Gynecologic Sugery with daVinci

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  • Open gynecologic surgery, using a large incision for access to the uterus and surrounding anatomy, was for many years the standard approach to many gynecologic procedures. But with open surgery can come significant pain, trauma, a long recovery process and threat to surrounding organs and nerves. For women facing gynecologic surgery, the period of pain, discomfort and extended time away from normal daily activities that usually follows traditional surgery can now be replaced by less invasive options. Some gynecologic procedures enable Dr. Sopp to access the target anatomy using a vaginal approach, which may not require an external incision. But for complex hysterectomies and other gynecologic procedures, robot-assisted surgery with the daVinci® Surgical System may be the most effective, least invasive treatment option. Through tiny, 1/2" incisions and using the daVinci® System, he can operate with greater precision and control, minimizing the pain and risk while increasing the likelihood of excellent clinical outcomes and fast recovery (typical return to normal activity is 2 weeks). Dr. Sopp teaches daVinci® Robotic Surgery.

    Learn More
    To learn more about daVinci Hysterectomy or any other gynecologic surgery utilizing the daVinci® Surgical System, click here.
    * Also referred to as the daVinci Robot

    While clinical studies support the effectiveness of the daVinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the daVinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.

    For additional information on minimally invasive surgery with the daVinci® Surgical System visit www.daVincisurgery.com

  • When a woman faces a medical condition that affects her uterus, the hollow, muscular organ that holds and feeds a fertilized egg, the emotional impact can often be as challenging as the physical. These conditions include, but are not limited to, cervical and uterine cancers such as endometrial cancer, uterine fibroids, uterine prolapse, excessive bleeding and endometriosis.

    Treatment options are as varied as the conditions themselves, depending on individual circumstances. A woman’s age, health history, surgical history and diagnosis (benign or cancerous), all factor into the recommended course of action.


    Female Anatomy

    Endometriosis, also known as endometrial hyperplasia, is a condition in which the endometrial tissue grows outside the uterus, causing scarring, pain, and heavy bleeding. It can often damaging the fallopian tubes and ovaries in the process. A common organic cause of infertility, endometriosis can be treated with medications such as lupron for endometriosis that lowers hormone levels and decreases endometrial growths. While such medications often relieve associated symptoms, a patient should understand the potential side effects before pursuing this treatment regimen.

    For endometrial cancer, also known as uterine cancer and more common among women after menopause, standard treatment options include hormone therapy, radiation therapy, chemotherapy and hysterectomy (surgical removal of the uterus). Three of these — radiation therapy, chemotherapy and hysterectomy — are also used to treat cervical cancer.

    For benign (non-cancerous) conditions like menorrhagia (heavy menstrual bleeding), non-surgical treatments like hormone therapy or minimally invasive ablative therapies may offer relief. For fibroids, uterine-preserving myomectomy – a surgical alternative to hysterectomy -- may be an option.

    Hysterectomy
    For most uterine conditions, if available non-surgical treatments fail to relieve symptoms, many women choose a more certain result with elective hysterectomy. Each year in the U.S. alone, doctors perform about 600,000 hysterectomies, making it the second most common surgical procedure.1

    While symptoms such as chronic pain and bleeding often point a woman and her doctor toward hysterectomy as the preferred treatment choice, life-threatening conditions such as cancer or uncontrollable bleeding in the uterus often necessitate a hysterectomy and follow-up treatment.

    While hysterectomy is relatively safe, always ask your doctor about all treatment options, as well as their risks and benefits, to determine which approach is right for you. And if hysterectomy is recommended or required, you owe it to yourself to learn about daVinci Hysterectomy, a robot-assisted, minimally invasive surgery that for many women has potential as the safest and most effective treatment available.

    Learn More
    Read about hysterectomy
    Read about the benefits of daVinci® when used for hysterectomy

    1 Center for Disease Control. Keshavarz H, Hillis S, Kieke B, Marchbanks P. Hysterectomy Surveillance — United States, 1994–1999. Morbidity and Mortality Weekly Report. Surveillance Summaries. July 12, 2002. Vol. 51 / SS-5. Page 1. www.cdc.gov/mmwr/PDF/ss/ss5105.pdf

    While clinical studies support the effectiveness of the daVinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the daVinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.

