![Page 1: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/1.jpg)
Training Course for Advanced Oncologic Laparoscopy
Robotic Urology
St Petersbourg16 February 2006
Ch.-H. RochatGeneva
![Page 2: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/2.jpg)
Urology and mini-invasive surgery
radical radical prostatectomyprostatectomynephrectomynephrectomy (partial or total)(partial or total)pyeloplastypyeloplastyurouro--genitalgenital prolapseprolapsecystectomycystectomylymphadenectomylymphadenectomySpermaticSpermatic veinvein ligationligation / / ectopicectopic testistestis
![Page 3: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/3.jpg)
Sept.1991Sept.1991 FirstFirst intrapintrapeeritonritoneealalWW. WW. SchuesslerSchuessler, , U.S.AU.S.A
JuneJune 1997 1997 FirstFirst extraextra--ppeeritonritoneealalA. A. RaboyRaboy, , U.S.A.U.S.A.
Nov. 1997 Nov. 1997 French French firstfirstR. GastonR. Gaston, , BordeauxBordeaux ((followedfollowed bbyy CC. CC. AbbouAbbou, B. , B. GuillonneauGuillonneau andand G. G. VallencienVallencien,,Paris)Paris)
MarMarchch 19991999 SwissSwiss firstfirstC.H. Rochat, R. GastonC.H. Rochat, R. Gaston, , GenGeneevvaa
DDeec. 1999c. 1999 FirstFirst retrograderetrograde extraextra--ppeeritonritoneealalP.DubernardP.Dubernard, , LyonLyon
Laparoscopic prostatectomy (LP)
![Page 4: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/4.jpg)
antero-lateral incision of the NVB
Vidéo
Retrograde extra-peritoneallaparoscopic prostatectomy
![Page 5: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/5.jpg)
Vidéo
Santorini plexus and anterior urethra division
Retrograde extra-peritoneallaparoscopic prostatectomy
![Page 6: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/6.jpg)
Retrograde extra-peritoneallaparoscopic prostatectomy
apical dissection
Vidéo
![Page 7: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/7.jpg)
Retrograde extra-peritoneallaparoscopic prostatectomy
Vidéo
retrograde dissection
![Page 8: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/8.jpg)
bladder neck incision
Vidéo
Retrograde extra-peritoneallaparoscopic prostatectomy
![Page 9: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/9.jpg)
Vesico urethral anastomosis :
separate stitches (extra or intra corporeal knots)
or running suture
Retrograde extra-peritoneallaparoscopic prostatectomy
![Page 10: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/10.jpg)
The Da Vinci robot ®
![Page 11: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/11.jpg)
![Page 12: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/12.jpg)
2 cameras
2 sources of cold light
view in the axis of the arms
3-D Image
![Page 13: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/13.jpg)
1 cm5 cm
2:1 to 5:1 reduced movements
less shaking
Precision
![Page 14: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/14.jpg)
History of Da Vinci® at the Clinique Générale Beaulieu, GenevaOctober 2002
Decision to test the Da Vinci robot at the CGB in Geneva
January 200311 interventions in 1 week and a broadcast with IRCAD-EITS (R. Gaston, C.-H. Rochat).
March - June 2003Approval of the project and training of teams.
