Robot-assisted surgery

The concept of using standard hand grips to control manipulators and cameras of various sizes down to sub-miniature was described in the Robert Heinlein story 'Waldo' in August 1942, which also mentioned brain surgery.

The first robot to assist in surgery was the Arthrobot, which was developed and used for the first time in Vancouver in 1983.{{cite journal | pmc=3941295 | date=2013 | title=Robotic surgery | journal=Journal of Oral Biology and Craniofacial Research | volume=3 | issue=1 | page=2 | doi=10.1016/j.jobcr.2013.03.002 | pmid=25737871 | vauthors = Mohammad S }}{{Cite web|url=http://www.brianday.ca/imagez/1051_28738.pdf|title=Medical Post 23:1985|access-date=3 December 2014|archive-date=23 September 2015|archive-url=https://web.archive.org/web/20150923194508/http://www.brianday.ca/imagez/1051_28738.pdf|url-status=live}}{{cite journal | vauthors = Lauterbach R, Matanes E, Lowenstein L | title = Review of Robotic Surgery in Gynecology-The Future Is Here | journal = Rambam Maimonides Medical Journal | volume = 8 | issue = 2 | date = April 2017 | pages = e0019 | pmid = 28467761 | pmc = 5415365 | doi = 10.5041/rmmj.10296 }} This robot assisted in being able to manipulate and position the patient's leg on voice command. Intimately involved were biomedical engineer James McEwen, Geof Auchinleck, a UBC engineering physics grad, and Dr. Brian Day as well as a team of engineering students. The robot was used in an orthopaedic surgical procedure on 12 March 1983, at the UBC Hospital in Vancouver. The next great step was in 1985. in brain biopsy under CT guidance with the assistance of a robotic arm—PUMA560.{{cite journal | pmc=5415365 | date=2017 | title=Review of Robotic Surgery in Gynecology—The Future is Here | journal=Rambam Maimonides Medical Journal | volume=8 | issue=2 | pages=e0019 | doi=10.5041/RMMJ.10296 | pmid=28467761 | vauthors = Lauterbach R, Matanes E, Lowenstein L }} Over 60 arthroscopic surgical procedures were performed in the first 12 months, and a 1985. National Geographic video on industrial robots, The Robotics Revolution, featured the device. Other related robotic devices developed at the same time included a surgical scrub nurse robot, which handed operative instruments on voice command, and a medical laboratory robotic arm. A YouTube video entitled Arthrobot – the world's first surgical robot illustrates some of these in operation.{{cite web|date=2014-01-08|title=Arthrobot - the world's first surgical robot|url=https://www.youtube.com/watch?v=ca7JPD9pg-8 |archive-url=https://ghostarchive.org/varchive/youtube/20211221/ca7JPD9pg-8 |archive-date=2021-12-21 |url-status=live|access-date=2019-04-14|vauthors=Day B|website=YouTube}}{{cbignore}}

In 1985 a robot, the Unimation Puma 200, was used to orient a needle for a brain biopsy while under CT guidance during a neurological procedure.{{cite journal | vauthors = Kwoh YS, Hou J, Jonckheere EA, Hayati S | title = A robot with improved absolute positioning accuracy for CT guided stereotactic brain surgery | journal = IEEE Transactions on Bio-Medical Engineering | volume = 35 | issue = 2 | pages = 153–160 | date = February 1988 | pmid = 3280462 | doi = 10.1109/10.1354 | s2cid = 31260974 }} In the late 1980s, Imperial College in London developed PROBOT, which was then used to perform prostatic surgery. The advantages to this robot was its small size, accuracy and lack of fatigue for the surgeon. In the 1990s, computer-controlled surgical devices began to emerge, enabling greater precision and control in surgical procedures. One of the most significant advancements in this period was the da Vinci Surgical System, which was approved by the FDA for use in surgical procedures in 2000 (Intuitive Surgical, 2021). The da Vinci system uses robotic arms to manipulate surgical instruments, allowing surgeons to perform complex procedures with greater accuracy and control.{{Cite journal |vauthors=Andellini M, Di Mauro R, Faggiano F, Derrico P, Ritrovato M |date=2019 |title=PP187 Robotic Surgery, Any Updates? |url=https://www.cambridge.org/core/journals/international-journal-of-technology-assessment-in-health-care/article/pp187-robotic-surgery-any-updates/41CA52372A9275AD1304595895CE729F |journal=International Journal of Technology Assessment in Health Care |language=en |volume=35 |issue=S1 |pages=72 |doi=10.1017/S0266462319002757 |s2cid=214168249 |issn=0266-4623 |access-date=19 April 2023 |archive-date=19 April 2023 |archive-url=https://web.archive.org/web/20230419043539/https://www.cambridge.org/core/journals/international-journal-of-technology-assessment-in-health-care/article/pp187-robotic-surgery-any-updates/41CA52372A9275AD1304595895CE729F |url-status=live }} In 1992, the ROBODOC was introduced and revolutionized orthopedic surgery by being able to assist with hip replacement surgeries.{{cite journal | vauthors = Paul HA, Bargar WL, Mittlestadt B, Musits B, Taylor RH, Kazanzides P, Zuhars J, Williamson B, Hanson W | title = Development of a surgical robot for cementless total hip arthroplasty | journal = Clinical Orthopaedics and Related Research | volume = 285 | issue = 285 | pages = 57–66 | date = December 1992 | pmid = 1446455 | doi = 10.1097/00003086-199212000-00010 | s2cid = 25245838 }} The latter was the first surgical robot that was approved by the FDA in 2008.{{cite journal | vauthors = Lanfranco AR, Castellanos AE, Desai JP, Meyers WC | title = Robotic surgery: a current perspective | journal = Annals of Surgery | volume = 239 | issue = 1 | pages = 14–21 | date = January 2004 | pmid = 14685095 | pmc = 1356187 | doi = 10.1097/01.sla.0000103020.19595.7d }} The ROBODOC from Integrated Surgical Systems (working closely with IBM) could mill out precise fittings in the femur for hip replacement.{{cite web|title=ROBODOC: Surgical Robot Success Story|url=http://www.robot.md/publications/robodoc-surgical-robot-sucess-story.pdf|access-date=25 June 2013|archive-date=29 September 2013|archive-url=https://web.archive.org/web/20130929033023/http://www.robot.md/publications/robodoc-surgical-robot-sucess-story.pdf|url-status=live}} The purpose of the ROBODOC was to replace the previous method of carving out a femur for an implant, the use of a mallet and broach/rasp.

