Rhode Island joins robotic community

Robotic surgery on prostate cancer arrives in R.I. | Rhode Island news | Rhode Island news | projo.com | The Providence Journal

This is robot-assisted surgery — and some say it’s the future of surgery. Miriam Hospital is the first hospital in the state to acquire the robot, called the da Vinci Surgical System, which makes it easier to operate in the tighter corners of the human body.

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AUA 2007 Recap for Intuitive Surgical

This past week, Intuitive Surgical participated in the 2007 AUA (American Urological Association) Meeting held in Anaheim, California. As noted, this years AUA Meeting was clearly the most prominent in the history of Intuitive Surgical.

We had a very strong showing with increased booth & program activities, higher visibility amongst leading academic & community urologists, 5 “Live” broadcasted da Vinci Procedures (including a formal AUA Satellite Live 3-D Broadcast) and a record attendance on the exhibit floor.

It was very clear that da Vinci Urology Procedures, such as dVP, are becoming routinely adopted across a larger audience of both urologists and hospitals. The ISI theme this year was focused on da Vinci Prostatectomy – “The Fastest Growing Treatment for Prostate Cancer”, the launch of da Vinci Nephrectomy & the promotion of da Vinci S with HD (High Definition) This theme was promoted through the showing of “Live” Telesurgery, Continuous HD narrated & unedited 3-D video, New Clinical Data, New Robotic Techniques, & New Upcoming Instrumentation.
Key Highlights:
3 – AUA Sanctioned Robotic Courses focused on da Vinci Urological Procedures. Over 200 urologists paid and attended these courses
2 – AUA Sanctioned “Lunch with the Experts” Programs covering: Techniques, Maximizing Outcomes, & Getting Started with da Vinci in Your Practice
78 – Moderated Abstracts: (This was an increase of 279% over 2006. Abstracts in 2006 were 28). 2007 AUA Abstracts covered: dVP, da Vinci Pyeloplasty, da Vinci Cystectomy, da Vinci Nephrectomy, & others
AUA Plenary Presentation: Dr. Pat Casale (Children’s Hospital of Philadelphia) gave an outstanding State-of-the ART Lecture presentation to an audience of more than 1,000 attendees titled, “The Application of Robotics in Pediatric Urology”. Dr. Casale showed the da Vinci System as a valuable tool for the Pediatric Urologist. Procedure talking points and video clips covered da Vinci Pyeloplasty, Ureteral Reimplantation, Appendicovesicostomy, & several other reconstructive urological procedures.
This year the AUA & ISI held a Hands-On Course, where da Vinci Pediatric Urology procedures were featured utilizing 3 surgical stations (2 with da Vinci Systems & and 1 with computerized simulation from Mimic) . 40 urologists paid and attended this course. This course was taught by Dr. Craig Peters (University of Virginia), Dr. Pat Casale (Children’s Hospital of Philadelphia), & Dr. Thomas Lendvay (Seattle Children’s Hospital)
ISI Booth Presentations: Booth Presentations covered da Vinci Prostatectomy, da Vinci Nephrectomy & Partial Nephrectomy w/ 3-D HD Video, da Vinci Pyeloplasty, & da Vinci Cystectomy.
5 exceptional “Live” Telesurgery Broadcasts (4 -dVP and 1-dVN) drew packed crowds of hundreds to the ISI Booth & accompanied Satellite Program.
Dr. Ash Tewari (Cornell University) performed a beautiful bilateral Nerve-sparing dVP in a swift 60 minutes (console time) to an audience of 150+ urologists. His anastomosis time was under 5 minutes using da Vinci. This surgery was moderated by Dr. Peter Carroll (University of California San Francisco), Dr. Dave Albala (Duke University), Dr. Robert Meyers (Mayo Clinic Rochester) & Dr. Dan Barocas (Cornell University).
Dr. Ingolf Tuerk (Lahey Clinic) performed an impressive extra-peritoneal dVP (First ever broadcasted dVP technique to AUA). The moderator was Dr. John Libertino (Chair of Urology, Lahey Clinic).
Dr. Domenico Savatta (Newark Beth Israel Medical Center) performed a very efficient da Vinci Nephrectomy to a large audience utilizing the da Vinci S System. (First ever broadcasted dVN to AUA). This surgery was moderated by Dr. Jay Yew (Sharp Memorial Healthcare – San Diego)
Dr. Randy Fagin (Westlake Hospital) performed a 4-arm Bilateral Nerve-sparing dVP in a quick 60 minutes (console time) to an audience of 150+ urologists. This surgery was moderated by Dr. Naveen Kella (Georgia Urology)
Dr. Timothy Wilson (City of Hope National Medical Center) performed a 4-arm Bilateral Nerve-Sparing & Endopelvic Fascia Sparing dVP to a large group of curious urologists. City of Hope has now performed over 2,300 dVP procedures. This surgery was moderated by Dr. David Josephson (City of Hope).
Source: email end of May

