1. Minimally Invasive Surgery
OR Consortium
Paige klem

2. Definitions: Endoscopy: Lapar-: Arthr-: Hyster-:
Examination of hollow body organs or cavities to permit visual inspection
Lapar-:
Abdomen, loin
Laparoscopy: Endoscopic examination of the peritoneal body cavity
Arthr-:
Joint
Arthroscopy: To look within the joint
Hyster-:
Uterus
Hysteroscopy: Examination of the cervix and interior of the uterus

3. MIS: Minimally Invasive Surgery Broad Term
Surgery utilizing minimal surgical incision to reduce trauma to the body
Laparoscopic Procedures
3-5 puncture sites
Robotics
1 puncture site
Single site hernia risk

4. Equipment needed for MIS Procedures:
Camera/Light Source
Includes:
Tower
Camera control unit
Printer
Insufflator
CO2 Tanks
Trocars
Scopes

5. Insufflation with Gas Pneumoperitoneum Use of Fluid Media
Most Common: CO2
Keep pressures less than 15 mmHg; 8-15 is the suggested range
Postoperative pain from insufflation
Gas embolism risk
Use of Fluid Media

6. Subcutaneous Emphysema
Crepitus
Rare Complication
At risk after laparoscopic procedures with Gas Insufflation
Factors:
Using 4 or more trocars
Using trocars that are not tight fitting
Increased operating time
Increased volume of gas

7. Insufflation with Fluid
Fluid Media:
Ex. Hysteroscopy Insufflation
You want low viscosity or isotonic solution
Glycine historically used for urological procedures
Managing measuring of lost fluid
Automated fluid management systems

8. Positioning Trendelenburg Issues with Positioning?
Aides in moving the surgical area into view
Issues with Positioning?

9. The transition from laparoscopic to robotic surgery?
Common question:
Is the robot doing the surgery or is the surgeon doing the surgery?
Why transition?
Ability to do more complex surgeries
3-D vision
Angulation of the robotic arms
Frequent concerns:
Cost
Surgical and Equipment Costs
Recovery and hospital inpatient costs

10. What is Robotics Surgery?
Surgeon sits at surgeon console
3D HD vision
Multiple wristed tools
Filters human tremor
Small openings to conduct complex procedures
1,300 Safety checks per second
Less blood loss, faster recovery, less pain for patients

11. The 3 components of the da Vinci System

12. DA VINCI SURGICAL SYSTEMS CORE TECHNOLOGIES
A natural extension of the surgeon’s eyes and hands into the patient
The da Vinci Xi Surgical System is built on the core technologies of da Vinci Surgery, which has always served as a natural extension of the surgeons eyes and hands while providing:
Magnified 3D HD Vision
Highly-magnified 3D HD ensures the surgeon can see the surgical site with true depth perception and clear vision.
EndoWrist Instrumentation
Wristed instruments bend and rotate far beyond the abilities of the human hand. Tremor filtration and Intuitive® motion technologies allow the surgeon to operate with steady, natural motion.
Enhanced Ergonomics
Whether it is the first or last case of the day, the ergonomically-adjustable surgeon console makes performing surgery more comfortable.
MAGNIFIED 3D HD VISION
ENDOWRIST INSTRUMENTATION WITH INTUITIVE® MOTION
ENHANCED ERGONOMICS
PN Rev A 3/14

13. Wristed Instruments: More freedom than the human hand
Wristed Instruments: More freedom than the human hand. 5mm, 8mm, 12mm sizes.

14. How does the surgeon know/decide where to put ports and how many?

15. Example: Sigmoid colon

16. Example: hysterectomy

17. Advanced technology- single site

18. How does a surgeon become a da Vinci surgeon?
Adequate volume
Appropriate background
On-line modules, hands-on practice, complete commitment
8 hour “basic training” with pig/cadaver lab
Credentialing** hospital determines credentialing requirements and volume requirements for re-appointment
First 3-4 cases proctored
Advanced course/ continuing education
More difficult cases

19. Robotics in Alaska 6 Robots in AK (2 Xi, 4 Si)
Prov AK (2), ARH (2), Mat Su (1), Fairbanks (1)
>1200 da Vinci cases completed in 2017 with 35% growth expected for 2018
Fastest areas of growth/adoption:
General surgery: inguinal and ventral hernia
Thoracic: minimally invasive pulmonary lobectomy
Colorectal: intracorporeal anastomosis for colectomy

21. Questions?