Advantages and limits of robot-assisted laparoscopic surgery: preliminary experience

  • F. Corcione
  • C. Esposito
  • D. Cuccurullo
  • A. Settembre
  • N. Miranda
  • F. Amato
  • F. Pirozzi
  • P. Caiazzo
Original article



In the last few years, robotics has been applied in clinical practice for a variety of laparoscopic procedures. This study reports our preliminary experience using robotics in the field of general surgery to evaluate the advantages and limitations of robot-assisted laparoscopy.


Thirty-two consecutive patients were scheduled to undergo robot-assisted laparoscopic surgery in our units from March 2002 to July 2003. The indications were cholecystectomy, 20 patients; right adrenalectomy, two points; bilateral varicocelectomy, two points; Heller’s cardiomyotomy, two points; Nissen’s fundoplication, two points; total splenectomy, one point; right colectomy, one point; left colectomy, 1 point; and bilateral inguinal hernia repair, one point. In all cases, we used the da Vinci surgical system, with the surgeon at the robotic work station and an assistant by the operating table.


Twenty-nine of 32 procedures (90.6%) were completed robotically, whereas three were converted to laparoscopic surgery. Conversion to laparoscopy was due in two patients to minor bleeding that could not be managed robotically and to robot malfunction in the third patient. There were no deaths. Median hospital stay was 2.2 days (range, 2–8).


The main advantages of robot-assisted laparoscopic surgery are the availability of three-dimensional vision and easier instrument manipulation than can be obtain with standard laparoscopy. The learning curve to master the robot was ≥ 10 robotic procedures. The main limitations are the large diameter of the instruments (8 mm) and the limited number of robotic arms (maximum, three). We consider these technical shortcomings to be the cause for our conversions, because it is difficult to manage bleeding episodes with only two operating instruments. The benefit to the patient must be evaluated carefully and proven before this technology can become widely accepted in general surgery.


Robotics Laparoscopy da Vinci surgical robot 


  1. 1.
    Ballantyne, GH 2002Robotic surgery, telerobotic surgery, telepresence, and telementoring: review of early clinical resultsSurg Endosc1013891402CrossRefGoogle Scholar
  2. 2.
    Ballantyne, GH, Moll, F 2003The da Vinci telerobotic surgical system: the virtual operative field and telepresence surgerySurg Clin North Am612931304Google Scholar
  3. 3.
    Cadière, GB, Himpens, J, Germay, O, Izizaw, R, Degueldre, M, Vandromme, J, Capelluto, E, Bruyns, J 2001Feasibility of robotic laparoscopic surgery: 146 casesWorld J Surg1114671477Google Scholar
  4. 4.
    Chapman, WH,3rd, Albrecht, RJ, Kim, VB, Young, JA, Chitwood, WR,Jr 2002Computer-assisted laparoscopic splenectomy with the da Vinci surgical robotJ Laparoendosc Adv Surg Tech3155159CrossRefGoogle Scholar
  5. 5.
    Goh, PM, Lomanto, D, So, JB 2002Robotic-assisted laparoscopic cholecystectomySurg Endosc1216217Google Scholar
  6. 6.
    Gould, JC, Melvin, WS 2003Telerobotic foregut and esophageal surgerySurg Clin North Am614211427Google Scholar
  7. 7.
    Horgan, S, Vanuno, D 2001Robots in laparoscopic surgeryJ Laparoendosc Adv Surg Tech6415419CrossRefGoogle Scholar
  8. 8.
    Hourmont, K, Chung, W, Pereira, S, Wasielewski, A, Davies, R, Ballantyne, GH 2003Robotic versus telerobotic laparoscopic cholecystectomy: duration of surgery and outcomesSurg Clin North Am614451462Google Scholar
  9. 9.
    Imme, A, Caglia, P, Gandolfo, L, Cavallaro, G, Donati, M, Amodeo, C 2002Robotic techniques in laparoscopic surgeryChir Ital1111113Google Scholar
  10. 10.
    Jacob, BP, Gagner, M 2003Robotics and general surgerySurg Clin North Am614051419Google Scholar
  11. 11.
    Kim, VB, Chapman, WH, Albrecht, RJ, Bailey, BM, Young, JA, Nifong, LW, Chitwood, WR,Jr 2002Early experience with telemanipulative robot-assisted laparoscopic cholecystectomy using da VinciSurg Laparosc Endosc Percutan Tech123340PubMedGoogle Scholar
  12. 12.
    Marescaux, J, Leroy, J, Gagner, M, Rubino, F, Mutter, D, Vix, M, Butner, SE,  et al. 2001Transatlantic robot-assisted telesurgeryNature13710714Google Scholar
  13. 13.
    Marescaux, J, Smith, MK, Folscher, D, Jamali, F, Malassagne, B, Leroy, J 2002Telerobotic laparoscopic cholecystectomy: initial clinical experience with 25 patientsAnn Surg3446447CrossRefGoogle Scholar
  14. 14.
    Merola, S, Weber, P, Wasielewski, A, Ballantyne, GH 2002Comparison of laparoscopic colectomy with and without the aid of a robotic camera holderSurg Laparosc Endosc Percutan Tech14651Google Scholar
  15. 15.
    Rockall, TA, Darzi, A 2003Robot-assisted laparoscopic colorectal surgerySurg Clin North Am614631468Google Scholar
  16. 16.
    Ruurda, JP, Broeders, IA 2003Robot-assisted laparoscopic intestinal anastomosisSurg Endosc2236241CrossRefGoogle Scholar
  17. 17.
    Ruurda, JP, Broeders, IA, Simmermacher, RP, Rinkes, IH, Vroonhoven, TJ 2002Feasibility of robot-assisted laparoscopic surgery: an evaluation of 35 robot-assisted laparoscopic cholecystectomiesSurg Laparosc Endosc Percutan Tech124145PubMedGoogle Scholar
  18. 18.
    Schluender, S, Conrad, J, Divino, CM, Gurland, B 2003Robot-assisted laparoscopic repair of ventral hernia with intracorporeal suturingSurg Endosc6656658Google Scholar
  19. 19.
    Stylopoulos, N, Rattner, D 2003Robotics and ergonomicsSurg Clin North Am613211337Google Scholar
  20. 20.
    Sung, GT, Gill, IS 2003Robotic renal and adrenal surgerySurg Clin North Am614691482Google Scholar
  21. 21.
    Yohannes, P, Rotariu, P, Pinto, P, Smith, AD, Lee, BR 2002Comparison of robotic versus laparoscopic skills: is there a difference in the learning curve?Urology13945CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • F. Corcione
    • 1
  • C. Esposito
    • 2
  • D. Cuccurullo
    • 1
  • A. Settembre
    • 1
  • N. Miranda
    • 1
  • F. Amato
    • 2
  • F. Pirozzi
    • 1
  • P. Caiazzo
    • 1
  1. 1.Department of Surgery and LaparoscopyAORN Monadi HospitalNaplesItaly
  2. 2.Department of Experimental and Clinical MedicineMagna Graecia UniversityCatanzaroItaly

Personalised recommendations