    For additional information on minimally invasive surgery with the daVinci® Surgical System visit www.daVincisurgery.com

  • Uterine fibroids* are benign (non-cancerous) tumors occurring in at least one quarter of all women.1 They can grow underneath the uterine lining, inside the uterine wall, or outside the uterus.

    Many women don’t feel any symptoms with uterine tumors or fibroids. But for others, these fibroids can cause excessive menstrual bleeding (also called menorrhagia), abnormal periods, uterine bleeding, pain, discomfort, frequent urination and infertility.2


    Fibroids

    Treatments include uterine fibroid embolization – which shrinks the tumor – and surgery. Surgical treatment for uterine tumors most often involves the surgeon removing the entire uterus, via hysterectomy.3

    While hysterectomy is a proven way to resolve fibroids, it may not be the best surgical treatment for every woman. If, for example, you hope to later become pregnant, you may want to consider alternatives to hysterectomy like myomectomy. Myomectomy is a uterine-preserving procedure performed to remove uterine fibroids.

    Types of Myomectomy
    Each year, roughly 65,000 myomectomies are performed in the U.S.4 The conventional approach to myomectomy is open surgery, through a large abdominal incision.5 After cutting around and removing each uterine fibroid, the surgeon must carefully repair the uterine wall to minimize potential uterine bleeding, infection and scarring. Proper repair is also critical to reducing the risk of uterine rupture during future pregnancies. Menorrhagia is extensive menstrual bleeding.

    While myomectomy is also performed laparoscopically, this approach can be challenging for the surgeon, and may compromise results compared to open surgery.6 Laparoscopic myomectomies often take longer than open abdominal myomectomies, and up to 28% are converted during surgery to an open abdominal incision.7

    A new category of minimally invasive myomectomy, daVinci® Myomectomy, combines the best of open and laparoscopic surgery. With the assistance of the daVinci Surgical System – the latest evolution in robotics technology – surgeons may remove uterine fibroids through small incisions with unmatched precision and control.

    Learn more
    If you would like to explore whether you are a candidate for myomectomy, ask your doctor.

    * Uterine fibroids are also called fibroids, uterine tumors, leiomyomata (singular – leiomyoma) and myomas or myomata (singular – myoma)

    1 Newbold RR, DiAugustine RP, Risinger JI, Everitt JI, Walmer DK, Parrott EC, Dixon D. Advances in uterine leiomyoma research: conference overview, summary, and future research recommendations. Environ Health Perspect. 2000 Oct;108 Suppl 5:769-73. Review.
    2 National Institutes of Health: Fast Facts about Uterine Fibroids. www.nichd.nih.gov/publications/pubs/fibroids/sub1.htm#where
    3 Becker ER, Spalding J, DuChane J, Horowitz IR. Inpatient surgical treatment patterns for patients with uterine fibroids in the United States, 1998-2002. J Natl Med Assoc. 2005 Oct;97(10):1336-42.
    4 Lumsden MA.Embolization versus myomectomy versus hysterectomy: Which is best, when? Hum Reprod. 2002; 17:253-259. Review.
    5 Becker ER, Spalding J, DuChane J, Horowitz IR. Inpatient surgical treatment patterns for patients with uterine fibroids in the United States, 1998-2002. J Natl Med Assoc. 2005 Oct;97(10):1336-42.
    6 Kristen A. Wolanske, MD; Roy L. Gordon, MD. Uterine Artery Embolization: Where Does it Stand in the Management of Uterine Leiomyomas? Part 2. Appl Radiol 33(10):18-25, 2004. Medscape.10/27/2004.
    7 Advincula AP, Song A, Burke W, Reynolds RK. Preliminary experience with robot-assisted laparoscopic myomectomy. J Am Assoc Gynecol Laparosc. 2004 Nov;11(4):511-8.

    While clinical studies support the effectiveness of the daVinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the daVinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.

