robotic surgery in urogynaecology - amazon s3...robotic surgery in urogynaecology marcus carey ....
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Robotic Surgery in
Urogynaecology
Marcus Carey
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Sacral Colpopexy
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425,000 POP procedures on 300,000 women 2010 in US Reuters Thompson
Traditional Repair
Mesk Kits
Sacral Colpopexy
71%
13%
16%
‘At least 100,000 POP repairs used mesh and about 75,000 were
transvaginal procedures’ FDA news release 2010
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da Vinci Si System
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Port placement
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Robot docking
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Robot Console
‘Surgeons performing minimally invasive sacrocolpopexy experienced
less neck, shoulder, and back discomfort when surgery was
performed robotically’ Tarr 2015
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‘Ultra-light’ and ‘smart’ meshes
TiMESH 16 or 35g/m² ; has a 30nm bonded layer of titanium
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Y Shaped Sacral Colpopexy Meshes
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Sacral Colpopexy with S-POP
10
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Robotic Sacral Colpopexy
for Uterine Prolapse
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Types of Sacral Colpopexy
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Total Hysterectomy and Sacral Colpopexy
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Subtotal Hysterectomy and Sacral Colpopexy
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Sacral Hysteropexy
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Appropriate preclinical robotic courses and skills laboratory
30 sacral colpopexy cases per anum
5 cases under preceptor supervision
Audit of cases
Registry
Epworth Credentialing for RSC
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0
10
20
30
40
50
60
Laparoscopic Robotic
n=48 (46%)
SC
or
SH
Cas
es 2
014
Laparoscopic and Robotic SC or SH for 2014 (n=105)
n=57 (54%)
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0
10
20
30
40
50
60
70
80
1 2 3 4 5 6 7 8 9 10
Con
sole
Tim
e (m
ins)
Case number
Robot console time for sacral colpopexy
Median 58 min (range 53-72 min)
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Robotic Removal of TVT
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Removal of TVT
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Robotic Surgery in Urogynaecology:
What does the future hold?
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The Future: what is needed
A robot for all surgical disciplines
Equivalent cost to straight stick
High usage
Small
Adaptable to any theatre
Modular
Quick set up
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The Future: what is needed
Removal of the barrier of console
Robotic surgery ideally replicates straight stick
Port sizes 5mm
Port positioning identical
Access to all four quadrants
Operation identical
Haptic feedback
Manual manipulation
Intelligent use of instruments
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da Vinci Systemsda Vinci Systems
ConsoleConsole--basedbased
Key patents expiring 2016 and 2017Key patents expiring 2016 and 2017
System is large and cannot easily and costSystem is large and cannot easily and cost--effectively effectively
perform many procedure typesperform many procedure types
System adds System adds ~$~$2,500 per procedure2,500 per procedure
Installed base: ~3,500 globallyInstalled base: ~3,500 globally
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da Vinci Xi and Single Site
Xi
Single Site 25 mm
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MedrobotixMedrobotix Flex®Flex®
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SOFAR SOFAR –– TelapTelap AlfAlf--XX
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AlphaAlpha--x x -- 2014 2014
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Titan
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Verb
Johnson &Johnson
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DLR DLR -- MIROMIRO
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Cambridge Medical Robotics