Further development of robotic systems was carried out by SRI International and Intuitive Surgical with the introduction of the da Vinci Surgical System and Computer Motion with the AESOP and the ZEUS robotic surgical system.{{cite journal | vauthors = Meadows M | title = Computer-assisted surgery: an update | journal = FDA Consumer | volume = 39 | issue = 4 | pages = 16–17 | year = 2005 | pmid = 16252396 | url = https://www.fda.gov/fdac/features/2005/405_computer.html | publisher = Food and Drug Administration | archive-url = https://web.archive.org/web/20090301135726/https://www.fda.gov/fdac/features/2005/405_computer.html | archive-date = 1 March 2009 }} The first robotic surgery took place at The Ohio State University Medical Center in Columbus, Ohio under the direction of Robert E. Michler.{{cite journal|vauthors=McConnell PI, Schneeberger EW, Michler RE|date=2003|title=History and development of robotic cardiac surgery|journal=Problems in General Surgery|volume=20|issue=2|pages=20–30|doi=10.1097/01.sgs.0000081182.03671.6e}}

AESOP was a breakthrough in robotic surgery when introduced in 1994, as it was the first laparoscopic camera holder to be approved by the FDA. NASA initially funded the company that produces AESOP, Computer Motion, due to its goal to create a robotic arm that can be used in space, but this project ended up becoming a camera used in laparoscopic procedures. Voice control was then added in 1996 with the AESOP 2000 and seven degrees of freedom to mimic a human hand was added in 1998 with the AESOP 3000.{{cite journal | vauthors = Unger SW, Unger HM, Bass RT | title = AESOP robotic arm | journal = Surgical Endoscopy | volume = 8 | issue = 9 | pages = 1131 | date = September 1994 | pmid = 7992194 | doi = 10.1007/BF00705739 | s2cid = 40064513 }}

ZEUS was introduced commercially in 1998, and started the idea of telerobotics or telepresence surgery where the surgeon is at a distance from the robot on a console and operates on the patient.{{cite journal | vauthors = Baek SJ, Kim SH | title = Robotics in general surgery: an evidence-based review | journal = Asian Journal of Endoscopic Surgery | volume = 7 | issue = 2 | pages = 117–123 | date = May 2014 | pmid = 24877247 | doi = 10.1111/ases.12087 | s2cid = 29441809 | doi-access = free }} ZEUS was first used during a gynecological surgery in 1997 to reconnect Fallopian tubes in Cleveland Ohio,{{cite web|date=29 September 1999|title=ZEUS robot system reverses sterilization to enable birth of baby boy|url=http://www.hoise.com/vmw/99/articles/vmw/LV-VM-11-99-1.html|publisher=Virtual Medical Worlds Monthly|vauthors=Versweyveld L|access-date=17 October 2007|archive-date=20 September 2017|archive-url=https://web.archive.org/web/20170920021509/http://www.hoise.com/vmw/99/articles/vmw/LV-VM-11-99-1.html|url-status=live}} a beating heart coronary artery bypass graft in October 1999,{{cite web|date=6 October 1999|title=Robotics: the Future of Minimally Invasive Heart Surgery|url=http://biomed.brown.edu/Courses/BI108/BI108_2000_Groups/Heart_Surgery/Robotics.html|access-date=29 November 2011|publisher=Division of Biology and Medicine, Brown University |url-status=dead |archive-url=https://web.archive.org/web/20020328150235/http://biomed.brown.edu/Courses/BI108/BI108_2000_Groups/Heart_Surgery/Robotics.html |archive-date=2002-03-28}} and the Lindbergh Operation, which was a cholecystectomy performed remotely in September 2001.{{cite web|title=Linbergh Operation – IRCAD/EITS Laparoscopic Center|url=http://www.ircad.fr/event/lindbergh/index.php?lng=en|access-date=19 January 2011|archive-date=21 July 2011|archive-url=https://web.archive.org/web/20110721001049/http://www.ircad.fr/event/lindbergh/index.php?lng=en|url-status=dead}} In 2003, ZEUS made its most prominent mark in cardiac surgery after successfully harvesting the left internal mammary arteries in 19 patients, all of which had very successful clinical outcomes.{{cite journal | vauthors = Boyd WD, Rayman R, Desai ND, Menkis AH, Dobkowski W, Ganapathy S, Kiaii B, Jablonsky G, McKenzie FN, Novick RJ | title = Closed-chest coronary artery bypass grafting on the beating heart with the use of a computer-enhanced surgical robotic system | journal = The Journal of Thoracic and Cardiovascular Surgery | volume = 120 | issue = 4 | pages = 807–809 | date = October 2000 | pmid = 11003767 | doi = 10.1067/mtc.2000.109541 | doi-access = free }}{{cite journal | vauthors = Boyd WD, Kiaii B, Kodera K, Rayman R, Abu-Khudair W, Fazel S, Dobkowski WB, Ganapathy S, Jablonsky G, Novick RJ | title = Early experience with robotically assisted internal thoracic artery harvest | journal = Surgical Laparoscopy, Endoscopy & Percutaneous Techniques | volume = 12 | issue = 1 | pages = 52–57 | date = February 2002 | pmid = 12008763 | doi = 10.1097/00019509-200202000-00009 | s2cid = 42287712 }}

