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Hellenic Journal of Surgery

, Volume 82, Issue 2, pp 114–124 | Cite as

Current status of robotics in general surgery

  • K. M. Konstantinidis
  • S. C. Hiridis
  • M. Vorias
  • G. Sambalis
  • M. Georgiou
  • K. Anastasakou
  • A. Xiarchos
Review

Abstract

Telesurgical systems have met with a great degree of acceptance in urology but indications are not yet that clear in the field of general surgery. The surgical robot overcomes certain limitations of conventional laparoscopy by offering three-dimensional, high definition vision, and seven degrees of freedom to the articulating instruments. Newer robots provide image integration, telestration and the dual-console capability for training purposes. According to our experiencs indications for robotic surgery are: the need for intracorporeal suturing, the expectant narrow surgical field, the expectant difficult dissection and/or adhesiolysis, especially in the upper abdomen, near the hiatus or very low in the pelvis. Although the use of robotic systems for simple laparoscopic cases is generally opposed on the basis of its increased operative time and cost, most teams accept that the beginning of the learning curve in robotic surgery must rely upon simple procedures such as cholecystectomies and Nissen fundoplications. Recent studies show more indications for robotic approach of cholecystectomies, such as in the setting of a reoperative, hostile abdomen following gangrenous cholecystitis, or in completion cholecystectomy.

Robotic surgery constitutes a revolutionary stage in the evolution of surgery. Current systems aim to overcome certain limitations of laparoscopy. More advanced forms of robotic assistance are expected in the future, incorporating special software for intraoperational navigation and augmented reality guidance, help with the decision-making process, and smart “robotic-assistants” with artificial intelligence and autonomy. Integration of this technology will determine the definite role of robotics in the operating theater.

