da Vinci® Hysterectomyfor Benign Gynecologic Conditions

Anthony R DeSalvo, MD

St Joseph Health Center

Hysterectomy Facts

Approximately 525,000 hysterectomies are performed each year in the U.S.1

By age 60, 1 in 3 women in the U.S. will have had a hysterectomy2

90% are performed for elective benign indications3

Fibroids Abnormal uterine bleeding Endometriosis Chronic pelvic pain

1Thomson Solucient data2US Department of Health & Human Services, womenshealth.gov, Hysterectomy FAQ. www.4woman.gov/faq/hysterectomy.htm3American College of Surgeons “About Hysterectomy” brochure.http://www.facs.org/public_info/operation/hysterectomy.pdf#search=%2290%25%20hysterectomies%20performed%20are%20elective%22

Complex Hysterectomy

Pelvic Adhesive Disease (PAD) Prior pelvic surgery Endometriosis Prior pelvic infection

Large Uteri High BMI Patient (BMI ≥ 30) Presence of single or

multipleadnexal masses

A significant portion of benign hysterectomies are complex.

Evolution of Hysterectomy

Total abdominal (TAH) & vaginal hysterectomy (TVH) Laparoscopic-assisted vaginal hysterectomy was

introduced by Reich in the late 1980s (LAVH) Laparoscopic supracervical hysterectomy (LSH) Total laparoscopic hysterectomy (TLH)

>50% of all hysterectomies performedin the U.S. are abdominal4

4 2008 Thomson Solucient data

da Vinci® Si™ Surgical System

Tremor filtration, motion scaling, 3D vision and robotic precision improve the technical quality of reconstruction

EndoWrist® instruments provide 7 degrees of freedom and added dexterity

Using the da Vinci System’s 4th arm to perform traction and retraction tasks provides the surgeon with enhanced control of the surgical site

Net result: Improved technical capabilities for quality reconstruction

When compared to the open approach, da Vinci offers the patient and surgeon numerous potential benefits

da Vinci Hysterectomy

da Vinci overcomes the limitations of conventional laparoscopy by enabling gynecologists to treat complex pathology minimally invasively, minimizing conversions and the need for total abdominal hysterectomy.

5 cm

1 cm

Patient Expectations and Benefits

Less need for pain medication2,4

Less blood loss and fewer transfusions1,3,4

Fewer complications and lower conversion rate1

Shorter hospital stay1,3,4

Quicker recovery and fast return to normal daily activities1,4

Small incisions for improved cosmesis

Better clinical outcomes and patient satisfaction as compared to open surgery1,2

3. Payne, T. N., F. R. Dauterive, et al. (2010). “Robotically assisted hysterectomy in patients with large uteri: outcomes in five communitypractices.” Obstet Gynecol 115(3): 535-542.4. Visco, A. G. and A. P. Advincula (2008). “Robotic Gynecologic Surgery.” Obstet Gynecol 112(6): 1369-1384.

Surgeon Benefits

To treat more pathology minimally invasively — safely, reproducibly and following open surgical technique1 —including patients with:

Adhesive disease1

Large pathology1

Obesity2

Greater access, precision and control for improved dissections1

Quicker, easier suturing during vaginal cuff closure1

Control of the camera and all three operative arms for the ultimate in surgical autonomy and efficiency1

1. Payne, T. N. and F. R. Dauterive (2008). “A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice.” J Minim Invasive Gynecol 15(3): 286-291.2. Piquion-Joseph, J. M., A. Nayar, et al. (2009). “Robot-assisted gynecological surgery in a community setting.” Journal of Robotic Surgery: 1-4.

Compared to conventional laparoscopy, the unsurpassed visualization, dexterity and control allow surgeons:

19992000200120022003

da Vinci® Surgical System U.S. Installed Base 1999 – 2010

2004

Alaska

2005

Hawaii

2006200720082009

2010- through Q2 close

The Future is Robotic Surgery

Robotic surgery is here to stay

The advantages to our patients with MIS are significant

Robotic surgery allows almost all patients to benefit from the advantages of MIS – especially those with >BMI