Robotics In SurgeryRobotics In Surgery

Presented byPresented by

Gordon TravisGordon Travis

ObjectivesObjectives

1. Describe trend Robotic system, the da Vinci S HD Robotic system, the da Vinci S HD

Surgical SystemSurgical System

2. Describe hardware/software3. Assess nursing implications4. Examine related legal/ethical

issues5. Advantages/Disadvantages from

nursing perspective

Trend DescriptionTrend Description

Robotic-assisted Minimally Robotic-assisted Minimally Invasive SurgeryInvasive Surgery

Shorter recovery timesShorter recovery times Fewer complicationsFewer complications Reduced hospitalization costs Reduced hospitalization costs Reduced trauma to the patient Reduced trauma to the patient

(Intuitive (Intuitive

Surgical 2005)(2)Surgical 2005)(2)

Trend DescriptionTrend Description

Robotic-assisted Robotic-assisted Minimally Minimally Invasive Surgery Invasive Surgery has become the has become the “GOLD”“GOLD” standard-of-care standard-of-care for particular for particular surgical surgical proceduresprocedures

ExamplesExamples ProstatectomyProstatectomy HysterectomyHysterectomy Mitral valve Mitral valve

repair repair (Intuitive Surgical 2005)(Intuitive Surgical 2005)

(3)(3)

Robotic SurgeryRobotic Surgery

Robotic HardwareRobotic Hardware

Console front viewConsole front view

(Intuitive Surgical (Intuitive Surgical 2005)2005)

Robotic HardwareRobotic Hardware

Surgical cart Surgical cart with with instrumentsinstruments

(Intuitive Surgical (Intuitive Surgical

2005)2005)

Robotic HardwareRobotic Hardware

Surgeon sits at Surgeon sits at console away console away from patient from patient

((Intuitive Intuitive Surgical 2005)Surgical 2005)

Robotic HardwareRobotic Hardware

VisionVision Magnification X Magnification X

1010 HD 3-D visionHD 3-D vision

(Intuitive Surgical (Intuitive Surgical

2005)2005)

Robotic Robotic Hardware/SoftwareHardware/Software

Robotic hardware Robotic hardware driven by Intuitive driven by Intuitive proprietary proprietary softwaresoftware

Software not based Software not based on any “well-on any “well-known” operating known” operating systemsystem

Software first Software first developed in 1994developed in 1994

Software version 11 Software version 11 in use at presentin use at present

(Ken Swartzman, Intuitive (Ken Swartzman, Intuitive engineer, personal engineer, personal communication, September communication, September 22, 2008) 22, 2008)

Robotic Robotic Hardware/SoftwareHardware/Software

Robotic movements, Robotic movements, driven by Intuitive driven by Intuitive proprietary softwareproprietary software SimultaneousSimultaneous FluidFluid AmbidextrousAmbidextrous

((Intuitive Surgical Intuitive Surgical

2005)2005)

Usability of SoftwareUsability of Software

The software interface has received The software interface has received national awards for its user friendly national awards for its user friendly designdesign

40 hours of practice with interface 40 hours of practice with interface must be completed prior to use on must be completed prior to use on patientspatients

Robotic interface software was trialed Robotic interface software was trialed for 10 years prior to FDA approval for 10 years prior to FDA approval

(Erik Weiker, Intuitive training engineer, personal communication, September 26, 2008)(Erik Weiker, Intuitive training engineer, personal communication, September 26, 2008)

Information systems Information systems used in da Vinci Robotic used in da Vinci Robotic

SurgerySurgery Dedicated system/Special Dedicated system/Special

purposepurpose

Used by Surgeons to assist Used by Surgeons to assist in surgery in surgery

Stand alone system that Stand alone system that runs on Intuitive proprietary runs on Intuitive proprietary softwaresoftware

American National Standards American National Standards Institute (ANSI)Institute (ANSI)

Would recommend for other Would recommend for other starting this trendstarting this trend

(Erik Weiker, Intuitive training engineer, (Erik Weiker, Intuitive training engineer, personal communication, October 8, 2008)personal communication, October 8, 2008)

Advantages of Robotic Advantages of Robotic SurgerySurgery

Areas that were once Areas that were once difficult to work in difficult to work in such as under the such as under the pubic symphysis for pubic symphysis for the bringing together the bringing together of the bladder and of the bladder and urethra (anastomosis) urethra (anastomosis) now become freely now become freely accessible to the accessible to the operating surgeon. operating surgeon.

