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DA VINCI ROBOT-ASSISTED HYSTERECTOMY AND LYMPH NODE DISSECTION - page 10 / 17

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the console, you do all those things, you never really have to make and in-quote transition. It doesn't feel that differently in terms of intimacy with the procedure I think than standard laparoscopy where we're standing at the table. You're not actually in another room. There's nothing virtual about this. You're right there using a camera and you're controlling the camera that's in the patient in the same room. 00:31:51 TODD D. TILLMANNS, M.D.: I think that's a fascinating question and when I first -- my vision of what it would be like to do a robotic procedure was I would be behind some glass wall looking in at my patient and using a joystick type thing. So it's actually, once you've seen it, and today's a beautiful example of that, you're in the room with the patient and you're really -- it actually feels much easier than a standard laparoscopic procedure and most doctors who have operated laparoscopically with the robot say they'll never go back to standard laparoscopy because it's just so much easier and it honestly feels like your hands are inside of the patient just like an open procedure except it's a minimally invasive procedure, which is so much better for the patient. 00:32:34 DILJEET K. SINGH, M.D.: So, we have some questions that I think are interesting. One of them is a great question and maybe we'll get Dr. Lowe's take if he has a minute but the question is, “Do you think that robotic surgery will replace laparoscopy in the future?” You just heard Dr. Tillmann's sort of addressing that. I think that for some things it will and for some things it won't. It's like anything else in medicine. We have to choose the right procedures and the right things for the right technology. Sometimes residents make fun of me because I say this but I say, “Everybody doesn't need an iPhone and everybody doesn't need a BlackBerry and everybody doesn't need a Palm,” but there are situations in people's professions and other things that they need those things as opposed to the some things, you can pick up a phone and that's the right technology. So I don't know that it will actually replace laparoscopy because I think there will always be a role for laparoscopy. But for us for example, here endometrial and cervical cancer and gynecologic cancers, the robot clearly allows us to do things that we can't do with standard laparoscopy. So it allows people to have surgeries they wouldn't be able to have, get back to work, get back to their lives faster and I think have better surgeries because there is less blood loss. 00:33:48 TODD D. TILLMANNS, M.D.: I would echo that same statement. He is actually -- one of the questions came from Jennifer and she asked, “Is this a zero-degree scope?” and indeed he is using a zero-degree scope today on this case. Occasionally when we're doing periaortic nodes, we may switch briefly to a 30-degree scope or if you're in a situation where you have to take more of a downward view to get a good angle. Sometimes we'll switch to a 30-degree scope. But this is a zero degree scope today and generally we're able to complete the pelvic and periaortic lymph node dissection and the entire hysterectomy would be as so with the zero degree scope. That's a great question. 00:34:24 DILJEET K. SINGH, M.D.: So, I'm wondering if we can go back to looking at the abdomen of the patient. We have a question here from somebody who's watching asking, “As they instruments travel through the body during surgery, how are we ensuring that the arms are not damaging sensitive parts of the body?” It would be great if we could take a look at the actual patient. That would be fabulous. The thing, it's an experience in that it's set up. At the beginning of surgery we were very careful and the robot has got a lot of protections built into it, so that if it's pushing on a patient or it's meeting resistance. So here you see those are standard trocars that are going through

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