The original telesurgery robotic system that the da Vinci was based on was developed at Stanford Research Institute International in Menlo Park with grant support from DARPA and NASA.{{cite web|title=Telerobotic Surgery|url=http://www.sri.com/work/timeline-innovation/timeline.php?timeline=health#!&innovation=telerobotic-surgery|access-date=30 September 2013|publisher=SRI International|archive-date=19 November 2016|archive-url=https://web.archive.org/web/20161119182210/https://www.sri.com/work/timeline-innovation/timeline.php?timeline=health#!&innovation=telerobotic-surgery|url-status=dead}} A demonstration of an open bowel anastomosis was given to the Association of Military Surgeons of the US.{{cite journal | vauthors = Satava RM | title = Surgical robotics: the early chronicles: a personal historical perspective | journal = Surgical Laparoscopy, Endoscopy & Percutaneous Techniques | volume = 12 | issue = 1 | pages = 6–16 | date = February 2002 | pmid = 12008765 | doi = 10.1097/00129689-200202000-00002 | s2cid = 45163715 }} Although the telesurgical robot was originally intended to facilitate remotely performed surgery in the battlefield to reduce casualties and to be used in other remote environments, it turned out to be more useful for minimally invasive on-site surgery.{{cite journal | vauthors = George EI, Brand TC, LaPorta A, Marescaux J, Satava RM | title = Origins of Robotic Surgery: From Skepticism to Standard of Care | journal = JSLS | volume = 22 | issue = 4 | pages = e2018.00039 | date = 2018 | pmid = 30524184 | pmc = 6261744 | doi = 10.4293/JSLS.2018.00039 }}{{cite journal | vauthors = Tameze Y, Low YH | title = Outpatient Robotic surgery: Considerations for the Anesthesiologist | journal = Advances in Anesthesia | volume = 40 | issue = 1 | pages = 15–32 | date = December 2022 | pmid = 36333045 | pmc = 9626246 | doi = 10.1016/j.aan.2022.06.001 }} The patents for the early prototype were sold to Intuitive Surgical in Mountain View, California. The da Vinci senses the surgeon's hand movements and translates them electronically into scaled-down micro-movements to manipulate the tiny proprietary instruments. It also detects and filters out any tremors in the surgeon's hand movements, so that they are not duplicated robotically. The camera used in the system provides a true stereoscopic picture transmitted to a surgeon's console. Compared to the ZEUS, the da Vinci robot is attached to trocars to the surgical table, and can imitate the human wrist. In 2000, the da Vinci obtained FDA approval for general laparoscopic procedures and became the first operative surgical robot in the US.{{cite journal | vauthors = Sung GT, Gill IS | title = Robotic laparoscopic surgery: a comparison of the DA Vinci and Zeus systems | journal = Urology | volume = 58 | issue = 6 | pages = 893–898 | date = December 2001 | pmid = 11744453 | doi = 10.1016/s0090-4295(01)01423-6 }} Examples of using the da Vinci system include the first robotically assisted heart bypass (performed in Germany) in May 1998, and the first performed in the United States in September 1999;{{Citation needed|date=January 2011}} and the first all-robotic-assisted kidney transplant, performed in January 2009.{{cite news|date=22 June 2009|title=New Robot Technology Eases Kidney Transplants: N.J. Hospital Performs World's First All-Robotic Transplant |work=CBS News | vauthors = Gomez M |url=http://wcbstv.com/health/da.vinci.robot.2.1055154.html|access-date=8 July 2009 |url-status=dead |archive-url=https://web.archive.org/web/20090804104220/http://wcbstv.com/health/da.vinci.robot.2.1055154.html |archive-date=2009-08-04}} The da Vinci Si was released in April 2009 and initially sold for $1.75 million.{{cite web|title=da Vinci Si Surgical System|url=http://www.intuitivesurgical.com/products/davinci_surgical_system/davinci_surgical_system_si/|access-date=30 September 2013|publisher=Intuitive Surgical|archive-date=21 October 2013|archive-url=https://web.archive.org/web/20131021222409/http://www.intuitivesurgical.com/products/davinci_surgical_system/davinci_surgical_system_si/|url-status=live}}

