Da Vinci Robotics a UK experience

1
Da Vinci Robotics a UK experience

• Mr Chris Ogden MS FRCSUrol FEBU

2
Introduction

• Experience of the first group in the UK to be
  recognized in the Da Vinci Prostatectomy
• Chris Ogden Consultant Urologist at Imperial
  College London based at Chelsea and Westminster
  and St Marys Hospitals with colleagues Mr Omer
  Karim, Mr Justin Vale and David Hrouda

3
Topics of Discussion

• Set up and training model
• Early experience
• Overall results
• Current Experience

4
Training Model 1

• Initial attendance to the Detroit Robotic
  symposium in Autumn 2004
• The European school of surgery in Paris Cadaver
  work October 2004
• Mentoring with 1st,2nd then 10th and 12th case

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Training model 2

• Four surgeons
• three with laparoscopic experience three with
  open experience
• Operation divided into four phases
• Surgeons rotated every five cases
• After twenty cases complete operations performed
• After forty cases operating independently

6
Patient cohort

• Over 120 procedures since beginning of 2005
• 18 T2 disease on DRE
• 14 Gleason 4 or above
• PSA average 6.68 Max 19 Min 1.25

7
Pathological Results

• 20 Margin rates
• 15 Lateral Margins
• 7 apical Margins
• 0 bladder neck margins
• 3 seminal vesicle involvement

8
Surgery Time

• Total time Average 300mins. Best 200mins Worst
  530mins
• Robot setup time for fist 2 cases 50mins now 8
  mins
• Anesthetic time one hour
• Consol time Average 236mins, Minimum 161mins,
  Maximum 423mins

9
Immediate Complications

• Average Blood loss first 40 cases 1000mls last
  40 cases 521mls
• Three conversions
• Two rectal injuries
• Two abandoned
• Three robotic failures
• Three urinary leaks with ileus
• One ileus

10
Late Complications

• Two Pulmonary Embolus
• Early incontinence 60
• Late incontinence 3
• Early erectile dysfunction 90

11
Lessons leant

• Bladder neck reconstruction has improved early
  incontinence
• Define bladder neck laterally first