Robotics In Objectives General Surgery
Robotics inGeneral SurgeryObjectives Brief History of Robotics in General Surgery Robotic General Surgery Procedures Advantages/Disadvantages of Robotic General Surgery Role of Robotic Surgery in Bariatric SurgeryJennifer S. Schwartz, MDAssistant Professor of SurgeryDepartment of SurgeryDivision of General & Gastrointestinal SurgeryThe Ohio State University Wexner Medical CenterHistory Multiple previous robotic devices createdincluding Puma 560 (1985) for neurosurgicalbiopsies, AESOP (1993) for robotic assistedendoscopic surgeries, and ROBODOC for hipreplacement surgery Role of Robotic Surgery in Foregut Surgery Role of Robotic Surgery in Ventral Hernia Surgery1999 In 2000, the da Vinci Surgical System receivedFDA approval for minimally invasive surgery. Ohio State was one of the first robotic centerworldwide (2000) First reports of robotic Heller myotomy (2001),Pancreatic resection (2001), and Four armsurgery (2004).ROBODOCLanfranco AR1, Castellanos AE, Desai JP, Meyers WC. Robotic Surgery: ACurrent Perspective. Ann Surg. 2004 Jan;239(1):14-21.1
Si System2017Xi Systemda Vinci Robot Initially developed for Cardiac Surgery use Ultimately expanded to other specialtieswith specific traction in Urology andAuthor: CmgleeGynecology(CC BY-SA 3.0) Over 3,100 systems worldwide(U.S. Air Force photo byKemberly Groue/Released)Author: IntuitiveSurgical (CC BY-SA 3.0) 2017 Intuitive Surgical, Inc. 2017 Intuitive Surgical, Inc.2
AdvantagesNational Trends in Hernia Repair by SurgicalApproach1 3 dimensional viewing80% Wrist articulation60% 2017 Intuitive Surgical, Inc.DAVINCILAP40% Increased ability to perform fine dissectionOPEN19%20%PN 1027535-US Rev B08/166%1%2%201320140%2008200920102011201220152016 Minimally invasive approach to previousopen procedures Better ergonomics for surgeons1. Analysis of 2008-2015 Premier database. Primary procedure.2. 2016 da Vinci market penetration projection based on Goldman Sachs Financial Model 02/06/16 2017 Intuitive Surgical, Inc.Disadvantages Cost- Capital investment- Instruments – 10 use Longer Surgery Duration Learning Curve Patient advantage?Robotic GeneralSurgery ProceduresFDA Approved procedures:- Bariatric procedures (sleeve, gastric bypass)- Foregut Surgery: Nissen fundoplication,Heller Myotomy- Gastrectomy (benign, malignant)- Hernia repair- Cholecystectomy- Pancreatectomy (benign, malignant)- Colectomy- Rectal resection3
The Obesity Epidemic- 78.6 million (34.9%) Americans areconsidered obese- More than doubled from 13.3% in 1960BariatricSurgery- Obesity-related conditions affect nearlyevery organ systemand are some of the leading causes ofpreventable deaths- www.cdc.govEstimate of Bariatric SurgeryNumbers, %BPD/DS0.9%1%1%0.4%0.6%Revisions 6%6%6%11.5%13.6%Other2.3%2.7%0.1%3.2%3.2%Balloons 700casesV-Bloc18 casesASMBS total bariatric procedures numbers from 2011, 2012, 2013, 2014 and 2015 arebased on the best estimation from available data (BOLD, ASC/MBSAQIP, NationalInpatient Sample data and outpatient estimations).asmbs.orgRobotic Bariatric SurgeryRoux-en-Y Gastric BypassSleeve GastrectomyImages from https://en.wikipedia.org/wiki/Gastric bypass surgery4
Robotic Bariatric Surgery Advantages: Studies have shown at least equal outcomesto laparoscopic surgery May decrease gastrojejunostomy leak rate,stricture rate, length of stayForegut Surgery Disadvantages: Procedure length of time Cost? More studies needed to determine if there is atrue patient benefitRobotic Foregut SurgeryRobotic Foregut Surgery Hiatal hernia repair with Nissen (360⁰) or Toupet(270⁰) fundoplication Paraesophageal hernia 00181 5.htm5
Robotic Foregut Surgery Heller myotomy for achalasiaRobotic Foregut Surgery Advantages of Robotic Foregut Surgery: 3D Visualization Magnification of Surgical Field Very useful for redo operations wheremore precise movement are needed Very useful for Heller myotomy forachalasia where precise division ofmuscle fibers is critical to preventesophageal perforationAuthor: Farnoosh Farrokhi, Michael F. Vaezi. - CC BY 2.0Advantages: MinimallyInvasive ApproachVentral HerniaRepair Minimally invasive hernia repairs are associatedwith shorter length of stay, fewer wound-relatedcomplications, improved postoperative painprofiles Limitations of Laparoscopic ventral hernia repair: intraperitoneal mesh placement difficult to re-approximate the midline high cost of mesh and fixation devices Bulging/Eventration of the mesh with largerdefects Technique not always equal to open6
