Geschrieben von Tilak
"Viereinhalb Jahre nach seinem ersten Einsatz hat das Op-Robotersystem 'Da Vinci' an der Innsbrucker Klinik in manchen chirurgischen Fachdisziplinen, wie beispielsweise der Urologie - seinen fixen Platz eingenommen.
Heute (8. Dezember) und morgen (Samstag) treffen sich internationale Spezialisten zu einem fachlichen Austausch in Innsbruck. Bei diesem Kongress werden neben Fachvorträgen und Zukunftsvisionen auch Live-Op-Einstiege dargeboten.
Am 21. Juni 2001 wurde an der Innsbrucker Universitätsklinik erstmals eine minimalinvasive Herzoperation mit dem um 13 Mio. Schilling ( rund € 945.000,-) angeschafften Robotersystem 'Da Vinci' durchgeführt. Am selben Tag erfolgte – an der Univ.-Klinik für Allgemeinchirurgie – eine Gallenblasenentfernung. Inzwischen sind viereinhalb Jahre vergangen und die Bilanz der insgesamt am Landeskrankenhaus Innsbruck – Universitätskliniken durchgeführten Operationen beläuft sich auf ca. 400. Es handelt sich dabei um Methoden, die seit etwa 15 Jahren laparoskopisch – also ohne größere Eröffnung des Bauch- bzw. Brustraumes - möglich sind. Die sogenannte 'Knopflochchirurgie' ist längst etabliert und verkürzt den postoperativen Heilungsprozess und reduziert Schmerzen. Auch kosmetische Aspekte spielen dabei eine Rolle. Das Robotersystem vereint die Vorteile der minimalinvasiven Methoden mit jenen der 'offenen' Operationsmethoden, dadurch dass trotz kleiner Körperöffnungen (sogenannte Ports) eine größere Beweglichkeit der Instrumente gegeben ist. Der Operateur (der Chirurg) sitzt während der Operation an einer Konsole und hat ein dreidimensionales Bild vom Körper vor sich. Der größte Vorteil des Robotersystem liegt in der erhöhten Präzision beim Lenken der Spitzen der Instrumente. In den letzten vier Jahren haben neben der Allgemeinchirurgie vor allem die Universitätsklinik für Urologie, die Universitätsklinik für Gynäkologie und Geburtshilfe und die Klinische Abteilung für Herzchirurgie mit dem revolutionären Gerät gearbeitet und gute Ergebnisse erzielt".
Internationaler Kongress
"Vom 8. bis zum 10. Dezember findet im Hotel 'The Penz' in Innsbruck das erste weltweite Treffen der MIRA (Minimally invasive robotic association) – einer internationalen Vereinigung führender Mediziner auf dem Gebiet der Roboterchirurgie –statt. Neben State of the art-Vorträgen wird auch die Entwicklungsgeschichte der Roboterchirurgie und vor allem das künftige Potenzial zur Sprache kommen. Live-Op Schaltungen von der Klinik Innsbruck in die Kongressräumlichkeiten bilden einen Höhepunkt dieser hochkarätig besuchten Veranstaltung. Allen voran wird der Organisator des Kongresses, Univ.-Prof. Dr. Thomas Schmid seine Vorstellungen von der Zukunft der Roboterchirurgie präsentieren. Er sieht in der weiteren Entwicklung und Erprobung sowie dem regelmäßigen Einsatz des Op-Roboters 'Da Vinci' eine enorme Chance für die Innsbrucker Klinik. Ein weiterer Vorteil des Systems ist auch, dass schwierige Operationen am Computer geprobt werden können, so lange, bis jeder 'Handgriff' sitzt und dies erleichtert auch das Lernen für 'Nachwuchsmediziner'. 'Roboterchirurgie bedeutet Fortschritt, hohe Präzision und auf lange Sicht gesehen Kostendämpfung, weil der Patient nach der Operation schneller genesen und somit wieder in den Arbeitsprozess zurückkehren kann' betont auch TILAK Vorstandsdirektor Dr. Herbert Weissenböck die Sinnhaftigkeit der Investition.
Zukunftsivisionen
Derzeit wird an jenen Kliniken, in denen der Roboter schon im Einsatz ist, versucht, immer schwierigere Operationen durchzuführen. Die Bezeichnung Roboter ist eigentlich nicht exakt, da es sich beim Operationssystem 'Da Vinci' um einen sogenannten Telemanipulator handelt. Das heißt, es bedarf auf alle Fälle eines erfahrenen Chirurgen, um die Instrumente über das virtuelle Operationsfeld zu navigieren. Allerdings muss dieser nicht vor Ort sein, sondern kann auch aus der Distanz operieren. Ein Pionier auf diesem Gebiet ist der Mediziner Marescaux, der in Strassburg mit seinem Team intensiv an der sogenannten Bildfusion arbeitet. Dabei wird während des Eingriffes ein Computertomographiebild in das virtuelle Operationsfeld eingespielt, um die individuelle Anatomie des Patienten besser abgrenzbar zu machen und effizienter und schonender operieren zu können. In Zukunft könnten Teile von Operationen bereits vollautomatisiert ablaufen. Was die Zukunft bringen wird, hängt auch davon ab, wieviel mit dem System gearbeitet wird und wie sorgfältig Ergebnisse evaluiert werden. Im Fachbereich Urologie beispielsweise zeichnet sich in den Vereinigten Staaten bereits ein Wechsel von der offenen zur Roboterchirurgie bei einigen Operationen wie beispielsweise der radikalen Prostatatektomie (Entfernung der männlichen Vorsteherdrüse) ab, da das System dort intensiv erprobt und angewandt wird. Die Anschaffungskosten amortisieren sich – volkswirtschaftlich gesehen - rasch durch schnellere postoperative Erholung des Patienten".
Im Zoom Info
7. -10. Dezember 2005: MIRA : große Chance durch Roboterchirurgie
1rst Worldwide Meeting of the Minimally Invasive Robotic Association:
==> Dec. 7-10 / 2005, Innsbruck, Austria.
"Der Kongress der MIRA - minimally invasive robotic association wird von Univ.-Prof. Dr. Thomas Schmid, Chirurg an der Klinischen Abteilung für Allgemein- und Transplantationschirurgie Innsbruck und Sekretär der MIRA, veranstaltet.
Rund 200 TeilnehmerInnen aus den USA, Europa und Japan werden dazu erwartet.
Die internationalen Tagung ist das erste gemeinsame Meeting aller Fachdisziplinen in der Roboterchirurgie (Allgemeinchirurgie, Urologie, Herzchirurgie und Gynäkologie) und soll dazu beitragen, diese Operationsmethode zu födern".
© 2005 Tiroler Landeskrankenanstalten Ges.m.b.H. - www.tilak.at
Innsbrucker Klinik
"Eine große Chance für die Zukunft sieht die Innsbrucker Universitätsklinik in der Roboterchirurgie. Das System 'Da Vinci' ist seit viereinhalb Jahren im Einsatz.
400 Operationen wurden in dieser Zeit damit durchgeführt.
Kleinere Schnitte, mehr Präzision
Das Robotersystem vereine die Vorteile der minimalinvasiven Methoden mit jenen der 'offenen' Operationsmethoden, hieß es. Trotz kleiner Körperöffnungen sei eine größere Beweglichkeit der Instrumente gegeben.
Der größte Vorteil des Robotersystems, bei dem der Operateur an einer Konsole sitzt und ein dreidimensionales Bild vom Körper vor sich hat, liege vor allem in der erhöhten Präzision. Zudem verlaufe der Heilungsprozess rascher als bei herkömmlichen Operationsmethoden.
Neben der Allgemeinchirurgie kam der Telemanipulator bisher vor allem in der Universitätsklinik für Urologie, der Universitätsklinik für Gynäkologie und Geburtshilfe und in der Klinischen Abteilung für Herzchirurgie zum Einsatz.
Zukunftsvisionen
Künftig könnte der Roboter verstärkt bei so genannten Hybrid-Operationen, bei denen extreme Genauigkeit notwendig sei, verwendet werden, erläuterte Univ.-Prof. Thomas Schmid von der Uni-Klinik für Allgemein-, Thorax- und Transplantationschirurgie.
Als weitere Zukunftsvision nannte er die 'Bildfusion'. Dabei wird während des Eingriffs ein Computertomographiebild in das virtuelle Operationsfeld eingespielt, um die individuelle Anatomie des Patienten besser abgrenzbar zu machen und effizienter und schonender operieren zu können.
Zudem könnten Teile von Operationen demnächst vollautomatisiert ablaufen. Zugutzerletzt wäre es laut Schmid möglich, dass Medizinstudenten und junge Ärzte ihr 'Trockentraining' am Roboter absolvieren und damit eine Operation virtuell durchspielen.
Einsatz seit 2001
Die Innsbrucker Uniklinik nimmt laut Schmid nicht nur Österreichweit, sondern auch international gesehen, eine Vorreiterrolle in der Roboterchirurgie ein. Erstmals wurde mit dem um 945.000 Euro angeschafften System im Juni 2001 eine minimalinvasive Herzoperation durchgeführt. Die hohen Kosten würden daraus resultieren, dass die Instrumente nach zehn Eingriffen ausgetauscht werden müssten. Aus volkswirtschaftlicher Sicht sei der Einsatz von 'Da Vinci' jedoch sinnvoll".
Kongress
Quelle :
Tirol.orf.at
==> Dec. 7-10 / 2005, Innsbruck, Austria.
MIRA is the new interdisciplinary, international society for minimally invasive robotic surgery.
"Der Kongress der MIRA - minimally invasive robotic association wird von Univ.-Prof. Dr. Thomas Schmid, Chirurg an der Klinischen Abteilung für Allgemein- und Transplantationschirurgie Innsbruck und Sekretär der MIRA, veranstaltet.
Rund 200 TeilnehmerInnen aus den USA, Europa und Japan werden dazu erwartet.
Die internationalen Tagung ist das erste gemeinsame Meeting aller Fachdisziplinen in der Roboterchirurgie (Allgemeinchirurgie, Urologie, Herzchirurgie und Gynäkologie) und soll dazu beitragen, diese Operationsmethode zu födern".
© 2005 Tiroler Landeskrankenanstalten Ges.m.b.H. - www.tilak.at
Innsbrucker Klinik
"Eine große Chance für die Zukunft sieht die Innsbrucker Universitätsklinik in der Roboterchirurgie. Das System 'Da Vinci' ist seit viereinhalb Jahren im Einsatz.
400 Operationen wurden in dieser Zeit damit durchgeführt.
Kleinere Schnitte, mehr Präzision
Das Robotersystem vereine die Vorteile der minimalinvasiven Methoden mit jenen der 'offenen' Operationsmethoden, hieß es. Trotz kleiner Körperöffnungen sei eine größere Beweglichkeit der Instrumente gegeben.
Der größte Vorteil des Robotersystems, bei dem der Operateur an einer Konsole sitzt und ein dreidimensionales Bild vom Körper vor sich hat, liege vor allem in der erhöhten Präzision. Zudem verlaufe der Heilungsprozess rascher als bei herkömmlichen Operationsmethoden.
Neben der Allgemeinchirurgie kam der Telemanipulator bisher vor allem in der Universitätsklinik für Urologie, der Universitätsklinik für Gynäkologie und Geburtshilfe und in der Klinischen Abteilung für Herzchirurgie zum Einsatz.
Zukunftsvisionen
Künftig könnte der Roboter verstärkt bei so genannten Hybrid-Operationen, bei denen extreme Genauigkeit notwendig sei, verwendet werden, erläuterte Univ.-Prof. Thomas Schmid von der Uni-Klinik für Allgemein-, Thorax- und Transplantationschirurgie.
Als weitere Zukunftsvision nannte er die 'Bildfusion'. Dabei wird während des Eingriffs ein Computertomographiebild in das virtuelle Operationsfeld eingespielt, um die individuelle Anatomie des Patienten besser abgrenzbar zu machen und effizienter und schonender operieren zu können.
Zudem könnten Teile von Operationen demnächst vollautomatisiert ablaufen. Zugutzerletzt wäre es laut Schmid möglich, dass Medizinstudenten und junge Ärzte ihr 'Trockentraining' am Roboter absolvieren und damit eine Operation virtuell durchspielen.
Einsatz seit 2001
Die Innsbrucker Uniklinik nimmt laut Schmid nicht nur Österreichweit, sondern auch international gesehen, eine Vorreiterrolle in der Roboterchirurgie ein. Erstmals wurde mit dem um 945.000 Euro angeschafften System im Juni 2001 eine minimalinvasive Herzoperation durchgeführt. Die hohen Kosten würden daraus resultieren, dass die Instrumente nach zehn Eingriffen ausgetauscht werden müssten. Aus volkswirtschaftlicher Sicht sei der Einsatz von 'Da Vinci' jedoch sinnvoll".
Kongress
Vom 8. bis 10. Dezember findet in Innsbruck das erste weltweite Treffen der MIRA (Minimally invasive robotic association) - einer internationalen Vereinigung führender Mediziner auf dem Gebiet der Roboterchirurgie - statt. 180 Teilnehmer wurden zu dem von Schmid organisierten Kongress erwartet.
Quelle :
Tirol.orf.at
Boston Scientific souhaite acheter Guidant
"Boston Scientific offre 25G$US pour acheter Guidant, une offre qui est supérieure de 3,5G$ à celle proposée par Johnson & Johnson.
En décembre 2004, J&J avait annoncé l'acquisition de Guidant pour un montant de 25,4G$. Toutefois, le rappel par Guidant de 88 000 défibrillateurs et de 200 000 stimulateurs cardiaques défectueux depuis le mois de juin dernier avaient refroidi les ardeurs de J&J. À la mi-novembre, après quelques démêlés juridiques, Johnson & Johnson avait finalement accepté d'acheter Guidant, mais pour 21,5G$US*.
La mise de Boston Scientific vient donc relancer la valeur de Guidant à la hausse. Le titre de Guidant grimpait d'ailleurs de 9% à 67,37$ à la Bourse de New York en fin de matinée.
L'offre de Boston Scientific, au comptant et par échange d'actions, chiffre la valeur des actions de Guidant à 72$US. La société soutient qu'il s'agit d'une prime de 14% par rapport à l'offre révisée de J&J.
Le président du conseil de Boston Scientific, Pete Nicholas, a tout simplement affirmé que son entreprise était intéressée à ajouter les défibrillateurs et les stimulateurs cardiaques de Guidant à sa gamme de produits.
Le titre de Boston Scientific perdait 1,21% de sa valeur à 27,00$ à la Bourse de New York en fin de matinée, alors que l'action de J&J gagnait 0,34%
à 61,42$".
* Tous les montants sont en dollars américains.
Source :
Les Affaires
En décembre 2004, J&J avait annoncé l'acquisition de Guidant pour un montant de 25,4G$. Toutefois, le rappel par Guidant de 88 000 défibrillateurs et de 200 000 stimulateurs cardiaques défectueux depuis le mois de juin dernier avaient refroidi les ardeurs de J&J. À la mi-novembre, après quelques démêlés juridiques, Johnson & Johnson avait finalement accepté d'acheter Guidant, mais pour 21,5G$US*.
La mise de Boston Scientific vient donc relancer la valeur de Guidant à la hausse. Le titre de Guidant grimpait d'ailleurs de 9% à 67,37$ à la Bourse de New York en fin de matinée.
L'offre de Boston Scientific, au comptant et par échange d'actions, chiffre la valeur des actions de Guidant à 72$US. La société soutient qu'il s'agit d'une prime de 14% par rapport à l'offre révisée de J&J.
Le président du conseil de Boston Scientific, Pete Nicholas, a tout simplement affirmé que son entreprise était intéressée à ajouter les défibrillateurs et les stimulateurs cardiaques de Guidant à sa gamme de produits.
Le titre de Boston Scientific perdait 1,21% de sa valeur à 27,00$ à la Bourse de New York en fin de matinée, alors que l'action de J&J gagnait 0,34%
à 61,42$".
* Tous les montants sont en dollars américains.
Source :
Les Affaires
Boston Scientific défie J&J, lance une contre-offre sur Guidant
NEW YORK (Reuters) - "Le fabricant américain d'appareils médicaux Boston Scientific a défié Johnson & Johnson en offrant 25 milliards de dollars pour racheter son homologue Guidant, convoité depuis un an par le géant des médicaments et des produits de santé.
Boston Scientific a présenté une offre mixte en titres et numéraire au prix unitaire de 72 dollars, soit 13,5% de plus que les 63,43 dollars proposés par J&J.
