Health & Fitness
Health and Fitness
Health and Fitness
Fri, January 23, 2009
Thu, January 22, 2009 OR-Live, Inc.: REMINDER: Surgical Tutorial on da Vinci(R) Anterior Pelvic Exenteration
PHILADELPHIA, PA--(Marketwire - January 22, 2009) - OR-Live.com, the University of Pennsylvania Health System and Intuitive Surgical, Inc. will present a case review on a da Vinci (robotic) Anterior Pelvic Exenteration on January 22, 2009 from 4:00-5:30 PM (ET). [ Dr. Thomas Randall ], Associate Professor of Clinical Obstetrics and Gynecology and Chief of Gynecologic Oncology at Pennsylvania Hospital and Dr. [ Daniel Eun ], Assistant Professor of Urology in Surgery at the Hospital of the University of Pennsylvania and at Pennsylvania Hospital, will moderate the event to explain critical portions of the surgery and to answer e-mail questions from viewers.
The anterior pelvic exenteration will include a radical hysterectomy, bilateral para-aortic lymphadenectomy, bilateral pelvic lymphadenectomy and a radical cystectomy. Drs. Randall and Eun will elaborate on strategies for surgically managing this type of complex gynecologic surgical case while leveraging the potential advantages offered by the [ da Vinci® Surgical System ].
According to Dr. Randall, "da Vinci provides a means to offer a minimally invasive option to patients that need to undergo extensive procedures such as an anterior pelvic exenteration. While utilization of the da Vinci System in this type of case can take longer, the potential benefits to patients -- including minimal blood loss, reduced risk of transfusion, reduced length of stay, significantly less pain and quicker return to normal activities -- can outweigh the added operative time."[ ]
The da Vinci® Surgical System is designed to overcome the limitations of both traditional open surgery and conventional laparoscopy -- and enhance the surgeon's ability to perform more complex gynecologic procedures using a minimally invasive approach.[ ]The da Vinci's high-definition 3D vision system, fully wristed EndoWrist® instrumentation, Intuitive® motion and ergonomic design provide additional precision, vision and control, allowing gynecologists to perform more complex procedures minimally invasively with improved reproducibility across their patient population.
In an extremely complex case, such as an anterior pelvic exenteration, open surgery is the most common approach. This is due in part to the learning curve associated with conventional laparoscopy and its associated complications(1) as well as the complex nature of this type of procedure (often requiring in excess of eight operative hours to complete) and the surgeon's ability to physically withstand the duration of the case without compromising clinical technique.
Anterior exenteration can be done for invasive cervical cancer, as in this case, or for invasive bladder cancer. Anterior exenteration is typically performed for invasive carcinoma of the bladder. "Traditionally, this procedure is performed through a large open incision; it takes a long time and is associated with significant blood loss and fluid absorption," explains Dr. Eun.
"In experienced hands," Dr. Eun continued, "the procedure can be done robotically with minimal additional time, significantly less blood loss and a much smaller incision -- as we have demonstrated in this case. The superior 3D optics coupled with precise, wristed, robotic instruments enable the surgeon to dissect, cut and tie in very tight areas that would otherwise be impossible to get to using tiny incisions. This translates into a better, safer and less painful surgical experience for our patients, while allowing us to maintain improved cancer control."
"Not many institutions in the world are offering this surgery utilizing this approach," Dr. Eun said, "but a growing body of urologic literature has shown robotic cystectomy and anterior exenteration to be an excellent, safe approach. (2)(3) Going back to this case, even with prior whole pelvis radiation, robotics is a safe and feasible surgical option. Given that the patient is a Jehovah's Witness (and therefore unable to accept a blood transfusion), I would say that robotics was her best and maybe only option."
"What's really significant with our case," adds Dr. Randall, "is that this was an anterior exenteration performed for a central pelvic recurrence of cervical cancer, years after the patient was treated with chemotherapy and radiation therapy. We are not aware of many centers where the da Vinci System has been used for this clinical purpose. We feel that the challenge posed by performing surgery in a patient who has been treated with radiation highlights the strengths of the robotic system."