    For additional information on minimally invasive surgery with the daVinci® Surgical System visit www.daVincisurgery.com

  • Physicians perform hysterectomy – the surgical removal of the uterus – to treat a wide variety of uterine conditions. Each year in the U.S. alone, doctors perform approximately 600,000 hysterectomies, making it the second most common surgical procedure.1


    Female Anatomy

    Types of Hysterectomy
    There are various types of hysterectomy that are performed depending on the patient’s diagnosis:

    • Supracervical hysterectomy – removes the uterus, leaves cervix intact
    • Total hysterectomy – removes the uterus and cervix
    • Radical hysterectomy or modified radical hysterectomy – a more extensive surgery for gynecologic cancer that includes removing the uterus and cervix and may also remove part of the vagina, fallopian tubes, ovaries and lymph nodes in order to stage the cancer (determine how far it has spread).

    Approaches to Hysterectomy
    Surgeons perform the majority of hysterectomies using an “open” approach, which is through a large abdominal incision. An open approach to the hysterectomy procedure requires a 6-12 inch incision. When cancer is involved, the conventional treatment has always been open surgery using a large abdominal incision, in order to see and, if necessary, remove related structures like the cervix or the ovaries.

    A second approach to hysterectomy, vaginal hysterectomy, involves removal of the uterus through the vagina, without any external incision or subsequent scarring. Surgeons most often use this minimally invasive approach if the patient’s condition is benign (non-cancerous), when the uterus is normal size and the condition is limited to the uterus.

    In laparoscopic hysterectomy, the uterus is removed either vaginally or through small incisions made in the abdomen. The surgeon can see the target anatomy on a standard 2D video monitor thanks to a miniaturized camera, inserted into the abdomen through the small incisions. A laparoscopic approach offers surgeons better visualization of affected structures than either vaginal or abdominal hysterectomy alone.

    While minimally invasive vaginal and laparoscopic hysterectomies offer obvious potential advantages to patients over open abdominal hysterectomy – including reduced risk for complications, a shorter hospitalization and faster recovery – there are inherent drawbacks. With vaginal hysterectomy, surgeons are challenged by a small working space and lack of view to the pelvic organs. Additional conditions can make the vaginal approach difficult, including when the patient has:

    • A narrow pubic arch (an area between the hip bones where they come together)2
    • Thick adhesions due to prior pelvic surgery, such as C-section3
    • Severe endometriosis4
    • Non-localized cancer (cancer outside the uterus) requiring more extensive tissue removal, including lymph nodes

    With laparoscopic hysterectomy, surgeons may be limited in their dexterity and by 2D visualization, potentially reducing the surgeon's precision and control when compared with traditional abdominal surgery.

    daVinci® Hysterectomy

    A new, minimally invasive approach to hysterectomy, da Vinc®i Hysterectomy, combines the advantages of conventional open and minimally invasive hysterectomies – but with far fewer drawbacks. daVinci® Hysterectomy is becoming the treatment of choice for many surgeons worldwide. It is performed using the daVinci® System, which enables surgeons to perform surgicall procedures with unmatched precision, dexterity and control. Read about what may be the most effective, least invasive approach to hysterectomy – daVinci® Hysterectomy.

    1 Center for Disease Control. Keshavarz H, Hillis S, Kieke B, Marchbanks P. Hysterectomy Surveillance — United States, 1994–1999. Morbidity and Mortality Weekly Report. Surveillance Summaries. July 12, 2002. Vol. 51 / SS-5. Page 1. www.cdc.gov/mmwr/PDF/ss/ss5105.pdf
    2 Harmanli OH, Khilnani R, Dandolu V, Chatwani AJ. Narrow pubic arch and increased risk of failure for vaginal hysterectomy. Obstet Gynecol. 2004 Oct;104(4):697-700.
    3 Paparella P, Sizzi O, Rossetti A, De Benedittis F, Paparella R. Vaginal hysterectomy in generally considered contraindications to vaginal surgery. Arch Gynecol Obstet. 2004 Sep;270(2):104-9. Epub 2003 Jul 10.
    4 Johnson N, Barlow D, Lethaby A, Tavender E, Curr L, Garry R. Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials. BMJ. 2005 Jun 25;330(7506):1478. Review.

    While clinical studies support the effectiveness of the daVinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the daVinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.

    For additional information on minimally invasive surgery with the daVinci® Surgical System visit www.daVincisurgery.com

  • If your doctor recommends hysterectomy, you may be a candidate for daVinci®Hysterectomy, one of the most effective, least invasive treatment options for a range of uterine conditions. daVinci® Hysterectomy is performed using the daVinci® Surgical System, which enables surgeons to perform with unmatched precision and control – using only a few small incisions.