Boston Scientific a expliqué que cette fusion lui permettrait d'accéder au marché des implants cardiaques, un segment connu sous le nom de 'gestion du rythme cardiaque' (Cardiac Rythm Management, CRM) qui pèse dix milliards de dollars.
'Ce que nous obtenons, c'est la diversification et la croissance pour Boston Scientific et nous l'obtenons grâce à la CRM. A l'évidence, l'actif crucial, c'est la CRM', a déclaré Paul LaViolette, directeur général délégué.
C'est cette perspective qui avait déjà incité Johnson & Johnson à offrir un prix similaire de 25,4 milliards de dollars pour reprendre Guidant en décembre 2004.
Mais le laboratoire avait ensuite menacé de renoncer à son projet en raison de divers problèmes rencontrés par sa cible, dont le rappel d'implants cardiaques.
Le différend s'est réglé à la mi-novembre devant la justice, J&J acceptant de racheter le fabricant d'appareils médicaux mais à un prix inférieur de 15% à sa proposition initiale.
Boston Scientific et J&J sont déjà concurrents sur le marché lucratif des stents, ces minuscules prothèses introduites à l'intérieur des artères pour éviter leur fermeture. En cas de fusion, Boston Scientific accéderait en outre à la gamme de défibrillateurs et de stimulateurs cardiaques de Guidant.
'L'alliance de Guidant et Boston Scientific donnerait naissance au numéro un mondial des appareils cardiovasculaires, accélérant la diversification et la croissance', a estimé le président de Boston Scientific, Pete Nicholas, dans le communiqué annonçant l'offre.
'Nous sommes très confiants dans notre proposition. Nous pensons que le problème des rappels est tout à fait gérable', a ajouté Paul LaViolette, interrogé par Reuters. 'Nous connaissons cette activité. Nous avons de l'expérience sur ces questions. Même s'il nous faut conduire un audit détaillé des comptes, nous pensons qu'il confirmera notre opinion.'
CADEAU DE NOËL
'C'est une contre-attaque phénoménale. Ils disent carrément à J&J: offrez mieux ou taisez-vous', commente Mark Landy, analyste à Susquehanna Financial Group, qui qualifie l'offre de 'cadeau de Noël bienvenu pour Guidant'.
Boston Scientific a expliqué que la transaction lui permettrait de diversifier de manière significative ses sources de revenus et le placerait en position plus forte sur le marché.
'Grâce à ce rapprochement, Boston Scientific se diversifiera, en se plaçant sur deux des plus grands marchés de l'équipement médical, la cardiologie interventionnelle et la gestion du rythme cardiaque', a déclaré Jim Tobin, directeur général du groupe.
Boston Scientific espère finaliser l'offre au cours du premier trimestre 2006 et donc parvenir à un accord d'ici la fin de l'année 2005. La société a précisé avoir intégré dans son offre une somme de 625 millions de dollars comme indemnité de rupture.
Thomas Gunderson, analyste chez Piper Jaffray, qualifie la décision de 'très intelligente' et remarque qu''une offre à 72 dollars est difficile à ignorer'.
Un autre analyste, Les Funtleyder, de Miller Tabak, prévient toutefois que même si elle fait sens d'un point de vue stratégique, l'intégration prendra du temps et le délai pourrait affaiblir les deux sociétés.
Boston Scientific prévoit que la transaction augmentera ses bénéfices à partir de 2008. A propos du financement, la société s'attend à retrouver un endettement net proche de zéro d'ici 2009.
'Nous pensons toujours que J&J est un meilleur parti pour Guidant que Boston Scientific. Cela dit, St Jude Medical (numéro trois mondial des implants cardiaques) est toujours disponible et J&J pourrait se dire que Guidant ne vaut pas une telle bagarre', souligne Funtleyder.
Le titre Boston Scientific avait grimpé fortement vendredi, à son meilleur niveau depuis août, sur des rumeurs d'une offre d'achat d'Abbott Laboratories, démenties par ce dernier.
Ces spéculations avaient été alimentées par une activité inhabituelle entourant Boston Scientific sur le marché des options".
Source :
La Tribune
Boston Scientific a présenté une offre mixte en titres et numéraire au prix unitaire de 72 dollars, soit 13,5% de plus que les 63,43 dollars proposés par J&J.
Boston Scientific a expliqué que cette fusion lui permettrait d'accéder au marché des implants cardiaques, un segment connu sous le nom de 'gestion du rythme cardiaque' (Cardiac Rythm Management, CRM) qui pèse dix milliards de dollars.
'Ce que nous obtenons, c'est la diversification et la croissance pour Boston Scientific et nous l'obtenons grâce à la CRM. A l'évidence, l'actif crucial, c'est la CRM', a déclaré Paul LaViolette, directeur général délégué.
C'est cette perspective qui avait déjà incité Johnson & Johnson à offrir un prix similaire de 25,4 milliards de dollars pour reprendre Guidant en décembre 2004.
Mais le laboratoire avait ensuite menacé de renoncer à son projet en raison de divers problèmes rencontrés par sa cible, dont le rappel d'implants cardiaques.
Le différend s'est réglé à la mi-novembre devant la justice, J&J acceptant de racheter le fabricant d'appareils médicaux mais à un prix inférieur de 15% à sa proposition initiale.
Boston Scientific et J&J sont déjà concurrents sur le marché lucratif des stents, ces minuscules prothèses introduites à l'intérieur des artères pour éviter leur fermeture. En cas de fusion, Boston Scientific accéderait en outre à la gamme de défibrillateurs et de stimulateurs cardiaques de Guidant.
'L'alliance de Guidant et Boston Scientific donnerait naissance au numéro un mondial des appareils cardiovasculaires, accélérant la diversification et la croissance', a estimé le président de Boston Scientific, Pete Nicholas, dans le communiqué annonçant l'offre.
'Nous sommes très confiants dans notre proposition. Nous pensons que le problème des rappels est tout à fait gérable', a ajouté Paul LaViolette, interrogé par Reuters. 'Nous connaissons cette activité. Nous avons de l'expérience sur ces questions. Même s'il nous faut conduire un audit détaillé des comptes, nous pensons qu'il confirmera notre opinion.'
CADEAU DE NOËL
'C'est une contre-attaque phénoménale. Ils disent carrément à J&J: offrez mieux ou taisez-vous', commente Mark Landy, analyste à Susquehanna Financial Group, qui qualifie l'offre de 'cadeau de Noël bienvenu pour Guidant'.
Boston Scientific a expliqué que la transaction lui permettrait de diversifier de manière significative ses sources de revenus et le placerait en position plus forte sur le marché.
'Grâce à ce rapprochement, Boston Scientific se diversifiera, en se plaçant sur deux des plus grands marchés de l'équipement médical, la cardiologie interventionnelle et la gestion du rythme cardiaque', a déclaré Jim Tobin, directeur général du groupe.
Boston Scientific espère finaliser l'offre au cours du premier trimestre 2006 et donc parvenir à un accord d'ici la fin de l'année 2005. La société a précisé avoir intégré dans son offre une somme de 625 millions de dollars comme indemnité de rupture.
Thomas Gunderson, analyste chez Piper Jaffray, qualifie la décision de 'très intelligente' et remarque qu''une offre à 72 dollars est difficile à ignorer'.
Un autre analyste, Les Funtleyder, de Miller Tabak, prévient toutefois que même si elle fait sens d'un point de vue stratégique, l'intégration prendra du temps et le délai pourrait affaiblir les deux sociétés.
Boston Scientific prévoit que la transaction augmentera ses bénéfices à partir de 2008. A propos du financement, la société s'attend à retrouver un endettement net proche de zéro d'ici 2009.
'Nous pensons toujours que J&J est un meilleur parti pour Guidant que Boston Scientific. Cela dit, St Jude Medical (numéro trois mondial des implants cardiaques) est toujours disponible et J&J pourrait se dire que Guidant ne vaut pas une telle bagarre', souligne Funtleyder.
Le titre Boston Scientific avait grimpé fortement vendredi, à son meilleur niveau depuis août, sur des rumeurs d'une offre d'achat d'Abbott Laboratories, démenties par ce dernier.
Ces spéculations avaient été alimentées par une activité inhabituelle entourant Boston Scientific sur le marché des options".
Source :
La Tribune
Robotic prostatectomy at New York Presbyterian Hospital
NEW YORK /PR Newswire/
"In August, Dr. Ashutosh Tewari, director of robotic prostatectomy at New York Presbyterian Hospital/Weill Cornell, removed Stuart Forbes's walnut-size prostate and lymph nodes and reattached his bladder to his urethra without once putting his hands inside the patient. Using Intuitive Surgical's da Vinci™ robotic system and operating through five tiny incisions, Tewari conducted the entire procedure from across the room. He sat at a console and turned two knobs to remotely manipulate tiny surgical instruments attached to adjustable robotic arms. Forbes was walking within hours of his surgery and was discharged the next day. By midweek, he was walking three miles daily. After three weeks he was playing golf again; by late October he'd regained normal urinary, and most sexual, function. 'I'm about as excited as anyone can be about this procedure,' says Forbes in the December 12 issue of Newsweek."
Source:
Red Orbit
"In August, Dr. Ashutosh Tewari, director of robotic prostatectomy at New York Presbyterian Hospital/Weill Cornell, removed Stuart Forbes's walnut-size prostate and lymph nodes and reattached his bladder to his urethra without once putting his hands inside the patient. Using Intuitive Surgical's da Vinci™ robotic system and operating through five tiny incisions, Tewari conducted the entire procedure from across the room. He sat at a console and turned two knobs to remotely manipulate tiny surgical instruments attached to adjustable robotic arms. Forbes was walking within hours of his surgery and was discharged the next day. By midweek, he was walking three miles daily. After three weeks he was playing golf again; by late October he'd regained normal urinary, and most sexual, function. 'I'm about as excited as anyone can be about this procedure,' says Forbes in the December 12 issue of Newsweek."
Source:
Red Orbit
La chirurgie robotisée avec le système chirurgical da Vinci, par le Dr. Charles-Henry Rochat, Clinique Générale de Beaulieu (Suisse)
Docteur Charles-Henri Rochat, Chirurgien responsable d'urologie au Centre romand de chirurgie laparoscopique robotisée, Membre du Conseil et Directeur de projet à la Fondation Genevoise pour la Formation et la Recherche Médicales, Président de la Société Médicale de Beaulieu, Clinique Générale de Beaulieu :
Présentations et "abstracts" concernant la chirurgie robotique :
=> L ’image en chirurgie : le robot Da Vinci®
=> Prostatectomie radicale laparoscopique "robot assistée"
Par : P. Dubernard, R. Gaston, C.-H. Rochat
=> Robotique en urologie (abstract)
=> Présentation du système de chirurgie assistée par ordinateur
Da Vinci® (vidéo)
=> Chirurgie laparoscopique robotisée
=> Présentation du système de chirurgie assistée par ordinateur
Da Vinci® (présentation sur PowerPoint, Juin 2005)
Toutes ces présentations sont à télécharger à l'adresse suivante :
http://www.gfmer.ch/Formation_Fr/Rochat.htm
Présentations:
=> Création d’un centre multidisciplinaire en chirurgie robotisée :
Aspects financiers - C.-H. Rochat
=> L ’image en chirurgie : le robot Da Vinci®
C-H.Rochat
=> Prostatectomie radicale laparoscopique "robot assistée",
P. Dubernard, R. Gaston, C.-H. Rochat
=> Retrograde Extraperitoneal Laparoscopic Prostatectomy (R.E.L.P.):
The Lyon technique – Results in 204 cases, P. Dubernard,
P. Chaffange, B. Cuzin, C.-H. Rochat
=> Robotique en urologie (abstract), C.-H. Rochat
Vidéos
=> da Vinci® prostatectomy (low band-width) / (high band width)
=> Excision d'une tumeur rénale (low band-width) / (high band width) C.-H. Rochat
=> Laparoscopic prostatectomy. The intraperitoneal approach in 2005, C.-H. Rochat, J. Sauvain
=> Néphrourétérectomie par dissection robot assistée, C.-H. Rochat, J. Sauvain
=> Présentation du robot, C.-H. Rochat
=> Prostatectomie laparoscopique (low band-width) / (high band width), C.-H. Rochat
=> Prostatectomie robot assistée : évolution 2005, C.-H. Rochat,
J. Sauvain
=> Radical laparoscopic robot-assisted prostatectomy with nerve sparing (Da Vinci) (low band-width) / (high band width), R. Gaston, C.-H. Rochat
Manifestations
=> European Robotic Urology Symposium - Geneva, February 24-25, 2005
Toutes ces présentations sont à télécharger à l'adresse suivante :
http://www.gfmer.ch/Formation_Fr/Chirurgie_laparoscopique_robotisee.htm
Source :
gfmer.ch
Présentations et "abstracts" concernant la chirurgie robotique :
=> L ’image en chirurgie : le robot Da Vinci®
=> Prostatectomie radicale laparoscopique "robot assistée"
Par : P. Dubernard, R. Gaston, C.-H. Rochat
=> Robotique en urologie (abstract)
=> Présentation du système de chirurgie assistée par ordinateur
Da Vinci® (vidéo)
=> Chirurgie laparoscopique robotisée
=> Présentation du système de chirurgie assistée par ordinateur
Da Vinci® (présentation sur PowerPoint, Juin 2005)
Toutes ces présentations sont à télécharger à l'adresse suivante :
http://www.gfmer.ch/Formation_Fr/Rochat.htm
Présentations:
=> Création d’un centre multidisciplinaire en chirurgie robotisée :
Aspects financiers - C.-H. Rochat
=> L ’image en chirurgie : le robot Da Vinci®
C-H.Rochat
=> Prostatectomie radicale laparoscopique "robot assistée",
P. Dubernard, R. Gaston, C.-H. Rochat
=> Retrograde Extraperitoneal Laparoscopic Prostatectomy (R.E.L.P.):
The Lyon technique – Results in 204 cases, P. Dubernard,
P. Chaffange, B. Cuzin, C.-H. Rochat
=> Robotique en urologie (abstract), C.-H. Rochat
Vidéos
=> da Vinci® prostatectomy (low band-width) / (high band width)
=> Excision d'une tumeur rénale (low band-width) / (high band width) C.-H. Rochat
=> Laparoscopic prostatectomy. The intraperitoneal approach in 2005, C.-H. Rochat, J. Sauvain
=> Néphrourétérectomie par dissection robot assistée, C.-H. Rochat, J. Sauvain
=> Présentation du robot, C.-H. Rochat
=> Prostatectomie laparoscopique (low band-width) / (high band width), C.-H. Rochat
=> Prostatectomie robot assistée : évolution 2005, C.-H. Rochat,
J. Sauvain
=> Radical laparoscopic robot-assisted prostatectomy with nerve sparing (Da Vinci) (low band-width) / (high band width), R. Gaston, C.-H. Rochat
Manifestations
=> European Robotic Urology Symposium - Geneva, February 24-25, 2005
Toutes ces présentations sont à télécharger à l'adresse suivante :
http://www.gfmer.ch/Formation_Fr/Chirurgie_laparoscopique_robotisee.htm
Source :
gfmer.ch
Yahoo! Message Boards: Intuitive Surgical ISRG
==> Access the Yahoo! Message Board: click here.
The Yahoo! Message Board about this Robotic Surgery Blog:
==> click here.
On thursday, Dr. Domenico Zavatta sent me an e-mail:
Associates in Urology LLC's Blog :
A Blog about Robotic Surgery in Urology:
==> Click here.
Robotic Surgery at Newark Beth Israel Medical Center,
New Jersey:
==> click here.
The Yahoo! Message Board about this Robotic Surgery Blog:
==> click here.
On thursday, Dr. Domenico Zavatta sent me an e-mail:
Your site looked good, except that I can not read French.
I thought I had the worlds first robotic blog, but you beat me. Congrats.
Good luck and check back. I will be adding new video of new procedures I develop and comments on my blog. Thanks from NJ,
Domenico Savatta, MD
Associates in Urology, LLC
741 Northfield Ave.
West Orange, NJ 07052
Associates in Urology LLC's Blog :
A Blog about Robotic Surgery in Urology:
==> Click here.
Robotic Surgery at Newark Beth Israel Medical Center,
New Jersey:
==> click here.
CATEL Télésanté
==> accès au site internet de CATEL Télésanté
Spécialités médicales, Technologies associées, Territoires :
==> cliquer ici
Adhérents depuis mars 2005 au CATEL:
Dr. Adrian Lobontiu - Intuitive Surgical Inc., Abdelkrim Samiri - Medica Systems, Stéphane Rivière - Aide au montage de projets de téléchirurgie.