Increased Increased visualization, due to visualization, due to 10X magnification10X magnification

Hand movements of Hand movements of the surgeon are the surgeon are transmitted transmitted precisely to the precisely to the working instruments working instruments

(Dean (Dean 2006)2006)

Disadvantages of Disadvantages of Robotic SurgeryRobotic Surgery

Possible Risks and ComplicationsPossible Risks and Complications Pressure on nerves due to positioningPressure on nerves due to positioning Blood lossBlood loss Injury to other structuresInjury to other structures

Bowel, Bladder, RectumBowel, Bladder, Rectum Prolonged procedureProlonged procedure

Robotic surgery can take 1 ½ to 2 times Robotic surgery can take 1 ½ to 2 times longer then open procedure longer then open procedure

Conversion to open procedureConversion to open procedure(Intuitive Surgical 2005)(2)(Intuitive Surgical 2005)(2)

Ethical issues related Ethical issues related to Robotic Surgeryto Robotic Surgery

The surgeon is in The surgeon is in complete control complete control of the robots of the robots movementsmovements

The da Vinci The da Vinci system cannot be system cannot be programmed, nor programmed, nor can it make can it make decisionsdecisions

(Intuitive Surgical 2005)(Intuitive Surgical 2005)

Informatics competencies Informatics competencies required for nurses in Robotic required for nurses in Robotic

SurgerySurgery

Nurse requirements prior to doing Robotic Nurse requirements prior to doing Robotic surgerysurgery

Must complete two four hour training Must complete two four hour training programs given by Intuitive representativesprograms given by Intuitive representatives

Required to watch Robotic surgery DVD and Required to watch Robotic surgery DVD and take competency examtake competency exam

Required to complete minimum 5 case Required to complete minimum 5 case observation of Robotic casesobservation of Robotic cases

Responsibilities of the Responsibilities of the informatics nurse in Robotic informatics nurse in Robotic

surgerysurgery

Set-up and preparation of RobotSet-up and preparation of Robot Hardware and software check with Hardware and software check with

pre-case checklistpre-case checklistSterile drapingSterile draping

Correct positioning of robot Correct positioning of robot during surgeryduring surgeryAlways with attention to patient Always with attention to patient

safety (robot in correct position as safety (robot in correct position as to not injury patient)to not injury patient)

SummarySummary

Cutting edge technologyCutting edge technology Hardware/software proprietary to Hardware/software proprietary to

IntuitiveIntuitive ““Gold” standard surgery for certain Gold” standard surgery for certain

casescases Requires proper training and in-service Requires proper training and in-service

for both nurses and surgeonsfor both nurses and surgeons Robot only works under surgeon controlRobot only works under surgeon control Developing technology, limits of its use Developing technology, limits of its use

are still unknownare still unknown

ReferencesReferences

Intuitive Surgical, Inc. (2005). Intuitive Surgical, Inc. (2005). The da Vinci® Surgical SystemThe da Vinci® Surgical System. Retrieved . Retrieved September 18, 2008, from September 18, 2008, from http://www.intuitivesurgical.com/products/davinci_surgicalsystem/index.asphttp://www.intuitivesurgical.com/products/davinci_surgicalsystem/index.aspxx

Intuitive Surgical, Inc. (2005)(2). Intuitive Surgical, Inc. (2005)(2). The da Vinci® Surgical SystemThe da Vinci® Surgical System. Retrieved . Retrieved September 19, 2008, from September 19, 2008, from http://www.intuitivesurgical.com/products/robotic/index.aspxhttp://www.intuitivesurgical.com/products/robotic/index.aspx

Intuitive Surgical, Inc. (2005)(3). Intuitive Surgical, Inc. (2005)(3). The da Vinci® Surgical SystemThe da Vinci® Surgical System. Retrieved . Retrieved October 2, 2008 2008, from October 2, 2008 2008, from http://www.intuitivesurgical.com/products/fdaclearance/index.aspxhttp://www.intuitivesurgical.com/products/fdaclearance/index.aspx

Dean, Md, William. (2006). Dean, Md, William. (2006). Dr. Dean explains the robotic advantageDr. Dean explains the robotic advantage. Retrieved . Retrieved September 26, 2008, from Intuitive Surgical: September 26, 2008, from Intuitive Surgical: http://http://roboticadvantage.comroboticadvantage.com//