In 2005, a surgical technique was documented in canine and cadaveric models called the transoral robotic surgery (TORS) for the da Vinci robot surgical system as it was the only FDA-approved robot to perform head and neck surgery.{{cite journal | vauthors = Oliveira CM, Nguyen HT, Ferraz AR, Watters K, Rosman B, Rahbar R | title = Robotic surgery in otolaryngology and head and neck surgery: a review | journal = Minimally Invasive Surgery | volume = 2012 | pages = 286563 | date = 2012 | pmid = 22567225 | pmc = 3337488 | doi = 10.1155/2012/286563 | doi-access = free }}{{cite journal | vauthors = Weinstein GS, O'malley BW, Hockstein NG | title = Transoral robotic surgery: supraglottic laryngectomy in a canine model | journal = The Laryngoscope | volume = 115 | issue = 7 | pages = 1315–1319 | date = July 2005 | pmid = 15995528 | doi = 10.1097/01.MLG.0000170848.76045.47 | s2cid = 30860198 }} In 2006, three patients underwent resection of the tongue using this technique. The results were more clear visualization of the cranial nerves, lingual nerves, and lingual artery, and the patients had a faster recovery to normally swallowing.{{cite journal | vauthors = Lee SY, Park YM, Byeon HK, Choi EC, Kim SH | title = Comparison of oncologic and functional outcomes after transoral robotic lateral oropharyngectomy versus conventional surgery for T1 to T3 tonsillar cancer | journal = Head & Neck | volume = 36 | issue = 8 | pages = 1138–1145 | date = August 2014 | pmid = 23836492 | doi = 10.1002/hed.23424 | s2cid = 25773206 }} In May 2006 the first artificial intelligence doctor-conducted unassisted robotic surgery was on a 34-year-old male to correct heart arrhythmia. The results were rated as better than an above-average human surgeon. The machine had a database of 10,000 similar operations, and so, in the words of its designers, was "more than qualified to operate on any patient".{{cite news|date=19 May 2006|vauthors=Blass E|title=Autonomous Robotic Surgeon performs surgery on first live human|work=Engadget|url=https://www.engadget.com/2006-05-19-robot-surgeon-performs-worlds-first-unassisted-operation.html|access-date=30 November 2022|archive-date=30 November 2022|archive-url=https://web.archive.org/web/20221130005100/https://www.engadget.com/2006-05-19-robot-surgeon-performs-worlds-first-unassisted-operation.html|url-status=live}}{{cite news|title=Robot surgeon carries out 9-hour operation by itself|url=http://www.physorg.com/news67222790.html|website=Phys.Org|date=May 19, 2006|access-date=21 July 2009|archive-date=6 June 2011|archive-url=https://web.archive.org/web/20110606210358/http://www.physorg.com/news67222790.html|url-status=live}} In August 2007, Dr. Sijo Parekattil of the Robotics Institute and Center for Urology (Winter Haven Hospital and University of Florida) performed the first robotic-assisted microsurgery procedure denervation of the spermatic cord for chronic testicular pain.{{cite web|title=Robotic Infertility|url=http://www.roboticinfertility.com/|access-date=11 October 2012|vauthors=Parekattil S|archive-date=27 February 2024|archive-url=https://web.archive.org/web/20240227050703/https://avanturol.com/|url-status=live}} In February 2008, Dr. Mohan S. Gundeti of the University of Chicago Comer Children's Hospital performed the first robotic pediatric neurogenic bladder reconstruction.{{cite news|date=20 November 2008|title=Surgeons perform world's first pediatric robotic bladder reconstruction|publisher=Esciencenews.com|url=http://esciencenews.com/articles/2008/11/20/surgeons.perform.worlds.first.pediatric.robotic.bladder.reconstruction|access-date=29 November 2011|archive-date=22 November 2010|archive-url=https://web.archive.org/web/20101122112621/http://esciencenews.com/articles/2008/11/20/surgeons.perform.worlds.first.pediatric.robotic.bladder.reconstruction|url-status=live}}

On 12 May 2008, the first image-guided MR-compatible robotic neurosurgical procedure was performed at University of Calgary by Dr. Garnette Sutherland using the NeuroArm.{{cite web|date=16 May 2008|title=neuroArm : revolutionary procedure a world first|url=https://www.ucalgary.ca/news/may2008/neuroArm|access-date=14 November 2012|publisher=ucalgary.ca|archive-date=2 May 2019|archive-url=https://web.archive.org/web/20190502165123/https://www.ucalgary.ca/news/may2008/neuroArm|url-status=dead}} In June 2008, the German Aerospace Centre (DLR) presented a robotic system for minimally invasive surgery, the MiroSurge.{{cite journal|vauthors=Hagn U, Nickl M, Jörg S, Tobergte A, Kübler B, Passig G, Gröger M, Fröhlich F, Seibold U, Konietschke R, Le-Tien L, Albu-Schäffer A, Grebenstein M, Ortmaier T, Hirzinger G|date=2008|title=DLR MiroSurge – towards versatility in surgical robotics|journal=Jahrestagung der Deutschen Gesellschaft für Computer und Roboterassistierte Chirurgie; Proceedings of CURAC|volume=7|pages=143–146}} In September 2010, the Eindhoven University of Technology announced the development of the Sofie surgical system, the first surgical robot to employ force feedback.{{cite web|date=27 September 2010|title=Beter opereren met nieuwe Nederlandse operatierobot Sofie|url=http://w3.wtb.tue.nl/nl/nieuws/artikel/?tx_ttnews%5Btt_news%5D=10041&tx_ttnews%5BbackPid%5D=465&cHash=ebb243e7ff|url-status=dead|archive-url=https://web.archive.org/web/20110724171318/http://w3.wtb.tue.nl/nl/nieuws/artikel/?tx_ttnews%5Btt_news%5D=10041&tx_ttnews%5BbackPid%5D=465&cHash=ebb243e7ff|archive-date=24 July 2011|access-date=10 October 2010|publisher=TU/e|language=nl|df=dmy-all}} In September 2010, the first robotic operation at the femoral vasculature was performed at the University Medical Centre Ljubljana by a team led by Borut Geršak.{{cite news|date=8 November 2010|title=V UKC Ljubljana prvič na svetu uporabili žilnega robota za posege na femoralnem žilju|language=sl|trans-title=The First Use of a Vascular Robot for Procedures on Femoral Vasculature|url=http://med.over.net/index.php?full=1&id=25545&title=V_UKC_Ljubljana_prvi___na_svetu_uporabili___ilnega_robota_za_posege_na_femoralnem___ilju|access-date=1 April 2011|archive-date=20 August 2011|archive-url=https://web.archive.org/web/20110820221055/http://med.over.net/index.php?full=1&id=25545&title=V_UKC_Ljubljana_prvi___na_svetu_uporabili___ilnega_robota_za_posege_na_femoralnem___ilju|url-status=live}}{{cite news|date=30 March 2011|title=UKC Ljubljana kljub finančnim omejitvam uspešen v razvoju medicine|language=sl|trans-title=UMC Ljubljana Successfully Develops Medicine Despite Financial Limitations|url=http://www.dnevnik.si/novice/zdravje/1042434634|access-date=1 April 2011|archive-date=5 November 2011|archive-url=https://web.archive.org/web/20111105031951/http://www.dnevnik.si/novice/zdravje/1042434634|url-status=live}}

