THEM SUCCESSFULLY IN VIRTUAL REALITY ON THE DA VINCI SYSTEM

Johannes Bodner, Florian Augustin, Heinz Wykypiel, John Fish, Gilbert Muehlmann, Gerold Wetscher, Thomas Schmid. “The da Vinci robotic system for general surgical applications: a critical interim appraisal.” SWISS MED WKLY 2005;135:674–678. Web. 24 Oct. 2015.

ResourcesResources[1] “Features”. Intuitive Surgical. 2015 Intuitive Surgical, Inc. Web. 24 Oct. 2015.

http://www.davincisurgery.com/da-vinci-surgery/da-vinci-surgical-system/features.php.

[2] Johannes Bodner, Florian Augustin, Heinz Wykypiel, John Fish, Gilbert Muehlmann, Gerold Wetscher, Thomas Schmid. “The da Vinci robotic system for general surgical applications: a critical interim appraisal.” SWISS MED WKLY 2005;135:674–678. Web. 24 Oct. 2015.

[3] Montalti, Roberto, Giammauro Berardi, Alberto Patriti, Marco Vivarelli, and Roberto Troisi. "Outcomes of Robotic vs Laparoscopic Hepatectomy: A Systematic Review and Meta-analysis." World Journal of Gastroenterology : WJG. Baishideng Publishing Group Inc. Web. 24 Oct. 2015.

[4] “da Vinci instruments”. Intuitive Surgical. 2015 Intuitive Surgical, Inc. Web. 24 Oct. 2015. http://intuitivesurgical.com/company/media/images/davinci_instruments_images.html.