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Haptics update from John Hopkins

Johns Hopkins Magazine

Robotics, along with stem-cell research, will drive much of the innovation in medicine in the coming decades. Mohsen Mahvash Mohammady, an assistant research professor at the Engineering Research Center for Computer-Integrated Surgical Systems and Technology (ERC CISST) at Johns Hopkins, and a fixture in the haptics lab, says that collaboration is the key to the lab’s success. “Without a doctor’s input, I would be able to develop a nicely controlled robot, but I wouldn’t be able to incorporate what surgeons need,” says Mohammady, who is working on developing haptic scissors, as well as finding the best ways to retrofit the daVinci with the most useful types of force feedback.

Update from John Hopkins engineering school. Haptics for robotic surgery is being investigated in the form of tactile feedback. I think the need for haptics for experienced robotic surgeries is less than most people would think, but it can help. I think for beginners it will help a great deal. Other forms of feedback were discussed as well, the most promising one being visual feedback in the form of color changes as tension increased.
It is likely a few years away, but on the horizon.

Robotic Surgery Growth: Cardiac surgery started in the Czech Republic

First heart surgery performed by robots in CzechRep – Prague Daily Monitor
First heart surgery performed by robots in CzechRep
By Prague Daily Monitor/ČTK / Published 16 March 2007

beige_quote.bmpPrague, March 15 (CTK) – The first robotic heart operation was performed in the Czech Republic in Prague’s Na Homolce hospital this week, hospital spokeswoman Jitka Kalouskova told CTK today.
Six patients suffering from heart failure underwent the unique operation using robotic systems.
The hospital, which holds an international quality accreditation, ranks among pioneers in robotic operations in the Czech Republic. It opened a robotic operating theatre in October 2005.

daVinci Surgery: PK dissecting forceps

One of my favorite instruments for robotic surgery is the PK dissector.

As all daVinci instruments, It is made by intuitive surgical. It was developed in combination with gyrus medical.
It is a bipolar instrument that can be used instead of the maryland bipolar or precise bipolar.
The main advantages include:
Less charring and sticking to tissue.
A wider opening angle to grab tissue easier.
Sound feedback to tell you when the tissue should be coagulated enough.
The main disadvantage is the blunt tip which makes it less useful as a dissector than the maryland bipolar (but more useful than the blunter precise).

For surgeons interested in obtaining this you also need a gyrus PK generator to provide the input.

1st daVinci S robot in Morris county, New Jersey

Straus Newspapers – Advertiser News / News: Robotic surgery brings tomorrow’s surgical techniques to Saint Clare’s today

DENVILLE — As part of its ongoing commitment to provide the latest in medical care and technology to its patients in the communities in which they live, Saint Clare’s has announced that it performed its first robot-assisted, minimally
invasive surgery on March 1,  following successful deployment of the da Vinci S Surgical System at Saint Clare’s Hospital, in Denville.

This unique system, from Intuitive Surgical, the world’s leading innovator of robotic surgery technology, couples advanced surgical instrumentation and 3-D visualization with ergonomic comfort while bringing the future of surgery to our community.

