Laparoscopia Robótica

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Dr. Milton Tatsuo tanaka

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  • First let’s take a look at the current state of dVP (da Vinci Prostatectomy).
  • Over the last five years the installed base of da Vinci Surgical Systems has grown significantly.
  • Over the last five years the installed base of da Vinci Surgical Systems has grown significantly.
  • Over the last five years the installed base of da Vinci Surgical Systems has grown significantly.
  • First let’s take a look at the current state of dVP (da Vinci Prostatectomy).
  • First let’s take a look at our number one procedure, da Vinci Prostatectomy.
  • This slide shows the shift in prostate cancer treatment therapies in percentages as a result from implementing a successful dVP (da Vinci Prostatectomy) Robotics Program. This analysis breaks out by sample size each type of treatment by year: 2000 – (Before da Vinci) 2003 – (First year with da Vinci) 2007 - (Fourth year after starting their da Vinci Program)
  • This slide shows the economic impact at Henry Ford Hospital in Detroit, Michigan. Henry Ford Hospital has been performing da Vinci® Prostatectomy since early 2001. Since acquiring their da Vinci® System, Henry Ford has generated over 400% growth in annualized Radical Prostatectomy surgical volume. As this slide demonstrates, their “Open” Prostatectomies (RRP) have significantly declined while their Robotic Prostatectomies (dVP) have significantly increased. Henry Ford now attracts over 86% of their robotic prostatectomy patients from outside their current healthcare market. These patients have come from all over, including out-of-state and out-of-country. Due to this increased demand, Henry Ford purchased a 2 nd da Vinci® Clinical System in early 2004. In summary, Henry Ford has made da Vinci® Prostatectomy the single largest revenue producing procedure in the hospital.
  • We continue to see an emerging trend in hospitals around the world who have set-up a successful da Vinci® Prostatectomy program. As this slide demonstrates, Hackensack University Hospital (Hackensack, NJ) has shifted away from “Open” Radical Prostatectomy (RRP) towards da Vinci® Prostatectomy (dVP). This shift is being driven by the superior clinical outcomes of dVP vs. RRP. At the same time patients continue to seek out leading centers who offer this robotic approach.
  • First let’s take a look at the current state of dVP (da Vinci Prostatectomy).
  • Let’s look at the market share breakdowns for surgical treatment in the U.S.. In 2006, by meeting dVP procedure goals, the market share more than doubled from the prior year 2005. dVP continues to grow quarter after quarter with more surgeons adopting this approach. dVP will continue to erode share from both Open and straight laparoscopic procedures.
  • In 2007, dVP will continue on its growth & adoption path increasing over 20% in market share as compared to 2006. This growth in market share will come from both Open and straight Laparoscopic Radical Prostatectomy as well as other prostate cancer treatments, including Radiation Therapy.
