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about when we do an open surgery, but sometimes in standard laparoscopy is something we struggle with because we aren't always able to see things just as we want, which is something that's completely removed from the picture when we're doing things with the robot. 00:24:37 TODD D. TILLMANNS, M.D.: Yeah and I think, like you brought up, I think the other thing is that sometimes the person that's assisting you has to almost anticipate where you want to look with the camera and the standard laparoscopy, whereas with the robot, you have to anticipate your own movements, which as we all know is very easy. 00:24:52 DILJEET K. SINGH, M.D.: Right, we know what we want. 00:24:54 TODD D. TILLMANNS, M.D.: Exactly. 00:24:56 DILJEET K. SINGH, M.D.: Just like everybody else out there. Again, don't forget, if you guys have any questions for us, please feel free to email us, we're happy to answer questions. It looks like Dr. Lowe is sort of now on the other side. Maybe we can take it back and look in the surgery. 00:25:12 M. PATRICK LOWE, M.D.: Yeah, so what we're doing right now, we've completed the dissection on the right side of the patient's uterus, and so what you can see is, here is our Foley bulb inside the bladder. Here is the edge of the bladder peritoneum, we've dissected that away. One of the nice things when you compare it to conventional laparoscopy is when you're developing your bladder peritoneum and what you can do with the robotic system since the instruments are wrested. What I can do is just push that down as if I was doing an open surgery and so I kind of think that robotics mimics more open traditional surgery than laparoscopy because the instruments are wristed. And another advantage that I think is really wonderful is the camera is three-dimensional so I have depth of field, so I know precisely how far I am away with this grasping instrument from picking up that piece of tissue, as compared to a conventional laparoscopy which is two-dimensional. This is where we're going to make our incision when we've completed the hysterectomy. This is going to be the vaginal incision to remove the uterus. What you can see over here and I'll demonstrate this on the left side is you can see where we've divided the uterine arteries here and carried those all the way down to where we're going to be making our vaginal incision. What's really nice, this patient has a wonderful anatomy, not only for teaching but also for the purposes of this presentation. Here you can the patient's ureter traveling into the pelvis, past the uterine artery, and into the bladder. So, we'll start working back on this side, on the left side a little bit more. This is that avascular space of Graves that I'm talking about. I'll show it to you in just a second. This is part of the bladder peritoneum right here on the left side. It's always important to mobilize the bladder away from the uterus. It involves the anterior surface of the uterus when you're doing hysterectomy. And making sure that you have nice adequate vaginal margins so that when you close the vaginal cuff together, you're bladder's not close to that area and we have that down very nicely right there right now. 00:27:32 TODD D. TILLMANNS, M.D.: Patrick, can you hear me? I wanted to -- what you just did with that bladder where you flattened out your instrument and kind of pushed the bladder off of the top of the uterus, that's a really nice technique which you just showed a few minutes ago and I think that in a lot of proctored cases, showing that and teaching that technique to people learning it is just a wonderful way to teach them how to basically take down that bladder so nicely and so carefully.

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