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The current status of robotic pelvic surgery: results of a multinational interdisciplinary consensus conference

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Abstract

Background

Despite the significant benefits of laparoscopic surgery, limitations still exist. One of these limitations is the loss of several degrees of freedom. Robotic surgery has allowed surgeons to regain the two lost degrees of freedom by introducing wristed laparoscopic instruments.

Methods

At the first Pelvic Surgery Meeting held in Brescia in June 2007, the participants focused on the role of robotic surgery in pelvic operations surgery for malignancy including prostate, rectal, uterine, and cervical carcinoma. All members of the interdisciplinary panel were asked to define the role of robotic surgery in prostate, rectal, and uterine carcinoma. All key statements were reformulated until a consensus within the group was achieved (Murphy et al., Health Technol Assess 2(i–v):1–88, 1998). For the systematic review, a comprehensive literature search was performed in Medline and the Cochrane Library from January 1997 to June 2007. The keywords used were Da Vinci®, telemonitoring, laparoscopy, neoplasms for urology, colorectal, gynecology, visceral surgery, and minimally invasive surgery. The pelvic surgery meeting was supported by Olympus Medical Systems Europa.

Results

As of December 31, 2007, there were 795 unit shipments worldwide of the Da Vinci®: 595 in North America, 136 in Europe, and 64 in the rest of the world (http://investor.intuitivesurgical.com/phoenix.zhtml?c=122359&p=irol-faq#22324). It was estimated that, during 2007, approximately 50,000 radical prostatectomies were performed with the Da Vinci® robot system in the USA, reflecting market penetration of 60% of radical prostatectomies in the USA. This utilization represents 50% growth as in 2006 only 42% of all radical prostatectomies performed in the USA employed robotics.

Conclusion

While robotic prostatectomy has become the most widely accepted method of prostatectomy, robotic hysterectomy and proctectomy remain far less widely accepted. The theoretical benefits of the increased degrees of freedom and three-dimensional visualization may be outweighed in these areas by the loss of haptic feedback, increased operative times, and increased cost.

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Acknowledgements

The authors would like to acknowledge the additional members of the Robotic Consensus Group: Dr. Clément Claude, Dr. Abbou, Dr. Günter Janetschek, Dr. Adrian Joyce, Dr. Paolo Puppo, Dr. Jens-Uwe Stolzenburg, Dr. Ben Van Cleynenbreugel, Dr. Stephanie Berdah, Dr. Eiji Kanehira, Dr. Ferdinand Kockerling, Dr. Lukas Krähenbühl, Dr. Luca Minelli, Dr. Michael Abou-Dakn, Dr. Francisco Carmona, Dr. Mordechai Goldenberg, Dr. Michael Hohl, Dr. Andrew Kent, Dr. Marc Possover, Dr. Giovanni Scambia, and Dr. Roberto Tozzi.

Disclosures:

Steven D Wexner M.D. has stock options in intuitive surgical for work done as a consultant for Computer Motion, Inc. The pelvic surgery meeting was supported by ‘Olympus Medical Systems Europa GmbH Hamburg, Germany'.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA

    Steven D. Wexner

  2. Division of Colorectal Surgery, State University of New York, Stony Brook, NY, USA

    Roberto Bergamaschi

  3. Hospital Clinic i Provincial de Barcelona, Calle Villarroel, 170, 08036, Barcelona, Spain

    Antonio Lacy

  4. Department of Urology, Hannover Medical School, Carl Neuberg Str. 1, 30625, Hannover, Germany

    Jonas Udo

  5. Department of Obstetrics and Gynaecology, VU University Medical Center, De Boelelaan 1117, 1181HV, Amsterdam, The Netherlands

    Hans Brölmann

  6. Department of Surgery, Northwick St Mark’s Hospital, Park Watford Road, Harrow, Middlesex, HA1 3UJ, London, UK

    Robin H. Kennedy

  7. Facharzt FMH für Urologie, spez. operative Urologie, Klinik Hirslanden, Zentrum für Urologie, Witellikerstrasse 40, 8008, Zürich, Switzerland

    Hubert John

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  1. Steven D. Wexner
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Correspondence to Steven D. Wexner.

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Wexner, S.D., Bergamaschi, R., Lacy, A. et al. The current status of robotic pelvic surgery: results of a multinational interdisciplinary consensus conference. Surg Endosc 23, 438–443 (2009). https://doi.org/10.1007/s00464-008-0202-8

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  • DOI: https://doi.org/10.1007/s00464-008-0202-8

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