Textbook of
Robotic Urologic
Surgery.



Release Date:
January, 2007

Michael Esposito,
Vincent Lanteri
&
Jeffrey Stock

Robot Surgery Assistants Get 3-D View
From Renal & Urology News -- November 2007

By Vincent Lanteri, MD, Michael P. Esposito, MD, and Mutahar Ahmed, MD

Digital vision system helps them anticipate the robotic surgeon's needs during radical prostatectomies

During the past five years, the da Vinci robot has increasingly been used to perform radical prostatectomies. This robotic technology has revolutionized prostate cancer surgery. Among other benefits, the robot enables the surgeon to perform the operation in three dimensions (3D). Assisting surgeons, however, have had to view the procedure in two dimensions (2D). This has changed with the introduction of the Viking System’s Endosite Digital Vision System, which affords assisting surgeons the same 3D view as the robotic surgeon. 

The depth and dimension provided by a 3D view enables optimal hand eye coordination while minimizing eye strain. Visual accuracy and optical immersion make the endoscopic surgical field-of-view appear open. The comfortable head-mounted display (HMD) provides the ultimate in clarity, flexibility and ergonomic design, and allows the assistant to focus on the surgical field, and reduces the fatigue associated with turning or moving to view a standard monitor. 

Vincent Lanteri, MD, is using the 3D Viking Endosite system while assisting during a da Vinci robotic prostatectomy.

Since January 2002, 950 da Vinci robotic prostatectomies were performed by the robots as Hackensack University Medical Center, with the surgical assistant using the 2D field. Recently, 100 consecutive procedures were performed with the assisting surgeon using the Viking Endosite System. The ability of the assisting surgeon to anticipate the robotic surgeon’s needs were enhanced by his 3D field. Specific examples include:

• Retraction while the bladder is dropped
• Opening the endopelvic fascia
• Coordination with ligation of the dorsal venous complex (DVC)
• Tapering and transaction of the bladder neck
• Dissection of the vas deferentia and seminal vesicles
• Athermal bilateral nerve sparing
• Transection of the DVC and urethra
• Aid in the urethrovesicle anastomosis
• Retraction during the bilateral lymph node dissection

Additional benefits include hands on training of board-certified urologists, fellows and resident, allowing them to view the 3D surgical field and promoting interactive learning experiences during the procedure.

Having both Intuitive Surgical’s da Vinci system and Viking System’s Endosite Digital Vision system is the ultimate combination and allows the surgeon and the assistant to finally operate on the same surgical field. Additionally, the advantage of both systems may translate into improved operative times, shortened learning curves, and greater surgeon-assistant comfort. This might allow the beginning robotic surgeons and assistants to become experts quicker and without limitations.

The authors are the directors of Oncology and Minimally Invasive Surgery at Hackensack University Medical Center in Hackensack, N.J., clinical assistants in urology at the University of Medicine and Dentistry of New Jersey in Newark, and attendings in urology at Monmouth Medical Center in Long Branch, N.J.