Robotic Pre-Peritoneal VentralHernia Repair – videoAdvantages: MinimallyInvasive Approach Robotic ventral hernia repair may bridge the gapbetween open and laparoscopic repairs Robotic ventral hernia repair allows for largerdefects to be repaired minimally invasivelyincluding myofascial releases: Transversus abdominus release (TAR) External oblique release Bilateral postrectus sheath incision withretrorectus hernia repairGonzalez, A., Escobar, E., Romero,R. et al. Surg Endosc (2016).Advantages: MinimallyInvasive Approach Retrorectus herniarepair: brings fascialedges to the midlineto create a morefunctional abdominalwallAdvantages: MinimallyInvasive Approach Recent study compared length of stay ofrobotic retrorectus ventral hernia repair(r-RVHR) to open retrorectus ventralhernia repair (o-RVHR) Evaluating value added to patients andthe health system by assessing onecomponent, length of stayCarbonell AM, et. al. Ann Surg. 2017 Mar 277
Advantages: MinimallyInvasive ApproachRobotic Retrorectus VentralHernia Repair – VideoAdvantages: MinimallyInvasive ApproachCurrent Status of Robotics in Hernia Utilizing data from the Americas HerniaSociety Quality Collaborative (AHSQC),evaluated the largest collection of r-RVHR todate. Length of Stay (statistically significant): r-RVHR – 2 days o-RVHR – 3 days Despite the increased cost of roboticplatform, cost savings was noted fromdecreased length of stay, mesh choice. Growing experience and increasing numberof studies, however still very little dataavailable Literature primarily single surgeon experience Largest study: Multicenter retrospective study 368 patients underwent robotic primary or incisional herniarepair by 5 surgeons Reproducibly safe Short term outcomes comparable to laparoscopic results Scrutiny over cost vs. benefitGonzalez, A., Escobar, E., Romero, R. et al.Surg Endosc (2016).Carbonell AM, et. al. Ann Surg. 2017 Mar 278
Robotics in General SurgeryReferencesAR1,1. LanfrancoCastellanos AE, Desai JP, Meyers WC. RoboticSurgery: A Current Perspective. Ann Surg. 2004 Jan;239(1):14-21.2. asmbs.org3. https://medlineplus.gov/ency/presentations/100181 5.htm4. https://www.sages.org/publications/5. Carbonell AM1, Warren JA, Prabhu AS, Ballecer CD, Janczyk RJ,Herrera J, Huang LC, Phillips S, Rosen MJ, Poulose BK. ReducingLength of Stay Using a Robotic-assisted Approach for RetromuscularVentral Hernia Repair: A Comparative Analysis From the AmericasHernia Society Quality Collaborative. Ann Surg. 2017 Mar 27. doi:10.10976. Gonzalez, A., Escobar, E., Romero, R. et al. Robotic-assisted ventralhernia repair: a multicenter evaluation of clinical outcomes. SurgEndosc (2016). doi:10.1007/s00464-016-511.8-0Robotics inGeneral SurgeryObjectives Role of Robotic Surgery in Inguinal HerniaSurgeryMichael Paul Meara, MD, MBA, FACSAssistant Professor of SurgeryCenter for Minimally Invasive SurgeryDivision of General & Gastrointestinal SurgeryThe Ohio State University Wexner Medical Center Role of Robotic Surgery in Biliary Surgery Role of Robotic Surgery in SurgicalResident Education9
Inguinal Hernia Repairs Wide Variety of Repairs Open Tissue RepairsInguinal HerniaRepair Open Mesh Repairs Laparoscopic Mesh Repairs Totally Extraperitoneal Trans Abdominal Repairs Robotic Mesh RepairsAdvantages: MIS Inguinal Approaches Both open and minimally invasive inguinal herniarepairs continue to be largely outpatientprocedures. Minimally invasive inguinal hernia repairs areassociated with: Smaller incisions Fewer wound-related complications and meshinfections Improved postoperative pain profiles Fewer complications related to chronic nerveissues Bowel evaluation in emergent casesLimitations: MIS InguinalApproaches Limitations of Laparoscopic Inguinal herniarepair: Steep learning curve High cost of fixation devices Difficulty managing larger defects Technique not always equal to open Previous Repairs may necessitatedifferent approaches10
