ORLive presents robotic-assisted hysterectomy for endometrial cancer with staging

Chapel Hill 23 January 2007OR-Live.com, with technical assistance from the University of North Carolina (UNC) School of Medicine, including the UNC School of Medicine's Office of Information Systems/Digital Media Services, will present a webcast of a da Vinci robotic hysterectomy for endometrial cancer with staging, broadcast live from North Carolina Women's Hospital at the University of North Carolina Hospitals, on February 21, 2007. The minimally invasive procedure will be performed using the latest da Vinci Surgical System, the da Vinci S model, and will include a hysterectomy for endometrial cancer with emphasis on the para-aortic lymphadenectomy to surgically stage the disease.


Dr. John Boggess, Associate Professor of Obstetrics & Gynaecology and Fellowship Programme Director, Division of Gynaecologic Oncology at UNC School of Medicine, will perform the procedure. Dr. Paola A. Gehrig, Associate Professor of Obstetrics & Gynaecology, Division of Gynaecologic Oncology, will moderate the event to explain critical portions of the surgery and answer e-mail questions from viewers.

da Vinci is a breakthrough robotic system designed to transcend the limitations of both open surgery and laparoscopy - thereby expanding the surgeon's capabilities and providing patients a minimally invasive option for many complex procedures. With the da Vinci S System, surgeons now have improved range of motion in the upper abdomen, combined with improved access to reach the deep pelvis. These advantages can be particularly helpful in staging endometrial cancer, since the surgeon can readily access the para-aortic lymph nodes for staging and the deep pelvis to perform the hysterectomy as well as the pelvic lymph node dissection.

Dr. Boggess will demonstrate how the 4th arm of the da Vinci S System can be used during lymphadenectomy, along with his approach to port placement given the da Vinci S model's longer instruments and improved range of motion - designed to allow greater access to the upper abdomen and the deep pelvis.

Based upon his clinical experience of more than 180 da Vinci procedures - with over 80 percent being performed for the treatment of gynaecologic malignancies - Dr. Boggess believes that da Vinci surgery for the treatment of early stage gynaecologic cancer can provide women with significantly better results compared to traditional open hysterectomy or conventional laparoscopy. "The results", stated Dr. Boggess, "are remarkable."

The da Vinci System's advanced, endoscopic 3D vision, combined with unsurpassed surgical dexterity, facilitate anatomical dissection of tissue planes and isolation of pedicles. This allows for greater precision and control when dissecting the lymph node bundle off the abdominal aorta and vena cava, for example. In addition, the da Vinci System provides better access to difficult-to-navigate areas, such as the obturator space, behind the pelvic vessels and behind the abdominal aorta. According to Dr. Boggess, "da Vinci allows for superior lymph node harvest, with greater surgical precision and ease, as compared to both open and laparoscopic techniques. This allows surgeons to perform more precise and thorough lymph node dissections for a more comprehensive staging procedure."

Comparing his data on staging endometrial cancer using da Vinci (n = 43) versus lap staging (n = 101), Dr. Boggess concludes that in his da Vinci patient group (n = 43), significantly more nodes were retrieved (30 vs. 23, p = 0.004), less blood was lost (63 vs. 142 cc, p = 0.0001), operative time was less (163 vs. 213 minutes, p = 0.002) and patients were sent home more quickly (1 vs. 1.2 days, p = 0.04) as compared with his laparoscopic cohort (n = 101). In addition, there were no conversions to laparotomy for the da Vinci group, compared to 3 percent for the laparoscopic group. According to Dr. Boggess, "What may be most significant is that we were able to perform comprehensive staging on larger women (BMI 33 vs. 29, p = 0.008). These data suggest that da Vinci surgery surpasses our laparoscopic approach in terms of surgical and patient outcomes for the treatment of endometrial cancer."

When compared to open surgery, patient outcomes are even more dramatic. "Post-operative pain is dramatically reduced, since none of our patients required IV pain medication, and most required only minimal pain meds for the first two post-operative days. Average blood loss was minimal (only 63 cc), and nearly half of our patients had no measurable blood loss. Hospital stays were only 1 day, and most patients had rapid recoveries and returned to their normal lifestyles within two weeks", Dr. Boggess stated. "And what we no longer see are the wound problems normally encountered in obese women who undergo open surgery for endometrial cancer."

"It has been our goal at UNC to develop reproducible and teachable techniques for treating women's cancers, while reducing morbidity and recovery. With the da Vinci S System, we are finding that we are better able to accomplish this goal while preserving the cancer outcomes that we expect. As a result, we suspect that robotics will allow more surgeons to adopt a minimally invasive procedure for staging uterine cancer", Dr. Boggess concluded.

Intuitive Surgical Inc., headquartered in Sunnyvale, California, is a global technology expert in the rapidly emerging field of robot-assisted, minimally invasive surgery (MIS). Intuitive Surgical develops, manufactures and markets robotic technologies designed to improve clinical outcomes and help patients return more quickly to active and productive lives. The company's mission is to extend the benefits of minimally invasive surgery to the broadest possible base of patients.

The da Vinci Surgical System is a sophisticated robotic platform designed to enable complex surgery using a minimally invasive approach. The da Vinci System consists of an ergonomic surgeon's console, a patient-side cart with four interactive robotic arms, a high-performance vision system and proprietary EndoWrist instruments. Powered by state-of-the-art robotic technology, the da Vinci System is designed to scale, filter and seamlessly translate the surgeon's hand movements into more precise movements of the EndoWrist instruments. The net result is an intuitive interface with breakthrough surgical capabilities.

By providing surgeons with superior visualization, enhanced dexterity, greater precision and ergonomic comfort, the da Vinci Surgical System makes it possible for more surgeons to perform minimally invasive procedures involving complex dissection or reconstruction. This ultimately raises the standard of care for complex surgeries, translating into numerous potential patient benefits, including less pain, a shorter recovery and quicker return to normal daily activities.

More news on the da Vinci Surgical System is available in the VMW March 2006 article University of Texas Southwestern doctors test robotic surgeon for laparoscopy. To learn more about the robotic-assisted hysterectomy procedure and to view a programme preview, you can visit the ORLive web site.

Leslie Versweyveld

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