Robotic Surgery Presented by KatieMcAleer
Objectives • Robotic Surgery using the da Vinci Surgical System • Components of the system • Nursing Roles in robotic surgery • Legal and ethical issues • Does robotic surgery benefit nurses?
What is robotic surgery?? • Surgeon controls movement through robotic arms • One arm controls the camera and scopes • The other arms control robotic surgical instruments • Trocars are inserted through tiny incisions • Can be used for: • Cardiac surgery • Gynecologic and Urologic surgery • Weight loss surgery Tabor (2007)
Robotic Surgery vs. Traditional Methods ROBOTIC sURGERY Traditional/ Laparoscopic surgery • Greater dexterity, precision, and control • Three dimensional view • Better camera stability • Improved ergonomics • Limited dexterity, precision, and control • Two dimensional view • Camera instability • Poor ergonomics Tabor (2007)
Hardware Components • Surgeon console • Patient side cart with robotic arms • EndoWrist Instruments • Vision System • Assistant Monitor Intuitive Surgical (2005)
The 3D Vision System • High resolution 3D endoscope • Two independent vision channels • Two high resolution monitors • Surgical camera repositioned with foot controls. • Noise reduction equipment Intuitive Surgical (2005 )
Software • 3-Dimensional video software • Allows the physician to conduct surgery. • Robotic hardware is driven by proprietary software. • The software was developed in 1994. • Currently uses version 11. Intuitive Surgical (2005)
Is this software user friendly? • Preference for design • Focus of use is on the physician and healthcare team. • Software version 11 • Studies showing effectiveness
System Review • Dedicated special purpose system • Used by trained physicians • What surgeries can the da Vinci be used for? • Stand alone system using proprietary software • American National Standards Institute Intuitive Surgical (2005)
Advantages of the da Vinci • Reduced body trauma • Reduced blood loss and need for transfusion • Less pain and discomfort • Less risk of infection • Shorter hospital stay and quicker recovery • Smaller scars
Advantages for Healthcare Workers • Greater surgical precision • Improved dexterity for the surgeon • Excellent visualization • No fulcrum effect
Disadvantages • Expensive capital and running cost • No tactile feedback • Reduced trainee experience • Lengthy set-up times • Large layout • May require extra storage space Murphy et al. (2008)
Informatics • Half day training session at the hospital • Hands on practicum for surgeons and nurses • Off site training at regional training center • Live procedure observation • Clinical support with laboratory sessions • Staff training includes software and hardware. Intuitive Surgical (2005)
Legal Issues • Injury from the machine • Patient choice • Possibility of machine malfunctions • Physician preparation Murphy et al. (2008)
Nursing Roles in Robotic Surgery • Ensure the patient has given informed consent • Check all cords and equipment are off of the patient • Patient positioning • Thorough understanding of the hardware and software • Trouble- shooting Tabor (2007)
da Vinci Surgical System • Technology advances allows for improved patient outcomes • Minimal disadvantages • Low risk • Reliable training • Higher output with staff efficency • Continued software improvements.
Reliable Technology • Recommended by many physicians • Improved patient outcomes • Thorough training • Cost offset • 19 training centers in the U.S. • Ease of use • Clinical collaboration Intuitive Surgical (2005)
References • Intuitive Surgical, Inc. (2005). The da Vinci surgical system. Retrieved November 12, 2008 from http://www.intuitivesurgical.com/products /davinci_surgicalsystem/index.aspx • Murphy, D. G., Hall, R., Tong, R., Goel, R., & Costello, A.J. (2008). Robotic Technology in surgery: Current status in 2008. ANZ J. Surg. 2008; 78: 1076–1081. • Tabor, W. (2007). On the cutting edge of robotic surgery. Nursing2007, 37 (2), 48-50.