TORS (Trans Oral Robotic Surgery) nell’anziano CHIRURGIA “VIRTUALE” TORS (Trans Oral Robotic Surgery) nell’anziano RENATO PIANTANIDA DIRETTORE S.C. di Otorinolaringoiatria Ospedale “Alessandro Manzoni” LECCO

INTUITIVE SURGICAL: IL SISTEMA DA VINCI

da Vinci System – Sviluppo Prodotto 2007 1.1 2006 da Vinci S Surgical System 2003 4th Arm 1998 da Vinci Surgical System To reinforce our focus on product leadership and with so many new people on our sales force, I’d like to quickly review the development history of our robotic systems, vision systems and instruments. Let’s first look at the development curve of the robotic system…. The technology for robotic-assisted, 3D surgery was originally developed in the late 1980’s as a military project to explore remote battlefield surgery. In 1995, Intuitive Surgical was founded, and acquired this technology from SRI, MIT and IBM The first live robotic human case was performed in 1997 with a system called Mona, short for Mona Lisa. By late 1998, the da Vinci Surgical System made its public debut, providing surgeons with superior visualization, enhanced dexterity and greater surgical precision. The “4th Arm” upgrade was added to the da Vinci platform in 2003, giving surgeons the additional control over the surgical field. 1 year ago, the da Vinci S Surgical System was launched. The da Vinci S was a significant leap in the maturity of the system and offered increased surgical range of motion and improved ease of use for the entire OR team. Today we will introduce a number of new da Vinci S system features called “1.1” that will continue to improve system setup, ease of use and surgical efficiency. 1995 Intuitive Surgical Founded 1997 “Mona” First live human case 6 6

Vision System – Sviluppo Prodotto 2007 3D HD 2006 da Vinci S with TilePro 2002 Schoelly Scope 1998 da Vinci with InSite vision Now, let’s look at the Vision system development curve The vision system used with Mona was an off the shelf 3D scope from Welch Allyn that was barely adequate for surgery. In 1998, The 3D Insite Vision system was released with the da Vinci system and was really the first commercial embodiment of a 3D system with enough image quality to perform surgery. In 2002, the Schoelly scope was introduced and offered increased resolution along with a brighter field of view In 2006, the new da Vinci S system included a higher resolution viewer, an integrated touchscreen monitor and TilePro, a multi-input video feature for display of patient critical information to the da Vinci surgeon Today, we are pleased to launch the world’s 1st 3D High Definition vision system offering unparalleled visualization, a wider field of view and digital zoom 1995 Intuitive Surgical founded 1997 “Mona” First live human case 7

InSite™ Vision System Endoscopio a due canali Due telecamere 3 CCD Risoluzione del 75% superiore a qualsiasi sistema video tridimensionale

Finer Anatomical Details Better outcomes HD Imaging da Vinci S  720 x 486 da Vinci S 1st gen HD 1024 x 768 da Vinci S 2nd gen HD  1280 x 1024 or higher Finer Anatomical Details Better outcomes

Console chirurgica Computer enhanced precision Possibilità di scalare il movimento della mano Eliminazione digitale dei tremori 5 cm 1 cm

Immersive Display – “Cockpit” Customize layout to surgeon’s needs Flexible inputs This is an example of what da Vinci’s display could be with some of the higher resolution technologies. The 3D surgical view would be of higher resolution than is available today and it would also have the ability to display additional images that could consist of patient vitals, ultrasound, or pre-operative/intra-operative images. These images are becoming more relevant as imaging continues to improve and become more cost effective. (next slide)

Carrello robotico 4 Bracci meccanici Sistema di snodi multipli per accedere ad anatomie diverse Bilanciato per un’ estrema sicurezza Carrellabile per un facile set up

Strumenti EndoWrist™ Progettati per riprodurre i movimenti della mano umana Completa libertà di movimenti

Strumenti EndoWrist™ Trasportano le dita alla punta dello strumento Mantengono le manovre classiche della chirurgia tradizionale

Strumenti EndoWrist™ Guidati via cavo Riproducono i tendini della mano Precisione assoluta Grande libertà di movimento Risposta immediata Autoclavabili -sterilità garantita Riutilizzabili per 10 interventi

For surgeons Unparalleled dexterity, precision and control. For patients Shorter LOS, lower complication rates, less post-op pain and superior outcomes. For hospitals Increased patient satisfaction, improved operating efficiencies and significant market share gain. Proven ~400 da Vinci Surgical Systems installed worldwide Thousands of scientific publications and presentations Tens of thousands of satisfied patients This core technology provides surgeons with unparalleled precision, dexterity and control. And it’s a proven technology with a large installed base. Commitment Intuitive Surgical is committed to ongoing product development and service in order to expand the utility and longevity of every da Vinci product.