In 2019 the Versius Surgical Robotic System was launched and is a rival of the Da Vinci surgical system and claims to be more flexible and versatile, having independent modular arms which are "quick and easy to set up". The small-scale design means that it is suitable for virtually any operating room and can be operated at either a standing or a sitting position.{{cite news |title=New Versius robot surgery system coming to NHS |url=https://www.bbc.co.uk/news/health-45370642 |access-date=8 October 2018 |publisher=BBC |date=3 September 2018 |archive-date=5 September 2018 |archive-url=https://web.archive.org/web/20180905204921/https://www.bbc.co.uk/news/health-45370642 |url-status=live }}

Ophthalmology is still part of the frontier for robotic-assisted surgeries. However, there are a couple of robotic systems that are capable of successfully performing surgeries.{{cite journal | vauthors = de Smet MD, Naus GJ, Faridpooya K, Mura M | title = Robotic-assisted surgery in ophthalmology | journal = Current Opinion in Ophthalmology | volume = 29 | issue = 3 | pages = 248–253 | date = May 2018 | pmid = 29553953 | doi = 10.1097/ICU.0000000000000476 | s2cid = 4574073 }}

• PRECEYES Surgical System is being used for vitreoretinal surgeries. This is a single arm robot, that is tele manipulated by a surgeon. This system attaches to the head of the operating room table and provides surgeons with increased precision with the help of the intuitive motion controller.{{Cite web|url=http://www.preceyes.nl/preceyes-surgical-system/|title=PRECEYES Surgical System – Preceyes BV|access-date=23 March 2021|archive-date=10 April 2021|archive-url=https://web.archive.org/web/20210410115512/http://www.preceyes.nl/preceyes-surgical-system/|url-status=live}} Preceyes is the only robotic instrument to be CE certified. Some other companies like Forsight Robotics,{{Cite web|url=https://www.forsightrobotics.com/oryom/|title=ORYOM™|website=Forsight Robotics|access-date=19 October 2022|archive-date=19 October 2022|archive-url=https://web.archive.org/web/20221019132240/https://www.forsightrobotics.com/oryom/|url-status=live}} Acusurgical {{Cite web|url=https://acusurgical.com/|title=Acusurgical is developing robots for retinal surgery|website=ACUSURGICAL|access-date=26 April 2023|archive-date=26 April 2023|archive-url=https://web.archive.org/web/20230426221927/https://acusurgical.com/|url-status=live}} that raised 5.75 M€ (France),{{cite news |url=https://www.businesswire.com/news/home/20210217005035/en/AcuSurgical-raises-%E2%82%AC5.75-Million-in-Series-A-financing-to-advance-its-robotic-ocular-microsurgery-platform. |title=AcuSurgical raises €5.75 Million in Series A financing, to advance its robotic ocular microsurgery platform. |work=Businesswire |date=18 February 2021 |access-date=7 April 2022 |archive-date=7 April 2022 |archive-url=https://web.archive.org/web/20220407135436/https://www.businesswire.com/news/home/20210217005035/en/AcuSurgical-raises-%E2%82%AC5.75-Million-in-Series-A-financing-to-advance-its-robotic-ocular-microsurgery-platform. |url-status=live }} and Horizon (US) are working in this field.
• The da Vinci Surgical System, though not specifically designed for ophthalmic procedures, uses telemanipulation to perform pterygium repairs and ex-vivo corneal surgeries.

Some examples of heart surgery being assisted by robotic surgery systems include:

• Atrial septal defect repair{{cite journal | vauthors = Kim JE, Jung SH, Kim GS, Kim JB, Choo SJ, Chung CH, Lee JW | title = Surgical Outcomes of Congenital Atrial Septal Defect Using da VinciTM Surgical Robot System | journal = The Korean Journal of Thoracic and Cardiovascular Surgery | volume = 46 | issue = 2 | pages = 93–97 | date = April 2013 | pmid = 23614093 | pmc = 3631797 | doi = 10.5090/kjtcs.2013.46.2.93 }} – the repair of a hole between the two upper chambers of the heart,
• Mitral valve repair{{cite journal | vauthors = Gillinov AM, Mihaljevic T, Javadikasgari H, Suri RM, Mick SL, Navia JL, Desai MY, Bonatti J, Khosravi M, Idrees JJ, Lowry AM, Blackstone EH, Svensson LG | title = Early results of robotically assisted mitral valve surgery: Analysis of the first 1000 cases | journal = The Journal of Thoracic and Cardiovascular Surgery | volume = 155 | issue = 1 | pages = 82–91.e2 | date = January 2018 | pmid = 28893396 | doi = 10.1016/j.jtcvs.2017.07.037 | s2cid = 8495890 | doi-access = free }} – the repair of the valve that prevents blood from regurgitating back into the upper heart chambers during contractions of the heart,
• Coronary artery bypass{{cite journal | vauthors = Halkos ME, Liberman HA, Devireddy C, Walker P, Finn AV, Jaber W, Guyton RA, Puskas JD | title = Early clinical and angiographic outcomes after robotic-assisted coronary artery bypass surgery | journal = The Journal of Thoracic and Cardiovascular Surgery | volume = 147 | issue = 1 | pages = 179–185 | date = January 2014 | pmid = 24172691 | doi = 10.1016/j.jtcvs.2013.09.010 | doi-access = free }} – rerouting of blood supply by bypassing blocked arteries that provide blood to the heart.

