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DA VINCI ROBOT-ASSISTED HYSTERECTOMY AND LYMPH NODE DISSECTION - page 11 / 17

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the patient and one of the reasons we think that people have less pain with robotic surgery than they do with standard laparoscopy is the actual movement at the level of the skin and muscle is substantially less. They're all fulcrummed right as we enter the abdomen and so we think we get less pain for that reason. If you'll look at the rest of the instruments, they're truly sort of sitting off the patient so the arms aren't hitting the patient, the legs are positioned so they're out of the area, so the chances of hurting someone or damaging a sensitive part of the body is relatively limited and it's one of the good things about the robotic system that it's really well-set up to avoid that. 00:35:45 TODD D. TILLMANNS, M.D.: One of the -- what's built in as one of the safety processes is that the robot takes its cues exactly where it is and where it's location is based upon preset references that you actually set as the surgeon based upon how deep the trocars are placed into the abdomen. There's actually something you can't see on the inside of the abdomen that are little marks that we set so that the robot knows exactly where it is. I thought that initial picture where you saw the abdomen almost looked like it was lit up from the inside and it's because it truly is because the intensity of this light is so great. That's what provides us such wonderful vision and wonderful view is a very nice optical viewing system because the intensity of the camera and the brightness is so nice as well. 00:36:35 DILJEET K. SINGH, M.D.: Maybe we can go back to the surgery now. I'm sure that's what our viewers are interested in. 00:36:39 TODD D. TILLMANNS, M.D.: Yeah, and maybe Dr. Lowe, you can describe a little bit of what you're doing right now. 00:36:44 M. PATRICK LOWE, M.D.: A few little adhesions here between the fallopian tube and the medial leaf of the broad ligament. What you can see is we have now some adhesions right next to our friend the ureter right here and what we did we just mobilized that out of the way. We can clearly see it now. We just have a few more adhesions along this medial leaf. The broad ligament sort of mobilized to get the ureter away from the field of dissection. Then what we'll do on this side is divide the ovarian vessels and proceed with further dissection along the lateral aspect of the left side of the uterus. Okay? Then divide the uterine vessels on the left side, complete the hysterectomy, and then hopefully will get to a portion of the lymph node dissection before the conclusion of the program. Here you can see -- let me just point this anatomy out to you. Here's the fallopian tube, here's the ovary, here's the ovarian vessels. Once again on this side, this is the round ligament, external iliac artery, superior vesicle artery. Here's is our obturator space where we'll be later dissecting some lymph nodes out from around the obturator nerve. Also once again on this side you have your external iliac vein, which is right there, compressed a little bit from the pneumoperitoneum, but otherwise it's very visible, okay. 00:38:05 DILJEET K. SINGH, M.D.: Just some other really quick questions, we had a question about shoulder palsy and the incidence with this kind of surgery. I suspect you're asking about what we call brachial plexis injuries. Those do happen during surgeries and they have to do with how the arms are positioned. They don't happen in surgeries like because the arms are actually positioned by the patient's side. That kind of stretch injury that happens when your arm is out, so I'd say it's zero. 00:38:35

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