Keywords

Robotic surgery Tele surgery Laparoscopy surgery 

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References

  1. 1.
    Mose F., Horgan S. Robotics in General Surgery: Today and Tomorrow In: Satava RM, Gaspari A, Lorenzo ND, editors. Emerging Technologies in Surgery. Springer; 2007.pp.75–85Google Scholar
  2. 2.
    Jacob BP, Gagner M. Robotics and general surgery. Surg Clin North Am 2003;83:1405–1419CrossRefPubMedGoogle Scholar
  3. 3.
    Kim VB et al. Early experience with telemanipulative robot-assisted laparoscopic cholecystectomy using da Vinci. Surg Laparosc Endosc Percutan Tech 2002;12:33–40CrossRefPubMedGoogle Scholar
  4. 4.
    Marescaux J et al. Telerobotic laparoscopic cholecystectomy: initial clinical experience with 25 patients. Ann Surg 2001;234:1–7CrossRefPubMedGoogle Scholar
  5. 5.
    Breitenstein, Nocito S, Puhan A, Held M, Weber U, Clavien M. Robotic-assisted versus laparoscopic cholecystectomy: outcome and cost analyses of a case-matched control study Ann Surg. 2008 Jun;247(6):987–993.CrossRefPubMedGoogle Scholar
  6. 6.
    Gurusamy KS, Samraj K, Fusai G, Davidson BR. Robot assistant for laparoscopic cholecystectomy. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD006578.Google Scholar
  7. 7.
    Kohn GP, Martinie JB. Laparoscopic robot-assisted completion cholecystectomy: a report of three cases. Int J Med Robot. 2009 Dec;5(4):406–409. 2009PubMedGoogle Scholar
  8. 8.
    Belsley SJ, DeRose JJ Jr, Connery CC, McGinty JJ, Rothschild O, Ashton RC Jr ROBOTIC ASSISTED TRANSTHORACIC ESOPHAGECTOMY In: laparoscopic.md. 2006 http://www.laparoscopic.md/Public/PDFS/RobotEsophagus.pdf
  9. 9.
    Sugarbaker DJ Dec Camp MM. Selecting the surgical approach to the cancer of the esophagus. Chest 1993; 103(Suppl): 410S–414s. 1993CrossRefPubMedGoogle Scholar
  10. 10.
    Millikan KW, Silverstein J, Hart V, et al. A 15-year review of esophagectomy for carcinoma of the esophagus and cardia. Arch Surg 1995;130:617–624PubMedGoogle Scholar
  11. 11.
    Wilson EB. THE EVOLUTION OF ROBOTIC GENERAL SURGERY Scandinavian Journal of Surgery 2009;98:125–129PubMedGoogle Scholar
  12. 12.
    Galvani CA, Gorodner MV, Moser F, et al. Robotically assisted laparoscopic transhiatal esophagectomy. Surg Endosc 2008; 22(1):188–195CrossRefPubMedGoogle Scholar
  13. 13.
    Orringer MB. Transthoracic versus transhiatal esophagectomy: what difference does it make? Ann Thorac Surg 1987; 44: 116–118. 1987PubMedCrossRefGoogle Scholar
  14. 14.
    Gutt CN, Bintintan VV, Köninger J, Müller-Stich BP, Reiter M, Büchler MW. Robotic-assisted transhiatal esophagectomy Langenbecks Arch Surg. 2006 Aug;391(4):428–434. Epub 2006 Jun 22.CrossRefGoogle Scholar
  15. 15.
    Kernstine KH, DeArmond DT, Shamoun DM, Campos JH. The first series of completely robotic esophagectomies with three-field lymphadenectomy: initial experience. Surg Endosc. 2008 Sep;22(9):2102. Epub 2008 May 18CrossRefPubMedGoogle Scholar
  16. 16.
    Kim DJ, Hyung WJ, Lee CY, Lee JG, Haam SJ, Park IK, Chung KY. Thoracoscopic esophagectomy for esophageal cancer: Feasibility and safety of robotic assistance in the prone position. J Thorac Cardiovasc Surg. 2010 Jan;139(1):53–59.e1. Epub 2009 Jul 29.CrossRefPubMedGoogle Scholar
  17. 17.
    Galvani C, Gorodner MV, Moser F, et al. Laparoscopic Heller myotomy for achalasia facilitated by robotic assistance. Surg Endosc 2006;20(7):1105–1112CrossRefPubMedGoogle Scholar
  18. 18.
    Melvin WS, Dundon JM, Talamini M, Horgan S. Computer enhanced robotic telesurgery minimizes esophageal perforation during Heller myotomy. Surgery 2005; 138: 553–558; 2005CrossRefPubMedGoogle Scholar
  19. 19.
    Horgan S, Galvani C, Gorodner MV, Omelanczuck P, Elli F, Moser F, Durand L, Caracoche M, Nefa J, Bustos S, Donahue P, Ferraina P. Robotic-assisted Heller myotomy versus laparoscopic Heller myotomy for the treatment of esophageal achalasia: multicenter study. J Gastrointest Surg 2005; 9: 1020–1029CrossRefPubMedGoogle Scholar
