the value of da vinci surgery
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daVinci surgery has replaced open and laparoscopic surgery for many operations due to the many advantages of using the robotic interfaceTRANSCRIPT
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