The Value Of Da Vinci Surgery
29
The da Vinci Advantage: The Value of daVinci Surgery Randy Fagin, MD Senior Medical Advisor – Training | Intuitive Surgical Director of Robotic Surgery | The Hospital at Westlake Medical Center
description
daVinci surgery has replaced open and laparoscopic surgery for many operations due to the many advantages of using the robotic interface
Transcript of The Value Of Da Vinci Surgery
The da Vinci Advantage:The Value of daVinci Surgery
Randy Fagin, MDSenior Medical Advisor – Training | Intuitive SurgicalDirector of Robotic Surgery | The Hospital at Westlake Medical Center
The da Vinci Advantage:Why Listen to Me– In 2000 I trained in LRP with Bertrand Guionneau
and Guy Valancien in Paris, France– I performed over 300 LRP• Operative Time 2 - 2½ hours• Blood transfusion rate less than 1%• Return to erections 75%
– I assumed what I was doing was “best in class”– I felt threatened by da Vinci surgery• I believed “you don’t need a fancy multimillion dollar
robot to do a good operation”
The da Vinci Advantage:Why Listen to Me:– In 2000 I trained in LRP with Bertrand Guionneau
and Guy Valancien in Paris, France– I performed over 300 LRP• Operative Time 2 - 2½ hours• Blood transfusion rate less than 1%• Return to erections 75%
– I assumed what I was doing was “best in class”– I felt threatened by da Vinci surgery• I believed “you don’t need a fancy multimillion dollar
robot to do a good operation”
The da Vinci Advantage:Why Listen to Me:
“you don’t need a fancy multimillion dollar robot to do a good operation”
TRUE
However, you do need one if you want to do a better operation
The da Vinci Advantage:Why Listen to Me
“you don’t need a fancy multimillion dollar robot to do a good operation”
TRUE
However, you do need one if you want to do a better operation
The da Vinci Advantage:Why Listen to Me:– On August 22nd, 2003 I sat down for the 1st time at
a da Vinci console– I spent the next 12 months on a mission to get my
hospital to purchase a daVinci system
The da Vinci Advantage:Why Listen to Me– Monday October 1, 2004 I performed my first dVP– Monday April 25, 2005 I performed dVP #200 – Wednesday April 27, 2005 I performed 2dVP’s– Thursday April 28, 2005 I performed 1 LRP
• some insurance would not cover da Vinci surgery back then
– Friday April 28, 2005 I decided never to perform another LRP again
As of today I have performed ≈2,000 dVP’s my patients have come from
over 30 of the United States and 12 countries
The da Vinci Advantage:Why Listen to Me– Monday October 1, 2004 I performed my first dVP– Monday April 25, 2005 I performed dVP #200 – Wednesday April 27, 2005 I performed 2dVP’s– Thursday April 28, 2005 I performed 1 LRP
• some insurance would not cover da Vinci surgery back then
– Friday April 28, 2005 I decided never to perform another LRP again
As of today I have performed ≈2,000 dVP’s my patients have come from
over 30 of the United States and 12 countries
The da Vinci Advantage:Why Listen to Me– Monday October 1, 2004 I performed my first dVP– Monday April 25, 2005 I performed dVP #200 – Wednesday April 27, 2005 I performed 2dVP’s– Thursday April 28, 2005 I performed 1 LRP
• some insurance would not cover da Vinci surgery back then
– Friday April 28, 2005 I decided never to perform another LRP again
As of today I have performed ≈2,000 dVP’s my patients have come from
over 30 of the United States and 12 countries
The da Vinci Advantage:Why Listen to Me– Monday October 1, 2004 I performed my first dVP– Monday April 25, 2005 I performed dVP #200 – Wednesday April 27, 2005 I performed 2dVP’s– Thursday April 28, 2005 I performed 1 LRP
• some insurance would not cover da Vinci surgery back then
– Friday April 28, 2005 I decided never to perform another LRP again
As of today I have performed ≈2,000 dVP’s my patients have come from
over 30 of the United States and 12 countries
