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DA VINCI ROBOT-ASSISTED HYSTERECTOMY AND LYMPH NODE DISSECTION - page 15 / 17

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come along that area right there. That's really nice as he's getting close and ready and prepared to come around the uterine manipulating device to enter through the vagina. 00:48:57 DILJEET K. SINGH, M.D.: Why don't we just take a couple minutes. People are asking questions for things that I think we had some slides that would be addressing those questions. I think Dr. Lowe has addressed this aspect. When the program was established here, we were pretty bare bones and that we're excited to have Dr. Lowe come join us. At that time we had goals that sort of were directed around both education and then increasing the amount of surgery that we were approaching from a minimally invasive procedure. I'll take the next slide. Right now, sort of a year later, a month from a year later, we have four surgeons, board-certified gynecologic oncologists who are using the robotic system. We've made numerous videos. We are continuing to proctor surgeons here in house and in other places. We have something called “N-CASE”, which is essentially a lab where we teach residents and fellows and other doctors getting trained in laparoscopic surgery and now we're able to use the da Vinci there to further education. Our initial goal been that we do at least 50 cases in the first year. As you can see, we surpassed that. At this point in time, we're really approaching about 50 percent of our practice of endometrial and cervical cancer using minimally invasive methods. I'll take the next slide. So someone asked sort of what procedures can you do. So far, at least in our program, we've been doing simple and radical hysterectomies, pelvic and periaortic lymph nodes, doing what we call omentectomies, that be part of both uterine cancer and ovarian cancer. We've treated endometrial cancer, uterine sarcomas, cervical cancer, other tumors of the ovary, benign and malignant tumors of the ovary, and then we've taken care of a number of benign uterine diseases. I think one of our questions asked about that and Dr. Tillmann was addressing that. Things like fibroids, endometriosis, other diseases that can sometimes be challenging, that a robotic system offers us things that -- ways of visualizing, offers us mobility, offers us the ability to access things in a different way. I'll take the next slide. We can kind of get back to surgery quickly, so I'm just going to go through these pretty quickly. That's just looking at sort of the number of cervical cancer patients treated with robotics versus a traditional open procedure and I think our next slide will give us the opportunity to look at endometrial cancer. We see again a substantial shift from about ten cases to 53 cases. Over half of our cases. I think that's the last of that and I think that does address all the questions that we got sort of directed at this. 00:51:49 TODD D. TILLMANNS, M.D.: Yeah, this is a really nice time because Dr. Lowe is now, as his assistant pushes up from below on this manipulator, he is actually outlining around the vagina and you'll see that manipulator come into view and you'll see a little flash of the green color of the manipulator show up in just a few moments and it's serving as almost like a cup that is against the vagina and the cervix would be almost inside of that cup and as he uses the monopolar device known as the hot shears to come around that cup, you'll see a flash in just a few moments. He's just about there now. This is really the fun part about the case as you're drawing near to removing the uterus and the tubes in the ovaries. There you saw -- what you can't see is he can see that little flash right there. That's a beautiful picture of that. 00:52:40 DILJEET K. SINGH, M.D.: And I have to say for people who are considering undergoing this procedure or patients who are watching, I think this is one of the things that I always find is hard to explain to people or hard to visualize, “What's going to be left at the top of my vagina?” and now you're going to essentially see that there's sort of a circle that attaches the cervix to the vagina and

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