The da Vinci Surgical System is used regularly in common gynecologic procedures, such as a simple hysterectomy and more specialized procedures such as myomectomy or tubal anastomosis. This technology ultimately allows surgeons to offer a more precise, complete and reproducible surgery to their patients regardless of anatomical and clinical differences.
To see a program preview, visit [ http://www.or-live.com/vbc/daVinci ] and go to the "Chose Category" drop-down menu and select "Gynecologic Surgery."
Editor's Note: Dr. Eun is a compensated consultant for Intuitive Surgical, Inc.
About OR-Live
OR-Live is the world's leading surgical broadcasting company, providing communication solutions to hospitals, device manufacturers, and pharmaceutical companies that demonstrate, communicate, and educate the latest clinical and technological advances in surgery to surgeons, physicians, allied health professionals, and consumers. The OR-Live broadcasting network provides an intimate look at over 600 live and on-demand surgeries to a global audience, streaming over 23,000 hours of programming each month. The OR-Live network can be found on-line at [ www.OR-Live.com ].
About Intuitive Surgical, Inc.
Intuitive Surgical, Inc. (
About the da Vinci® Surgical System
The da Vinci Surgical System is a sophisticated robotic platform designed to enable complex surgery using a minimally invasive approach. The da Vinci System consists of an ergonomic surgeon's console, a patient-side cart with four interactive robotic arms, a high-performance vision system and proprietary EndoWrist® instruments. Powered by state-of-the-art robotic technology, the da Vinci System is designed to scale, filter and seamlessly translate the surgeon's hand movements into more precise movements of the EndoWrist instruments. The net result is an intuitive interface with breakthrough surgical capabilities. By providing surgeons with superior visualization, enhanced dexterity, greater precision and ergonomic comfort, the da Vinci Surgical System makes it possible for more surgeons to perform minimally invasive procedures involving complex dissection or reconstruction. This ultimately raises the standard of care for complex surgeries, translating into numerous potential patient benefits, including less pain, a shorter recovery and quicker return to normal daily activities.
The content presented above is for general information only and is not intended to substitute for formal medical training or certification. An independent surgeon, who is not an Intuitive Surgical employee, provides procedure descriptions. Intuitive Surgical trains only on the use of its products and is not responsible for surgical credentialing or for training in surgical procedure or technique. As a result, Intuitive is not responsible for procedural content. While clinical studies support the use of the da Vinci Surgical System as an effective tool for minimally invasive surgery, individual results may vary. Intuitive®, da Vinci®, InSite® and EndoWrist® are registered trademarks of Intuitive Surgical, Inc.
(1) Garry, R. Laparoscopic Surgery. Best Pract Res Clin Obstet Gynaecol. 2006 Feb;20(1):89-104. Epub 2005 Dec 20.
(2) Pruthi, R., Stefanik H., Hubbard J., Wallen E. Robotic Anterior Exenteration for bladder Cancer in the Female: Outcomes and Comparisons to Their Male Couterparts, Journal of Laparoendocsopic and Advanced Surgical Techniques, Nov 2, 2008 [Ebub ahead of print]
(3) Yuh, B., Padalino, J., Butt, Z., Tan, W., Wilding, G., Kim, H., Mohler, J., Guru, K. Impact of Tumor Volume on Surgical and Pathologic Outcomes After Robotic-Assisted Radical Cystectomy, British Journal of Urology International, Pruthi, R., Stefanik H., Hubbard J., 2008 Sep;102(7):840-3. Epub 2008 May 15
Boggess JF. Robotic surgery in gynecologic oncology: evolution of a new surgical paradigm. J Robotic Surg (2007) 1:31-37
Payne TN, Dauterive FR. A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice. J Minim Invasive Gynecol. 2008 May-Jun;15(3):286-91.
Pitter MC, Anderson P, Blissett A, Pemberton N. Robotic-assisted