  20. 20.
    Bonavina L. Minimally Invasive Surgery for Esophageal Achalasia. World J Gastroenterol 2006 October 7; 12(37): 5921–5925PubMedGoogle Scholar
  21. 21.
    Galvani C, Gorodner MV, Moser F, Baptista M, Donahue P, Horgan S. Laparoscopic Heller myotomy for achalasia facilitated by robotic assistance. Surg Endosc. 2006 Jul;20(7):1105–1112. Epub 2006 May 13.CrossRefPubMedGoogle Scholar
  22. 22.
    Huffmanm LC, Pandalai PK, Boulton BJ, James L, Starnes SL, Reed MF, Howington JA, Nussbaum MS. Robotic Heller myotomy: a safe operation with higher postoperative quality-of-life indices Surgery. 2007 Oct;142(4):613–618.CrossRefPubMedGoogle Scholar
  23. 23.
    Morino M, Pellegrino L, Giaccone C, Garrone C, Rebecchi F. Randomized clinical trial of robot-assisted versus laparoscopic Nissen fundoplication. Br J Surg 2006;93(5):553–558CrossRefPubMedGoogle Scholar
  24. 24.
    Nakadi IE, Mélot C, Closset J, DeMoor V, Bétroune K, Feron P, Lingier P, Gelin M. Evaluation of da Vinci Nissen fundoplication clinical results and cost minimization. World J Surg. 2006;30(6):1050–1054CrossRefPubMedGoogle Scholar
  25. 25.
    Müller-Stich BP, Reiter MA, Wente MN, Bintintan VV, Köninger J, Büchler MW, Gutt CN. Robot-assisted versus conventional laparoscopic fundoplication: short-term outcome of a pilot randomized controlled trial. Surg Endosc. 2007;21(10):1800–1805. Epub 2007 Mar 13CrossRefPubMedGoogle Scholar
  26. 26.
    Albassam AA, Mallick MS, Gado A, Shoukry M. Nissen fundoplication, robotic-assisted versus laparoscopic procedure: a comparative study in children. Eur J Pediatr Surg. 2009 Oct;19(5):316–319. Epub 2009 Jun 9CrossRefPubMedGoogle Scholar
  27. 27.
    Heemskerk J, van Gemert WG, Greve JW, Bouvy ND. Robot-assisted Versus Conventional Laparoscopic Nissen Fundoplication: A Comparative Retrospective Study on Costs and Time Consumption. Surg Laparosc Endosc Percutan Tech. 2007 Feb;17(1):1–4CrossRefPubMedGoogle Scholar
  28. 28.
    Harrell AG, Heniford BT. Minimally invasive abdominal surgery: lux et veritas past, present, and future. Am J Surg. 2005 Aug;190(2):239–243.CrossRefPubMedGoogle Scholar
  29. 29.
    Draaisma WA, Gooszen HG, Consten EC, Broeders IA. Mid-term results of robot-assisted laparoscopic repair of large hiatal hernia; a symptomatic and radiological prospective cohort study. Surg Technol Int. 2008;17:165–170.PubMedGoogle Scholar
  30. 30.
    Hashizume M, Tsugawa K. Robotic Surgery and Cancer: the Present State, Problems and Future Vision Jpn J Clin Oncol. 2004 May;34(5):227–237. 3CrossRefPubMedGoogle Scholar
  31. 31.
    Song J, Oh SJ, Kang WH, Hyung WJ, Choi SH, Noh SH. Robot-assisted gastrectomy with lymph node dissection for gastric cancer: lessons learned from an initial 100 consecutive procedures. Ann Surg. 2009 Jun;249(6):927–932CrossRefPubMedGoogle Scholar
  32. 32.
    Song J, Kang WH, Oh SJ, Hyung WJ, Choi SH, Noh SH. Role of robotic gastrectomy using da Vinci system compared with laparoscopic gastrectomy: initial experience of 20 consecutive cases. Surg Endosc. 2009 Jun;23(6):1204–1211. Epub 2009 Mar 5.CrossRefPubMedGoogle Scholar
  33. 33.
    Kim MC, Heo GU, Jung GJ. Robotic gastrectomy for gastric cancer: surgical techniques and clinical merits. Surg Endosc. 2010 Mar;24(3):610–615. Epub 2009 Aug 18.CrossRefPubMedGoogle Scholar
  34. 34.
    Eric J. Hanly, M.D.a,b,c, Mark A. Talamini, M.D.a,* Robotic abdominal surgery The American Journal of Surgery 188 (Suppl to October 2004) 19S–26SGoogle Scholar
  35. 35.
    Talamini MA, Chapman W, Horgan S, Melvin WS. A prospective analysis of 211 robotic assisted surgical procedures. Surg Endosc 17:1521–1524. 2002CrossRefGoogle Scholar
  36. 36.