  • This slide shows the shift in prostate cancer treatment therapies as a result from implementing a successful dVP (da Vinci Prostatectomy) Robotics Program. City of Hope is a Regional Cancer Center and Community Hospital located in the Los Angeles suburbs (Duarte, California). Before 2003, City of Hope offered a broad base of Prostate Cancer Treatments. These included Laparoscopic Radical Prostatectomy (LRP). Once they obtained their first da Vinci System in 2003, there was an immediate shift towards dVP as their lead treatment for Prostate Cancer. The success of launching a dVP program has drawn in “new” incremental patients form outside their local market. This has also included numerous patients from other U.S. cities and States. Today, City of Hope has one of the busiest robotics programs worldwide. They have 4 active da Vinci Systems and perform multi-specialty robotic surgery (Urology, General Surgery, Colorectal Surgery, Hepatobiliary Surgery, Thoracic Surgery, & Gynecology). (* Please note: City of Hope is an NCI (National Cancer Institute) designated Comprehensive Cancer Center - one of just a handful of elite institutions nationwide. The NCI's Cancer Center program acknowledges institutions for their scientific excellence, and their ability to bring diverse research approaches to the problem of cancer. The "Comprehensive Cancer Center" designation indicates that City of Hope has undergone a rigorous peer review process, and has been found to be worthy of this highest level of recognition. For more info: http://www.cityofhope.org/ccc/)
  • Laparoscopia Robótica

    1. 1. Laparoscopia Robótica X simpósio de urologia do Hospital Memorial Milton Tatsuo Tanaka Masterclínica Cascavel Pr
    2. 2. Laparoscopia Robótica Urology Marketing San Jose, California – USA Setembro de 2007 Intuitive Factory
    3. 3. San Jose, California - USA Modelo: sutura e coordenação Centro de Treinamento Cirurgia em suíno
    4. 4. Composição do Sistema 4 arm da Vinci® Surgical System Console cirurgião Carro paciente Carro vídeo
    5. 6. <ul><ul><li>Perda da percepção de profundidade </li></ul></ul><ul><ul><li>Tremor das mãos </li></ul></ul><ul><ul><li>Reduzida amplitude de movimentos </li></ul></ul><ul><ul><li>Precisão comprometida </li></ul></ul><ul><ul><li>Ergonomicamente desconfortável </li></ul></ul><ul><ul><li>Difícil aprendizagem </li></ul></ul>Limitações da cirurgia laparoscópica
    6. 7. <ul><ul><ul><li>Visão 3D </li></ul></ul></ul><ul><ul><ul><li>Alinhamento olho-mão </li></ul></ul></ul><ul><ul><ul><li>Movimento escalonado </li></ul></ul></ul><ul><ul><ul><li>Elimina tremores </li></ul></ul></ul><ul><ul><ul><li>Destreza cirúrgica </li></ul></ul></ul><ul><ul><ul><li>Melhora ergonômica </li></ul></ul></ul><ul><ul><ul><li>Instrumental articulado com </li></ul></ul></ul><ul><ul><ul><li>7 graus de movimento </li></ul></ul></ul><ul><ul><ul><li>(laparoscopia 4 graus) </li></ul></ul></ul>4 arm da Vinci® Surgical System
    7. 9. Instrumentais Robóticos
    8. 11. <ul><li>Mini-Origami </li></ul>
    9. 13. da Vinci ® Surgical System U.S. Installed Base 1999 – 2007 Alaska Hawaii 1999 2000 2001 2004 2003 2005 2002 2006 2007-through Q2 close
    10. 14. da Vinci ® European Installed Base 1999 – 2007 1999 2000 2001 2002 2003 2005 2004 2006 2007-through Q2
    11. 15. da Vinci ® Asian Installed Base 1999 – 2007 2004 2003 2005 2006 2007-through Q2 2002
    12. 16. da Vinci ® South American Installed Base 1999 – 2007 2007: Primeiros 2 da Vinci System Brasil: H. Albert Einstein and SÍrio-Libanes 2006-through Q4
    13. 17. DESVANTAGENS <ul><li>Aus ência de feed-back t á ctil </li></ul><ul><li>Tamanho do sistema </li></ul><ul><li>Equipe cirurgica bem treinada e dedicada </li></ul><ul><li>Custo </li></ul>
    14. 18. da Vinci® Urology Procedures Urology Marketing
    15. 19. Radical Prostatectomy Radical Cystectomy w/ neobladder Pyeloplasty Radical Cystectomy w/ ileal conduit Nephrectomy Partial Nephrectomy Orchiopexy Adrenalectomy Abdominal Testicular Resection Uretereral reimplantation Bladder Neck Suspension Ureterectomy Varicocele Urethral Sling Placement Bilateral Heminephroureterectomy Mitrofanoff (Appendicovesicostomy) Bilateral Transvesical Ureteral Reimplantation (Cohen Technique) Pelvic Lymphadenectomy Renal Cystectomy Renal Artery Aneurysm Repair Sacralcolpopexy Vasovasostomy 22 da Vinci® Urology Procedures Performed
