Robotic surgery summary- September 2007

In September I performed 19 operations including 13 dvPs.
One simple prostatectomy was combined with a left inguinal hernia repair. This was the first time I had performed this combination, although I have performed close to 50 hernia repairs at the time of dvP.
The new thing to report is an improvement in continence that I have seen after adding a few sets of sutures to re-construct the pelvic anatomy after removal of the prostate and before the connection is made. I had been doing part of this since I read a paper from Rocco describing his procedure of repairing anatomy behind the connection of the bladder to the urethra. This addition has helped more men achieve quicker urinary control in my experience.
Dr. Tewari has added an additional technique to reconnect the anatomy in front of the connection site.
I have added some of my own modification and have seen a nice short term improvement in urinary control. The best part is that the cancer control has not been compromised in these patients and my positive margin rate has declined.

Robotic surgery summary- July/August 2007

For the summer months I had the pleasure of inviting my new associate, Dr. Brent Yanke, into our practice.
We spent July together and he is now on his own performing most of his robotic surgery. He was well trained at Thomas Jefferson and had participated in over 100 robotic operations.
In July and August I performed 30 robotic surgeries, including 22 dvPs, a pyeloplasty, 3 nephrectomies, 1 nephro-ureterectomy, a lymph node dissection for testicular cancer, a simple prostatectomy, and a nerve-sparing cysto-prostatetcomy and neobladder for bladder cancer.
The most important accomplishment was the bladder cancer operation. This was the first time that I have made a new bladder with the robot. Our patient had only a small incision in the lower abdomen to remove the specimen and went home in 3 days.

Robotic surgery summary- May/June 2007

I have been neglectful during the summer with keeping up on my blog.
I will hope to catch up and keep my monthly postings of how things are going in my practice.
In May and June I performed 32 dvPs, a nephrectomy, a simple prostatectomy, and a partial nephrectomy.
The nephrectomy was the live telecast for intuitive surgical at the AUA.
The cystectomy was notable because it was the first time that my team and I did a closed urinary diversion. Traditionally, we have been performing the second half of the operation with a small incision. This time we made an ileal conduit with the daVinci robot as well.
The simple prostatectomy was my 10th, giving me one of the worlds largest experience.

Robotic Whipple performed in the midwest

UIC News Release

A surgical team led by Dr. Pier Cristoforo Giulianotti, chief of the division of minimally invasive, general and robotic surgery at the University of Illinois Medical Center at Chicago, has performed the first fully robotic Whipple procedure in the Midwest.
The operation, also called a pancreaticoduodenectomy, is the most common surgical treatment for cancerous or benign tumors of the head of the pancreas. The procedure involves removal of the gallbladder, bile duct, part of the stomach and duodenum, and the head of the pancreas.
“The Whipple operation is one of the most demanding surgical procedures of the abdomen,” said Giulianotti, the Lloyd M. Nyhus Professor of Surgery at UIC. “It generally requires a very long abdominal incision to expose the pancreas and other organs, significant manipulation of the bowel, post-operative pain, and a greater chance of complications.”
In 2003, Giulianotti performed the first robotic Whipple procedure in the world while practicing in Italy. Since then, he has performed more than 40 such operations.

I had the opportunity to meet Dr. Giulianotti, a very impressive person to speak to about robotic surgery. I look forward to reading about his upcoming accomplishments.

Intuitive surgical purchases position tracking software

Luna Innovations Signs Multi-Year Development and Supply Agreement with Intuitive Surgical: Financial News – Yahoo! Finance
Luna Innovations Signs Multi-Year Development and Supply Agreement with Intuitive Surgical
Thursday June 14, 9:21 am ET
Luna’s Sensing Technology to be Integrated into Intuitive’s Surgical Products

ROANOKE, Va.–(BUSINESS WIRE)–Luna Innovations Incorporated (NASDAQ:LUNA – News) announced today that it has entered into an IP licensing, development, and supply agreement with Intuitive Surgical, Inc. (NASDAQ: ISRG – News), the global technology leader in robotic-assisted minimally invasive surgery (MIS). Under the terms of the multi-year agreement, Luna will develop and supply its fiber optic-based shape sensing and position tracking system for integration into Intuitive Surgical’s products, which includes the da Vinci� Surgical System.

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The state of telesurgery and technology in medicine

Telemedicine: Proven results and promise for the future – With recent advances in telecommunications and surgical robotics, telemedicine is poised to increase the efficiency of urologic practices and bring access to specialists and surgeons to even the most rural communities. – Modern Medicine

The future of telesurgery and telementoring. As telecommunications and robotic technology continue to advance, telesurgery is likely to take on a more prominent role in urologic practice. Citing an emerging body of literature supporting the idea of a correlation between a surgeon’s level of experience and clinical outcomes, many advocate the centralization of surgical care to centers of excellence. Telesurgery has the potential to play a significant role in this process, allowing for such centralization while obviating the need for patients to travel great distances to obtain such levels of care.
Much like the introduction of the telephone and email to the practice of medicine, the introduction of more sophisticated technology has been met with skepticism and concerns over quality of care. However, just as the telephone has become pivotal in the rapid and effective transmission of medical information, advanced telemedicine is likely to become part of routine urologic practice.

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Robotic Future through the eyes of a pioneer

The Surgical Revolution In Minimal Access Surgery- The Robotic Connection

Dr. Satava, Professor of Surgery, University of Washington discussed that robots are 12-15 times faster and function with greater precision than humans. Robots can work around the clock without taking coffee breaks, he said. Information is a basis for surgery in the new age. “Holomer” is a total body scan to guide intra-operative navigation during surgery. A surgeon could then use this to perform a virtual operation on a patient prior to the real operation. A robot is an information machine, rather than a machine, he said. Thinking as such will permit greater integration into our healthcare system. The surgeon is then an information manager, and can integrate all aspects of the care to include preoperative planning, surgical approaches, etc. The robot can give 1mm accuracy using a virtual robot to practice an operation ahead of time on a virtual patient.

Robotic Surgery Review in Contemporary Urology

The robotic revolution: Advancing laparoscopy and urology further into the future – The introduction of robotic technology and its increasing acceptance in urology have helped surgeons overcome many technical barriers to complex laparoscopic procedures. While preliminary safety and efficacy results for a number of procedures are promising, long-term data are needed to establish its role relative to more traditional approaches. – Modern Medicine

Laparoscopy has the potential for decreasing surgical morbidity, with smaller incisions, decreased blood loss, less postoperative pain with decreased intake of narcotics, shorter hospital stays, and faster recovery compared with open surgical procedures. While these benefits have been realized for urologic procedures such as nephrectomy, adrenalectomy, and pyeloplasty, technical obstacles have hindered its adoption in more advanced procedures such as prostatectomy.

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