Creating Value with ada Vinci Surgery Program

Presenter NamePresenter Title

Top Concerns Facing Hospital CEOs

Why da Vinci® Surgery?

Why da Vinci® Surgery?Value = Efficacy ÷ Invasiveness2

•Alternative Therapies (radiation)

•da Vinci

da Vinci Incisions

• Open

Surgery

Open Incision

Improving Patient Outcomes & Satisfaction

Improving Patient Outcomes & Satisfaction

In this Section• Improved clinicaloutcomes• Faster recovery time• Faster return to

normal function, activities

• Excellent patientsatisfaction ratings

Conclusionda Vinci Surgery offers the potential benefits of a minimally invasive procedure for complex conditions, with excellent outcomes and fast recovery — across multiple specialties. This results in a very high level of patient satisfaction and a willingness to recommend da Vinci Surgery to others.

Clinical outcomes - Cancer

da Vinci Prostatectomy: Patel VR, et al. Robotic radical prostatectomy: outcomes of 500 cases. BJU Int. 2007 May;99(5):1109-12. Open prostatectomy: Scardino PT. Open radical retropubic prostatectomy. Presented at the American Urological Association’s Carcinoma of the Prostate Course, San Francisco, CA, Sept. 30 – Oct. 1 2005. Lap prostatectomy: Touijer K, et al. Quality improvement in laparoscopic radical prostatectomy for pT2 prostate cancer: impact of video documentation review on positive surgical margin. J Urol. 2005 Mar;173(3):765-8. p. 766 da Vinci Hysterectomy: Boggess JF, et al. A comparative study of three surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy. Am Jrnl of Obst & Gyn. Oct 2008; 360. e1-360e9

Prostatectomy

Hysterectomy

Clinical outcomes - Cardiac

da Vinci Mitral Valve Repair: Murphy D, et al. Multicenter mitral valve study: a lateral approach using the da Vinci Surgical System. Innovations: technology and techniques in cardiothoracic and vascular surgery. 2007 March; 2(2): 56-6Sternotomy Valve Surgery: Society of Thoracic Surgeons Adult CV Surgery National Database - Fall 2005 Executive Summary

Return to normal function

Sexual Function: da Vinci: Kaul S, et al. Robotic radical prostatectomy with preservation of the prostatic fascia: a feasibility study. Uro. 2005; 66, 1261-1265Open: Parsons JK, et al. Effect of methylprednisolone on return of sexual function after nerve-sparing radical retropubic prostatectomy. Urology. 2004 Nov;64(5):987-90Lap: Su, L.M., et al. Nerve-sparing laparoscopic radical prostatectomy: replicating the open surgical technique. Urology. 2004; 64, 123Continence: da Vinci: Patel VR, et al. Robotic radical prostatectomy: outcomes of 500 cases. BJU Int. 2007 May;99(5):1109-12Open: Walsh PC. Patient-reported urinary continence and sexual function after anatomic radical prostatectomy. J Urol. 2000 Jul;164(1):242. p.59Lap: Su, L.M., et al. Nerve-sparing laparoscopic radical prostatectomy: replicating the open surgical technique. Urology. 2004; 64, 123

For men… post-prostatectomy

Return to normal activities

Bell MC, et al. Comparison of outcomes and cost for endometrial cancer staging via traditional laparotomy, standard laparoscopy and robotic techniques. Gynecol Oncol. 2008 Nov;111(3):407-11

For women … post-hysterectomy

Improving Patient Outcomes & Satisfaction

Safety & Quality of Care

Safety & Quality of Care

In this Section - • Reduced blood loss• Shorter OR times• Reduced risk of

hospital acquired conditions

• Lower complication rates

• Lower conversion rates

Conclusion - da Vinci Surgery has been proven to help minimize risksand complications, as well as rates of conversion to open surgery, maximizing patient safety and quality of care for even the highest-risk patients.

