Dr. Vinay Mahendra

  MS. Mch (Urol.), DBN (Urol.), FRCS (Glasg.) FRCS (Urol.)
Senior Consultant Urologist
Laparoscopic & Robotic Urological Surgeon & Renal Transplant Surgeon

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+91 98302 16715 / 98304 92572 / 98311 16715

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Q: Why is the Robotic Surgery System called the da Vinci® S Surgical System?
The product is called "da Vinci" in part because Leonardo da Vinci invented the first robot. He also used unparalleled anatomical accuracy and three-dimensional details to bring his masterpieces to life. The da Vinci Surgical System similarly provides physicians with such enhanced detail and precision that the system can simulate an open surgical environment while allowing operation through tiny incisions.


Q: Is a surgeon using the Robotic System operating in "virtual reality"?
Although seated at a console a few feet away from the patient, the surgeon views an actual image of the surgical field while operating in real-time, through tiny incisions, using electromechanically enhanced instruments. At no time does the surgeon see a virtual image or program/ command the system to perform any maneuver on its own/outside of the surgeon's direct, real-time control.


Q: What is Minimally Invasive Surgery (MIS)?
MIS is surgery typically performed through small incisions, or operating ports, rather than large incisions, resulting in shorter recovery times, fewer complications, reduced hospitalization costs and reduced trauma to the patient. MIS has become standard-of-care for particular surgical procedures; it has not been widely adopted for more complex or delicate procedures - for example, prostatectomy and mitral valve repair.

Intuitive Surgical believes that surgeons have been slow to adopt MIS for complex procedures because they generally find that fine-tissue manipulation - such as dissecting and suturing - is more difficult and less precise than in open surgery. Intuitive Surgical's technology, however, enables the use of MIS technique for complex procedures.


Q: Will the Robotic System make the surgeon unnecessary?
On the contrary, the da Vinci System enables surgeons to be more precise, advancing their technique and enhancing their capability in performing complex minimally invasive surgery. The system replicates the surgeon's movements in real time. It cannot be programmed, nor can it make decisions on its own to move in any way or perform any type of surgical maneuver without the surgeon's input.



Q: What are the benefits of using the Robotic System over more traditional methods of surgery?
Some of the major benefits experienced by surgeons using the da Vinci S Surgical System over traditional approaches have been greater surgical precision, increased range of motion, improved dexterity, enhanced visualization and improved access. Benefits experienced by patients may include a shorter hospital stay, less pain, less risk of infection, less blood loss, fewer transfusions, less scarring, faster recovery and a quicker return to normal daily activities. Individual results may vary.



Q: While using the Robotic System, can the surgeon feel anything inside the patient's chest or abdomen?
The system relays some force feedback sensations from the operative field back to the surgeon throughout the procedure. This force feedback provides a substitute for tactile sensation and is augmented by the enhanced vision provided by the high-resolution 3D view.



Q: What type of surgical procedures are currently available using the Robotic System?
Specially trained surgeons, including gynecologic oncologists, pediatric urologists, a pediatric surgeon, reproductive endocrinologist, a bariatric surgeon, a cardiac surgeon and urologists are performing the following; prostatectomies; hysterectomies; tubal ligation reversals; removal of ovaries; fallopian tubes and fibroid tumors; kidney reconstructive surgery; surgical weight loss; cardiac surgery; and other delicate procedures using robotic surgery.



Where will the incisions be?
In general there will be 4-6 small (1/4") incisions in the abdomen. The number and size of these may vary depending on your condition and the exact procedure you are having.



How long does the procedure take?
The length of the procedure depends on what you are having done. A simple hysterectomy takes about an hour. If you have lymph nodes removed, this can take an additional 1 to 1-1/2 hrs. For a radical hysterectomy, these usually take 3-4 hrs. Of course you are in the operating room for a longer period of time as it requires about 30-45 min of preparation time for the anesthesiologist to put you to sleep and get you properly positioned for the case.


What does the robot look like?
There is a console that is positioned away from the patient to the side of the room- this is where your surgeon will operate from.



How will I be positioned for the surgery?
You will be carefully placed on your back, with your legs in moveable stirrups that allow access to the perineum/vagina. Soft pads are placed under you, around your sides, and supporting your shoulders and head. This allows us to put you in a steep Trendelenberg position- tilted with your head down so we can operate safely in the pelvis.



Are there any special precautions taken to monitor me during the surgery?
Depending on the anesthesiologist preference and your medical condition, you may have a special IV catheter placed into an artery in your wrist- this allows the anesthesiologist to monitor your blood pressure carefully during the procedure. They also use a special brain wave monitor that allows them to carefully monitor your level of sedation.



How do you get everything out through those small incisions?
Your uterus, tubes, and ovaries as well as any large mass or large packet of lymph nodes are generally extracted through the vagina after the hysterectomy is completed. Occasionally the vagina is too stenotic (tight) to allow this and one of the laparoscopic port incisions has to be enlarged to allow passage through. Usually this is still pretty small however, and much smaller than the larger incision required if the surgery were done in the traditional open fashion.


What can I expect my recovery to be like?
Most patients are able to drink liquids the night of their surgery and sit up on the side of the bed. By the first day after surgery, most are able to eat light meals, walk in the halls, and generally get around as needed. Our goal is for most patients to go home on the first day after surgery, although if needed, we certainly will keep you as long as necessary for your safety. Many patients require little to no narcotic pain medication and are adequately controlled with simple ibuprofen or acetaminophen within a day or so. Most patients have fully recovered and are back to their normal activities within 1-2 weeks.



Are there any limitations on my activities?
Once you go home, you may do whatever you feel comfortable doing as long as it doesn't hurt. Stairs are ok if you are steady enough on your feet not to fall. You may drive once you are off of narcotics, can comfortably put on your seatbelt, and press the brake pedal in an emergency without hurting yourself or someone else. In general this is 1-2 weeks after surgery. You may bathe, or shower. Please do not place anything in the vagina or have intercourse for 4-6 weeks after surgery.

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