5 CHINA-HOSPEQ 2009 China Med 2010 da Vinci da Vinci Robotic Endo-laparoscopic Operating Team Of Pamela Youde Nethersole Eastern Hospital Nursing Pers

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2 5 CHINA-HOSPEQ 2009 China Med 2010 da Vinci da Vinci Robotic Endo-laparoscopic Operating Team Of Pamela Youde Nethersole Eastern Hospital Nursing Perspective: da Vinci Thyroidectomy Robotic Thyroidectomy in Hong Kong Sanatorium Hospital Short-term Outcome of Patients with Robot-assisted Versus Open Radical Prostatectomy: for Localised Carcinoma of Prostate Robotic Radical Prostatectomy in East Asia: Development, Surgical Results and challenges

3 Underwood 2005 Underwood

4 CHINA-HOSPEQ 2009 CHINA-HOSPEQ D da Vinci DepthQ

5 China Med (China Med 2010) Depth Q 4

6 China Med China Med

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8 da Vinciconsole surgeonpatient-side nurse da Vinciconsole surgeonpatient-side nurse da Vinciconsole surgeonpatient-side nurse

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10 Robotic Endo-laparoscopic Operating Team Of Pamela Youde Nethersole Eastern Hospital APN Anita Yeung Yuk Mui, Pamela Youde Nethersole Eastern Hospital, Over the past three decades, we have witnessed the evolution of endoscopic techniques and minimally invasive surgery (MIS). With the endoluminal approach and MIS, the needs of both techniques incorporated in the same Operating room (OR) became a real concern. An Endo-laparoscopic OR was established in Pamela Youde Nethersole Eastern Hospital in 2005, the first theatre of such kind in Asia. Over the last four years, the tools in armamentarium of Endo-laparoscopic OR have diversified. With the introduction of robot in the late 1990s, it has paved its way to become an integral part of armamentarium of MIS. The robot was integrated into our new Robotic Endolaparoscopic OR in 2009 to serve as one of the tools in MIS. MIS tools are concurrently used in applying the best technique to the patients when it is needed, and robot is viewed as no difference from the other tools in MIS. Nursing Roles in Robotic Surgery Two nurses from our unit including me attended a two-day hands-on training course at Intuitive Surgical Training Centres in United States early last year. My colleague also attended the Coordinator Training. Subsequently we sent eight more nurses to the Jockey Club Minimally Invasive Surgical Skills Centre (MISSC) in the Chinese University of Hong Kong for robotic training. Afterwards, we organized our in-service training program which is a two half day session course with ten participants each class. We have organized two classes since May 2009, and the third class is scheduled at end of March, These training programs are valuable as they provide the initial knowledge in the set-up of robot before actual practice on site. Further regular refresh training is required to consolidate their skill, and to experience the tricks in problem solving and trouble shooting. Beside the training program, we also arranged our operating surgical team not only the nurses but also the doctors into different groups to visit other robotic centers for live procedure observation and experience sharing. Cable management is one of our major concerns when using the Da Vinci S Surgical System in our Operating Room. We tailor- made linked metal covers for the cables, taking references from overseas hospitals. They are not only useful in protecting the cables, but also in alerting staffs from tripping, thus promoting the occupational safety in workplace. We are using anti-sliding foam to maintain patient in correct and stable position during robotic surgery to ensure patient safety. We have designed our own booking, recording and reporting systems which facilitate our communication in daily practice, for subsequent audits and for further improvements. Last but not least, we prepared our procedure guide books with updated information for different kind of robotic operations. Team work and good communication are of paramount important in OR, as it facilitates smooth operation of the Robotic Endo-Laparoscopic OR, ensuring ease of operation and patient safety. Robotic Endo-Laparoscopic OR Since May, 2009, over 80 robotic-assisted surgical operations including robotic prostatectomy, hepatectomy, biliary bypass, total mesorectal excision, abdominoperineal resection, thyroidectomy and oesophagectomy and total hysterectomy h a v e b e e n p e r f o r m e d i n o u r h o s p i t a l. T h e n e w R o b o t i c E n d o - l a p a r o s c o p i c O R w i t h the integration of the new imagining system

personnel in the operating room. This enables the team to work in synchrony and harmoniously with the console surgeon.

hospital training centre, as well as those in Hong Kong and overseas.

11 was completed in December It is equipped with two 3-dimensional monitors for the surgical assistants and operating room team a unique design by our medical physicist for Pamela Youde Nethersole Eastern Hospital. 3D-imagines previously enjoyed by the console surgeon only, are now shared by the patient-side surgeon, anaesthesiologists, the nurses and other personnel in the operating room. This enables the team to work in synchrony and harmoniously with the console surgeon. The integrated audiovisual system allows transmission and communication from the operating room to the lecture theatres and conference rooms in the hospital training centre, as well as those in Hong Kong and overseas. Not only our patients, but surgeons and nurses enjoy the full benefits of this OR design - it is easier for the surgeons, simpler for the operating room staffs and safer for the patients. Hopefully this will become the future of our OR design all around the world. Robotic Endolap OR in Pamela Youde Nethersole Hospital Grand Opening of Robotic Endo-Lap OR in Pamela Youde Nethersole Eastern Hospital Hands-on training course at Intuitive Surgical Training Centers in United States In-service Training