    16. 20. Urology Marketing
    17. 21. 2000 2003 (First da Vinci Year) 2007 (Projected) Open Conventional Lap Beam Brachy 37% da Vinci Conventional Lap Beam Brachy 87% da Vinci Beam Brachy Urology Marketing City of Hope Treatment Patterns (%)
    18. 22. dVP Economic Impact Nancy M. Schlichting President and CEO Henry Ford Health System Detroit, Michigan 2 nd da Vinci® purchased 3 rd & 4 th da Vinci® purchased 1st da Vinci® purchased
    19. 23. dVP Economic Impact Source chart: Urology Times publication 1/2006 2 nd da Vinci® purchased Ravi Munver, M.D. Chief of Minimally Invasive Urologic Surgery Hackensack University Medical Center Hackensack, N.J “ Currently in our institution, more than 95% of radical prostatectomies are performed with robotic assistance. Furthermore, the total number of prostatectomies performed has steadily increased between 2000 and 2005. “
    20. 24. <ul><li>Prostatectomia radical </li></ul>da Vinci® Urology Procedures Performed
    21. 25. CURVA DE APRENDIZADO <ul><li>Procedimento complexo (prostatectomia radical) </li></ul><ul><li>Laparoscopia pura 60 - 100 casos </li></ul><ul><li>Robô-assistida 10 - 20 casos </li></ul><ul><li>Experiência com laparoscopia não é indispensável </li></ul>Ahlering et al. J Urol 170, 2003 Patel et al. J Urol 174, 2005
    22. 26. SALA CIR Ú RGICA
    23. 27. COLOCA ÇÃO DOS TROCARTES
    24. 28. TEMPOS CIR ÚRGICOS <ul><li>C oloca ção de trocartes </li></ul><ul><li>Dock </li></ul><ul><li>Mobiliza ção vesical </li></ul><ul><li>Controle DVC </li></ul><ul><li>Secção colo vesical </li></ul><ul><li>Dissecção vesiculas seminais </li></ul><ul><li>Controle do pedículo prostático lateral </li></ul><ul><li>Nerve sparing </li></ul><ul><li>Dissecção apical e uretra </li></ul><ul><li>Anastomose uretro-vesical </li></ul>
    25. 29. Anastomose uretro-vesical
    26. 30. Resultados Dados per-operatórios: aberta, laparoscópica e robótica Martínez-Salamanca et al. Actas Urol Esp. 2007;31(4)
    27. 31. Resultados Dados pós-operatórios: aberta, laparoscópica e robótica Martínez-Salamanca et al. Actas Urol Esp. 2007;31(4)
    28. 32. Resultados Margens cirúrgicas positivas: aberta, laparoscópica e robótica Martínez-Salamanca et al. Actas Urol Esp. 2007;31(4)
    29. 33. Resultados Continência urinária: aberta, laparoscópica e robótica Martínez-Salamanca et al. Actas Urol Esp. 2007;31(4)
    30. 34. Resultados Função sexual: aberta, laparoscópica e robótica Martínez-Salamanca et al. Actas Urol Esp. 2007;31(4)
    31. 35. AUA Abstract # 627 <ul><li>Robotic equipment malfunction during robotic prostatectomy: a multi-institutional study </li></ul><ul><li>N=6426 </li></ul><ul><li>Falha cr ítica - 20 casos (0.3%) </li></ul><ul><ul><li>Cancelamento - 10 casos </li></ul></ul><ul><ul><li>Convers ão - 9 PRR e 1 PRL </li></ul></ul><ul><li>Falha pass ível de correção - 124 (1.9%) </li></ul><ul><li>Sistema óptico e braços mecânicos - responsáveis pela maioria das falhas </li></ul>
    32. 36. “ WE SHOT AT THE HEART AND HIT THE PROSTATE “ (Intuitive Surgical)
    33. 37. Obrigado
    34. 38. Masterclínica Fone(45)3224-2020 (Edilhone) 06 a 09 dezembro 2007 Cascavel Paraná
    35. 39. da Vinci® Surgical System
    36. 40. dVP Procedure Update Urology Marketing
    37. 41. 41.5% 0.5% 58.5% Urology Marketing 2006 U.S. Radical Prostatectomy Market
    38. 42. 63.0+% 0.2% 36.85% Urology Marketing
    39. 43. Open Conventional Lap Conventional Lap Urology Marketing City of Hope Treatment Evolution

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