    Talamini M, Campbell K, Stanfield C. Robotic gastrointestinal surgery: early experience and system description. J Laparoendosc Adv Surg Tech A 2002;12:225–232.CrossRefPubMedGoogle Scholar
  37. 37.
    Merola S, Weber P, Wasielewski A, Ballantyne GH. Comparison of laparoscopic colectomy with and without the aid of a robotic camera holder. Surg Laparosc Endosc Percutan Tech. 2002 Feb;12(1):46–51CrossRefPubMedGoogle Scholar
  38. 38.
    Lunca S, Bouras G, Stanescu AC. Gastrointestinal Robot-Assisted Surgery. A current perspective. Rom J Gastroenterol. 2005 Dec;14(4):385–391.PubMedGoogle Scholar
  39. 39.
    Weber PA, Merola S, Wasielewski A, Ballantyne GH. Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease. Dis Colon Rectum 2002;45:1689–1689CrossRefPubMedGoogle Scholar
  40. 40.
    Pigazzi A, Ellenhorn JD, Ballantyne GH, Paz IB. Robotic-assisted laparoscopic low anterior resection with total mesorectal excision for rectal cancer. Surg Endosc. 2006 Oct;20(10):1521–1525. Epub 2006 Aug 1.CrossRefPubMedGoogle Scholar
  41. 41.
    Delaney CP, Marcello PW, Sonoda T, Wise P, Bauer J, Techner L. Gastrointestinal recovery after laparoscopic colectomy: results of a prospective, observational, multicenter study.Surg Endosc. 2010 Mar;24(3):653–661. Epub 2009 Aug 18.CrossRefPubMedGoogle Scholar
  42. 42.
    Ostrowitz MB, Eschete D, Zemon H, Denoto G. Robotic-assisted single-incision right colectomy: early experience. Int J Med Robot. 2009 Dec;5(4):465–470.PubMedGoogle Scholar
  43. 43.
    Herron DM, Marohn M; SAGES-MIRA Robotic Surgery Consensus Group. A consensus document on robotic surgery Surg Endosc. 2008 Feb;22(2):313–325; discussion 311–2. Epub 2007 Dec 28.CrossRefPubMedGoogle Scholar
  44. 44.
    Giulianotti PC, Coratti A, Angelini M et al. Robotics in general surgery: personal experience in a large community hospital. Arch Surg 2003; 138: 777–784. 2003CrossRefPubMedGoogle Scholar
  45. 45.
    Siu WT. The Use of Robotic in GI Surgery In: The Hong Kong Medical Diary. 2007 http://www.fmshk.org/database/articles/04mb5.pdf
  46. 46.
    Chapman WH III, Albrecht RJ, Kim VB, Young JA, Chitwood WR Jr. Computer-assisted laparoscopic splenectomy with the da Vinci surgical robot. J Laparoendosc Adv Surg Tech A 2002;12(3):155–159CrossRefPubMedGoogle Scholar
  47. 47.
    Bodner J, Kafka-Ritsch R, Lucciarini P, Fish JH 3rd, Schmid T. A critical comparison of robotic versus conventional laparoscopic splenectomies. World J Surg. 2005;29(8):982–985; discussion 985–6.CrossRefPubMedGoogle Scholar
  48. 48.
    Yu SC, Clapp BL, Lee MJ, Albrecht WC, Scarborough TK, Wilson EB. Robotic assistance provides excellent outcomes during the learning curve for laparoscopic Roux-en-Y gastric bypass: results from 100 robotic-assisted gastric bypasses Am J Surg. 2006 Dec;192(6):746–749.CrossRefPubMedGoogle Scholar
  49. 49.
    Schluender S, Conrad J, Divino CM, Gurland B. Robot-assisted laparoscopic repair of ventral hernia with intracorporeal suturing Surg Endosc 2003;17:1391–1395CrossRefPubMedGoogle Scholar
  50. 50.
    Tayar C, Karoui M, Cherqui D, Fagniez PL. Robot-assisted laparoscopic mesh repair of incisional hernias with exclusive intracorporeal suturing: a pilot study Surg Endosc. 2007 Oct;21(10):1786–1789. Epub 2007 Mar 13. 2007CrossRefPubMedGoogle Scholar
  51. 51.
    Lewis CM, Chung WY, Holsinger FC. Feasibility and surgical approach of transaxillary robotic thyroidectomy without CO(2) insufflation. Head Neck. 2010 Jan;32(1):121–126.PubMedGoogle Scholar

Copyright information

© Hellenic Surgical Society 2010

Authors and Affiliations

  • K. M. Konstantinidis
    • 1
  • S. C. Hiridis
    • 1
  • M. Vorias
    • 1
  • G. Sambalis
    • 1
  • M. Georgiou
    • 1
  • K. Anastasakou
    • 1
  • A. Xiarchos
    • 1
  1. 1.Surgical department of Athens Medical CenterAthensGreece

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