Robotic surgery has become more widespread in thoracic surgery for mediastinal pathologies, pulmonary pathologies and more recently complex esophageal surgery.{{cite journal | vauthors = Melfi FM, Menconi GF, Mariani AM, Angeletti CA | title = Early experience with robotic technology for thoracoscopic surgery | journal = European Journal of Cardio-Thoracic Surgery | volume = 21 | issue = 5 | pages = 864–868 | date = May 2002 | pmid = 12062276 | doi = 10.1016/S1010-7940(02)00102-1 | doi-access = free }}

The da Vinci Xi system is used for lung and mediastinal mass resection. This minimally invasive approach as a comparable alternative to video-assisted thoracoscopic surgery (VATS) and the standard open thoracic surgery. Although VATS is the less expensive option, the robotic-assisted approach offers benefits such as 3D visualizations with seven degrees of freedom and improved dexterity while having equivalent perioperative outcomes.{{cite journal | vauthors = Latif MJ, Park BJ | title = Robotics in general thoracic surgery procedures | journal = Journal of Visualized Surgery | volume = 3 | pages = 44 | date = 11 April 2017 | pmid = 29078607 | pmc = 5637743 | doi = 10.21037/jovs.2017.03.14 | doi-access = free }}

The first successful robot-assisted cochlear implantation in a person took place in Bern, Switzerland in 2017.{{Cite web |title=Patient is First to Undergo Robot-Assisted Cochlear Implantation |work=American Association for the Advancement of Science (AAAS) |url=https://www.aaas.org/news/patient-first-undergo-robot-assisted-cochlear-implantation |access-date=2021-10-06 |date=15 March 2017 |vauthors=Song J |language=en |archive-date=6 October 2021 |archive-url=https://web.archive.org/web/20211006150715/https://www.aaas.org/news/patient-first-undergo-robot-assisted-cochlear-implantation |url-status=live }} Surgical robots have been developed for use at various stages of cochlear implantation, including drilling through the mastoid bone, accessing the inner ear and inserting the electrode into the cochlea.{{cite journal | vauthors = Panara K, Shahal D, Mittal R, Eshraghi AA | title = Robotics for Cochlear Implantation Surgery: Challenges and Opportunities | language = en-US | journal = Otology & Neurotology | volume = 42 | issue = 7 | pages = e825–e835 | date = August 2021 | pmid = 33993143 | doi = 10.1097/MAO.0000000000003165 | s2cid = 234747381 }}

Advantages of robot-assisted cochlear implantation include improved accuracy,{{Cite web|date=2017-09-19|title=Robotic Cochlear Implantation|url=https://www.artorg.unibe.ch/research/igt/research/robotic_cochlear_implantation/index_eng.html|access-date=2021-10-06|website=ARTORG Center for Biomedical Engineering Research|archive-date=6 October 2021|archive-url=https://web.archive.org/web/20211006160727/https://www.artorg.unibe.ch/research/igt/research/robotic_cochlear_implantation/index_eng.html|url-status=live}} resulting in fewer mistakes during electrode insertion and better hearing outcomes for patients.{{Cite web|vauthors=Choi CQ|date=2017-03-15|title=Robo First: Bot Assists with Tricky Cochlear-Implant Surgery|url=https://www.livescience.com/58274-robot-assists-tricky-cochlear-implant-surgery.html|access-date=2021-10-06|website=livescience.com|language=en|archive-date=6 October 2021|archive-url=https://web.archive.org/web/20211006150716/https://www.livescience.com/58274-robot-assists-tricky-cochlear-implant-surgery.html|url-status=live}} The surgeon uses image-guided surgical planning to program the robot based on the patient's individual anatomy. This helps the implant team to predict where the contacts of the electrode array will be located within the cochlea, which can assist with audio processor fitting post-surgery.{{Cite web|title=The HEARO Procedure for cochlear implantation|url=https://www.entandaudiologynews.com/features/ent-features/post/the-hearo-procedure-for-cochlear-implantation|access-date=2021-10-06|website=ENT & Audiology News|language=en|date=3 December 2020|vauthors=Vedat T|archive-date=6 October 2021|archive-url=https://web.archive.org/web/20211006150717/https://www.entandaudiologynews.com/features/ent-features/post/the-hearo-procedure-for-cochlear-implantation|url-status=live}} The surgical robots also allow surgeons to reach the inner ear in a minimally invasive way.

Challenges that still need to be addressed include safety, time, efficiency and cost.

Surgical robots have also been shown to be useful for electrode insertion with pediatric patients.{{cite journal | vauthors = Jia H, Pan J, Gu W, Tan H, Chen Y, Zhang Z, Jiang M, Li Y, Sterkers O, Wu H | title = Robot-Assisted Electrode Array Insertion Becomes Available in Pediatric Cochlear Implant Recipients: First Report and an Intra-Individual Study | journal = Frontiers in Surgery | volume = 8 | pages = 695728 | date = 2021-07-07 | pmid = 34307444 | pmc = 8294934 | doi = 10.3389/fsurg.2021.695728 | doi-access = free }}

