Robotic Surgery in

Urogynaecology

Marcus Carey

Sacral Colpopexy

425,000 POP procedures on 300,000 women 2010 in US Reuters Thompson

Traditional Repair

Mesk Kits

Sacral Colpopexy

71%

13%

16%

‘At least 100,000 POP repairs used mesh and about 75,000 were

transvaginal procedures’ FDA news release 2010

da Vinci Si System

Port placement

Robot docking

Robot Console

‘Surgeons performing minimally invasive sacrocolpopexy experienced

less neck, shoulder, and back discomfort when surgery was

performed robotically’ Tarr 2015

‘Ultra-light’ and ‘smart’ meshes

TiMESH 16 or 35g/m² ; has a 30nm bonded layer of titanium

Y Shaped Sacral Colpopexy Meshes

Sacral Colpopexy with S-POP

10

Robotic Sacral Colpopexy

for Uterine Prolapse

Types of Sacral Colpopexy

Total Hysterectomy and Sacral Colpopexy

Subtotal Hysterectomy and Sacral Colpopexy

Sacral Hysteropexy

Appropriate preclinical robotic courses and skills laboratory

30 sacral colpopexy cases per anum

5 cases under preceptor supervision

Audit of cases

Registry

Epworth Credentialing for RSC

0

10

20

30

40

50

60

Laparoscopic Robotic

n=48 (46%)

SC

or

SH

Cas

es 2

014

Laparoscopic and Robotic SC or SH for 2014 (n=105)

n=57 (54%)

0

10

20

30

40

50

60

70

80

1 2 3 4 5 6 7 8 9 10

Con

sole

Tim

e (m

ins)

Case number

Robot console time for sacral colpopexy

Median 58 min (range 53-72 min)

Robotic Removal of TVT

Removal of TVT

Robotic Surgery in Urogynaecology:

What does the future hold?

The Future: what is needed

A robot for all surgical disciplines

Equivalent cost to straight stick

High usage

Small

Adaptable to any theatre

Modular

Quick set up

The Future: what is needed

Removal of the barrier of console

Robotic surgery ideally replicates straight stick

Port sizes 5mm

Port positioning identical

Access to all four quadrants

Operation identical

Haptic feedback

Manual manipulation

Intelligent use of instruments

da Vinci Systemsda Vinci Systems

ConsoleConsole--basedbased

Key patents expiring 2016 and 2017Key patents expiring 2016 and 2017

System is large and cannot easily and costSystem is large and cannot easily and cost--effectively effectively

perform many procedure typesperform many procedure types

System adds System adds ~$~$2,500 per procedure2,500 per procedure

Installed base: ~3,500 globallyInstalled base: ~3,500 globally

da Vinci Xi and Single Site

Xi

Single Site 25 mm

MedrobotixMedrobotix Flex®Flex®

SOFAR SOFAR –– TelapTelap AlfAlf--XX

AlphaAlpha--x x -- 2014 2014

Titan

Verb

Johnson &Johnson

DLR DLR -- MIROMIRO

Cambridge Medical Robotics