Spécialités médicales, Technologies associées, Territoires :
==> cliquer ici
Adhérents depuis mars 2005 au CATEL:
Dr. Adrian Lobontiu - Intuitive Surgical Inc., Abdelkrim Samiri - Medica Systems, Stéphane Rivière - Aide au montage de projets de téléchirurgie.
Daily Double: Intuitive Surgical
How did it double?
"Robotic arms in an operating room seem like something out of Star Trek or pre-Annie Hall Woody Allen. However, Intuitive Surgical® (Nasdaq: ISRG) is the real deal. Its da Vinci Surgical® System has taken hospitals by storm, assisting in performing minimally invasive procedures and simplifying more complicated applications.
The real beauty of watching Intuitive Surgical® over the past few quarters isn't just watching the new installations grow. It's seeing the rest of the company's business growing even faster. With instruments, accessories, maintenance, and training zooming ahead at warp speed, the hospitals that are using da Vinci are clearly using them more often. That has led to a company that has consistently blown past Wall Street's profit targets."
Business description
"Taking surgery beyond the limits of the human hand™-- that's the company's motto. Robotic prostatectomies and open heart surgeries may seem like risky maneuvers, but Intuitive Surgical®'s systems have proven to be safe for patients and lucrative for hospitals.
But surgeons aren't becoming obsolete. Instead of using their own human hands, they man the four robotic arms through a separate console and oversee the process. Perhaps the company's promotional video would help explain the process better than words.
How could you have found this double?
As Stephen Simpson pointed out when reviewing the company's stellar third-quarter results last month, shares of Intuitive Surgical® had provided investors with buying opportunities during three distinct trading dips over the past two years.
The fact that Intuitive Surgical® has a history of bouncing back and blowing analysts away should have made the entry points inviting. If not, perhaps the stock's recommendation in the April issue of Motley Fool Rule Breakers should have tipped you off. The stock has risen by more than 160 per cent since that pick went public eight months ago.
Where to from here?
No, Intuitive Surgical® isn't cheap. Then again, it may not have seemed cheap at lower levels, either, and look where we find ourselves now. With the successful market debut of iRobot (Nasdaq: IRBT) earlier this month, robotic applications are as popular as ever -and this time they're not simply the work of sci-fi.
Analysts expect Intuitive Surgical® to earn $1.69 a share this year but only $1.47 a stub come 2006. Yes, the company has been known to blow past its targets, only to leave the market setting up higher projections. Earlier this month, the company was only expected to earn $1.25 per share this year and $1.08 in profits per share next year.
Let's hope the trend continues, because while growth investors may not balk at paying 69 times this year's profits for a dynamic growth company like Intuitive Surgical®, they may think twice if a bottom line dip prices the company at nearly 80 times forward earnings.
So let that robotic arm scratch your chin and your head. You may not find a more dynamic technology story than Intuitive Surgical®, although you may find cheaper one. "
Source:
The Motley Fool
By Rick Munarriz
Chindex International Announces First Intuitive Surgical Sale in China
The Chinese University of Hong Kong's Jockey Club MISS Centre Becomes First User of Intuitive Surgical's da Vinci® Surgical System
"Chindex International, Inc. (Nasdaq: CHDX - News), a leading independent American provider of western healthcare products and services in the People's Republic of China, announced today that it has concluded its first sale in China of the da Vinci® Surgical System, manufactured by Intuitive Surgical® (Nasdaq: ISRG - News), the innovator and market leader in surgical robotics. The system was purchased by The Chinese University of Hong Kong (CUHK) and was installed at the Prince of Wales Hospital under the management of the CUHK Jockey Club Minimally Invasive Surgical Skills (MISS) Centre, one of the comprehensive multi-disciplinary surgical skills centers in the Asia Pacific region."
"Roberta Lipson, Chindex President and CEO, commented from Beijing, 'We are very excited about this first sale of a da Vinci® Surgical System in Hong Kong, in particular because the CUHK Jockey Club MISS Centre will be such a high profile player and innovator in minimally invasive surgical procedures. The addition of this system to the Centre's state-of-the-art facility will both advance the quality of healthcare in the region as well as provide an opportunity to increase exposure to this exciting technology to surgeons throughout China.'
Intuitive Surgical's Senior Vice President of Sales, Jerry McNamara, said: 'We believe that the China market is ready to move to the next level of minimally invasive surgery with Intuitive Surgical's da Vinci® Surgical System, and are pleased that our partner, Chindex, is off to a good start with this system placement at The Chinese University of Hong Kong.'
Professor Andrew Van Hasselt, Chairman of the Executive Board for The CUHK Jockey Club MISS Centre expressed his delight about being the first China installation of the da Vinci® Surgical System, 'The mission of the Centre is to overcome the acknowledged drawbacks of traditional training methods in surgery by developing advanced training systems offering MIS techniques facilitated by virtual reality, robotic surgery and multimedia applications for training and education. The da Vinci® Surgical System will become a centerpiece in our facility.'
Chindex is an American healthcare company supplying both medical equipment and healthcare services to the Chinese marketplace, including Hong Kong. It sells medical equipment produced by a number of major multinational companies including Siemens AG as its exclusive distribution partner for the sales and servicing of color doppler ultrasound systems. It also arranges financing packages for the supply of medical equipment to hospitals in China utilizing the export loan and loan guarantee programs of both the U.S. Export-Import Bank and the German KfW Development Bank. It provides healthcare services through the operations of its network of private primary care hospitals and affiliated ambulatory clinics in China. With twenty-four years of experience, over 1,000 employees, and operations in the United States, China and Hong Kong, the Company's strategy is to expand its cross-cultural reach by providing leading edge healthcare technologies, quality products and services to Greater China's professional communities. Further company information may be found at the Company's websites http://www.chindex.com and http://www.unitedfamilyhospitals.com.
About Intuitive Surgical:
Intuitive Surgical, Inc., headquartered in Sunnyvale, California, is the global technology leader in the rapidly emerging field of robotic-assisted, minimally invasive surgery (MIS). Intuitive Surgical® develops, manufactures and markets robotic technologies designed to improve clinical outcomes and help patients return more quickly to active and productive lives. The company's mission is to extend the benefits of minimally invasive surgery to the broadest possible base of patients. More information is available at http://www.intuitivesurgical.com and http://www.davinciprostatectomy.com.
Some of the information in this press release may contain statements regarding future expectations, plans, prospects for performance of the Company that constitute forward-looking statements for purposes of the safe harbor provisions of The Private Securities Litigation Reform Act of 1995. The Company cannot guarantee future results, levels of activity, performance or achievements. The numbers discussed in this press release also involve risks and uncertainties. The following factors, among others, could cause actual results to differ materially from those described by such statements: our ability to manage our growth and maintain adequate controls, our ability to obtain additional financing, the loss of services of key personnel, general market conditions including inflation or foreign currency fluctuations, our dependence on relationships with suppliers, the timing of our revenues and fluctuations in financial performance, the availability to our customers of third-party financings, product liability claims and product recalls, competition, hiring and retaining qualified sales and service personnel, management of inventory, relations with foreign trade corporations, dependence on sub-distributors and dealers, completion and opening of healthcare facilities, attracting and retaining qualified physicians and other hospital personnel, regulatory compliance, the cost of malpractice, our dependence on our information systems, the economic policies of the Chinese government, the newness and undeveloped nature of the Chinese legal system, the regulation of the conversion of Chinese currency, future epidemics in China such as SARS or Avian Flu, the control over our operation by insiders, continuity of relationships and variability of financial margins with existing suppliers, our liquidity and availability of capital resources to meet cash requirements, including capital expenditures and bid and performance bonds, and those other factors contained in the section titled "Risk Factors" as set forth in the Company's Registration Statement on Form S-3 (File No. 333-114996) filed with the Securities and Exchange Commission, as well as other documents that may be filed by the Company from time to time with the Securities and Exchange Commission. The forward-looking statements and numbers contained herein represent the judgment of the Company, as of the date of this press release, and the Company disclaims any intent or obligation to update such forward- looking statements to reflect any change in the Company's expectations with regard thereto or any change in events, conditions, or circumstances on which such statements are based."
Sources:
=> Chindex International, Inc.
=> Yahoo Finance
"Chindex International, Inc. (Nasdaq: CHDX - News), a leading independent American provider of western healthcare products and services in the People's Republic of China, announced today that it has concluded its first sale in China of the da Vinci® Surgical System, manufactured by Intuitive Surgical® (Nasdaq: ISRG - News), the innovator and market leader in surgical robotics. The system was purchased by The Chinese University of Hong Kong (CUHK) and was installed at the Prince of Wales Hospital under the management of the CUHK Jockey Club Minimally Invasive Surgical Skills (MISS) Centre, one of the comprehensive multi-disciplinary surgical skills centers in the Asia Pacific region."
"Roberta Lipson, Chindex President and CEO, commented from Beijing, 'We are very excited about this first sale of a da Vinci® Surgical System in Hong Kong, in particular because the CUHK Jockey Club MISS Centre will be such a high profile player and innovator in minimally invasive surgical procedures. The addition of this system to the Centre's state-of-the-art facility will both advance the quality of healthcare in the region as well as provide an opportunity to increase exposure to this exciting technology to surgeons throughout China.'
Intuitive Surgical's Senior Vice President of Sales, Jerry McNamara, said: 'We believe that the China market is ready to move to the next level of minimally invasive surgery with Intuitive Surgical's da Vinci® Surgical System, and are pleased that our partner, Chindex, is off to a good start with this system placement at The Chinese University of Hong Kong.'
Professor Andrew Van Hasselt, Chairman of the Executive Board for The CUHK Jockey Club MISS Centre expressed his delight about being the first China installation of the da Vinci® Surgical System, 'The mission of the Centre is to overcome the acknowledged drawbacks of traditional training methods in surgery by developing advanced training systems offering MIS techniques facilitated by virtual reality, robotic surgery and multimedia applications for training and education. The da Vinci® Surgical System will become a centerpiece in our facility.'
About Chindex International, Inc.
Chindex is an American healthcare company supplying both medical equipment and healthcare services to the Chinese marketplace, including Hong Kong. It sells medical equipment produced by a number of major multinational companies including Siemens AG as its exclusive distribution partner for the sales and servicing of color doppler ultrasound systems. It also arranges financing packages for the supply of medical equipment to hospitals in China utilizing the export loan and loan guarantee programs of both the U.S. Export-Import Bank and the German KfW Development Bank. It provides healthcare services through the operations of its network of private primary care hospitals and affiliated ambulatory clinics in China. With twenty-four years of experience, over 1,000 employees, and operations in the United States, China and Hong Kong, the Company's strategy is to expand its cross-cultural reach by providing leading edge healthcare technologies, quality products and services to Greater China's professional communities. Further company information may be found at the Company's websites http://www.chindex.com and http://www.unitedfamilyhospitals.com.
About Intuitive Surgical:
Intuitive Surgical, Inc., headquartered in Sunnyvale, California, is the global technology leader in the rapidly emerging field of robotic-assisted, minimally invasive surgery (MIS). Intuitive Surgical® develops, manufactures and markets robotic technologies designed to improve clinical outcomes and help patients return more quickly to active and productive lives. The company's mission is to extend the benefits of minimally invasive surgery to the broadest possible base of patients. More information is available at http://www.intuitivesurgical.com and http://www.davinciprostatectomy.com.
Some of the information in this press release may contain statements regarding future expectations, plans, prospects for performance of the Company that constitute forward-looking statements for purposes of the safe harbor provisions of The Private Securities Litigation Reform Act of 1995. The Company cannot guarantee future results, levels of activity, performance or achievements. The numbers discussed in this press release also involve risks and uncertainties. The following factors, among others, could cause actual results to differ materially from those described by such statements: our ability to manage our growth and maintain adequate controls, our ability to obtain additional financing, the loss of services of key personnel, general market conditions including inflation or foreign currency fluctuations, our dependence on relationships with suppliers, the timing of our revenues and fluctuations in financial performance, the availability to our customers of third-party financings, product liability claims and product recalls, competition, hiring and retaining qualified sales and service personnel, management of inventory, relations with foreign trade corporations, dependence on sub-distributors and dealers, completion and opening of healthcare facilities, attracting and retaining qualified physicians and other hospital personnel, regulatory compliance, the cost of malpractice, our dependence on our information systems, the economic policies of the Chinese government, the newness and undeveloped nature of the Chinese legal system, the regulation of the conversion of Chinese currency, future epidemics in China such as SARS or Avian Flu, the control over our operation by insiders, continuity of relationships and variability of financial margins with existing suppliers, our liquidity and availability of capital resources to meet cash requirements, including capital expenditures and bid and performance bonds, and those other factors contained in the section titled "Risk Factors" as set forth in the Company's Registration Statement on Form S-3 (File No. 333-114996) filed with the Securities and Exchange Commission, as well as other documents that may be filed by the Company from time to time with the Securities and Exchange Commission. The forward-looking statements and numbers contained herein represent the judgment of the Company, as of the date of this press release, and the Company disclaims any intent or obligation to update such forward- looking statements to reflect any change in the Company's expectations with regard thereto or any change in events, conditions, or circumstances on which such statements are based."
Sources:
=> Chindex International, Inc.
=> Yahoo Finance
Guidant avalée, mais à un prix moindre
Guidant (GDT) sera bien avalée par Johnson & Johnson (JNJ) mais à un prix inférieur de 15% à celui convenu par les deux entités en décembre dernier.
Les difficultés survenues cet été par le fabricant américain d'appareils médicaux, Guidant, qui a été contraint de rappeler certains de ses implants cardiaques, menaçaient le rachat proposé par J&J.
Guidant en avait appelé à la justice pour contraindre J&J à mener à bien son acquisition après que ce dernier eut menacé d'y renoncer. J&J faisait valoir que le rappel des implants cardiaques et des enquêtes en cours visant Guidant avaient réduit la valeur de celui-ci.
J&J paiera finalement quelque 19G$ US pour prendre le contrôle de Guidant, soit 15% de moins que les 25,4G$ US annoncés en décembre.
J&J offre donc 33,25$US et 0,493 de ses actions pour chaque titre de Guidant. Le montant de la transaction atteint 21,5G$ US.
L'action de Guidant est ainsi valorisée à 63,08$US selon le cours de clôture de lundi, soit une prime de 9% par rapport à son prix de clôture de 57,75$US sur le New York Stock Exchange. Le prix initialement convenu en décembre était de 75$US.
L'accord révisé a été approuvé par les conseils d'administration des deux sociétés et doit être encore soumis aux actionnaires de Guidant. La transaction devrait être conclue au 1er trimestre de 2006.
Guidant annonce le départ de son président et chef de la direction, qui était en poste depuis 11 ans. Le président actuel de Guidant, James Cornelius, assumera la fonction par interim".
Source :
Webfin.ARGENT
Les difficultés survenues cet été par le fabricant américain d'appareils médicaux, Guidant, qui a été contraint de rappeler certains de ses implants cardiaques, menaçaient le rachat proposé par J&J.
Guidant en avait appelé à la justice pour contraindre J&J à mener à bien son acquisition après que ce dernier eut menacé d'y renoncer. J&J faisait valoir que le rappel des implants cardiaques et des enquêtes en cours visant Guidant avaient réduit la valeur de celui-ci.
J&J paiera finalement quelque 19G$ US pour prendre le contrôle de Guidant, soit 15% de moins que les 25,4G$ US annoncés en décembre.
J&J offre donc 33,25$US et 0,493 de ses actions pour chaque titre de Guidant. Le montant de la transaction atteint 21,5G$ US.
L'action de Guidant est ainsi valorisée à 63,08$US selon le cours de clôture de lundi, soit une prime de 9% par rapport à son prix de clôture de 57,75$US sur le New York Stock Exchange. Le prix initialement convenu en décembre était de 75$US.
L'accord révisé a été approuvé par les conseils d'administration des deux sociétés et doit être encore soumis aux actionnaires de Guidant. La transaction devrait être conclue au 1er trimestre de 2006.
Guidant annonce le départ de son président et chef de la direction, qui était en poste depuis 11 ans. Le président actuel de Guidant, James Cornelius, assumera la fonction par interim".
Source :
Webfin.ARGENT
USA: ENT/ORL Oncology Robotic Surgery
Dr. Gregory Weinstein is being interviewed by Christopher Dolinsky, MD, at the Abramson Cancer Center of the University of Pennsylvania, USA.