St. Clares is a very nice community hospital in Denville, NJ. It has the first daVinci S robot in Morris county, where I live. One of my friends is doing robotic surgery there now and I am awaiting privileges to bring some of my robotic cases to Denville.
My partner currently performs most of my ESWL (shock wave surgery) there for me currently.

Robotic Surgery Update- February 2007 with a focus on robotic times

This is the monthly report on my robotic surgery practice in West Orange, NJ.
It was a relatively slow month. I performed 11 dvPs, and no other robotic surgery.
The main reason was a prostate conference/ vacation that I took. I went away for 7 days and did not schedule any surgery the week I was going away, so I was restricted to 2 1/2 weeks of surgery.
I had 1 important development. I developed a new technique for large median lobes that I am in the process of submitting to a journal. I think this technique will be the preferred way to approach large median lobes.
I also presented an important poster at the Prostate Cancer Symposium (a multidisciplinary international prostate cancer meeting), which I will write about later.

Click on picture to enlarge

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Robotic Tips for Surgeons and Teams #1

This is a new topic to help explain some of the workings of the robotic systems.
This tip on black balance, white balance, and scope alignment comes form Sue Belluardo, my local intuitive surgical rep.

Remember 3 things:
– Black Balance is Camera Head Specific
– White Balance is Scope Specific
– Scope Alignment is Scope Angle Specific

Black Balance is not scope specific:  Black Balance with either scope
will be fine. I suggest doing your Black Balance without a Scope Prior to
draping the Camera; cover the Optics of Camera Head with the palm of your
hand completely (or press and hold the Camera Optics toward your stomach)
and press both the “ABC Button” on both the Left and Right CCU. (The Red
LED’s will stop blinking after about 20 Blinks; Black Balance is complete.
You will not have to Black Balance again unless you loose power to the CCU’s or Vision Tower.)

White Balance should be done each time you choose a different scope
(each scope will transfer light differently through the scope at different
brightness levels).

Scope Alignment
– White Balance Scope
– Put the appropriate end of the Scope Alignment Tool on the appropriate
– Select the Scope Angle
– Focus on the Crosshairs
– Select Align Scope Button
– Bring the Crosshairs together by using the Arrow Buttons
– When the Crosshairs are aligned; Press and Hold until you hear the 3 happy chimes…..(On a Standard daVinci the button is labeled “Test Image” on the daVinci-S it’s the the “Align Scope” button).
– Scope Alignment is Complete for the Selected Scope. Repeat the process
for the other Scope or Scope Angles.

The shortcut to remember is that black balance only needs to be done once, white balance twice (the 30 up and down are the same scope), and alignment 3 times if you plan on using the 30 up.
My team does all of these things prior to the patient coming into the room.
One time this was useful to know is when we dropped a scope (0 degree). It only took a white balance and 1 alignment of the new 0 scope.

Robotic reliability

I often get asked about the reliability of the daVinci robot and can it break down. I also received a comment from a reader about a bad experience with her husbands robotic surgery.

In my 299 robotic operations, we have had several problems.
The daVinci robots are complicated mechanical devices. They can break down. Robots can break down in different ways. They can have hardware failures, such as broken arms. We had this happen to our 4th arm on our standard daVinci once and performed the operation with only 3 arms.

They can have software failures and the robot is made to stop working and will not allow you to move any instruments. This happened twice. Once it was for a robotic nephrectomy which I converted to a laparoscopic nephrectomy without trouble.
The other one was 3/4 of the way through a davinci S dvP and I brought in our standard robot, which was not in use, and finished the operation with our 2nd robot.
2 other operations were affected by robotic failures that were discovered before the operation was started and 1 case was cancelled and 1 was delayed until our robot was fixed.

Robots can break down occasionally, and contingency plans should be in place, including conversion to laparoscopy or open surgery.

I am not familiar with any injuries caused by robotic failure or malfunction.

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