Advantages: Robotic MinimallyInvasive ApproachRobotic BilateralInguinal Hernia Repair Robotic inguinal hernia repair avoid costlyfixation devices Robotic inguinal hernia repair mayprovide improved ergonomics to thesurgeon during placement.LaparoscopicCholecystectomy First performed in September of 1985.Biliary Surgery Popularized as Standard of Care Gave birth to the Laparoscopic Revolutionof Surgery Continues to be one of the most commonprocedures performed in the United States11
Minimally Invasive Advancesin Biliary Surgery Fluorescence imaging popularize forimproved anatomic identification andprevention of complications Continues to push the boundaries of MISsurgeries including complex cancerresections and reconstructionsRobotic Cholecystectomywith Fluorescence Imaging Provides a stable platform for resident andfellow trainingRobotics in Residentand FellowshipTraining 2017 Intuitive Surgical, Inc.12
Robotic TrainingRequirementsNational Trends in Hernia Repair by SurgicalApproach180% Online surgical system course work Simulation modules with passing metrics60%40%DAVINCILAP Beside assisting casesOPEN Primary cases as the Console Surgeon Simulation modules with passing metrics19%20%PN 1027535-US Rev 1. Analysis of 2008-2015 Premier database. Primary procedure.2. 2016 da Vinci market penetration projection based on Goldman Sachs Financial Model02/06/16 2017 Intuitive Surgical, Inc.Robotics in General Surgery13
Jennifer S. Schwartz, MD Assistant Professor of Surgery Department of Surgery Division of General & Gastrointestinal Surgery The Ohio State University Wexner Medical Center Robotics in General Surgery Objectives Brief History of Robotics in General Surgery Robotic General Surgery
Jennifer S. Schwartz, MD Assistant Professor of Surgery Department of Surgery Division of General & Gastrointestinal Surgery The Ohio State University Wexner Medical Center Robotics in General Surgery Objectives Brief History of Robotics in General Surgery Robotic General Surgery
The Future of Robotics 269 22.1 Space Robotics 273 22.2 Surgical Robotics 274 22.3 Self-Reconfigurable Robotics 276 22.4 Humanoid Robotics 277 22.5 Social Robotics and Human-Robot Interaction 278 22.6 Service, Assistive and Rehabilitation Robotics 280 22.7 Educational Robotics 283
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General Surgery Rotation Goals and Objectives PGY 1 Year Surgical Oncology – Blue Service Thoracic Surgery . Manage general surgery ward/postoperative patients Manage ER/Trauma patients Assess surgical consult patients Prioritize patient acuity Manage ward emergencies (arrhythmia, hypoxia, myocardial infarct, shock, etc.) .File Size: 522KBPage Count: 97Learn morePlastic Surgery Residency Program Rotation Goals and .Goals of the Rotation. There are two primary focal points of the rotations on the General Surgical Services. The first focal point is experience in preoperative, operative and postoperative management of patients who present to the General Surgical service. The second focal point is the primary component of General Surgery.www.utmb.eduRecommended to you b
The VEX Robotics Game Design Committee, comprised of members from the Robotics Education & Competition Foundation, Robomatter, DWAB Technolog y , and VEX Robotics. VEX Robotics Competition Turning Point: A Primer VEX Robotics Competition Turning Point is played on a 12 ft x 12 ft foam-mat, surrounded by a sheet-metal and polycarbonate perimeter.
The VEX Robotics Game Design Committee, comprised of members from the Robotics Education & Competition Foundation, Robomatter, DWAB Technologi es, and VEX Robotics. VEX Robotics Competition In the Zone: A Primer VEX Robotics Competition In the Zone is played on a 12 ft x 12 ft foam-mat, surrounded by a sheet-metal and lexan perimeter.
Vascular Surgery 33 R3 Overview Overall Goals 35 Rotation Learning Objectives 35 Breast 35 Colon & Rectal Surgery 35 General Surgery – Kaiser 37 Trauma Acute Care Surgery & Critical Care 38 R4 Overview Overall Goals 42 Rotation Learning Objectives 42 Cardiothoracic Surgery 42 Endocrine 4
from Artificial Intelligence Eliezer Yudkowsky, Anna Salamon Machine Intelligence Research Institute Carl Shulman, Steven Kaas, Tom McCabe MIRI Visiting Fellows Rolf Nelson Abstract In 1965, I. J. Good proposed that machines would one day be smart enough to make themselves smarter. Having made themselves smarter, they would spot still further opportunities for improvement, quickly leaving .