Blood Loss

LEFT: Payne TN, Dauterive F. A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice. J Minim Invasive Gynecol. 2008 May-Jun; 15(3): 286-91. RIGHT: Poston RS, et al. Comparison of economic and patient outcomes with minimally invasive versus traditional off-pump coronary artery bypass grafting techniques. Ann Surg. 2008

Benign Hysterectomy

Complications

Major & minor complications in prostatectomy (LEFT): da Vinci: Bhandari A, et al. Perioperative complications of robotic radical prostatectomy after the learning curve. J Urol. 174, 915-918. Open: Brown, J.A., et al. Perioperative morbidity of laparoscopic radical prostatectomy compared with open radical retropubic prostatectomy. Urologic Oncology. 2004; 22, 102-106. Lap: Guillonneau B, et al. Perioperative complications of laparoscopic radical prostatectomy: the Montsouris 3-year experience. The Journal of Urology. 2002; 167, 51-56. In hysterectomy (RIGHT): Boggess JF, et al. A comparative study of three surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy. Am Jrnl of Obst & Gyn. Oct 2008; 360. e1-360e9

Conversions

OR Time (LEFT) and Conversion rate (RIGHT): Payne TN, Dauterive F. A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice. J Minim Invasive Gynecol. 2008 May-Jun; 15(3): 286-91.

Overcoming Capacity Constraints

Overcoming Capacity Constraints

In this Section• Shorter length of

stay (LOS)• Faster OR turnover

time• Maximizing cases

per day through OR efficiency

Conclusionda Vinci Surgery has a proven ability to reduce length of stay across multiple specialties and to match and surpass existing efficiency benchmarks as surgeons and OR staff become proficient with the system.

Length of Stay

Hysterectomy (All): Customer proprietary data, hysterectomy admission trends, community hospital. Reference ISI internal document, 871875. Prostatectomy (open): Dahl DM, et al. Laparoscopic radical prostatectomy: initial 70 cases at a U.S. university medical center. Urology. 2002 Nov;60(5):859-63. Prostatectomy (da Vinci): Bhandari A, et al. Perioperative complications of robotic radical prostatectomy after the learning curve. J Urol. 174, 915-918 Hysterectomy (benign): Payne TN, Dauterive F. A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice. J Minim Invasive Gynecol. 2008 May-Jun; 15(3): 286-91

OR Turnover and Efficiency

Customer proprietary data

OR Turnover and Efficiency

Customer proprietary data

Physician Hospital Relations

Physician Hospital Relations

In this Section• Attracting innovative

surgeons• Surgical residency

and fellowship program adoption of da Vinci

• Inclusion in national surgical society curriculum

Conclusionda Vinci Surgery programs have demonstrated the ability to attract skilled and innovative surgeons, which will become increasingly significant given the prevalence of da Vinci Systems at hospitals with residency and fellowship programs.

Physician Hospital Relations

Adopting New Technology

Adopting New Technology

In This Section• Best practices• Tools for success

ConclusionA commitment to implementing a da Vinci Surgery program by taking full advantage of a strong partnership with Intuitive Surgical, is the fastest path to success.

Adopting New Technology

Six best practices fundamental to building a highly successful da Vinci Surgery program:

HOSPITAL:1) Manage da Vinci Surgery as a keyprogram2) Coordinate operations3) Actively market the da Vinci program

SURGEON:1) Create a vision for your da Vinci practice2) Follow the prescribed clinical pathway3) Actively market your practice

Tools for Success

• Robotic Surgery Program Implementation Whitepaper• da Vinci Surgery Marketing Toolkit• 24/7, 365 days per year customer service• Reimbursement and Coding information hotline• da Vinci Surgery OR Efficiency Guide• da Vinci OR Specialist Program

Summary of da Vinci Program Benefits

Challenge Solution

1) Improving Patient Outcomes & Satisfaction

2) Safety and Quality of Care

3) Attracting Patients

4) Overcoming Capacity Constraints

5) Physician Hospital Relations

6) Adopting New Technology