Hysterectomy A Success With Combined Robots
EndoControl, the French company specializing in advanced laparoscopy just experienced its first success with the new application for their ViKY® robot: a Uterus Positioner.
On July 22nd for the first time in Europe, ViKY® was used in combination with the da Vinci surgical robot. Mr Peter Barton-Smith, Consultant Gynaecologist at the Royal Surrey County Hospital specializing in Minimal Access and Robotic Surgery was sitting in front of a da Vinci operating console wearing a wireless headset to control ViKY®. With very simple voice commands he was able to position the uterus in the optimal way for surgery.
ViKY® was attached to a uterine manipulator, a device which is inserted into the uterus and enables the surgeon to maneuver and position the uterus during the operation. By utilizing ViKY this avoided the need for an assistant sitting between the patient’s legs who has to try to respond to the surgeon’s instructions in order to position the uterus.
Patient underwent a total laparoscopic hysterectomy (TLH) and bilateral salpingo-oophorectomy for severe endometriosis. As the procedure was carried by minimally invasively robotics she only required four 1cm incisions in the abdomen. As a result she was discharged home in less than 24hrs the following day and will benefit from reduced pain and a faster return to normal activities.
Following the success of the ViKY® Endoscope Positioner, which has enabled more than 100 surgeons around the world to control the camera and scope themselves during laparoscopic surgery, the company decided to extend ViKY® applications by adding the ability to perform uterine manipulation for gynaecological surgery. ViKY can be used in conjunction with various uterine manipulator systems.
ViKY® is a very simple compact robot which takes up no floor space since it is attached to the operating table. The robot is voice or foot controlled by the surgeon for improved ergonomics and precision.
What does the surgeon say? Mr. Peter Barton-Smith, the operating surgeon declared: “Working with both robots makes it easier to operate since I can control multiple functions including the camera, instruments and uterine manipulator movements. The patient’s uterus is firmly held and proper upward traction is maintained throughout the procedure. Voice control of the ViKY® robot enables me to stay focused and get a rhythmn in my surgery by allowing me to position the uterus exactly how I want it without having to get up from the console or continually ask my assistant to readjust the position”.
How does ViKY® Uterus Positioner work? Correct positioning the uterus during laparoscopic hysterectomy is a crucial since it enables the surgeon to efficiently access the structures to be dissected and divided with precision thereby reducing the risk of complications such as vessel, ureter, bladder or bowel injury. According to Dr. Charles Koh, inventor of the Koh Colpotomizer, “During laparoscopic hysterectomy, significant upward traction must be applied to the cervix and uterus. This facilitates dissection of the ascending uterine arteries in a manner that reduces the risks of ureteral injury.”
Usually this traction is achieved by an assistant holding a uterine manipulator who moves it according to surgeon’s orders. During long procedures and in complex cases, it is difficult for the assistant to remain precise and steady.
With ViKY®, no risk of fatigue or incontrollable movements: with 3 degrees of freedom (anteversion & retroversion, lateral positioning and upward & downward traction), the system holds the uterus in a precise and stable position. The surgeon himself has total control of ViKY® through a multifunctional footswitch or a Bluetooth headset for voice control. Ergonomics are improved and procedures completed effectively and safely.
ViKY® UP can be used during major procedures such as robotic assisted hysterectomy. Dr. Arnold Advincula from Celebration, Florida is familiar with such a mix of technologies. He explains: “ViKY® doesn’t get tired and it maintains upward traction and holds the uterus in place, and throughout the course of the case and I have full control of the position of the uterus directly from the operating console.”