    Incision Compared Hysterectomy

    For most patients, daVinci® Hysterectomy can offer numerous potential benefits over traditional approaches to vaginal, laparoscopic or open abdominal hysterectomy, particularly when performing more challenging procedures like radical hysterectomy for gynecologic cancer. Potential benefits include:

    • Significantly less pain
    • Less blood loss
    • Fewer complications
    • Less scarring
    • A shorter hospital stay
    • A faster return to normal daily activities

    Moreover, daVinci provides the surgeon with a superior surgical tool for dissection and removal of lymph nodes during cancer operations, as compared to traditional open or minimally invasive approaches.1 daVinci® Hysterectomy also allows your surgeon better visualization of anatomy, which is especially critical when working around delicate and confined structures like the bladder. This means that surgeons have a distinct advantage when performing a complex, radical hysterectomy involving adhesions from prior pelvic surgery or non-localized cancer, or an abdominal hysterectomy.2

    As with any surgery, these benefits cannot be guaranteed, as surgery is both patient- and procedure-specific. While radical hysterectomy or abdominal hysterectomy performed using the daVinci® Surgical System are considered safe and effective, these procedures may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.

    Learn More
    If you are a candidate for hysterectomy, talk to a gynecologist or gynecologic oncologist (a cancer specialist) who performs daVinci® Hysterectomy.

    1 Boggess JF. daVinci® Hysterectomy for Endometrial Cancer with Staging. Presented at ISI WWSSM 1/06. 871391_rev B_dVH Endometrial Cancer Presentation
    2. UNC Department of Obstetric & Gynecology Health & Healing in the Triangle Vol 8 No 3 pp 22-23.

    While clinical studies support the effectiveness of the daVinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the daVinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.

    For additional information on minimally invasive surgery with the daVinci® Surgical System visit www.daVincisurgery.com

  • Q. Am I a Candidate for daVinci® Surgery?
    A. To determine if you are a candidate for daVinci® Surgery, and to ensure you get the information you need from a consultation with your physician, we have put together a brochure and brief questionnaire that you can take into your doctor’s appointment with you.

    Download and Print .pdf: Am I A Candidate?

    Q. What is Minimally Invasive Surgery (MIS)?
    A. MIS is surgery typically performed through small incisions, or operating ports, rather than large incisions, resulting in potentially shorter recovery times, fewer complications, reduced hospitalization costs and reduced trauma to the patient. While MIS has become standard-of-care for particular surgical procedures, it has not been widely adopted for more complex or delicate procedures – for example, prostatectomy and mitral valve repair.

    Intuitive Surgical believes that surgeons have been slow to adopt MIS for complex procedures because they generally find that fine-tissue manipulation – such as dissecting and suturing – is more difficult than in open surgery. Intuitive Surgical's technology, however, enables the use of MIS techniques for complex procedures.

    Q. Why do we need a new way to do minimally invasive surgery?
    A. Despite the widespread use of minimally invasive or laparoscopic surgery in today's hospitals, adoption of laparoscopic techniques, for the most part, has been limited to a few routine procedures. This is due mostly to the limited capabilities of traditional laparoscopic technology, including standard video and rigid instruments, which surgeons must rely on to operate through small incisions.

    In traditional open surgery, the physician makes a long incision and then widens it to access the anatomy. In traditional minimally invasive surgery – which is widely used for routine procedures -- the surgeon operates using rigid, hand-operated instruments, which are passed through small incisions and views the anatomy on a standard video monitor. Neither this laparoscopic instrumentation nor the video monitor can provide the surgeon with the excellent visualization needed to perform complex surgery like valve repair or nerve-sparing prostatectomy.

    Q. What are the benefits of daVinci® Surgery compared with traditional methods of surgery?
    A. Some of the major benefits experienced by surgeons using the daVinci® Surgical System over traditional approaches have been greater surgical precision, increased range of motion, improved dexterity, enhanced visualization and improved access. Benefits experienced by patients may include a shorter hospital stay, less pain, less risk of infection, less blood loss, fewer transfusions, less scarring, faster recovery and a quicker return to normal daily activities. None of these benefits can be guaranteed, as surgery is necessarily both patient- and procedure-specific.