We are very lucky to have the opportunity to interview Dr. Gregory Weinstein, Professor and Vice Chair of the Department of Otorhinolaryngology, Director of the Division of Head and Neck Surgery, and Co-Director of The Center for Head and Neck Cancer at the Hospital of the University of Pennsylvania.
Today we are going to be talking about a fascinating new technology available to patients at Penn: the daVinci Robotic Surgical System.
"Dr. Dolinsky: Dr. Weinstein, thank you so much for joining us today. Let's start from the top – what exactly is the daVinci Robotic Surgical System, and how does it work?
Dr. Weinstein: The daVinci Robotic System has been used for a number of years, both in the United States and abroad. There are 305 of these robots nationwide as of this year. The way that the system works is that the surgeon sits at a console where he or she operates with joysticks, using his or her fingers. The surgeon looks through a scope that has a 3D picture of whatever is in the visual field. It is like looking right at the patient. It has a bedside cart that the console is wired to, and the cart has four arms, although we only use three of them. The middle arm has an endoscope on it that has two cameras that allow for stereoscopic vision. The two lateral arms are long fit arms that are either 10 mm wide, 8 mm wide, or 5 mm wide, and they are quite long. At the very end is the working end of the instrument. There are a variety of different instruments that can be used.
Essentially, the end of the instrument moves exactly like your hand does. It is as if your hands miniaturized and in whatever small cavity is being operating upon. The system has perfect movement with 6° of freedom, so it actually completely reflects the wrist.
Dr. Dolinsky: This is certainly a different approach to surgery than the traditional methods – has it been difficult to learn to use this system?
Dr. Weinstein: It has a very short learning curve. For instance, studies of this system have compared students [who have] almost no experience [with] throwing sutures in laparoscopic cases to standardized laparoscopic experts; the students were doing almost as well as the experts in a very short time because it is so intuitive. Thus the name of the manufacturer, Intuitive Surgical.
Dr. Dolinsky: Has it been used for any other surgical sites? If so, which, and how are the results?
Dr. Weinstein: It has been estimated that 10 per cent of radical prostatectomies were done robotically last year in the United States. So radical prostatectomy is a popular procedure for this system. It is also used for cardiac procedures, other urologic procedures, and now it has been approved for gynecology. Essentially, anywhere that laparoscopes can be used - this overcomes the deficiencies of laparoscopic surgeries.
Dr. Dolinsky: What types of deficiencies?
Dr. Weinstein: Deficiencies of laparoscopic surgery are that they tend to be one-handed, because you have a video scope and you have a handing scope. Even if you have two hands, you have a fulcrum effect because of the abdominal wall. If you want your instrument to move one way, you have to move your hand the opposite way. It is counterintuitive. It does not have the degrees of freedom of your wrist at the end of the instrument, because the working end is at the tip of a long instrument that is now in the body cavity. The value of the daVinci system is that you can use both hands, and the working end of the instrument moves the way your hand does.
Dr. Dolinsky: Is anyone else using the system in a similar fashion?
Dr. Weinstein: We were the first in the world to apply it to trans-oral work. We are the only center in the world with an IRB-approved study to look at this, and in fact the only center right now reporting on this. Drs. Hockstein and O'Malley, from our department, first started with mannequin and cadaver work and figured out how to use the scopes to get into the mouth, then we moved up to animal models. We now have an IRB-approved protocol where the primary endpoint is exposure. The question is, can you achieve the exposure to do the procedure? And if you can get the exposure to do the procedure, you do the procedure. That is the way the study works. We are also looking at secondary endpoints of safety and efficacy.
Dr. Dolinsky: How many cases have you done? And how have they gone?
Dr. Weinstein: We have done 19 cases to date. That includes supraglottic laryngectomies for supraglottic cancer, numerous tongue base cancer resections, and numerous tonsil cancer resections. It included two cases so far where the resection that we did would, in typical hands, have required a jaw split and a free flap reconstruction. In one of them, we didn't do any reconstruction, and we are just letting it heal by secondary intention. In the other, we actually avoided the jaw split, did the resection, and then brought the flap up through the neck. That saved the jaw split plating, significant swallowing and dental problems for the patient, time in the operating room, and cosmetic deformity.
Dr. Dolinsky: So you answered a bunch of the initial questions I had for you. Besides yourself, who else is doing this?
Dr. Weinstein: Dr. Bert O'Malley, the Chairman of the Department of Otorhinolaryngology: Head and Neck Surgery. We do most cases together, it is important to stress that. The whole project began as a resident's project and the fundamental work was done under the guidance of Bert O'Malley. One of our former residents, Neil Hockstein, did the first mannequin and cadaver work out at the company in California . Then, Bert and I have brought it to the clinical arena. Both Bert O'Malley and I are the principal investigators on the study.
Dr. Dolinsky: Have you encountered any complications with the system?
Dr. Weinstein: We haven't had any complications so far. And we don't think the complications of this surgery, using the robot, are going to be very common. At this point, it is looking as if it is going to be no greater risk than doing standard trans-oral surgery. It also allows us to get to places we couldn't get to before.
There is no standard trans-oral technique giving good access to the back of the tongue because of line-of-sight problems. Traditionally, when you are working on the mouth, you are using long instruments through the laryngoscopes (which are very tight tubes), and you are looking straight down through a microscope which is outside [of] the patient. With this system, we have 30° scopes that can look up and instruments that can then be positioned to cut around the tongue base. In the past, the limitation of trans-oral resection of tonsil cancer was that it couldn't involve the tongue base. We are doing radical removal of the tonsil plus the tongue base through the mouth, a surgery which heretofore required a jaw split to get access. Some cases need reconstruction and some cases don't need reconstruction at all.
The key thing in head and neck cancer is that if you can get negative surgical margins, you really impact favorably on the patient's outcome. All of our margins have been negative so far. We had a close margin in one patient, but we were able to go back and re-resect.
In addition, if you can perform surgery and follow it with chemoradiation or radiation afterwards without worsening the outcome in terms of function, then there is really no downside doing the surgery to improve local control. If the surgery is not going to impact on function (which it doesn't appear to do when we perform it trans-orally in these types of cases), then there is no reason not to do it.
Dr. Dolinsky: This sounds like a great choice for patients, but I was wondering if there are specific contraindications?
Dr. Weinstein: There are preoperative and intra-operative exclusion criteria. Pre-operative contraindications include: unexplained fever, untreated active infection, pregnancy, previous head and neck surgery that precludes trans-oral robotic procedure (in other words, if the prior kind of surgical procedure does not allow me to get into the mouth), and the presence of medical conditions contraindicating general anesthesia or trans-oral surgical approach. Intra-operatively, [an exclusion criterion is] the inability to adequately visualize the anatomy to perform the diagnostic or therapeutic surgical approach trans-orally.
Dr. Dolinsky: Do these surgeries take about the same amount of time as standard oral surgeries?
Dr. Weinstein: They are taking less time. That is a very good question. For instance, a patient I did recently (my last case was a tongue base/ tonsil cancer) had his procedure in about 2 hours or so - counting resection, frozen sections, everything. He will come back to have another procedure for the neck (neck dissection), which is a staging procedure. He is going to avoid a tracheostomy, and the neck dissection will take about three hours.
The traditional approach to a tongue-based tonsil cancer, if you can use primary surgery, is a 15-hour procedure, with a jaw split, tracheostomy, and 8-day hospitalization. It is going to be much less than that for him.
I have another example. The two supraglottic cancers we did - one of them had perfect exposure and it took us about 2 hours. In another case, the exposure was not as good and it took a little longer. But, it was a good procedure and it turned out fine. A traditional laser supraglottic laryngectomy (which is very popular right now trans-orally for T1, T2, and selected T3 cancers of the supraglottis) takes me about 3 to 3.5 hours to perform.
In general, my expectation is that the robotic surgeries will be either faster, or take the same amount of time, but with better visualization because of the optics. So it will have other advantages besides time. That is my general impression at this point. It is certainly not taking longer.
Dr. Dolinsky: So what would you say the major advantages are?
Dr. Weinstein: One of the major advantages we already discussed is the length of the procedure. Another is that we are also going to have improved vision and magnification with high-end optics. The ability to use two hands, without the fulcrum effect present in standard endoscopic approaches, is certainly an advantage, as is the ability to use a miniaturized electric cauterer in places that we couldn't get to before. The high magnification 3 dimensional camera and endoscope that is very near to the surgical site allows us to see, dissect, and control critical nerves and blood vessels that we typically cannot see well or deal with when working through a tubular laryngoscope using a hand help endoscope or even with loops or a microscope used at a distance from the actual site of surgery in the mouth. Those are going to be the main benefits to the surgeon.
The main benefits to the patient are going to be (in many cases): avoidance of tracheostomy, avoidance of a long procedure that requires complex reconstruction, and a minimally invasive approach that will decrease patient's rehabilitation time. Those are the kind of things we see down the pike for patients. I am giving you a gestalt because I have not analyzed this. But that is my prediction.
Dr. Dolinsky: What do you think about the future of robotic surgery?
Dr. Weinstein: I think that the future we are going to see is very exciting. First of all, I think that there are going to be new instruments that come along that allow us to do even more robotically. Robotic surgery is going to be one additional tool that is in our armamentarium for selected patients, but it is not going to replace everything. It will take a few years for us to figure out which are the ideal cases. But, it will be an important tool for selected cases to help us eradicate cancer and improve function.
Dr. Dolinsky: Any ballpark estimates on what percent of cases will be done this way in the future?
Dr. Weinstein: It is hard to say. It is hard [to predict] with new ideas and new technology. It is always complicated to see how these things are going to catch on, but our key focus is development first, and then teaching second.
Years ago, (in the late 1980's and early 1990's), I introduced an operation called the supracricoid laryngectomy to the United States from France. I am not sure if you are familiar with it, but it is now a standard operation. It took us about 10 years for it to be in the text books, written about widely, done nationally in numerous institutions, and considered part of the standard-of-care based on practice guidelines from various organizations. The way that happened, in my opinion, was not only by doing it and proving it could work, but by spending time teaching it. A major focus is to first perfect the technique, which is what we are doing now, and then the second major focus is going to be teaching it. Teaching it by publishing, by giving lectures and CME courses. If you don't teach it and get it out there, then it's like it doesn't exist. Those who want to learn will learn it and we will see if it catches on. It will only catch on if it is of value and is used efficiently and effectively.
Dr. Dolinsky: If you encounter specific limitations to the system, is there a way for you to suggest improvement to the company? Or do you think that, at least currently with what you have seen, everything seems to be working the way you would like it to?
Dr. Weinstein: We have everything we need right now for all that we are doing, but we are working on ways to improve the instruments and design new instruments that will be useful specifically for Transoral Robotic Surgery.
Dr. Dolinsky: If you were a patient, what do you think the best reason for enrolling in the study would be?
Dr. Weinstein: I think there are a number of reasons a patient may benefit. They may benefit by avoiding a tracheostomy. I think we are seeing faster rehab in functional recovery. When it comes to things like not having to have your jaw split, it is less surgery, less deformity, and less pain.
It is another surgical tool, it is just a highly, highly, sophisticated surgical tool. Although it is called a robotic system, remember, this is not an independent robot like you might see in the cinema. I am kind of digressing here to make a point. I told my uncle, who is 85, that we are doing this, and he replied that he didn't want a robot operating on him. The reality is that it is not a robot operating on you - it is the surgeon. Unless you are in there and your head is in the goggles and your hands are on the controls, the system will not work. It can't do the surgery for you. It is a tool. It is an extension of the surgeon. To me, the benefit is going to be allowing us to do very complex, sophisticated, successful surgical operations, without having to do very wide surgical approaches that we had to do in the past.
Dr. Dolinsky: Based on the way this works, would it be possible, with Internet connections, to operate on someone from across the country?
Dr. Weinstein: Yes. There have been a couple of experiments with that. There was one many years ago where they operated on a gall bladder across the Atlantic across telephone lines. Then there is a group in Canada using a prior iteration of this machine called the 'Zeus' (which you can find on the Internet). They reported 21 cases where the patients were 400 km away, with two surgeons working across ISDN lines.
There are complexities that need to be worked out in terms of latency, broadband width, and the integrity of the connection. We are actually extremely interested in this here at Penn. But the complexity of what you are describing, which is tele-surgery -- we are very close to having the technology to do that. It is all the other issues that go along with it that will be the impediment for its success -- issues like insurance, patient acceptance, and physician acceptance.
I do see tele-surgery in the future as [a solution] to a major crisis in American healthcare, which is the lack of specialists in rural America. If you had a person who is trained as an assistant who can take care of surgical complications and who knew the rudiments of the case, while the highly-specialized person is at a hub somewhere else, actually performing the surgery - you might be able to deliver healthcare to a section of society that presently doesn't [have access to it], and I think that is an exciting prospect for the future.
In fact, trans-oral robotic surgery would be the ideal area to start that type of surgery, because remember, for every other type of surgery, you have to make incisions to get in. But here, the orifice for getting into the patient is already there - the mouth. The risks and complications for this type of approach will be much lower. It makes some sense to start in that arena. But at this point, that is science fiction. And I would prefer to limit our discussion to science fact."
Source:
Onco Link
Johnson & Johnson conteste l'action en justice de Guidant
Johnson & Johnson a répété lundi qu'il n'était pas tenu de finaliser l'acquisition de Guidant, s'opposant ainsi à l'action en justice que vient de lui intenter le fabricant américain d'appareils cardiologiques.
Source :
Boursier.com
==> Lire aussi :
"Guidant descend encore d'un cran, Johnson & Johnson pourrait abandonner son offre" : cliquer ici.
USA, Californie, Sunnyvale : un ouvrage complet sur la radiochirurgie robotique...
...publié par la CyberKnife(MD) Society Press, en collaboration avec des chefs de file internationaux dans plusieurs domaines, pour offrir un aperçu détaillé de la radiochirurgie robotique
La CyberKnife Society Press annonce avec fierté la publication de Robotic Radiosurgery-Volume 1, la publication la plus complète et la mieux documentée jamais rédigée sur la radiochirurgie stéréotaxique robotique.
"Premier d'une série, ce livre relié présente les expériences cliniques et les recherches de pointe de plus de 100 auteurs et rédacteurs sur la radiochirurgie stéréotaxique. Les sujets couverts comprennent des introductions sur l'histoire, la physique et la radiobiologie, suivies de chapitres complets sur le système nerveux central (SNC) et sur les applications autres que le SNC, le tout couvrant une gamme variée de sujets cliniques. Dans la liste impressionnante d'auteurs, notons des radio-oncologues, des neurochirurgiens et d'autres spécialistes de la chirurgie, de même que des technologues, des professeurs, des physiciens et des ingénieurs.
Le livre de 428 pages est divisé en 33 chapitres, remplis de chiffres, de tableaux et d'environ 1 000 références sur les effets bénéfiques de la radiochirurgie sur le cerveau, la colonne vertébrale, les poumons, le foie, le pancréas, la prostate et plus encore. 'Les chapitres de ce livre représentent l'effort collectif d'un groupe varié d'utilisateurs de CyberKnife, qui partagent une vue commune d'un avenir chirurgical non effractif', a déclaré le Dr John R. Adler, Jr., professeur de neurochirurgie à l'université Stanford et président de la CyberKnife Society. 'Au coeur de cet objectif se trouve la notion très simple que des radiations très précises nous permettent de franchir un seuil de possibilités thérapeutiques.'
'Il s'agit plus qu'une simple ressource pour la radiochirurgie stéréotaxique', fait remarquer le Dr John Kresl, directeur du centre de radiochirurgie stéréotaxique du St. Joseph's Hospital & Barrow Neurological Institute.
'C'est un regard vers l'avenir de cette technologie posé par certaines des plus grandes sommités dans une vaste gamme de disciplines.'
Le Robotic Radiosurgery a été co-publié par des sommités comme le Dr Richard Bucholz, directeur de la neurochirurgie à l'école de médecine de l'université de St. Louis; le Dr Gregory Gagnon, directeur de programme à CyberKnife, département de médicine de rayonnements au centre médical de l'université Georgetown; le Dr Peter Gerszten, département de chirurgie neurologique et de radio-oncologie de l'université de Pittsburgh; le Dr John Kresl, directeur du centre de radiochirurgie stéréotaxique du St. Joseph's Hospital & Barrow Neurological Institute; le Dr Peter Levendag, professeur et président de radio-oncologie au centre médical Erasmus; Richard Mould, physicien médical, South Croydon; et Raymond Schulz, directeur de rédaction et directeur des publications cliniques d'Accuray Incorporated."