September 2003Start of procedures
![Page 15: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/15.jpg)
Presentation of the robot
![Page 16: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/16.jpg)
Number of procedures: 2003 : 252004 : 952005 : 104
Limitation :6 Endoscopes only48 hours for sterilization per Endoscope(purchase of x system in 2006)
0
20
40
60
80
100
120
200320042005
![Page 17: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/17.jpg)
May 2000May 2000 J. Binder, FrankfurtJ. Binder, Frankfurt
July. July. 20002000 C.C. C.C. AbbouAbbou, Paris, Paris
Sept. 2000Sept. 2000 G. G. VallencienVallencien, Paris, Paris
Nov.Nov. 20012001 M. Menon, DetroitM. Menon, Detroit
Aug. 2002Aug. 2002 H. John, ZH. John, Züürichrich
Jan. 2003Jan. 2003 C.C.--H. Rochat, R. Gaston, H. Rochat, R. Gaston, GenevaGeneva
Robotic laparoscopicprostatectomies (RLP)
![Page 18: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/18.jpg)
![Page 19: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/19.jpg)
DVP : 150
– Trans-peritoneal 141antegrade 139
retrograde 2
– Extra-peritoneal 9antegrade 1
retrogade 8
– Staging 66
![Page 20: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/20.jpg)
Urological– nephrectomy 9– part. nephr. 5– nephro-uret. 2– cystectomy 3– promontofix. 4– vasect.revers 2– Pyéloplasty 2
Non urological– hiatal hernia 22– colon & sigm. 15– Gastroplasty 7– tubar plasty 3– others 9
Other procedures:
![Page 21: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/21.jpg)
![Page 22: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/22.jpg)
Major complicationsTechnical
2 robot initiation failure (>conv. laparoscopy)Medical
1 urethro-rectal fistula (Béniqué trauma !!)1 reoperation for retro-vesical hematoma2 severe bleeding (extraperitoneal technique)3 anastomotic leakage (3 weeks catheter)1 pulmonary embolie
![Page 23: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/23.jpg)
Intraperitoneal laparoscopicprostatectomy
evolution in 2005 / 06First lowering of the bladderFirst lowering of the bladderNo incision of the No incision of the endopelvicendopelvic fasciafasciaInitial access to the bladder neck Initial access to the bladder neck InterInter--fascialfascial dissection of dissection of neuroneuro--vascular bundles vascular bundles
by starting below the prostate (breaststroke by starting below the prostate (breaststroke movement)movement)
Selective section of urethra without Selective section of urethra without ligationligation of the of the plexus of plexus of SantoriniSantorini
AnastomosisAnastomosis in in twotwo halfhalf--runningrunning suturessutures
![Page 24: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/24.jpg)
![Page 25: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/25.jpg)
![Page 26: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/26.jpg)
www.egru.chwww.egru.ch
![Page 27: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/27.jpg)
Fonctional and oncological results underevaluation
EGRU data Base :– 6 centers for prospective study– Starting early 2006
Better vision,better precision….better results?
![Page 28: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/28.jpg)
Conclusion Advantages for the surgeon:
specialspecial 33--D visionD visioneasy access to difficult easy access to difficult
surgical sitessurgical sitesergonomicergonomic positionpositionprecisionprecision of of gesturesgestures by:by:
lessless shakingshakingreducedreduced movementsmovementsinstruments rotation on 6instruments rotation on 6directionsdirections
![Page 29: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/29.jpg)
ConclusionImprovements for the patient:
improvedimproved securitysecurityprecisionprecision of dissectionof dissectionsmallsmall incisionsincisionscombined advantages of thecombined advantages of theminimini--invasive surgeryinvasive surgery::
reducedreduced bleedingbleedingreducedreduced infectionsinfectionsreducedreduced painpainshortershorter hospitalizationhospitalization andandrecoveryrecovery periodperiod
![Page 30: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/30.jpg)
Financial aspects
Title: The FinancierArtist: Red Skelton
![Page 31: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/31.jpg)
Costs
PurchasePurchaseCashCashLeasingLeasingPrivatePrivate donations, donations, FoundationsFoundations
MaintenanceMaintenance
ConsumablesConsumables
![Page 32: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/32.jpg)
Da Vinci ® Consumables
ProstatectomyProstatectomy
COSTS
5 FORCEPS SFr. 2'362.45
2 TROCARTS SFr. 366.75
1 SUCTION SFr. 114.80
ROBOTIC DUST COVER SFr. 262.05
STERILIZATION SFr. 301.00
TOTAL COST SFr. 3'407.05
2200 €
![Page 33: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/33.jpg)
Benefits
TechnologicalTechnological advanceadvance
MultiMulti--disciplinarydisciplinary useuse
BenefitsBenefits of the miniof the mini--invasive invasive surgerysurgeryHospitalHospital staystayRecoveryRecovery
No direct No direct financialfinancial rentabilityrentability
![Page 34: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/34.jpg)
Films montage and assistance during the Films montage and assistance during the presentationpresentation::
Thierry Thierry VedrenneVedrenneComputer ConsultantComputer Consultant
«« SociSociééttéé MMéédicale Beaulieudicale Beaulieu »», Geneva, Geneva
![Page 35: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/35.jpg)
![Page 36: Robotic Urology - gfmer.ch · Robotic Urology St Petersbourg 16 February 2006 Ch.-H. Rochat Geneva. Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or](https://reader036.vdocuments.net/reader036/viewer/2022062507/5fc97a288cbe987202308da2/html5/thumbnails/36.jpg)