The advancement of laparoscopic robotic surgery largely depends on the development of innovative laparoscopic instrumentation. The most widely used system, the da Vinci surgical robot (Intuitive Surgical Inc., Sunnyvale, California), was introduced in 1998 and received FDA approval in 2000. Its popularity may largely be attributed to the development of EndoWrist instruments with increased degrees of freedom and improved stereoscopic vision. The electronics integrated into the system allow motion scaling of surgeon hand movement into smaller instrument tip movements in the field, reducing natural tremor of surgeon’s hands. Instruments have a total of six degrees of freedom plus grip, mimicking the up and down and side-to-side flexibility of human wrist. Recently da Vinci S system has introduced (Intuitive Surgical Inc.), which features easier docking, added system feedback and high-definition telemonitoring. Another feature of the new S system is the additional 2 inches of length of the instruments.
The combination of pure laparoscopic and robot-assisted tools constitutes a standard approach to the advanced endourological techniques.
There are many available tools at the disposal of the robotic surgeon. Similar to the surgeon performing open surgery, a robotic surgeon’s familiarity with available equipment and technology is essential. This knowledge of all the available tools is essential to the surgeon in maximizing the outcomes of the surgery and shortening the procedure times.