On peut se procurer le Robotic Radiosurgery-Volume 1 depuis le site Web de la CyberKnife Society et sur Amazon. Pour obtenir de plus amples renseignements, pour consulter la table des matières ou la liste des auteurs, veuillez consulter le site www.cksociety.org.
La CyberKnife Society, créée en 2002 à titre de prolongement académique d'Accuray, Inc., a comme mission de réunir divers experts médicaux, de partout dans le monde, pour encourager les échanges savants et pour partager des renseignements cliniques sur la radiochirurgie stéréotaxique CyberKnife.
REMARQUE : CyberKnife est une marque enregistrée d'Accuray, Inc. aux Etats-Unis et dans d'autres pays.
Source :
CNW Telbec (Canada)
Chirurgie en 3D
D'abord utilisée en neurochirurgie, la chirurgie assistée par ordinateur est en plein boom. Notre envoyée spéciale a suivi une intervention ORL sur une fillette de 4 ans.
"Le regard du chirurgien navigue entre les deux écrans. Ses mains continuent d'opérer. Sur le premier moniteur, le Pr Patrick Froehlich visualise les parois des fosses nasales de sa petite patiente, filmées en direct par la caméra numérique qu'il a introduite par une narine. Sur l'autre, il contrôle la position de ses instruments par rapport aux tissus environnants (os, cerveau, globes oculaires...), vus au scanner. Quatre coupes anatomiques, sur lesquelles se superposent des traits jaunes correspondant aux outils chirurgicaux, s'affichent simultanément sur la console. Grâce à ce système de guidage assisté par ordinateur, appelé neuronavigation, le chirurgien de l'hôpital Edouard-Herriot à Lyon dispose d'un maximum de repères pour un geste opératoire plus précis. Et le risque est moindre de léser les organes autour.
En moins d'une heure
Ce matin de septembre, il s'agit pour Patrick Froehlich de reperméabiliser la fosse nasale 'bouchée' d'une fillette de 4 ans. Laetitia est atteinte d'atrésie choanale, une malformation congénitale rare (une pour 6 000 naissances) qui consiste en une fermeture de la partie postérieure d'une des deux fosses nasales, ce qui empêche l'air de circuler du nez vers la gorge. Depuis sa naissance, l'enfant est parfois gênée pour respirer. Son nez est constamment encombré, et elle fait des otites à répétition. Un couteau, pour découper le tissu muqueux, puis une fraise, pour passer à travers l'os. A l'aide de mini-instruments, introduits par voie endoscopique et activés par une pédale, le chirurgien perfore la cloison bouchée et y crée un orifice de bonne taille. En moins d'une heure, Laetitia est sortie du bloc. Elle quittera l'hôpital dès le lendemain. La malformation aurait pu être corrigée plus tôt, mais les parents étaient réticents. La mère, porteuse elle aussi d'une atrésie choanale, gardait un très mauvais souvenir des suites opératoires de l'intervention, il y a de nombreuses années. 'Je ne voulais pas que ma fille en bave autant que moi. Mais quand on a entendu parler d'une nouvelle technique, moins douloureuse et moins dangereuse, ça nous a décidés', raconte-t-elle.
Patrick Froehlich confirme les progrès impressionnants dans ce domaine. 'Il y a encore dix ans, on opérait les atrésies choanales en passant à travers le palais. Il fallait ensuite laisser en place un tube entre la bouche et le nez pendant une à trois semaines. Depuis, on pénètre par les voies naturelles, sous endoscopie. C'est une chirurgie peu invasive, beaucoup plus légère.' Pour ce spécialiste, le guidage par ordinateur constitue une nouvelle révolution. 'Aussi importante que les interventions sous microscope', estime-t-il même. La caméra endoscopique permet de voir les parois de la gorge et du nez, mais pas de distinguer les organes qui sont cachés derrière. L'image, de bonne qualité, peut devenir illisible en cas d'hémorragie. Dès 1998, l'équipe lyonnaise a été l'une des premières au monde à appliquer le principe de la neuronavigation, déjà utilisé en neurochirurgie, à la chirurgie ORL de l'enfant. Les chirurgiens ont étroitement collaboré avec les ingénieurs de Brainlab, fabricant du système nommé Kolibri, pour l'adapter à ces nouvelles indications.
Une précision de l'ordre du millimètre
Depuis, Patrick Froehlich a opéré 350 enfants, pour diverses pathologies : malformations dont l'atrésie choanale, polypes des sinus (souvent au cours d'une mucoviscidose), tumeurs... Et la plupart des grands services français d'ORL (pédiatriques ou pour adultes) sont désormais équipés. 'Chez l'enfant, les contraintes de la chirurgie ORL sont maximales, justifie le Pr Froehlich. La cavité nasale est un espace minuscule, à proximité de zones sensibles comme les méninges, les orbites. On peut aussi blesser l'artère carotide, les bourgeons dentaires...' Par peur d'un geste trop agressif, l'opérateur avait tendance à limiter les résections. D'où des récidives fréquentes, pouvant nécessiter une seconde intervention. 'Avec la neuronavigation, la précision est de l'ordre du millimètre. Le geste est plus complet, avec moins de complications. Et le temps opératoire diminue d'environ 30 %', synthétise le chirurgien. A condition de maîtriser la technique, qui nécessite de six mois à un an d'apprentissage...
Assister à la préparation de l'intervention dans le bloc opératoire donne l'impression de visionner un épisode de Star Trek. Le chirurgien installe un curieux bandeau, surmonté de trois boules grises disposées en étoile, sur le front de la future opérée. Puis, muni d'une télécommande, il envoie des faisceaux de lumière infrarouge sur de multiples points du visage. Ceux-ci sont réfléchis par la peau et enregistrés par une caméra à infrarouge, postée à 2 mètres de là. 'Les boules sont des sphères réfléchissantes, sur le même principe que les bandes au milieu de la route. Elles servent de points de référence', décode Stéphane Komitau, responsable des marchés chez Brainlab. 'Le principe est de prendre des repères sur la peau, de les situer par rapport à l'étoile de référence, et de caler ce masque par rapport aux images de scanner. Le même type de calibrage est ensuite effectué avec les instruments chirurgicaux.'
Grâce à ce système complexe, le chirurgien a la sensation de savoir précisément où sont ses outils par rapport aux structures anatomiques. Impression exacte, à un détail près : le scanner a été réalisé la veille de l'intervention. Les quelque 200 coupes (tous les 0,2 millimètre) susceptibles de défiler sur l'écran ne sont pas des images en temps réel. 'Si par exemple on perfore la cloison nasale, on ne le verra pas à l'écran', traduit Patrick Froehlich. Handicap que le chirurgien doit garder en tête, mais qui s'avère finalement peu gênant en ORL. Les tissus de la face sont en effet immobiles ; contrairement aux tissus mous, et au cerveau [...]. En attendant la diffusion des techniques de neuronavigation peropératoires, qui permettront d'avoir des clichés en temps réel, la chirurgie assistée par ordinateur se développe à grande vitesse, dans plusieurs disciplines, en dépit du coût élevé de l'appareil, de 100 000 à 300 000 euros l'unité.
Reconstructions faciales
En ORL, les indications se multiplient aussi chez l'adulte pour des interventions endonasales. 'La neuronavigation commence également à être utilisée pour des opérations de l'oreille en Allemagne, annonce Stéphane Komitau. Plusieurs équipes françaises devraient bientôt s'y mettre.' Depuis deux ans, le guidage assisté par ordinateur a également trouvé une place en orthopédie, notamment pour les prothèses du genou. Et la technique pourrait se réveler utile lors de reconstructions faciales, après accident par exemple. Des recherches sont en cours dans ce domaine en Allemagne, révèle le représentant de Brainlab.
Mais ce sont les neurochirurgiens, utilisateurs de la neuronavigation depuis le début des années 90, qui en ont la plus grande expérience. 'Pour nous, c'est la routine, tous les gros plateaux techniques l'emploient régulièrement', assure Jean Régis, neurochirurgien au CHU de Marseille. Un intérêt historique, né des contraintes particulières à cette chirurgie. 'Dans le cerveau, dès qu'on touche autre chose que la lésion, cela peut être catastrophique, observe le neurochirurgien. La neuronavigation nous permet d'optimiser notre trajectoire, de nous repérer dans l'espace, comme avec un GPS. On l'utilise notamment pour la chirurgie de l'épilepsie, où il faut être très précis, ainsi que pour les tumeurs de petite taille, enfouies dans le cerveau.'"
Source :
Article de Sandrine CABUT
Libération
© Libération
Updates on robotic surgery : scientific press
1.- Laparoscopic radical prostatectomy: conventional and robotic.
Authors: Menon M, Shrivastava A, Tewari A., Vattikuti Urology Institute, The Josephine Ford Cancer Center, Henry Ford Health System, Detroit, Michigan 48202, USA. In: Urology. 2005 Nov;66(5 Suppl):101-4.
"By 2015, prostate cancer will become the most commonly diagnosed cancer in men. Radical prostatectomy reduces disease-specific mortality in patients with localized prostate cancer; however, the invasiveness of surgery and its resultant side effects cause many men to seek other treatments. In 2000, laparoscopic radical prostatectomy emerged as a minimally invasive alternative to open surgery; it has been refined recently by the addition of robotic technology. To examine the outcomes of robotic radical prostatectomy and compare them with those from open and conventional laparoscopic radical prostatectomy, we prospectively collected baseline demographic data on all patients undergoing surgery for prostate cancer over a 4-year period at our center. Urinary function and sexual function were evaluated using standardized criteria as well as a questionnaire preoperatively and at 1, 3, 6, 12, and 18 months after their procedure. Operative and postoperative outcomes were compared using values for open radical prostatectomy as the reference standard. A total of 100 men underwent open radical prostatectomy with conventional laparoscopic radical prostatectomy (n = 50) and robotic radical prostatectomy (n = 500). The odds ratios for operative times, blood loss, postoperative pain, complications, and median times to urinary continence and resumption of sexual activity all were lower for robotic than for open or laparoscopic radical prostatectomy. It appears safe to conclude that conventional laparoscopic radical prostatectomy is a reasonable alternative to open radical prostatectomy in the surgical treatment of patients with clinically localized prostate cancer. The incorporation of robotics may result in even better surgical outcomes than conventional laparoscopy. However, the surgical robot is expensive; few centers have access to the technology and even fewer have expertise in the technique. For robotic radical prostatectomy to become the standard of care for the treatment of localized prostate cancer will require economies of cost, dissemination of surgical expertise, and data from randomized trials."
2.- Robot-Assisted Endoscopic Surgery: A Four-Year Single-Center Experience.
Authors: Ruurda JP, Draaisma WA, van Hillegersberg R, Borel Rinkes IH, Gooszen HG, Janssen LW, Simmermacher RK, Broeders IA, Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. In: Dig Surg. 2005 Sep 28;22(5):313-320.
"Background: Robotic systems were introduced in the late 1990s with the objective to overcome the technical limitations of endoscopic surgery. In this prospective cohort study the potential safety, feasibility, pitfalls and challenges of robotic systems in gastrointestinal endoscopic surgery are assessed and our vision on future perspectives is presented. Methods:Between August 2000 and December 2004, 208 procedures were performed with support of the Intuitive Surgical da Vincitrade mark robotic system. We started with cholecystectomies (40) and Nissen fundoplications (41) to gain experience with robot-assisted surgery. In the following years more complex procedures were carried out, i.e. colorectal procedures (7), type III/IV paraesophageal hernia repair (32), redo Nissen fundoplications (9), Heller myotomies (24), esophageal resections (22), rectopexies (16) and aortobifemoral bypasses (3). Results:The median robotic set-up time was 13 min, and 7 min in the last 50 procedures. The median operating time for the total of procedures was 120 min (45-420) and the median blood loss was 30 ml (0-800). Fourteen procedures were converted to open surgery (6.7%). Equipment-related problems, such as start-up failures and positioning difficulties of the robotic arms, were encountered in 11 cases (5.3%). Postoperative complications were seen in 11 patients (11/176, 6.3%) after robot-assisted laparoscopic procedures. Pulmonary complications occurred in 11 patients, cardiac in 3, anastomic leakage in 3, chylous leakage in 3 and vocal cord paralysis in 3 after thoracoscopic esophagolymphadenectomy for esophageal cancer. One patient died 12 days after esophageal resection (0.5%).
Conclusion: During the implementation of this robotic system, we experienced an obvious learning curve, particularly with regard to the positioning of the robot cart and communication between the surgeon and operating team. After 4 years, we have experienced that the merits of the current generation of this technology probably is preserved to complex endoscopic procedures with delicate dissection and suturing. In the nearby future we will focus on the treatment of motility disorders and malignancies of the esophagus and stomach. The position of the robot in the endoscopic operating room will have to be clarified by the outcome of prospective research. Furthermore, priorities have to be acclaimed on technical sophistication and cost reduction of these systems."
Copyright © 2005 S. Karger AG, Basel.
3.- Laparoscopic morgagni hernia repair in children using robotic instruments.
Authors: Knight CG, Gidell KM, Lanning D, Lorincz A, Langenburg SE, Klein MD, the Maxine and Stuart Frankel Foundation Computer-Assisted Robot-Enhanced Surgery Program at Children's Hospital of Michigan, Detroit, Michigan.
In: Journal of Laparoendoscopic Advanced Surgical Techniques. 2005 Oct;15(5):482-6.
"Background: Robotic surgery enhances minimally invasive surgery through tremor filtration, motion scaling, indexed movement, articulation, and improved ergonomics. We report 2 cases of computer- assisted, robot-enhanced, laparoscopic repair of Morgagni hernia in a 23-month-old weighing 10.2 kg and a 5-year-old weighing 21.6 kg. Methods: Four 5 mm trocars were used to gain access to the abdomen. In the first case, standard laparoscopic instruments were used to dissect the liver from the rim of the defect and then reduce the hernia. In the second, robotic instruments were used for this dissection. In both cases, the robot- enhanced instruments were used to close the hernia defects with interrupted, nonabsorbable suture, using intracorporeal knot tying. Results: Both cases were completed laparoscopically without a patch. The robotic system took 9 minutes to set up and drape. The average operative time was 227 minutes. The older child tolerated oral intake the day of surgery and went home the following day. The younger child tolerated oral intake and went home on postoperative day 2.
Conclusion: Robot-assisted laparoscopic Morgagni hernia repair is feasible."
4.- Robotic-assisted thoracoscopic surgery (RATS) for benign and malignant esophageal tumors.
Authors: Bodner JC, Zitt M, Ott H, Wetscher GJ, Wykypiel H, Lucciarini P, Schmid T., Department of General and Transplant Surgery, Innsbruck Medical University, Innsbruck, Austria. In: Ann. Thorac. Surg. 2005 Oct;80(4):1202-6.
"BACKGROUND:
Robotic surgical systems are most effective for operations in areas that are small and difficult to reach. Ideal indications for this new technology have yet to be established. The esophagus possesses attributes that are interesting for general thoracic robotic surgeons.
METHODS:
Robotic-assisted thoracoscopic surgery (RATS) using the da Vinci system (Intuitive Surgical, Inc, Mountain View, CA) was performed in six patients with esophageal tumors. This comprised the dissection of the intrathoracic esophagus including lymph node dissection in four patients suffering from esophageal cancer and the extirpation of a benign lesion (one leiomyoma and one foregut cyst) in the remaining two patients. RESULTS: All procedures were completed successfully with the robot. The median overall operating time was 173 (160-190) minutes in the oncologic cases and 121 minutes in the benign cases, including the robotic act of 147 (135-160) minutes and 94 minutes, respectively. There were no intraoperative complications. One patient had to undergo a redo thoracoscopy because of a persistent lymph fistula. One cancer patient died after 12 months due to tumor progression and another patient had to be stented due to local tumor recurrence 19 months postoperatively.
CONCLUSIONS:
This first small series of various esophageal pathologies treated by robotic-assisted thoracoscopic surgery supports the impression that the esophagus is an ideal organ for a robotic approach. The potential of the da Vinci system, especially for oncologic indications, remains to be proven in future clinical trials."
5.- Technologic advances in Robotic Surgery.
Author: Waseem T., Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, 02115, USA. In: Journal of Coll. Physicians Surg Pak. 2005 Sep;15(9):559-61.
