ENDOMETRIOSIS RESECTION Solutions for minimally invasive gynecologic surgery The da Vinci Surgical System Monopolar Curved Scissors Surgeon Benefits Early clinical data suggest: As a result of da Vinci technology, da Vinci Endometriosis Resection may offer the following potential benefits: • Ability to accomplish technically challenging dissection1, 2, 3 • Low rate of complications1, 3, 4, 5 • Low blood loss3,5,7,8 and low likelihood for transfusion3, 5 • Low rate of conversion to abdominal surgery1, 3, 6, 7
Surgical Risks: • Bowel injury • Bladder injury • Urinary tract injury High-definition 3D vision EndoWrist® instrumentation Intuitive® 3D HD Vision motion 3D HD visualization facilitates accurate identification of the ureters while accessing the correct anatomical angles. Dual Console Support Dual console capability allows an additional surgeon to provide an assist and can facilitate teaching and proctoring. Application Highlights For technology videos visit www.daVinciSurgeryCommunity.com Four ways da Vinci technology facilitates a precise endometriosis resection: Stable and magnified visualization, scaling of movements, and fully articulating instrumentation enables the surgeon to identify and resect lesions and nodules throughout the pelvic cavity. The EndoWrist instrumentation also facilitates access to intraperitoneal and retroperitoneal anatomy for excision of nodules. Excellent visualization for better tissue plane identification.7 A compliment of wristed instruments facilitates delicate dissection along tissue planes. For example, the PK™ Dissecting Forceps and Long-Tip Forceps can be used together to provide traction/retraction for effective removal of the endometrioma. EndoWrist® instruments facilitate careful ureterolysis, even when the ureters are hidden by scar tissue and nodular disease. Wristed instrumentation also enables precise resection of lesions that have deeply infiltrated structures such as bowel and ureters. Surgical autonomy can be achieved utilizing the 3rd instrument arm to assist in tissue manipulation or retraction. 3D HD vision provides excellent visualization of tissue planes and the ability to accomplish technically challenging dissection. In addition, the Monopolar Curved Scissors offers two modes for meticulous freeing of adhesions throughout the pelvic cavity. Excision of Ovarian Endometrioma Adhesiolysis Resection of Rectovaginal Nodules Ureterolysis Clinical Data For additional data pertaining to these studies visit www.daVinciSurgeryCommunity.com Retrospective analysis of robot-assisted versus standard laparoscopy in the treatment of pelvic pain indicative of endometriosis John F. Dulemba, MD, Cyndi Pelzel, MD and Helen B. Hubert, Journal of Robotic Surgery, June 2012. Operative time (77 vs. 72 min), blood loss (29 vs. 25 mL), and complication rates (1.1% vs. 0%) in robot-assisted and standard laparoscopy were low and similar for both approaches. Differences were apparent in biopsies confirming endometriosis (80% robot-assisted vs. 56.8% traditional laparoscopy, p<0.001). Most patients reported improved postoperative pain at the first follow-up visit with no differences between the surgical approaches (85% vs. 80%, p = 0.365). This finding suggests that robot-assisted techniques, compared to standard laparoscopy, may provide more accurate visualization and, thus, excision of existing endometriosis. There are small subtle changes in the terrain of the peritoneum that cannot be seen with the 2-dimensional components of the traditional laparoscopic equipment. The authors experienced better tissue plane visualization with robot-assisted compared to conventional laparoscopic surgery due to the very stable and magnified views with scaling of movements. Limitations of this study are that it lacked validated and longer-term outcome measures needed to address symptom and fertility outcomes and that further investigation is required to evaluate the cost of acquiring and using robotic equipment versus the potential benefits. Peri-operative outcomes of patients with stage IV endometriosis undergoing robotic-assisted laparoscopic surgery Lorna Brudie, MD and Rob Holloway, MD, Journal of Robotic Surgery, October 2011. Stage IV endometriosis with a ‘‘frozen pelvis’’ presents surgical challenges that often exceed many oncology operations because of distorted anatomy and risks of damage to normal tissues. This is a large reported series of peri-operative and short-term post-operative outcomes of 80 patients with stage IV endometriosis who underwent surgery with the da Vinci Surgical System. Managing advanced stage endometriosis was feasible with few laparotomy conversions and low complications during the authors’ “learning-curve,” sparing many patients from the morbidity of laparotomy. Resolution of endometriosis-related pain at least 2 months following surgery was excellent. Limitations of this study include the retrospective design, the lack of long-term follow-up for recurrence of pain and endometriosis and that all data were retrieved from chart review without formal pain-score assessments. Parameter Robot-assisted Laparoscopy p Value Operative Time (minutes) 77.4 72.3 0.23 Patients w/ confirmed endometriosis 80.0% 56.8%
El Camino Women’s Medical Group offers the latest Minimally Invasive Solutions for gynecologic problems. Drs. Amy Teng, Erika Balassiano, and Pooja Gupta, all members of AAGL (American Association of Gynecologic Laparoscopy) are highly trained and experienced in the field of Minimally Invasive Gynecgologic Surgery. Dr. Erika Balassiano is also a graduate of the Minimally Invasive Gynecologic Surgery Fellowship at Stanford University, under the supervision of world-renowned Dr. Camran Nezhat.
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