daVinci surgery has replaced open and laparoscopic surgery for many operations due to the many advantages of using the robotic interface

1. The da Vinci Advantage:The Value of daVinci Surgery Randy Fagin, MD Senior Medical Advisor – Training | Intuitive Surgical Director of Robotic Surgery | The Hospital at Westlake Medical Center

2. The da Vinci Advantage:Why Listen to Me In 2000 I trained in LRP with Bertrand Guionneau and Guy Valancien in Paris, France I performed over 300 LRP Operative Time 2 - 2½ hours Blood transfusion rate less than 1% Return to erections 75% I assumed what I was doing was “best in class” I felt threatened by da Vinci surgery I believed “you don’t need a fancy multimillion dollar robot to do a good operation”

3. The da Vinci Advantage:Why Listen to Me: In 2000 I trained in LRP with Bertrand Guionneau and Guy Valancien in Paris, France I performed over 300 LRP Operative Time 2 - 2½ hours Blood transfusion rate less than 1% Return to erections 75% I assumed what I was doing was “best in class” I felt threatened by da Vinci surgery I believed “you don’t need a fancy multimillion dollar robot to do a good operation”

4. The da Vinci Advantage:Why Listen to Me: “you don’t need a fancy multimillion dollar robot to do a good operation” TRUE However, you do need one if you want to do a better operation

5. The da Vinci Advantage:Why Listen to Me “you don’t need a fancy multimillion dollar robot to do a good operation” TRUE However, you do need one if you want to do a better operation

6. The da Vinci Advantage:Why Listen to Me: On August 22nd, 2003 I sat down for the 1st time at a da Vinci console I spent the next 12 months on a mission to get my hospital to purchase a daVinci system

7. The da Vinci Advantage:Why Listen to Me Monday October 1, 2004 I performed my first dVP Monday April 25, 2005 I performed dVP #200 Wednesday April 27, 2005 I performed 2dVP’s Thursday April 28, 2005 I performed 1 LRP some insurance would not cover da Vinci surgery back then Friday April 28, 2005 I decided never to perform another LRP again As of today I have performed ≈2,000 dVP’s my patients have come from over 30 of the United States and 12 countries

8. The da Vinci Advantage:Why Listen to Me Monday October 1, 2004 I performed my first dVP Monday April 25, 2005 I performed dVP #200 Wednesday April 27, 2005 I performed 2dVP’s Thursday April 28, 2005 I performed 1 LRP some insurance would not cover da Vinci surgery back then Friday April 28, 2005 I decided never to perform another LRP again As of today I have performed ≈2,000 dVP’s my patients have come from over 30 of the United States and 12 countries

9. The da Vinci Advantage:Why Listen to Me Monday October 1, 2004 I performed my first dVP Monday April 25, 2005 I performed dVP #200 Wednesday April 27, 2005 I performed 2dVP’s Thursday April 28, 2005 I performed 1 LRP some insurance would not cover da Vinci surgery back then Friday April 28, 2005 I decided never to perform another LRP again As of today I have performed ≈2,000 dVP’s my patients have come from over 30 of the United States and 12 countries

10. The da Vinci Advantage:Why Listen to Me Monday October 1, 2004 I performed my first dVP Monday April 25, 2005 I performed dVP #200 Wednesday April 27, 2005 I performed 2dVP’s Thursday April 28, 2005 I performed 1 LRP some insurance would not cover da Vinci surgery back then Friday April 28, 2005 I decided never to perform another LRP again As of today I have performed ≈2,000 dVP’s my patients have come from over 30 of the United States and 12 countries

11. The da Vinci Advantage:Why Listen to Me Monday October 1, 2004 I performed my first dVP Monday April 25, 2005 I performed dVP #200 Wednesday April 27, 2005 I performed 2dVP’s Thursday April 28, 2005 I performed 1 LRP some insurance would not cover da Vinci surgery back then Friday April 29, 2005 I decided never to perform another LRP again As of today I have performed ≈2,000 dVP’s my patients have come from over 30 of the United States and 12 countries

12. The da Vinci Advantage:Why Listen to Me IF you believe that your current surgery is “as good as it gets” THEN you are performing yesterday’s standard of care maybe today’s standard of care but DEFINITELY NOT tomorrow’sstandard of care

13. The da Vinci Advantage:Why Listen to Me IF you believe that your current surgery is “as good as it gets” THEN you are already behind

14. The da Vinci Advantage: The Vision-Precision Advantage The Consistency Advantage

15. The da Vinci Advantage:The Vision – Precision Advantage Vision Stereoscopic view (better depth AND detail) 10x magnification High definition You place the camera EXACTLY where you want it If I can see it better I can do a better operation Precision Scaled motion Allows for more precise movements than my own hands are capable of With improved ergonomics comes improved precision If I have a more precise tool I can create less collateral damage

16. The da Vinci Advantage:The Vision – Precision Advantage Better Vision and Improved Precision: IS NOT a replacement for skill IS an advantage for ALL SURGEONS no matter what their skill level

17. The da Vinci Advantage:The Consistency Advantage What do YOUR LAP surgeons believe

18. The da Vinci Advantage:The Consistency Advantage What do YOUR LAP surgeons believe “my outcomes are as good as they get” “I’m at the TOP of my game”

19. The da Vinci Advantage:The Consistency Advantage What do YOUR LAP surgeons believe “my outcomes are as good as they get” “I’m at the TOP of my game” and if they never convert to dVP they are right

20. The da Vinci Advantage:The Consistency Advantage What do YOUR LAP surgeons believe OUTCOMES best LAP worst

21. The da Vinci Advantage:The Consistency Advantage What do YOUR LAP surgeons need to know OUTCOMES best dV best worst LAP worst

22. The da Vinci Advantage:The Consistency Advantage What do YOUR LAP surgeons need to know OUTCOMES easy dV easy hard LAP hard

23. The da Vinci Advantage:The Consistency Advantage YOUR LAP surgeons need to know They are STUCK at their current level if they continue with LAP There is a level above LAP, but to get there they need to transition to daVinci

24. The da Vinci Advantage:The Consistency Advantage daVinci surgery Improves the best outcomes A LITTLE Improves the worst outcomes A LOT Reduces the distance between BEST-WORST EASIEST-HARDEST

25. The da Vinci Advantage:The Consistency Advantage daVinci surgery Reduces Variability in the Difficulty of an Operation Reduces Variability in Outcomes

26. The da Vinci Advantage:The Consistency Advantage daVinci surgery Reducing Variability in Outcomes Better Vision Improved Precision 4th Arm Improved control over your operation Reduced Fatigue

27. The da Vinci Advantage:The Consistency Advantage Reduced Fatigue Ergonomic Advantage of daVinci surgery 87% of surgeons who regularly perform standard laparoscopic surgery experience discomfort/pain neck, hand, and lower extremities J Am CollSurg 2010 Standard Laparoscopic Surgery increases surgeon fatigue and reduces performance Surgery 2010;147:318-30

28. The da Vinci Advantage:The Consistency Advantage Reduced Fatigue Ergonomic Advantage of daVinci surgery Improve ergonomics of performing an operation Improve Performance of the Surgeon Improve Consistency of Patient Outcomes

29. The da Vinci Advantage: Surgery today is NOT as good as it gets Better Vision and a More Precise tool is an advantage for ALL surgeons Reducing Variability in Difficulty Reduces Variability in Outcomes