"Medical science has achieved enormous accomplishments during the past couple of decades. These advances encompass the list of techniques involving manipulations of DNA and stem cells to minimally invasive techniques. The recent advances in integration of computer sciences, biomechanics and electronic miniaturization have made it possible to make the surgical techniques less invasive and highly precise. Much progress has been made in integrating robotic technologies with surgical instrumentation, as evident by thousands of successful robot-assisted surgical procedures. Such advances will enable continued progress in surgical instrumentation and, ultimately, surgical care."
6.- Maintenance of Hemostasis in Transoral Robotic Surgery.
Authors: Hockstein NG, Weinstein GS, O'malley Jr BW., Department of Otorhinolaryngology - Head and Neck Surgery, The University of Pennsylvania, Philadelphia, Pa., USA. In: ORL J Otorhinolaryngol Relat Spec. 2005 Sep 5;67(4):220-224.
"Background:
The last decade has seen a tremendous growth in the field of robotic surgery with an increasing number of cardiac and urologic procedures performed each year. Several attributes of this technology may offer advantages to laryngeal and pharyngeal surgery in that it allows for exceptional visualization of the operative field, precise handling of soft tissues, and multiplanar transection of tissues. One potential limitation is the management of bleeding in transoral pharyngeal and laryngeal surgery, which is critical to prevent both intravascular volume loss and aspiration.
Objectives:
To demonstrate methods for management of bleeding in the surgical field during transoral robotic surgery (TORS). Methods: We developed a canine robotic surgery model for the evaluation of the ability to control bleeding in laryngeal and pharyngeal procedures using the daVinci((R)) surgical robot (Intuitive Surgical, Inc., Sunnyvale, Calif., USA). Both large- and small-vessel hemostasis was obtained with both robotically controlled monopolar and bipolar cautery and with robotically controlled small hemoclips. Additionally, manually controlled large hemoclips were applied by an assistant surgeon viewing on a video monitor for management of large arterial vessels. Suction was performed with both flexible suction catheters controlled by the robotic arms and with manually controlled conventional suction catheters. Data were collected with still and video photography.
Results:
The lingual artery as well as small arteries and veins were easily controlled and there were no difficulties with maintenance of hemostasis.
Conclusions:
Effective hemostasis with control of both large and small vessels can be obtained using both surgical hemoclips and electrocautery during TORS in a canine model." Copyright © 2005 S. Karger AG, Basel.
7.- Computer-assisted laparoscopic colon resection with the Da Vinci system: our first experiences.
Authors: Braumann C, Jacobi CA, Menenakos C, Borchert U, Mueller JM, Rueckert JC, Department of General, Visceral, Vascular and Thoracic Surgery, Medical Faculty Charite, Humboldt University, Berlin, Germany. In: Dis Colon Rectum. 2005 Sep;48(9):1820-7.
"PURPOSE:
Telerobotic surgery is a developing and promising modality that highly improves the laparoscopic dexterity. We have performed more than 100 laparoscopic and thoracoscopic procedures since December 2002 with the aid of the Da Vinci robotic system. This study was designed to assess the value of robots in colonic laparoscopic surgery. We present our first cases of robotic-assisted colectomies.
METHODS:
Two patients underwent a telerobotic-assisted sigmoidectomy for sigmadiverticulitis. One of these cases was complicated with a sigmoid-bladder fistula. Three other patients were submitted to a colon resection for cancer: sigmoidectomy (n = 2), and right colectomy (n = 1). A four-trocar technique was used for all operations. Tissue dissection of colonic adhesions, mobilization of the colon, management of the fistula, mesenteric dissection and division, and bowel resection were fully performed with the telerobotic system.
RESULTS:
Three operations were completed using the Da Vinci system without any problems in acceptable times. In two patients, the operation had to be converted to laparotomy because of severe adhesions and locally extended tumor growth. Postoperative courses of all patients were uneventful. Patients were discharged between postoperative Days 9 and 20, and were well six months later.
CONCLUSIONS:
Colonic telerobotic surgery can be performed safely. Benefits were seen during dissection of the rectum in the small pelvis. A major limitation is a lack of a large operation field especially if there is the need to dissect a colonic flexure in the upper abdomen. The enormous costs and the lack of appropriate instruments can be a major problem in the further expansion of the telerobotic surgery."
8.- Robotic coronary artery surgery: past, present and future.
Authors: Dogan S, Akbulut B, Aybek T, Mierdl S, Moritz AR, Wimmer-Greinecker G., Department of Cardiovascular and Thorax Surgery, Johann Wolfgang Goethe University, D-60590, Frankfurt, Germany. In: Anadolu Kardiyol Derg. 2005 Sep;5(3):210-5.
"Minimally invasive endoscopic procedures in cardiac surgery have only become possible since the introduction of telemanipulator systems. In this study we review robotic assisted telemanipulation systems and procedures on beating and arrested heart for total endoscopic revascularization. Robotic surgery is still under development. The most important factors limiting this new technique are high costs and the fact that only selected patients are able to be operated on. But studies on technology especially to improve anastomotic techniques are going on to produce an alternative for coronary revascularisation. We did not yet hit all goals but the future seems promising."
9.- Adhesiolysis is facilitated by robotic technology in reoperative cardiac surgery.
Authors: Martens TP, Morgan JA, Hefti MM, Brunacci DA, Cheema FH, Kesava SK, Xydas S, Dang NC, Vigilance DW, Kohmoto T, Gorenstein LA, Smith CR Jr, Argenziano M., Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, New York, USA. In: Ann Thorac Surg. 2005 Sep;80(3):1103-5.
"Over a 2-year period, 5 patients who required reoperative chest surgery underwent robotic adhesiolysis with the da Vinci (Intuitive, Sunnyvale, CA) system. Resternotomy was performed under direct visualization for coronary revascularization (n = 2) or valve replacement (n = 1). A fourth patient required coronary revascularization after a previous axilloaxillary bypass. The final case involved the preparation of a substernal pathway for a gastric pull-up. In all cases adhesions were taken down without injury to the underlying structures. All grafts were preserved, and all patients recovered uneventfully. Robotic adhesiolysis is a versatile technique that allows careful lysis of adhesions and minimizes the risk of major complication during reoperative chest surgery."
10.- Comparison of laparoscopic pyeloplasty with and without robotic assistance.
Authors: Bernie JE, Venkatesh R, Brown J, Gardner TA, Sundaram CP., Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
In: JSLS. 2005 Jul-Sep;9(3):258-61.
"OBJECTIVES:
The benefits of laparoscopic surgery with robotic assistance (da Vinci Robotic Surgical System, Intuitive Surgical, Sunnyvale, CA) includes elimination of tremor, motion scaling, 3D laparoscopic vision, and instruments with 7 degrees of freedom. The benefit of robotic assistance could be most pronounced with reconstructive procedures, such as pyeloplasty. We aimed to compare laparoscopic pyeloplasty, with and without robotic assistance, during a surgeon's initial experience to determine whether robotic assistance has distinct advantages over the pure laparoscopic technique.
METHODS:
We retrospectively compared the first 7 laparoscopic pyeloplasties with the first 7 robotic pyeloplasties performed by a single surgeon. All patients were preoperatively evaluated with computed tomographic angiography with 3D reconstruction to image crossing vessels at the ureteropelvic junction. All patients were followed up by lasix renograms and routine clinic visits.
RESULTS:
Patients were similar with respect to mean age (34 in laparoscopic pyeloplasty group vs 32 in the robotic pyeloplasty group), operative time (5.2 hours vs 5.4 hours), estimated blood loss (40 mL vs 60 mL), and hospital stay (3 days vs 2.5 days). Two patients in the laparoscopic pyeloplasty group had small anastomotic leaks managed conservatively, and one patient in the robotic pyeloplasty group had a febrile urinary tract infection necessitating treatment with intravenous antibiotics. Another patient in the robotic pyeloplasty group was readmitted with hematuria that was treated conservatively without transfusion. No recurrences were detected in either group.
CONCLUSIONS:
Operating times and outcomes during the learning curve for laparoscopic pyeloplasty were similar to those for robotic pyeloplasty. Long-term data with greater experience is needed to make definitive conclusions about the superiority of either technique and to justify the expense of robotic pyeloplasty."
11.- Robot-assisted laparoscopic dismembered pyeloplasty.
Authors: Palese MA, Munver R, Phillips CK, Dinlenc C, Stifelman M, DelPizzo JJ., the Mount Sinai School of Medicine, Department of Urology, New York, New York, USA.
In: JSLS. 2005 Jul-Sep;9(3):252-7.
"OBJECTIVE:
Advanced laparoscopic skills limit the implementation of laparoscopic pyeloplasty to centers with extensive experience. The introduction of robotic technology into the field of minimally invasive surgery has facilitated complex surgical dissection and genitourinary reconstruction. We report our experience with robot-assisted laparoscopic pyeloplasty using the da Vinci Robotic Surgical System at 3 New York City medical centers.
METHODS:
A review of all robot-assisted laparoscopic Anderson-Hynes dismembered pyeloplasty cases in 38 patients (21 females, 17 males) between April 2001 and January 2004 was performed. All patients had symptoms or radiographic evidence of ureteropelvic junction obstruction. Robotic assistance with the da Vinci Robotic Surgical System was used after preparation of the ureteropelvic junction with a standard laparoscopic approach.
RESULTS:
The average patient age was 39.3 years (range, 15 to 69). The mean operative time and suturing time were 225.6+/-59.3 minutes and 64.2+/-14.6 minutes. The average estimated blood loss was minimal at 77.3+/-55.3 mL. The mean length of hospitalization was 69.6 hours (range, 28 to 310). The average use of intravenous morphine was 26.5 mg (range, 0 to 162). No intraoperative complications occurred, and open conversions were not necessary. A mean follow-up of 12.2 months revealed a success rate of 94.7% with 2/38 patients requiring further treatments.
CONCLUSIONS:
This combined multi-institutional series reveals that robot-assisted pyeloplasty with the da Vinci Surgical System is safe and reproducible. These intermediate results appear comparable to results with open and laparoscopic pyeloplasty repairs."
12.- Innovative techniques in coronary bypass surgery.
Author: Loisance D., Academie Nationale de Medecine. In: Bull Acad Natl Med. 2005 Feb;189(2):269-82; discussion 283.
"Coronary artery surgery is now being challenged by percutaneous techniques of coronary revascularization, coronary dilatation and arterial stenting. Improvements are being made in three directions, namely selection of optimal conduits, with the aim of improving long-term graft patency; minimizing complications of cardiopulmonary circulation (or avoiding it altogether), and improving access to coronary vessels. The ultimate goal is robotic keyhole surgery of the beating heart. This paper offers a critical analysis of these developments."
13.- Treatment of double vessel coronary artery disease by totally endoscopic bypass surgery and drug-eluting stent placement in one simultaneous hybrid session.
Authors: Bonatti J, Schachner T, Bonaros N, Jonetzko P, Ohlinger A, Lockinger A, Stalzer B, Eschertzhuber S, Friedrich G., Departments of Cardiac Surgery, Cardiac Anesthesiology, and Cardiology, Innsbruck Medical University, Innsbruck, Austria.
In: Heart Surg Forum. 2005;8(4):E284-6.
"Hybrid coronary artery revascularization is a combination of minimally invasive coronary artery surgery and catheter-based coronary intervention. Hybrid procedures enable adequate revascularization of patients with multivessel coronary artery disease without complete opening of the chest and with the advantage of the most durable option, a left internal mammary artery (LIMA) graft is placed to the left anterior descending (LAD) artery. The hybrid concept is gaining renewed interest because totally endoscopic LIMA to LAD placement has become feasible and because drug-eluting stents in non-LAD targets may be competitive even for arterial bypass grafts. Simultaneous hybrid procedures would be desirable. We report on a case in which robotic totally endoscopic LIMA to LAD grafting using the da Vinci(TM) telemanipulation system was combined with placement of a rapamycin coated stent to the right coronary artery in one single procedure."
14.- Total Endoscopic CABG* Using Robotics on Beating Heart.
* CABG = Coronary Artery Bypass Graft
Authors: Fleck T, Tschernko E, Hutschala D, Simon-Kupilik N, Bader T, Wolner E, Wisser W., Department of Cardiothoracic Surgery, Medical University Vienna, Austria.
In: Heart Surg Forum. 2005;8(4):E266-8.
"Background:
The implementation of a total endoscopic coronary surgery on the beating heart with the aid of the Da Vinci surgical system (Intuitive, Sunnyvale, CA) requires a stepwise learning process. After cadaveric training and clinical start of the program in November 2002, we gained experience with arrested heart procedures starting in May 2003. In November 2003, we moved to beating heart surgery.
Methods:
From November 2003 to January 2005, 14 patients with coronary artery disease (mean age of 62 +/- 5 years, female to male ratio 2:12) were operated with the intention to perform a beating heart TECAB (totally endoscopic coronary artery bypass grafting) procedure.
Results:
Total conversion rate was 35% (5/14), due to pleural adhesions in 2 patients, injury of the lung during port placement, inability to occlude the LAD with saddle loops, atherosclerotic diseased mammary artery in 1 patient each. Mean operating time was 298 +/- 110 minutes with a steady decline throughout the study period (first 5 patients: 342 +/- 61 minutes, patients 6 to 9: 337 +/- 87 minutes, last 4 patients: 290 +/- 53 minutes), resulting in a 60 minute shorter operating time. Mean ICU stay was 1.3 days and hospital stay lasted on average 8.4 +/- 2.8 days.
Conclusion:
Total endoscopic bypass surgery on the beating heart with the Da Vinci surgical system can be safely implemented in clinical use. The learning curve results in a constantly decreasing procedure time due to a more effective table team-console surgeon-robotic system interaction and a moderate conversion rate."
15.- Robotic mitral valve repair: a community hospital experience.
Authors: Jones BA, Krueger S, Howell D, Meinecke B, Dunn S., BryanLGH Heart Institute, Lincoln, Nebraska 68516, USA. In: Tex Heart Inst J. 2005;32(2):143-6.
"Robotically assisted cardiac surgery has been presented as less invasive than conventional surgery, with shortened hospital stays and faster return to daily activities. We evaluated our experience with the da Vinci robot to determine whether we could in fact demonstrate those findings. All mitral and tricuspid valve repairs were performed by the same surgeon. Cardiopulmonary bypass was performed with femoral cannulation, antegrade cardioplegia, and transthoracic aortic cross-clamping. Multiple valve repair techniques were used, including quadrant resection, cord replacement, Alfieri leaflet coaptation, and ring annuloplasty. Access was by 2 ports and a 5-cm right anterolateral thoracotomy. All annuloplasty rings were secured using surgical clips. From October 2003 through September 2004, 32 patients underwent robotically assisted mitral valve repair. The mean age of our population was 676 years (range, 43-82 years). Four patients also underwent the 1st tricuspid valve repair using the da Vinci robot in the United States. There were 3 conversions for irreparable valves, 1 stroke, and 2 deaths. The average procedure time, cardiopulmonary bypass time, and aortic cross-clamp time were all reduced, when the first 20 patients were compared with the last 12. Length-of-stay also improved. One patient required early mitral valve replacement for recurrent regurgitation. Two patients required late (> 3 month) mitral valve replacement for recurrent regurgitation. We have shown that a dedicated nonacademic institute can develop a robotic cardiac surgery program and perform mitral and tricuspid valve repairs successfully. There is a several-case learning curve, and patient selection is paramount."
16.- Totally robotic Roux-en-Y gastric bypass.
Authors: Mohr CJ, Nadzam GS, Curet MJ., Department of Surgery, Stanford School of Medicine, Stanford Hospital, Stanford, CA 94305, USA. In: Arch Surg. 2005 Aug;140(8):779-86.
"HYPOTHESIS:
We hypothesized that we could develop a safe and effective technique for performing a totally robotic laparoscopic Roux-en-Y gastric bypass procedure using the da Vinci surgical system. We anticipated that the learning curve for this totally robotic procedure could be shorter than the learning curve for standard laparoscopic bariatric surgery. DESIGN: Retrospective case comparison study.
SETTING:
Academic tertiary care center. PATIENTS: Consecutive samples of patients who met National Institutes of Health (NIH) criteria for morbid obesity and who completed the Stanford Bariatric Surgery Program evaluation process. INTERVENTION: A port placement and robot positioning scheme was developed so that the entire case could be performed robotically. The first 10 patients who underwent a totally robotic laparoscopic Roux-en-Y gastric bypass were compared with a retrospective sample of 10 patients who had undergone laparoscopic Roux-en-Y gastric bypass surgery.
MAIN OUTCOME MEASURES:
Patient age, gender, body mass index (BMI), numbers of NIH-defined comorbidities, operative time, length of stay, and complications.
