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DA VINCI ROBOT-ASSISTED HYSTERECTOMY AND LYMPH NODE DISSECTION - page 4 / 17

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DILJEET K. SINGH, M.D.: I guess that's a topic we haven't really gotten to, surgical recovery after surgery like this. 00:09:33 TODD D. TILLMANNS, M.D.: Right. What are your, for instance, in a non-robotic approach, what would you say your average length of stay in the hospital would be after an open procedure, a standard hysterectomy and removal of lymph nodes and ovaries through a big vertical incision? 00:09:49 DILJEET K. SINGH, M.D.: For us, and I think we're pretty aggressive about trying to get people back on their feet and eating and drinking, but people stay in-house at least two nights, with an average of three and I think that's pretty nationally accepted. For our patients who undergo robotic surgery, people go home the next day. 00:10:08 TODD D. TILLMANNS, M.D.: Which is nice. Then, for recovery time, what would you estimate as a recovery time for a standard open procedure compared to this robotic procedure? 00:10:17 DILJEET K. SINGH, M.D.: You know, it's interesting, as we talk to patients we sort of talk about, “Oh, in four to six weeks you'll be feeling better,” but I think honestly it takes eight weeks before people aren't uncomfortable and are definitely not using pain medicine. For me, I think about two weeks after a robotic procedure. It takes us that long roughly to have people kind of back at their working level. Would you agree with that? 00:10:40 TODD D. TILLMANNS, M.D.: I would. It was interesting, and this is anecdotal information, but I think it's kind of the fun part about doing the procedure is you will have patients come up and tell you about their own personal experience, and one of my patients who is a 70-year old woman, she said, “You know, I've never had to work in my life, but if I was a working mother, I wouldn't want any other procedure than this,” and the reason why is she said, “I really felt like after having surgery on a Wednesday, I could go back to work on Monday morning,” which surprised me. 00:11:08 DILJEET K. SINGH, M.D.: I had a patient who taught from 9 am to 1 pm against my advice actually, four days after her hysterectomy lymph node removal and she's 67 and in reasonable good shape and she said this was a class she had to teach and something she needed to communicate. It was at the end of the school year and it was really important to her. She said she was fine. She though I was sort of silly and overprotective. So I don't know if Dr. Lowe would like to take a few minutes to talk with us. 00:11:37 M. PATRICK LOWE, M.D.: Yeah, let me get you guys caught up to where we're at and so what I normally do for all these procedures, specifically for patients with endometrial cancer, I think Dr. Tillmanns and Dr. Singh kind of pointed out that we like to open up the retroperitoneal space and there's a portion of the broad ligament and there's actually an avascular space of Grave's that you saw me open and divide earlier. Here you can see the external iliac artery. Under that's going to be the external iliac vein. This here is going to be your superior vesicle artery. What this allows you to do, at least in robotic cases and also laparoscopic cases, is to open and develop the space. What that does is, when you come back later to do the lymph node dissection, when you have this space open and develop, I think it facilitates your lymph node dissection after you've completed the hysterectomy. In addition, we like to divide our ovarian vessels close to the pelvic brim which will allow us to later on in the case -- this is the common iliac artery here going up to the bifurcation of

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