    Q. Why can't surgeons perform complex procedures such as cardiac surgery through 1-2 cm ports today?
    A. Complex procedures like cardiac surgery require an excellent view of the operative field and the ability to maneuver instruments within tight spaces with precision and control. Surgeons historically have used invasive approaches like "open sternotomy" for heart surgery, which means splitting the breastbone and pulling back the ribs and typically results in a foot-long incision. This provides visibility and allows room for the surgeon to get his or her hands and instruments very close to the operative site, but results in significant pain, blood loss and a long recovery for patients. More recently, smaller incisions have been used to perform a variety of cardiac procedures. However, many cardiac surgeons feel the reduced access may limit visualization and may impede access to the operative field.

    Q: Where is the daVinci® Surgical System being used now?
    A. Currently, The daVinci® Surgical System is being used in hundreds of locations worldwide, in major centers in the United States, Austria, Belgium, Canada, Denmark, France, Germany, Italy, India, Japan, the Netherlands, Romania, Saudi Arabia, Singapore, Sweden, Switzerland, United Kingdom, Australia and Turkey.

    Q. Has the daVinci® Surgical System been cleared by the FDA?
    A. The U.S. Food and Drug Administration (FDA) has cleared the daVinci® Surgical System for a wide range of procedures. Please see the FDA Clearance page for specific clearances and representative uses.

    Q: Is daVinci® Surgery covered by insurance?
    A. daVinci® Surgery is categorized as robot-assisted minimally invasive surgery, so any insurance that covers minimally invasive surgery generally covers daVinci® Surgery. This is true for widely held insurance plans like Medicare. It is important to note that your coverage will depend on your plan and benefits package. For specifics regarding reimbursement for daVinci Surgery, or if you have been denied coverage, please call the Reimbursement Hotline at 1-888-868-4647 ext. 3128. From outside the United States, please call 33-1-39-04-26-90.

    Q. Will the daVinci® Surgical System make the surgeon unnecessary?
    A. On the contrary, the daVinci® System enables surgeons to be more precise, advancing their technique and enhancing their capability in performing complex minimally invasive surgery. The System replicates the surgeon's movements in real time. It cannot be programmed, nor can it make decisions on its own to move in any way or perform any type of surgical maneuver without the surgeon's input.

    Q. Is a surgeon using the daVinci® Surgical System operating in "virtual reality"?
    A. Although seated at a console a few feet away from the patient, the surgeon views an actual image of the surgical field while operating in real-time, through tiny incisions, using miniaturized, wristed instruments. At no time does the surgeon see a virtual image or program/command the system to perform any maneuver on its own/outside of the surgeon's direct, real-time control.

    Q. Is this telesurgery? Can you operate over long distances?
    A. The daVinci® Surgical System can theoretically be used to operate over long distances. This capability, however, is not the primary focus of the company and thus is not available with the current daVinci® Surgical System.

    Q. While using the daVinci® Surgical System, can the surgeon feel anything inside the patient's chest or abdomen?
    A. The system relays some force feedback sensations from the operative field back to the surgeon throughout the procedure. This force feedback provides a substitute for tactile sensation and is augmented by the enhanced vision provided by the high-resolution 3D view.

    Q: What procedures have been performed using the daVinci® Surgical System? What additional procedures are possible?
    A. The daVinci® System is a robotic surgical platform designed to enable complex procedures of all types to be performed through 1-2 cm incisions or operating “ports.” To date, tens of thousands of procedures including general, urologic, gynecologic, thoracoscopic, and thoracoscopically-assisted cardiotomy procedures have been performed using the daVinci® Surgical System.

    Q. Why is it called the daVinci® Surgical System?
    A. The product is called "daVinci" in part because Leonardo daVinci invented the first robot. He also used unparalleled anatomical accuracy and three-dimensional details to bring his masterpieces to life. The daVinci® Surgical System similarly provides physicians with such enhanced detail and precision that the System can simulate an open surgical environment while allowing operation through tiny incisions.

    Learn More
    To learn more about daVinci® Hysterectomy or any other gynecologic surgery utilizing the daVinci® Surgical System, click here.
    * Also referred to as the daVinci® Robot

    While clinical studies support the effectiveness of the daVinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the daVinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.

    For additional information on minimally invasive surgery with the daVinci® Surgical System visit www.daVincisurgery.com