RESULTS: No significant differences existed between the 2 patient series with regard to age, gender, or BMI. The median surgical times were significantly lower for the robotic procedures (169 vs 208 minutes; P = .03), as was the ratio of procedure time to BMI (3.8 vs 5.0 minutes per BMI for the laparoscopic cases; P = .04).
CONCLUSIONS:
This study details the first report, to our knowledge, of a totally robotic laparoscopic Roux-en-Y gastric bypass and demonstrates the feasibility, safety, and potential superiority of such a procedure. In addition, the learning curve may be significantly shorter with the robotic procedure. Further experience is needed to understand the long-term advantages and disadvantages of the totally robotic approach."
17.- Nerve-sparing Axillary Dissection Using the da Vinci Surgical System.
Authors: Lim SM, Kum CK, Lam FL., Centre for Breast Screening and Surgery, Centre for Robotic Surgery, Mount Elizabeth Medical Centre, S228510 , Singapore. In: World J Surg. 2005 Sep 15.
"This is an initial report of a new method of axillary dissection via a periareolar incision and an 8 mm incision in the axilla with the da Vinci Surgical System. The 10x magnification and three-dimensional image, together with the versatility and precision of the robotic telemanipulators, has enabled us to perform nerve-sparing axillary dissection in four patients with invasive ductal carcinoma of the breast undergoing segmental (conservative) excision and level II axillary dissection. The time for the robotic axillary dissection ranged from 30 to 105 minutes (average 70.5 minutes). The average number of lymph nodes retrieved was 13 (11, 11, 13, and 17, respectively). Postoperatively all four patients recovered well and were discharged the next day. The robotic system can enhance the surgeon's ability by providing a high-definition, magnified, three-dimensional view of the operative field, intuitively controlled articulating instruments, and elimination of tremors; and it has potential benefits for the patient."
18.- Use of fourth arm in da Vinci robot-assisted extraperitoneal laparoscopic prostatectomy: novel technique.
Authors: Esposito MP, Ilbeigi P, Ahmed M, Lanteri V., Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey 07601, USA. In: Urology. 2005 Sep;66(3):649-52.
"INTRODUCTION:
The da Vinci robot-assisted laparoscopic radical prostatectomy is a relatively new approach that is revolutionizing the surgical treatment of localized prostate cancer. Since its introduction, several improvements have been made in the robot design model, as well as in the surgical technique for prostatectomy. One of the more recent advances in this technology has been the introduction of a four-arm robot model. This modified system allows the operating surgeon to use the fourth arm for key steps and maneuvers during the operation, thereby decreasing the reliance on advanced assistant laparoscopic skills. In this report, we describe our modifications for the extraperitoneal approach for laparoscopic removal of the prostate using the four-arm da Vinci surgical system.
TECHNICAL CONSIDERATIONS:
During a 24-month period, 154 consecutive patients with clinically localized prostate cancer underwent extraperitoneal robot-assisted laparoscopic radical prostatectomy using the four-arm da Vinci robot system. All cases were videotaped and subsequently reviewed. Important factors regarding extraperitoneal access, patient positioning, port placement, and assistant role with or without the fourth arm were defined.
CONCLUSIONS: Our experience has revealed that the extraperitoneal approach allows for a more natural patient position during the operation and avoids intraperitoneal organ injury. The addition of the fourth arm to the da Vinci robot provides the operating surgeon with a great deal of independence, which facilitates all aspects of robot-assisted laparoscopic prostatectomy. It allows the operating surgeon to retract tissue during critical steps in this challenging operation and reduces the reliance on highly trained laparoscopic assistants."
19.- Use of robotics during laparoscopic gastric bypass for morbid obesity.
Authors: Artuso D, Wayne M, Grossi R., Department of Surgery, Cabrini Medical Center, New York, New York, USA. In: JSLS. 2005 Jul-Sep;9(3):266-8.
"To evaluate the theoretical increased precision offered by utilization of the robotic instrument, we attempted to determine whether incorporation of its use into traditional laparoscopic gastric bypass would duplicate or improve the success of the operation without increasing complications. The Roux-en-Y gastric bypass is the most commonly performed procedure for morbid obesity in the United States. We performed 120 gastric bypass procedures with traditional laparoscopy during a 30-month period. We began introducing the da Vinci Robotic Surgical System into our laparoscopic gastric bypass procedure and evaluated its effectiveness."
Sources:PubMed
Authors: Menon M, Shrivastava A, Tewari A., Vattikuti Urology Institute, The Josephine Ford Cancer Center, Henry Ford Health System, Detroit, Michigan 48202, USA. In: Urology. 2005 Nov;66(5 Suppl):101-4.
"By 2015, prostate cancer will become the most commonly diagnosed cancer in men. Radical prostatectomy reduces disease-specific mortality in patients with localized prostate cancer; however, the invasiveness of surgery and its resultant side effects cause many men to seek other treatments. In 2000, laparoscopic radical prostatectomy emerged as a minimally invasive alternative to open surgery; it has been refined recently by the addition of robotic technology. To examine the outcomes of robotic radical prostatectomy and compare them with those from open and conventional laparoscopic radical prostatectomy, we prospectively collected baseline demographic data on all patients undergoing surgery for prostate cancer over a 4-year period at our center. Urinary function and sexual function were evaluated using standardized criteria as well as a questionnaire preoperatively and at 1, 3, 6, 12, and 18 months after their procedure. Operative and postoperative outcomes were compared using values for open radical prostatectomy as the reference standard. A total of 100 men underwent open radical prostatectomy with conventional laparoscopic radical prostatectomy (n = 50) and robotic radical prostatectomy (n = 500). The odds ratios for operative times, blood loss, postoperative pain, complications, and median times to urinary continence and resumption of sexual activity all were lower for robotic than for open or laparoscopic radical prostatectomy. It appears safe to conclude that conventional laparoscopic radical prostatectomy is a reasonable alternative to open radical prostatectomy in the surgical treatment of patients with clinically localized prostate cancer. The incorporation of robotics may result in even better surgical outcomes than conventional laparoscopy. However, the surgical robot is expensive; few centers have access to the technology and even fewer have expertise in the technique. For robotic radical prostatectomy to become the standard of care for the treatment of localized prostate cancer will require economies of cost, dissemination of surgical expertise, and data from randomized trials."
2.- Robot-Assisted Endoscopic Surgery: A Four-Year Single-Center Experience.
Authors: Ruurda JP, Draaisma WA, van Hillegersberg R, Borel Rinkes IH, Gooszen HG, Janssen LW, Simmermacher RK, Broeders IA, Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. In: Dig Surg. 2005 Sep 28;22(5):313-320.
"Background: Robotic systems were introduced in the late 1990s with the objective to overcome the technical limitations of endoscopic surgery. In this prospective cohort study the potential safety, feasibility, pitfalls and challenges of robotic systems in gastrointestinal endoscopic surgery are assessed and our vision on future perspectives is presented. Methods:Between August 2000 and December 2004, 208 procedures were performed with support of the Intuitive Surgical da Vincitrade mark robotic system. We started with cholecystectomies (40) and Nissen fundoplications (41) to gain experience with robot-assisted surgery. In the following years more complex procedures were carried out, i.e. colorectal procedures (7), type III/IV paraesophageal hernia repair (32), redo Nissen fundoplications (9), Heller myotomies (24), esophageal resections (22), rectopexies (16) and aortobifemoral bypasses (3). Results:The median robotic set-up time was 13 min, and 7 min in the last 50 procedures. The median operating time for the total of procedures was 120 min (45-420) and the median blood loss was 30 ml (0-800). Fourteen procedures were converted to open surgery (6.7%). Equipment-related problems, such as start-up failures and positioning difficulties of the robotic arms, were encountered in 11 cases (5.3%). Postoperative complications were seen in 11 patients (11/176, 6.3%) after robot-assisted laparoscopic procedures. Pulmonary complications occurred in 11 patients, cardiac in 3, anastomic leakage in 3, chylous leakage in 3 and vocal cord paralysis in 3 after thoracoscopic esophagolymphadenectomy for esophageal cancer. One patient died 12 days after esophageal resection (0.5%).
Conclusion: During the implementation of this robotic system, we experienced an obvious learning curve, particularly with regard to the positioning of the robot cart and communication between the surgeon and operating team. After 4 years, we have experienced that the merits of the current generation of this technology probably is preserved to complex endoscopic procedures with delicate dissection and suturing. In the nearby future we will focus on the treatment of motility disorders and malignancies of the esophagus and stomach. The position of the robot in the endoscopic operating room will have to be clarified by the outcome of prospective research. Furthermore, priorities have to be acclaimed on technical sophistication and cost reduction of these systems."
Copyright © 2005 S. Karger AG, Basel.
3.- Laparoscopic morgagni hernia repair in children using robotic instruments.
Authors: Knight CG, Gidell KM, Lanning D, Lorincz A, Langenburg SE, Klein MD, the Maxine and Stuart Frankel Foundation Computer-Assisted Robot-Enhanced Surgery Program at Children's Hospital of Michigan, Detroit, Michigan.
In: Journal of Laparoendoscopic Advanced Surgical Techniques. 2005 Oct;15(5):482-6.
"Background: Robotic surgery enhances minimally invasive surgery through tremor filtration, motion scaling, indexed movement, articulation, and improved ergonomics. We report 2 cases of computer- assisted, robot-enhanced, laparoscopic repair of Morgagni hernia in a 23-month-old weighing 10.2 kg and a 5-year-old weighing 21.6 kg. Methods: Four 5 mm trocars were used to gain access to the abdomen. In the first case, standard laparoscopic instruments were used to dissect the liver from the rim of the defect and then reduce the hernia. In the second, robotic instruments were used for this dissection. In both cases, the robot- enhanced instruments were used to close the hernia defects with interrupted, nonabsorbable suture, using intracorporeal knot tying. Results: Both cases were completed laparoscopically without a patch. The robotic system took 9 minutes to set up and drape. The average operative time was 227 minutes. The older child tolerated oral intake the day of surgery and went home the following day. The younger child tolerated oral intake and went home on postoperative day 2.
Conclusion: Robot-assisted laparoscopic Morgagni hernia repair is feasible."
4.- Robotic-assisted thoracoscopic surgery (RATS) for benign and malignant esophageal tumors.
Authors: Bodner JC, Zitt M, Ott H, Wetscher GJ, Wykypiel H, Lucciarini P, Schmid T., Department of General and Transplant Surgery, Innsbruck Medical University, Innsbruck, Austria. In: Ann. Thorac. Surg. 2005 Oct;80(4):1202-6.
"BACKGROUND:
Robotic surgical systems are most effective for operations in areas that are small and difficult to reach. Ideal indications for this new technology have yet to be established. The esophagus possesses attributes that are interesting for general thoracic robotic surgeons.
METHODS:
Robotic-assisted thoracoscopic surgery (RATS) using the da Vinci system (Intuitive Surgical, Inc, Mountain View, CA) was performed in six patients with esophageal tumors. This comprised the dissection of the intrathoracic esophagus including lymph node dissection in four patients suffering from esophageal cancer and the extirpation of a benign lesion (one leiomyoma and one foregut cyst) in the remaining two patients. RESULTS: All procedures were completed successfully with the robot. The median overall operating time was 173 (160-190) minutes in the oncologic cases and 121 minutes in the benign cases, including the robotic act of 147 (135-160) minutes and 94 minutes, respectively. There were no intraoperative complications. One patient had to undergo a redo thoracoscopy because of a persistent lymph fistula. One cancer patient died after 12 months due to tumor progression and another patient had to be stented due to local tumor recurrence 19 months postoperatively.
CONCLUSIONS:
This first small series of various esophageal pathologies treated by robotic-assisted thoracoscopic surgery supports the impression that the esophagus is an ideal organ for a robotic approach. The potential of the da Vinci system, especially for oncologic indications, remains to be proven in future clinical trials."
5.- Technologic advances in Robotic Surgery.
Author: Waseem T., Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, 02115, USA. In: Journal of Coll. Physicians Surg Pak. 2005 Sep;15(9):559-61.
"Medical science has achieved enormous accomplishments during the past couple of decades. These advances encompass the list of techniques involving manipulations of DNA and stem cells to minimally invasive techniques. The recent advances in integration of computer sciences, biomechanics and electronic miniaturization have made it possible to make the surgical techniques less invasive and highly precise. Much progress has been made in integrating robotic technologies with surgical instrumentation, as evident by thousands of successful robot-assisted surgical procedures. Such advances will enable continued progress in surgical instrumentation and, ultimately, surgical care."
6.- Maintenance of Hemostasis in Transoral Robotic Surgery.
Authors: Hockstein NG, Weinstein GS, O'malley Jr BW., Department of Otorhinolaryngology - Head and Neck Surgery, The University of Pennsylvania, Philadelphia, Pa., USA. In: ORL J Otorhinolaryngol Relat Spec. 2005 Sep 5;67(4):220-224.
"Background:
The last decade has seen a tremendous growth in the field of robotic surgery with an increasing number of cardiac and urologic procedures performed each year. Several attributes of this technology may offer advantages to laryngeal and pharyngeal surgery in that it allows for exceptional visualization of the operative field, precise handling of soft tissues, and multiplanar transection of tissues. One potential limitation is the management of bleeding in transoral pharyngeal and laryngeal surgery, which is critical to prevent both intravascular volume loss and aspiration.
Objectives:
To demonstrate methods for management of bleeding in the surgical field during transoral robotic surgery (TORS). Methods: We developed a canine robotic surgery model for the evaluation of the ability to control bleeding in laryngeal and pharyngeal procedures using the daVinci((R)) surgical robot (Intuitive Surgical, Inc., Sunnyvale, Calif., USA). Both large- and small-vessel hemostasis was obtained with both robotically controlled monopolar and bipolar cautery and with robotically controlled small hemoclips. Additionally, manually controlled large hemoclips were applied by an assistant surgeon viewing on a video monitor for management of large arterial vessels. Suction was performed with both flexible suction catheters controlled by the robotic arms and with manually controlled conventional suction catheters. Data were collected with still and video photography.
Results:
The lingual artery as well as small arteries and veins were easily controlled and there were no difficulties with maintenance of hemostasis.
Conclusions:
Effective hemostasis with control of both large and small vessels can be obtained using both surgical hemoclips and electrocautery during TORS in a canine model." Copyright © 2005 S. Karger AG, Basel.
7.- Computer-assisted laparoscopic colon resection with the Da Vinci system: our first experiences.
Authors: Braumann C, Jacobi CA, Menenakos C, Borchert U, Mueller JM, Rueckert JC, Department of General, Visceral, Vascular and Thoracic Surgery, Medical Faculty Charite, Humboldt University, Berlin, Germany. In: Dis Colon Rectum. 2005 Sep;48(9):1820-7.
"PURPOSE:
Telerobotic surgery is a developing and promising modality that highly improves the laparoscopic dexterity. We have performed more than 100 laparoscopic and thoracoscopic procedures since December 2002 with the aid of the Da Vinci robotic system. This study was designed to assess the value of robots in colonic laparoscopic surgery. We present our first cases of robotic-assisted colectomies.
METHODS:
Two patients underwent a telerobotic-assisted sigmoidectomy for sigmadiverticulitis. One of these cases was complicated with a sigmoid-bladder fistula. Three other patients were submitted to a colon resection for cancer: sigmoidectomy (n = 2), and right colectomy (n = 1). A four-trocar technique was used for all operations. Tissue dissection of colonic adhesions, mobilization of the colon, management of the fistula, mesenteric dissection and division, and bowel resection were fully performed with the telerobotic system.
RESULTS:
Three operations were completed using the Da Vinci system without any problems in acceptable times. In two patients, the operation had to be converted to laparotomy because of severe adhesions and locally extended tumor growth. Postoperative courses of all patients were uneventful. Patients were discharged between postoperative Days 9 and 20, and were well six months later.
CONCLUSIONS:
Colonic telerobotic surgery can be performed safely. Benefits were seen during dissection of the rectum in the small pelvis. A major limitation is a lack of a large operation field especially if there is the need to dissect a colonic flexure in the upper abdomen. The enormous costs and the lack of appropriate instruments can be a major problem in the further expansion of the telerobotic surgery."
8.- Robotic coronary artery surgery: past, present and future.
Authors: Dogan S, Akbulut B, Aybek T, Mierdl S, Moritz AR, Wimmer-Greinecker G., Department of Cardiovascular and Thorax Surgery, Johann Wolfgang Goethe University, D-60590, Frankfurt, Germany. In: Anadolu Kardiyol Derg. 2005 Sep;5(3):210-5.