The da Vinci Advantage:Why Listen to Me– Monday October 1, 2004 I performed my first dVP– Monday April 25, 2005 I performed dVP #200 – Wednesday April 27, 2005 I performed 2dVP’s– Thursday April 28, 2005 I performed 1 LRP
• some insurance would not cover da Vinci surgery back then
– Friday April 29, 2005 I decided never to perform another LRP again
As of today I have performed ≈2,000 dVP’s my patients have come from
over 30 of the United States and 12 countries
The da Vinci Advantage:Why Listen to Me
– IF you believe that your current surgery is “as good as it gets”
– THEN you are performing • yesterday’s standard of care• maybe today’s standard of care• but DEFINITELY NOT tomorrow’s standard of care
The da Vinci Advantage:Why Listen to Me
– IF you believe that your current surgery is “as good as it gets”
– THEN you are already behind
The da Vinci Advantage:
• The Vision-Precision Advantage• The Consistency Advantage
The da Vinci Advantage:The Vision – Precision Advantage• Vision
– Stereoscopic view (better depth AND detail)– 10x magnification– High definition– You place the camera EXACTLY where you want it
If I can see it better I can do a better operation
• Precision– Scaled motion
• Allows for more precise movements than my own hands are capable of
– With improved ergonomics comes improved precision
If I have a more precise tool I can create less collateral damage
The da Vinci Advantage:The Vision – Precision Advantage
• Better Vision and Improved Precision:– IS NOT a replacement for skill– IS an advantage for ALL SURGEONS no matter
what their skill level
The da Vinci Advantage:The Consistency Advantage
• What do YOUR LAP surgeons believe
The da Vinci Advantage:The Consistency Advantage
• What do YOUR LAP surgeons believe
“my outcomes are as good as they get”
“I’m at the TOP of my game”
The da Vinci Advantage:The Consistency Advantage
• What do YOUR LAP surgeons believe
“my outcomes are as good as they get”
“I’m at the TOP of my game”
• and if they never convert to dVP they are right
The da Vinci Advantage:The Consistency Advantage
• What do YOUR LAP surgeons believe
OUTCOMES LAP
best
worst
The da Vinci Advantage:The Consistency Advantage
• What do YOUR LAP surgeons need to know
OUTCOMES LAP
dVbest
best
worst
worst
The da Vinci Advantage:The Consistency Advantage
• What do YOUR LAP surgeons need to know
OUTCOMES LAP
dVeasy
easy
hard
hard
The da Vinci Advantage:The Consistency Advantage
YOUR LAP surgeons need to know
• They are STUCK at their current level if they continue with LAP
• There is a level above LAP, but to get there they need to transition to daVinci
The da Vinci Advantage:The Consistency Advantage
• daVinci surgery– Improves the best outcomes A LITTLE– Improves the worst outcomes A LOT– Reduces the distance between • BEST-WORST • EASIEST-HARDEST
The da Vinci Advantage:The Consistency Advantage
• daVinci surgery
Reduces Variability in the Difficulty of an Operation
Reduces Variability in Outcomes
The da Vinci Advantage:The Consistency Advantage
• daVinci surgery– Reducing Variability in Outcomes• Better Vision• Improved Precision• 4th Arm
– Improved control over your operation
• Reduced Fatigue
The da Vinci Advantage:The Consistency Advantage
• Reduced Fatigue– Ergonomic Advantage of daVinci surgery• 87% of surgeons who regularly perform standard
laparoscopic surgery experience discomfort/pain neck, hand, and lower extremities– J Am Coll Surg 2010
• Standard Laparoscopic Surgery increases surgeon fatigue and reduces performance – Surgery 2010;147:318-30
The da Vinci Advantage:The Consistency Advantage
• Reduced Fatigue– Ergonomic Advantage of daVinci surgery
Improve ergonomics of performing an operation
Improve Performance of the Surgeon
Improve Consistency of Patient Outcomes
The da Vinci Advantage:
• Surgery today is NOT as good as it gets
• Better Vision and a More Precise tool is an advantage for ALL surgeons
• Reducing Variability in Difficulty Reduces Variability in Outcomes