12 Nursing Perspective: da Vinci Thyroidectomy YUE, Sau-wai, Registered Nurse (OTS), QMH, HK. Starting from September, four cases of robotic assisted thyroidectomy have been performed successfully in Queen Mary Hospital, Hong Kong by November take up most of the roles in preparing the theatre, calibrating and draping the machine, patient positioning, docking of the patient cart as well as preparing the equipments. In the nursing perspective, peri-operative nurses Key Points for Sharing da Vinci Thyroidectomy Patient Positioning (for a right side lesion) The approach of da Vinci thyroidectomy is different from the conventional open thyroidectomy, which is a gasless trans-auxiliary approach: Place the patient in supine position. Position the patient s right arm in extension along side the head to exposed the axilla area so as to create the shortest distance for the dissection from the skin incision to the thyroid. Pad pressure points and bony prominences. Position the patient s left arm alongside the body to lessen the possibility of shoulder injury. Retraction of the Strap Muscles A special designed thyroid retractor system with table mount lift is used to create the working space and aid in smoke evacuation during electro-surgery.

through improved dexterity and precision, advanced imaging techniques with threedimensional depth perception, may reduce likelihood of recurrent

13 Patient Cart Placement and Docking The patient cart should always drive in contra-lateral to the location of the thyroid lesion. Potential Patient Benefits The use of robotic assisted technology as a mean to overcome traditional surgical limitations in open thyroidectomy, through improved dexterity and precision, advanced imaging techniques with threedimensional depth perception, may reduce likelihood of recurrent laryngeal nerve damage as well as improve preservation of parathyroid glands. Moreover, the patient can obtained an excellent cosmetic outcome because of no neck scars.

Robotic Thyroidectomy in Hong Kong Sanatorium Hospital Three clinical cases of Robotic Thyroidectomy with Bilateral Auxiliary Breast Approach (BABA) in HKSH were successfully performed by Anthony

14 Robotic Thyroidectomy in Hong Kong Sanatorium Hospital Three clinical cases of Robotic Thyroidectomy with Bilateral Auxiliary Breast Approach (BABA) in HKSH were successfully performed by Anthony Yuen Powing, a professor of otorhinolaryngology at University of Hong Kong since December All the patients were well post-operatively with no adverse effect and with minimal blood loss. visualization at the neck area, desired cosmetic results and minimal post-operative pain. The thyroid gland often posed a difficult challenge for many endoscopic surgeons. Robotic surgery with da Vinci surgical system is useful in this area due to its excellent magnification, intuitive movement and wrist-like instrumentations. This approach provides an excellent operative

15 Short-term Outcome of Patients with Robot-assisted versus Open Radical Prostatectomy: for Localized Carcinoma of Prostate Lo KL, Ng CF, Lam CN, Hou SS, To KF, Yip SKh. (Courtesy of Professor Sidney Yip) Division of Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong. OBJECTIVE. To compare the short-term outcome of patients undergoing robot-assisted versus open radical prostatectomy. DESIGN. Retrospective analysis of prospectively collected data. SETTING. A university teaching hospital in Hong Kong. PATIENTS. Twenty consecutive cases having robotassisted radical prostatectomy were compared with the last 20 cases of open radical prostatectomy (prior to November 2005 when the robotic system was introduced). MAIN OUTCOME MEASURES. Perioperative functional evaluation (with special emphasis on continence) and oncological evaluation (included margin studies and prostate-specific antigen levels). RESULTS. Regarding baseline clinical characteristics of the patients, there was no statistically significant difference between the robotic and open radical prostatectomy groups. For perioperative outcome, in the robotic group the blood transfusion rate was significantly lower (5 vs 65%), hospital stay was shorter (8 vs 17 days), and the catheter time was shorter (12 vs 18 days). For early oncological outcome, there was no statistically significant difference in the margin positive rate and early prostate-specific antigen results. Regarding continence (use of 0-1 pads/day), it was achieved by 95% in the robotic group with a mean follow-up of 6 months compared to 85% in the open group with a mean follow-up of 42 months. CONCLUSIONS. Robot-assisted radical prostatectomy offered the benefits of a minimally invasive operation with less blood loss, shorter catheter time and hospital stay, and earlier continence. It has therefore become the preferred surgical option in our institution. Hong Kong Med J Feb;16(1):31-5. Robotic Radical Prostatectomy in East Asia: Development, Surgical Results and Challenges Yip SKh, Sim HG.(Courtesy of Professor Sidney Yip) Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong. sidneyyip@surgery.cuhk.edu.hk PURPOSE OF REVIEW: The shift toward robotassisted laparoscopic radical prostatectomy has reshaped the surgical approach for localized prostate cancer in America and many parts of Europe. Its impact on Asia, however, has been somewhat delayed and less widespread compared with western countries. We reviewed and surveyed the evolving trends in robotic prostatectomy in east Asia and describe how the influence of cancer demography, financial reimbursement models, refinements in robotic technology and robotic surgical training will alter the future direction of the procedure in this region. RECENT FINDINGS: There are about 50 systems installed in east Asia. Numerous centers have reported successful implementation of robotic prostatectomy program, with transfusion rate of %. Margin positivity for T2 disease ranges from 9.8 to 24%, whereas continence rates range from 75 to 94% over 3-6 months. Significant increase in number of prostatectomy has been observed in some centers. SUMMARY: The outlook for robotic prostatectomy in east Asia remains rosy despite the obstacles in financial reimbursement, patient volume and surgical skill development. Future robotic systems with smaller footprint, leaner instrument arms and lower costs will help to accelerate its integration into more Asian hospitals.

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