"Minimally invasive endoscopic procedures in cardiac surgery have only become possible since the introduction of telemanipulator systems. In this study we review robotic assisted telemanipulation systems and procedures on beating and arrested heart for total endoscopic revascularization. Robotic surgery is still under development. The most important factors limiting this new technique are high costs and the fact that only selected patients are able to be operated on. But studies on technology especially to improve anastomotic techniques are going on to produce an alternative for coronary revascularisation. We did not yet hit all goals but the future seems promising."
9.- Adhesiolysis is facilitated by robotic technology in reoperative cardiac surgery.
Authors: Martens TP, Morgan JA, Hefti MM, Brunacci DA, Cheema FH, Kesava SK, Xydas S, Dang NC, Vigilance DW, Kohmoto T, Gorenstein LA, Smith CR Jr, Argenziano M., Department of Surgery, Columbia University, College of Physicians and Surgeons, New York, New York, USA. In: Ann Thorac Surg. 2005 Sep;80(3):1103-5.
"Over a 2-year period, 5 patients who required reoperative chest surgery underwent robotic adhesiolysis with the da Vinci (Intuitive, Sunnyvale, CA) system. Resternotomy was performed under direct visualization for coronary revascularization (n = 2) or valve replacement (n = 1). A fourth patient required coronary revascularization after a previous axilloaxillary bypass. The final case involved the preparation of a substernal pathway for a gastric pull-up. In all cases adhesions were taken down without injury to the underlying structures. All grafts were preserved, and all patients recovered uneventfully. Robotic adhesiolysis is a versatile technique that allows careful lysis of adhesions and minimizes the risk of major complication during reoperative chest surgery."
10.- Comparison of laparoscopic pyeloplasty with and without robotic assistance.
Authors: Bernie JE, Venkatesh R, Brown J, Gardner TA, Sundaram CP., Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
In: JSLS. 2005 Jul-Sep;9(3):258-61.
"OBJECTIVES:
The benefits of laparoscopic surgery with robotic assistance (da Vinci Robotic Surgical System, Intuitive Surgical, Sunnyvale, CA) includes elimination of tremor, motion scaling, 3D laparoscopic vision, and instruments with 7 degrees of freedom. The benefit of robotic assistance could be most pronounced with reconstructive procedures, such as pyeloplasty. We aimed to compare laparoscopic pyeloplasty, with and without robotic assistance, during a surgeon's initial experience to determine whether robotic assistance has distinct advantages over the pure laparoscopic technique.
METHODS:
We retrospectively compared the first 7 laparoscopic pyeloplasties with the first 7 robotic pyeloplasties performed by a single surgeon. All patients were preoperatively evaluated with computed tomographic angiography with 3D reconstruction to image crossing vessels at the ureteropelvic junction. All patients were followed up by lasix renograms and routine clinic visits.
RESULTS:
Patients were similar with respect to mean age (34 in laparoscopic pyeloplasty group vs 32 in the robotic pyeloplasty group), operative time (5.2 hours vs 5.4 hours), estimated blood loss (40 mL vs 60 mL), and hospital stay (3 days vs 2.5 days). Two patients in the laparoscopic pyeloplasty group had small anastomotic leaks managed conservatively, and one patient in the robotic pyeloplasty group had a febrile urinary tract infection necessitating treatment with intravenous antibiotics. Another patient in the robotic pyeloplasty group was readmitted with hematuria that was treated conservatively without transfusion. No recurrences were detected in either group.
CONCLUSIONS:
Operating times and outcomes during the learning curve for laparoscopic pyeloplasty were similar to those for robotic pyeloplasty. Long-term data with greater experience is needed to make definitive conclusions about the superiority of either technique and to justify the expense of robotic pyeloplasty."
11.- Robot-assisted laparoscopic dismembered pyeloplasty.
Authors: Palese MA, Munver R, Phillips CK, Dinlenc C, Stifelman M, DelPizzo JJ., the Mount Sinai School of Medicine, Department of Urology, New York, New York, USA.
In: JSLS. 2005 Jul-Sep;9(3):252-7.
"OBJECTIVE:
Advanced laparoscopic skills limit the implementation of laparoscopic pyeloplasty to centers with extensive experience. The introduction of robotic technology into the field of minimally invasive surgery has facilitated complex surgical dissection and genitourinary reconstruction. We report our experience with robot-assisted laparoscopic pyeloplasty using the da Vinci Robotic Surgical System at 3 New York City medical centers.
METHODS:
A review of all robot-assisted laparoscopic Anderson-Hynes dismembered pyeloplasty cases in 38 patients (21 females, 17 males) between April 2001 and January 2004 was performed. All patients had symptoms or radiographic evidence of ureteropelvic junction obstruction. Robotic assistance with the da Vinci Robotic Surgical System was used after preparation of the ureteropelvic junction with a standard laparoscopic approach.
RESULTS:
The average patient age was 39.3 years (range, 15 to 69). The mean operative time and suturing time were 225.6+/-59.3 minutes and 64.2+/-14.6 minutes. The average estimated blood loss was minimal at 77.3+/-55.3 mL. The mean length of hospitalization was 69.6 hours (range, 28 to 310). The average use of intravenous morphine was 26.5 mg (range, 0 to 162). No intraoperative complications occurred, and open conversions were not necessary. A mean follow-up of 12.2 months revealed a success rate of 94.7% with 2/38 patients requiring further treatments.
CONCLUSIONS:
This combined multi-institutional series reveals that robot-assisted pyeloplasty with the da Vinci Surgical System is safe and reproducible. These intermediate results appear comparable to results with open and laparoscopic pyeloplasty repairs."
12.- Innovative techniques in coronary bypass surgery.
Author: Loisance D., Academie Nationale de Medecine. In: Bull Acad Natl Med. 2005 Feb;189(2):269-82; discussion 283.
"Coronary artery surgery is now being challenged by percutaneous techniques of coronary revascularization, coronary dilatation and arterial stenting. Improvements are being made in three directions, namely selection of optimal conduits, with the aim of improving long-term graft patency; minimizing complications of cardiopulmonary circulation (or avoiding it altogether), and improving access to coronary vessels. The ultimate goal is robotic keyhole surgery of the beating heart. This paper offers a critical analysis of these developments."
13.- Treatment of double vessel coronary artery disease by totally endoscopic bypass surgery and drug-eluting stent placement in one simultaneous hybrid session.
Authors: Bonatti J, Schachner T, Bonaros N, Jonetzko P, Ohlinger A, Lockinger A, Stalzer B, Eschertzhuber S, Friedrich G., Departments of Cardiac Surgery, Cardiac Anesthesiology, and Cardiology, Innsbruck Medical University, Innsbruck, Austria.
In: Heart Surg Forum. 2005;8(4):E284-6.
"Hybrid coronary artery revascularization is a combination of minimally invasive coronary artery surgery and catheter-based coronary intervention. Hybrid procedures enable adequate revascularization of patients with multivessel coronary artery disease without complete opening of the chest and with the advantage of the most durable option, a left internal mammary artery (LIMA) graft is placed to the left anterior descending (LAD) artery. The hybrid concept is gaining renewed interest because totally endoscopic LIMA to LAD placement has become feasible and because drug-eluting stents in non-LAD targets may be competitive even for arterial bypass grafts. Simultaneous hybrid procedures would be desirable. We report on a case in which robotic totally endoscopic LIMA to LAD grafting using the da Vinci(TM) telemanipulation system was combined with placement of a rapamycin coated stent to the right coronary artery in one single procedure."
14.- Total Endoscopic CABG* Using Robotics on Beating Heart.
* CABG = Coronary Artery Bypass Graft
Authors: Fleck T, Tschernko E, Hutschala D, Simon-Kupilik N, Bader T, Wolner E, Wisser W., Department of Cardiothoracic Surgery, Medical University Vienna, Austria.
In: Heart Surg Forum. 2005;8(4):E266-8.
"Background:
The implementation of a total endoscopic coronary surgery on the beating heart with the aid of the Da Vinci surgical system (Intuitive, Sunnyvale, CA) requires a stepwise learning process. After cadaveric training and clinical start of the program in November 2002, we gained experience with arrested heart procedures starting in May 2003. In November 2003, we moved to beating heart surgery.
Methods:
From November 2003 to January 2005, 14 patients with coronary artery disease (mean age of 62 +/- 5 years, female to male ratio 2:12) were operated with the intention to perform a beating heart TECAB (totally endoscopic coronary artery bypass grafting) procedure.
Results:
Total conversion rate was 35% (5/14), due to pleural adhesions in 2 patients, injury of the lung during port placement, inability to occlude the LAD with saddle loops, atherosclerotic diseased mammary artery in 1 patient each. Mean operating time was 298 +/- 110 minutes with a steady decline throughout the study period (first 5 patients: 342 +/- 61 minutes, patients 6 to 9: 337 +/- 87 minutes, last 4 patients: 290 +/- 53 minutes), resulting in a 60 minute shorter operating time. Mean ICU stay was 1.3 days and hospital stay lasted on average 8.4 +/- 2.8 days.
Conclusion:
Total endoscopic bypass surgery on the beating heart with the Da Vinci surgical system can be safely implemented in clinical use. The learning curve results in a constantly decreasing procedure time due to a more effective table team-console surgeon-robotic system interaction and a moderate conversion rate."
15.- Robotic mitral valve repair: a community hospital experience.
Authors: Jones BA, Krueger S, Howell D, Meinecke B, Dunn S., BryanLGH Heart Institute, Lincoln, Nebraska 68516, USA. In: Tex Heart Inst J. 2005;32(2):143-6.
"Robotically assisted cardiac surgery has been presented as less invasive than conventional surgery, with shortened hospital stays and faster return to daily activities. We evaluated our experience with the da Vinci robot to determine whether we could in fact demonstrate those findings. All mitral and tricuspid valve repairs were performed by the same surgeon. Cardiopulmonary bypass was performed with femoral cannulation, antegrade cardioplegia, and transthoracic aortic cross-clamping. Multiple valve repair techniques were used, including quadrant resection, cord replacement, Alfieri leaflet coaptation, and ring annuloplasty. Access was by 2 ports and a 5-cm right anterolateral thoracotomy. All annuloplasty rings were secured using surgical clips. From October 2003 through September 2004, 32 patients underwent robotically assisted mitral valve repair. The mean age of our population was 676 years (range, 43-82 years). Four patients also underwent the 1st tricuspid valve repair using the da Vinci robot in the United States. There were 3 conversions for irreparable valves, 1 stroke, and 2 deaths. The average procedure time, cardiopulmonary bypass time, and aortic cross-clamp time were all reduced, when the first 20 patients were compared with the last 12. Length-of-stay also improved. One patient required early mitral valve replacement for recurrent regurgitation. Two patients required late (> 3 month) mitral valve replacement for recurrent regurgitation. We have shown that a dedicated nonacademic institute can develop a robotic cardiac surgery program and perform mitral and tricuspid valve repairs successfully. There is a several-case learning curve, and patient selection is paramount."
16.- Totally robotic Roux-en-Y gastric bypass.
Authors: Mohr CJ, Nadzam GS, Curet MJ., Department of Surgery, Stanford School of Medicine, Stanford Hospital, Stanford, CA 94305, USA. In: Arch Surg. 2005 Aug;140(8):779-86.
"HYPOTHESIS:
We hypothesized that we could develop a safe and effective technique for performing a totally robotic laparoscopic Roux-en-Y gastric bypass procedure using the da Vinci surgical system. We anticipated that the learning curve for this totally robotic procedure could be shorter than the learning curve for standard laparoscopic bariatric surgery. DESIGN: Retrospective case comparison study.
SETTING:
Academic tertiary care center. PATIENTS: Consecutive samples of patients who met National Institutes of Health (NIH) criteria for morbid obesity and who completed the Stanford Bariatric Surgery Program evaluation process. INTERVENTION: A port placement and robot positioning scheme was developed so that the entire case could be performed robotically. The first 10 patients who underwent a totally robotic laparoscopic Roux-en-Y gastric bypass were compared with a retrospective sample of 10 patients who had undergone laparoscopic Roux-en-Y gastric bypass surgery.
MAIN OUTCOME MEASURES:
Patient age, gender, body mass index (BMI), numbers of NIH-defined comorbidities, operative time, length of stay, and complications.
RESULTS: No significant differences existed between the 2 patient series with regard to age, gender, or BMI. The median surgical times were significantly lower for the robotic procedures (169 vs 208 minutes; P = .03), as was the ratio of procedure time to BMI (3.8 vs 5.0 minutes per BMI for the laparoscopic cases; P = .04).
CONCLUSIONS:
This study details the first report, to our knowledge, of a totally robotic laparoscopic Roux-en-Y gastric bypass and demonstrates the feasibility, safety, and potential superiority of such a procedure. In addition, the learning curve may be significantly shorter with the robotic procedure. Further experience is needed to understand the long-term advantages and disadvantages of the totally robotic approach."
17.- Nerve-sparing Axillary Dissection Using the da Vinci Surgical System.
Authors: Lim SM, Kum CK, Lam FL., Centre for Breast Screening and Surgery, Centre for Robotic Surgery, Mount Elizabeth Medical Centre, S228510 , Singapore. In: World J Surg. 2005 Sep 15.
"This is an initial report of a new method of axillary dissection via a periareolar incision and an 8 mm incision in the axilla with the da Vinci Surgical System. The 10x magnification and three-dimensional image, together with the versatility and precision of the robotic telemanipulators, has enabled us to perform nerve-sparing axillary dissection in four patients with invasive ductal carcinoma of the breast undergoing segmental (conservative) excision and level II axillary dissection. The time for the robotic axillary dissection ranged from 30 to 105 minutes (average 70.5 minutes). The average number of lymph nodes retrieved was 13 (11, 11, 13, and 17, respectively). Postoperatively all four patients recovered well and were discharged the next day. The robotic system can enhance the surgeon's ability by providing a high-definition, magnified, three-dimensional view of the operative field, intuitively controlled articulating instruments, and elimination of tremors; and it has potential benefits for the patient."
18.- Use of fourth arm in da Vinci robot-assisted extraperitoneal laparoscopic prostatectomy: novel technique.
Authors: Esposito MP, Ilbeigi P, Ahmed M, Lanteri V., Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey 07601, USA. In: Urology. 2005 Sep;66(3):649-52.
"INTRODUCTION:
The da Vinci robot-assisted laparoscopic radical prostatectomy is a relatively new approach that is revolutionizing the surgical treatment of localized prostate cancer. Since its introduction, several improvements have been made in the robot design model, as well as in the surgical technique for prostatectomy. One of the more recent advances in this technology has been the introduction of a four-arm robot model. This modified system allows the operating surgeon to use the fourth arm for key steps and maneuvers during the operation, thereby decreasing the reliance on advanced assistant laparoscopic skills. In this report, we describe our modifications for the extraperitoneal approach for laparoscopic removal of the prostate using the four-arm da Vinci surgical system.
TECHNICAL CONSIDERATIONS:
During a 24-month period, 154 consecutive patients with clinically localized prostate cancer underwent extraperitoneal robot-assisted laparoscopic radical prostatectomy using the four-arm da Vinci robot system. All cases were videotaped and subsequently reviewed. Important factors regarding extraperitoneal access, patient positioning, port placement, and assistant role with or without the fourth arm were defined.
CONCLUSIONS: Our experience has revealed that the extraperitoneal approach allows for a more natural patient position during the operation and avoids intraperitoneal organ injury. The addition of the fourth arm to the da Vinci robot provides the operating surgeon with a great deal of independence, which facilitates all aspects of robot-assisted laparoscopic prostatectomy. It allows the operating surgeon to retract tissue during critical steps in this challenging operation and reduces the reliance on highly trained laparoscopic assistants."
19.- Use of robotics during laparoscopic gastric bypass for morbid obesity.
Authors: Artuso D, Wayne M, Grossi R., Department of Surgery, Cabrini Medical Center, New York, New York, USA. In: JSLS. 2005 Jul-Sep;9(3):266-8.
"To evaluate the theoretical increased precision offered by utilization of the robotic instrument, we attempted to determine whether incorporation of its use into traditional laparoscopic gastric bypass would duplicate or improve the success of the operation without increasing complications. The Roux-en-Y gastric bypass is the most commonly performed procedure for morbid obesity in the United States. We performed 120 gastric bypass procedures with traditional laparoscopy during a 30-month period. We began introducing the da Vinci Robotic Surgical System into our laparoscopic gastric bypass procedure and evaluated its effectiveness."
Sources:PubMed
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