Multiple types of procedures have been performed with either the 'Zeus' or da Vinci robot systems, including bariatric surgery and gastrectomy{{cite journal | vauthors = Hyun MH, Lee CH, Kim HJ, Tong Y, Park SS | title = Systematic review and meta-analysis of robotic surgery compared with conventional laparoscopic and open resections for gastric carcinoma | journal = The British Journal of Surgery | volume = 100 | issue = 12 | pages = 1566–1578 | date = November 2013 | pmid = 24264778 | doi = 10.1002/bjs.9242 | s2cid = 205514054 | doi-access = free }} for cancer. Surgeons at various universities initially published case series demonstrating different techniques and the feasibility of GI surgery using the robotic devices.{{cite journal | vauthors = Talamini MA, Chapman S, Horgan S, Melvin WS | title = A prospective analysis of 211 robotic-assisted surgical procedures | journal = Surgical Endoscopy | volume = 17 | issue = 10 | pages = 1521–1524 | date = October 2003 | pmid = 12915974 | doi = 10.1007/s00464-002-8853-3 | s2cid = 25327137 }} Specific procedures have been more fully evaluated, specifically esophageal fundoplication for the treatment of gastroesophageal reflux{{cite journal | vauthors = Melvin WS, Needleman BJ, Krause KR, Schneider C, Ellison EC | title = Computer-enhanced vs. standard laparoscopic antireflux surgery | journal = Journal of Gastrointestinal Surgery | volume = 6 | issue = 1 | pages = 11–15; discussion 15–16 | date = 2002 | pmid = 11986012 | doi = 10.1016/S1091-255X(01)00032-4 | s2cid = 678863 }} and Heller myotomy for the treatment of achalasia.{{cite journal | vauthors = Melvin WS, Dundon JM, Talamini M, Horgan S | title = Computer-enhanced robotic telesurgery minimizes esophageal perforation during Heller myotomy | journal = Surgery | volume = 138 | issue = 4 | pages = 553–558; discussion 558–559 | date = October 2005 | pmid = 16269282 | doi = 10.1016/j.surg.2005.07.025 }}{{cite journal | vauthors = Shaligram A, Unnirevi J, Simorov A, Kothari VM, Oleynikov D | title = How does the robot affect outcomes? A retrospective review of open, laparoscopic, and robotic Heller myotomy for achalasia | journal = Surgical Endoscopy | volume = 26 | issue = 4 | pages = 1047–1050 | date = April 2012 | pmid = 22038167 | doi = 10.1007/s00464-011-1994-5 | s2cid = 22756808 }}

Robot-assisted pancreatectomies have been found to be associated with "longer operating time, lower estimated blood loss, a higher spleen-preservation rate, and shorter hospital stay[s]" than laparoscopic pancreatectomies; there was "no significant difference in transfusion, conversion to open surgery, overall complications, severe complications, pancreatic fistula, severe pancreatic fistula, ICU stay, total cost, and 30-day mortality between the two groups."{{cite journal | vauthors = Zhou JY, Xin C, Mou YP, Xu XW, Zhang MZ, Zhou YC, Lu C, Chen RG | title = Robotic versus Laparoscopic Distal Pancreatectomy: A Meta-Analysis of Short-Term Outcomes | journal = PLOS ONE | volume = 11 | issue = 3 | pages = e0151189 | date = 2016 | pmid = 26974961 | pmc = 4790929 | doi = 10.1371/journal.pone.0151189 | doi-access = free | bibcode = 2016PLoSO..1151189Z }}

The first report of robotic surgery in gynecology was published in 1999 from the Cleveland Clinic.{{cite journal | vauthors = Falcone T, Goldberg J, Garcia-Ruiz A, Margossian H, Stevens L | title = Full robotic assistance for laparoscopic tubal anastomosis: a case report | journal = Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A | volume = 9 | issue = 1 | pages = 107–113 | date = February 1999 | pmid = 10194702 | doi = 10.1089/lap.1999.9.107 }} The adoption of robotic surgery has contributed to the increase in minimally invasive surgery for gynecologic disease.{{cite journal | vauthors = Lawrie TA, Liu H, Lu D, Dowswell T, Song H, Wang L, Shi G | title = Robot-assisted surgery in gynaecology | journal = The Cochrane Database of Systematic Reviews | volume = 4 | issue = 4 | pages = CD011422 | date = April 2019 | pmid = 30985921 | pmc = 6464707 | doi = 10.1002/14651858.CD011422.pub2 }} Gynecologic procedures may take longer with robot-assisted surgery and the rate of complications may be higher, but there are not enough high-quality studies to know at the present time. In the United States, robotic-assisted hysterectomy for benign conditions was shown to be more expensive than conventional laparoscopic hysterectomy in 2015, with no difference in overall rates of complications.{{cite journal | vauthors = | title = Committee opinion no. 628: robotic surgery in gynecology | journal = Obstetrics and Gynecology | volume = 125 | issue = 3 | pages = 760–767 | date = March 2015 | pmid = 25730256 | doi = 10.1097/01.AOG.0000461761.47981.07 | s2cid = 886451 | doi-access = free }}

This includes the use of the da Vinci surgical system in benign gynecology and gynecologic oncology. Robotic surgery can be used to treat fibroids, abnormal periods, endometriosis, ovarian tumors, uterine prolapse, and female cancers. Using the robotic system, gynecologists can perform hysterectomies, myomectomies, and lymph node biopsies. The Hominis robotic system developed by Momentis Surgical™{{cite web |title=FDA approves first robotic device for transvaginal procedures |url=https://www.medicaldevice-network.com/news/memic-hominis/ |website=Medical Device Network |access-date=19 February 2022 |date=2 March 2021 |archive-date=20 January 2022 |archive-url=https://web.archive.org/web/20220120053356/https://www.medicaldevice-network.com/news/memic-hominis/ |url-status=live }} is aimed to provide a robotic platform for natural orifice transluminal endoscopic surgery (NOTES) for myomectomy through the vagina.{{cite journal | vauthors = Wang T, Tang H, Xie Z, Deng S | title = Robotic-assisted vs. laparoscopic and abdominal myomectomy for treatment of uterine fibroids: a meta-analysis | journal = Minimally Invasive Therapy & Allied Technologies | volume = 27 | issue = 5 | pages = 249–264 | date = October 2018 | pmid = 29490530 | doi = 10.1080/13645706.2018.1442349 | s2cid = 3618672 }}

