Robotic Equipment and Instrumentation

  • Armine K. Smith
  • Jeffrey S. Palmer
Part of the Current Clinical Urology book series (CCU)


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.


Equipment Instrumentation Laparoscopy Robotics Pediatrics 


  1. 1.
    Sim H.G., Yip S.K. and Ceng C.W. (2006) Equipment and technology in surgical robotics. World J Urol 24, 128–35PubMedCrossRefGoogle Scholar
  2. 2.
    Marescaux J. and Rubino F. (2003) The ZEUS robotic system: experimental and clinical applications. Surg Clin North Am 83, 1305–15PubMedCrossRefGoogle Scholar
  3. 3.
    Murphy D., Challacombe B., Khan M.S. and Dasgupta P. (2006) Robotic technology in urology. Postgrad Med J 82, 743–7PubMedCrossRefGoogle Scholar
  4. 4.
    Kim V.B., Chapman W.H., Albrecht R.J., Bailey B.M., Young J.A., Nifong L.W. and Chitwood W.R. Jr. (2002) Early experience with telemanipulative robot-assisted laparoscopic cholecystectomy using da Vinci. Surg Laparosc Endosc Percutan Tech 12, 33–40PubMedCrossRefGoogle Scholar
  5. 5.
    EndoWrist instrument and accessory catalog (2007) Intuitive Surgical Inc.Google Scholar
  6. 6.
    Azurin D.J., Go L.S., Arroyo L.R. and Kirkland M.L. (1995) Trocar-site herniation following laparoscopic cholecystectomy and the significance of an incidental preexisting umbilical hernia. Am Surg 61, 718–20PubMedGoogle Scholar
  7. 7.
    Florio G., Silvestro C. and Polito D.S. (2003) Peri-umbilical Veress needle pneumoperitoneum: technique and results in 2126 cases. Chir Ital 55, 51–4PubMedGoogle Scholar
  8. 8.
    Bonjer H.J., Hazebroek E.J., Kazemier G., Gluffrida M.C., Meijer W.S. and Lance J.F. (1997) Open versus closed establishment of pneumoperitoneum in laparoscopic surgery. Br J Surg 84, 599–602PubMedCrossRefGoogle Scholar
  9. 9.
    Phillips P.A. and Amaral F.A. (2001) Abdominal access complications in laparoscopic surgery. J Am Coll Surg 192, 525–36CrossRefGoogle Scholar
  10. 10.
    The da Vinci endoscopic instrument control system user manual. (2004) Intuitive Surgical Inc.Google Scholar
  11. 11.
    Vancaillie T.G. (1998) Active electrode monitoring. How to prevent unintentional thermal injury associated with monopolar electrosurgery at laparoscopy. Surg Endosc 12, 1009–12PubMedCrossRefGoogle Scholar
  12. 12.
    Bishoff J.T., Allaf M.T., Kirkels W., Moore R.G., Kavoussi L.R. and Schroder F (1999) Laparoscopic bowel injuries: incidence and clinical presentation. J Urol 161, 887–90PubMedCrossRefGoogle Scholar
  13. 13.
    Pursifull N.F. and Morey A.F (2007) Tissue glues and nonsuturing techniques. Curr Opin Urol 17, 396–401PubMedCrossRefGoogle Scholar
  14. 14.
    Hong Y.M. and Loughlin K.R (2006) The use of hemostatic agents and sealants in urology. J Urol 176, 2367–74PubMedCrossRefGoogle Scholar
  15. 15.
    Tonouchi H., Ohmori Y., Kobayashi M. and Kusunoki M (2004) Trochar site hernia. Arch Surg 139, 1248–56PubMedCrossRefGoogle Scholar
  16. 16.
    Shaher Z. (2007) Port closure. Surg Endosc 21, 1264–74PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press, a Part of Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Armine K. Smith
    • 1
  • Jeffrey S. Palmer
    • 2
  1. 1.Glickman Urological and Kidney Institute, Cleveland ClinicClevelandUSA
  2. 2.Glickman Urological and Kidney Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve UniversityClevelandUSA

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