1. Robotic Surgery Status Quo + Development Martin Kaloš Czech Society for Robotic Surgery 3rd of December 2012 Almaty

2. Czech Society of Robotic Surgery

3. da Vinci ® Si HD

5. S Model Updates Si Model Updates 3D HD Vision (720p) Multi-quadrant access Interactive video displays Enhanced HD Vision (1080i) Dual Console option Upgradable architecture 3D Vision EndoWrist Instrumentation Intuitive ® Motion Core Technology 876337 Rev A 4/12 1999 2006 2009

6. Current Development da Vinci ® Si™ Firefly™ Fluorescence Imaging Skills ® Simulator™ Advanced Instrumentation* Single-Site™ *EndoWrist Stapler is pending 510(k) clearance 876337 Rev A 4/12

7. Single Site Surgery: Open Surgery Single Incision Laparoscopy Laparoscopic Surgery PN 875265 Rev A 11/11 Single-Site™ Instrumentation has CE Mark and is FDA-cleared for cholecystectomy.

8. da Vinci TM Single Site SCOPE

9. da Vinci TM Single Site

11. New Instruments

12. Fluorescence Excitation laser light from illuminator Return signal from fluorescing ICG

13. Identify vessels during IMA / IMV dissection Assess perfusion of large bowel prior to transection Assess perfusion of rectal stump prior to transection Fluorescence

14. ROBOTIC SURGERY IN THE WORLD

15. Installations worldwide: 2 341 – 389 v Europe – 1 707 USA – 245 Rest of the World

16. Installments – World Data 2 132 2 341

17. Procedures – World Data 278 000 360 000

18. Abdominal Surgery Thoracic Surgery General surgery Vascular Surgery Gynecology Lung Surgery UROLOGY Cardiosurgery ENT ThyreidoctomyTongue Base CA

19. Indications – World Data

20. Indications – Czech data

21. Adoption curve: Q2 2009

22. Adoption curve: : Q2 2010

23. Adoption curve: : Q2 2011

24. Urology Most Frequent 1.daVinci Radical Prostatectomy 2.daVinci Partial Nephrectomy

25. daVinci Prostatectomy Results

26. Oncological effects of Robotic Surgery Positive margins Robotic x Laparo x Open

27. 1.dVH : da Vinci Hysterectomy 2.dVSC : da Vinci Sacrocolpopexis 3.dVM : da Vinci Myomektomie Gynecology Most Frequent

28. daVinci Hysterectomy Results

29. General Surgery Most Frequent 1.dV LAR : da Vinci Low Anterior Resection 2.dVTh : da Vinci Thyreoidectomy

30. robotic Versus Laparoscopic Low Anterior Resection of Rectal Cancer: Short-Term Outcome of a Prospective Comparative Study* from Dr. Baik. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea Annals of Surgical Oncology. 2009. *Baik, et al. robotic Versus Laparoscopic Low Anterior Resection of Rectal Cancer: Short-Term Outcome of a Prospective Comparative Stud. Ann Surg Oncol DOI 10.1245/s10434-009-0435-3. Da Vinci Low Anterior Resection (Baik)

31. Other 1.ENT – Transoral 2.Cardiac 3.Lung

34. Thank you !