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DA VINCI ROBOT-ASSISTED HYSTERECTOMY AND LYMPH NODE DISSECTION - page 16 / 17

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then we remove that and then we close that. That's something that I know patients always find it funny that we call something a vaginal cuff, but that is essentially the vaginal cuff and you'll see where it's closed and you can see why this is probably the biggest incision that we have when we do our robotics case. It's an incision at the top of the vagina. All of the other incisions are a centimeter or less, the ones on the abdomen. 00:53:23 TODD D. TILLMANNS, M.D.: This is the part of the case where after you've been doing robots for a while and my OR nurse, she and I joke at this point at the procedure, because I say, “Can you feel me touching you right there, because I can feel it,” and even though I can't actually feel my instruments touching up against the top of that cup, it really does see -- your mind and your eyes play tricks on you that you can actually feel it. I saw Dr. Lowe do that just a minute ago and I know that was the same sensation that he had. Maybe we can get back to Dr. Lowe and tell us if he can give us some comments about what he's going through right now. 00:54:02 M. PATRICK LOWE, M.D.: Yeah, and so right now we're just sort of making the vaginal incision, sort of finishing up here on the left side with mobilizing our uterine artery laterally, away from where our cuff angle is going to be, our vaginal cuff angle, which we will suture together a little bit later in the case, and it's just like Dr. Tillmanns said, once you identified the cup from the uterine manipulator, it actually has a groove right there and you can follow that groove all the way around to complete the vaginal incision. The nice thing about this so far, we haven't taken the camera out, we haven't changed our instruments, our visualization has been fabulous, and the other nice thing is -- I don't know if we'll be able to show, but we actually have a smoke filter that we place through the camera port. Margarita, let's retrovert the uterus a little bit, please. That's good right there. -- that actually allows us to vent a lot of the plume from the smoke and that helps. If anyone has used a lot of electrocautery during their surgeries and their procedures, you'll quickly realize that if you don't have very good ventilation or very high flow from your insufflation system you'll generate a lot of smoke. Then what will happen is that smoke will obscure your vision and then it will actually create a mist or a fog on your camera and then you repetitively are taking your camera out of the patient's abdomen, wiping it off, exposing it to cold air, putting the camera back in, and then once you get your camera lens cold, you place it back inside a patient who's body temperature is 95, 96 degrees Fahrenheit, well, it continues to fog. So, one of the nice things is we've got good visualization. We're mobilizing our smoke out of the patient's abdomen, maintaining a good abdominal temperature. We don't have any fogging of the camera system and so far this case is going very well. We should have the uterus out here shortly. Margarita, if you could just hold still right there. 00:56:35 DILJEET K. SINGH, M.D.: The case has really gone beautifully. We are going to need to wrap up in a few minutes. If we have any other email questions, that would be wonderful. We'll probably have a couple seconds to take those and take a peak at those. 00:56:46 M. PATRICK LOWE, M.D.: How much time do we have, Dr. Singh? 00:56:48 DILJEET K. SINGH, M.D.: Dr. Lowe was talking a little bit about the systems. I think for surgeons who are sort of adjusting to the robotics as opposed to standard laparoscopy, I do think that's probably one of the biggest adjustments. I don't know if you agree Dr. Tillmanns, but sort of needing to control, needing to move things around, sort of having everything set up at the

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