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DA VINCI ROBOT-ASSISTED HYSTERECTOMY AND LYMPH NODE DISSECTION - page 14 / 17

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want to do, Anna, here is get inside that little peritoneal [unclear] that I have divided and just isolate the vessels only. Good, right there. Is that the handle is longer than a lot of the other uterine manipulators and so you do have a little bit of limited access to the peritoneum and to the vagina when you're using the robotic system. I don't know if we can flash over to the camera really quick to the patient and see where the robot is actually positioned between the patient's legs. Okay? Let's Antivert the uterus a little bit more, Margarita. 00:45:33 DILJEET K. SINGH, M.D.: You need to pan down to the foot of the patient actually just to show what Dr. Lowe is talking about. 00:45:37 M. PATRICK LOWE, M.D.: So, what happens is if you have a patient who's really obese, you may have an even less access to the vagina. So what this uterine manipulator does, it has a cup that's placed at the junction of the cervix to the vagina and when you elevate the uterus it will bulge out and I'll demonstrate this for you guys really quick. It will actually bulge out the anterior vaginal wall right here. So what it does is it really allows us to push that bladder down even further and it identifies the line of the incision that we're going to make for the completion of the hysterectomy. 00:46:16 TODD D. TILLMANNS, M.D.: There is another question here. “Are there further applications for robotic techniques in gynecologic or obstetric interventions?” Probably not as many obstetric interventions, but certainly gynecologic. There are other physicians that do sacral [unclear] using the robotic procedure. They have some urogynecologists where we are that are doing that now. As well, you can do myomectomies. You can certainly do super-cervical hysterectomies as well. Pretty much anything that you can do laparoscopically, you can do with a robot in a similar fashion. So just about anything gynecologic that can be done with standard laparoscopy. 00:46:59 DILJEET K. SINGH, M.D.: We could actually, if we have a moment, we've got some slides on sort of the different oncologic applications that we've had. Maybe we can take a few minutes to go through those. 00:47:13 TODD D. TILLMANNS, M.D.: What Dr. Lowe is doing right now is he's just kind of once again showing the great visualization of the robot. You can see his hands once again moving and manipulating the device. For those who have not turned in earlier, this is how he controls the instruments. You can see the hands moving back and forth underneath the surgeons console and they're transmitted directly to the robot. 00:47:50 DILJEET K. SINGH, M.D.: Great, and while we're kind of getting to those, we could even take a little time to go back into surgery and Dr. Lowe has used a couple different instruments to coagulate vessels, but I think watching him coagulate the vessels laparoscopically with the laparoscopic instruments, I think is very interesting. The instrument we used previously, he talked about, but I think this is another way to do it. I don't know how you do it. 00:48:15 TODD D. TILLMANNS, M.D.: Yeah, I think one of the nice techniques that he's demonstrating here is activating the bipolar device before he actually touches the tissue. That's something that's a subtle little trick but it actually helps prevent collection of the charred tissue on the instruments and allows you to have better coagulation with further episodes of use. As you can see right now, he used the bipolar to seal the vessels and now he's using the monopolar hot shear scissors to kind of

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