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Minimally invasive, patient-friendly approaches based on rapid technological advances have revolutionized surgery. A decade after the approval of the Da Vinci® Surgical System (DVSS; Intuitive Surgical Inc., CA, USA) by the US FDA and two decades after the introduction of laparoscopic surgery, increasing evidence for the superiority of minimally invasive approaches progressively replaces traditional open surgery. The potential advantages of the DVSS over conventional laparoscopic surgery (CLS) include its greater precision, lower error rates, reduced bleeding, shorter hospital stays, more rapid patient recovery and reduced pain [1]. In this article, we discuss whether evidence for the safety and efficacy superiority of the DVSS over CLS, also considering cost-effectiveness aspects, encourages wider use in a day-to-day clinical practice for all or only specific surgical procedures. Expectations and limitations, particularly for improving outcomes of patients with solid cancer, are also described.
The DVSS is an emerging minimal invasive technology. The surgeon directs the robotic arms of the system through a console by means of hand controls and pedals, making use of a stereoscopic viewing system. DVSS is currently being used in general, urological, gynecologic and cardiothoracic surgery.
Why robots in surgery?
The potential advantages of DVSS over CLS include its greater precision, lower error rates, potentially reduced bleeding, shorter hospital stays, more rapid patient recovery and reduced pain. Collectively, the short-term postoperative improvement in outcomes can also be termed as quality-of-life (QoL) improvement. It also has ergonomic advantages for the surgeon; for example, the surgeon remains seated during the operation. Three- and four-arm versions are available. A DVSS robotic device costs approximately US$1 million. The surgical instruments designed for use with the robotic arms can be used for diverse applications.
Although robotic surgery is in its early stages, many surgeons have begun to use it in daily practice. It is being used for radical prostatectomy, pyeloplasty, nephrectomy, cystectomy, esophageal surgery, bariatric surgery, gastrectomy, cholecystectomy, colorectal resection, hysterectomy, and cardiac septum and valve surgery.
Trends & implementations
Robotic surgery was first used in 2000 after approval by the US FDA. A number of robotic surgery devices have been developed, with the DVSS the newest and most widely used device. Robotic technology has been adopted rapidly over the past 4 years in both the USA and Europe....