A 2017 review of surgical removal of the uterus and cervix for early cervical cancer robotic and laparoscopic surgery resulted in similar outcomes with respect to the cancer.{{cite journal | vauthors = Zanagnolo V, Garbi A, Achilarre MT, Minig L | title = Robot-assisted Surgery in Gynecologic Cancers | journal = Journal of Minimally Invasive Gynecology | volume = 24 | issue = 3 | pages = 379–396 | date = 16 January 2017 | pmid = 28104497 | doi = 10.1016/j.jmig.2017.01.006 }}

Robots are used in orthopedic surgery.{{cite book|title = Computer and robotic assisted hip and knee surgery| veditors = DiGioia AM, Jaramaz B, Picard F, Nolte LP |publisher = Oxford University Press|date = 2004|isbn = 978-0-19-850943-1|pages = 127–156}}

ROBODOC is the first active robotic system that performs some of the surgical actions in a total hip arthroplasty (THA). It is programmed preoperatively using data from computer tomography (CT) scans. This allows for the surgeon to choose the optimal size and design for the replacement hip.{{cite journal | vauthors = Sugano N | title = Computer-assisted orthopaedic surgery and robotic surgery in total hip arthroplasty | language = English | journal = Clinics in Orthopedic Surgery | volume = 5 | issue = 1 | pages = 1–9 | date = March 2013 | pmid = 23467021 | pmc = 3582865 | doi = 10.4055/cios.2013.5.1.1 }}{{cite journal | vauthors = Kiefer H, Löchel J, Sambo K, Leder B, Wassilew GI | title = Anterior pelvic plane registration accuracy and cup position measurement using ultrasound- and pointer-based navigation in primary total hip arthroplasty | journal = Technology and Health Care | volume = 28 | issue = 3 | pages = 315–323 | date = 2020-05-20 | pmid = 31658073 | doi = 10.3233/THC-191888 | s2cid = 204952537 }}

Acrobot and Rio are semi-active robotic systems that are used in THA. It consists of a drill bit that is controlled by the surgeon however the robotic system does not allow any movement outside the predetermined boundaries.

Mazor X is used in spinal surgeries to assist surgeons with placing pedicle screw instrumentation. Inaccuracy when placing a pedicle screw can result in neurovascular injury or construct failure. Mazor X functions by using templating imaging to locate itself to the target location of where the pedicle screw is needed.{{cite journal | vauthors = Sayari AJ, Pardo C, Basques BA, Colman MW | title = Review of robotic-assisted surgery: what the future looks like through a spine oncology lens | journal = Annals of Translational Medicine | volume = 7 | issue = 10 | pages = 224 | date = May 2019 | pmid = 31297389 | pmc = 6595200 | doi = 10.21037/atm.2019.04.69 | doi-access = free }}

Robotic devices started to be used in minimally invasive spine surgery starting in the mid-2000s.{{cite journal | vauthors = Shweikeh F, Amadio JP, Arnell M, Barnard ZR, Kim TT, Johnson JP, Drazin D | title = Robotics and the spine: a review of current and ongoing applications | journal = Neurosurgical Focus | volume = 36 | issue = 3 | pages = E10 | date = March 2014 | pmid = 24580002 | doi = 10.3171/2014.1.focus13526 | doi-access = free }} As of 2014, there were too few randomized clinical trials to judge whether robotic spine surgery is more or less safe than other approaches.

As of 2019, the application of robotics in spine surgery has mainly been limited to pedicle screw insertion for spinal fixation.{{cite journal | vauthors = Berni G, Cagnoli L, Lagi A | title = [Goodpasture's syndrome. Case report] | journal = Recenti Progressi in Medicina | volume = 59 | issue = 5 | pages = 465–478 | date = November 1975 | pmid = 1243701 | doi = 10.1007/s11701-019-00983-6 | s2cid = 195695119 }} In addition, the majority of studies on robot-assisted spine surgery have investigated lumbar or lumbosacral vertebrae only. Studies on use of robotics for placing screws in the cervical and thoracic vertebrae are limited.

The first fully robotic kidney transplantations were performed in the late 2000s. It may allow kidney transplantations in people who are obese who could not otherwise have the procedure. Weight loss however is the preferred initial effort.{{cite journal | vauthors = Hameed AM, Yao J, Allen RD, Hawthorne WJ, Pleass HC, Lau H | title = The Evolution of Kidney Transplantation Surgery Into the Robotic Era and Its Prospects for Obese Recipients | journal = Transplantation | volume = 102 | issue = 10 | pages = 1650–1665 | date = October 2018 | pmid = 29916987 | doi = 10.1097/TP.0000000000002328 | doi-access = free }}

With regards to robotic surgery, this type of procedure is currently best suited for single-quadrant procedures,{{cite journal | vauthors = Thomas DJ | title = 3D white light interferometry assessment of robotic laser scalpel assisted surgery to minimise scar tissue formation | journal = International Journal of Surgery | volume = 38 | pages = 117–118 | date = February 2017 | pmid = 28027996 | doi = 10.1016/j.ijsu.2016.12.037 | doi-access = }} in which the operations can be performed on any one of the four quadrants of the abdomen. Cost disadvantages are applied with procedures such as a cholecystectomy and fundoplication, but are suitable opportunities for surgeons to advance their robotic surgery skills.

File:Columbia Hernia Center.jpg

Over the past several decades, there have been great advances in the field of abdominal wall and hernia surgery especially when it comes to robotic-assisted surgery. Unlike laparoscopic surgery, the robotic platform allows for the correction of large hernia defects with specialized techniques that would traditionally only be performed via an open approach. Compared to open surgery, robotic surgery for hernia repair can reduce pain, length of hospital stay, and improve outcomes.{{Cite journal |last1=Bracale |first1=U. |last2=Corcione |first2=F. |last3=Neola |first3=D. |last4=Castiglioni |first4=S. |last5=Cavallaro |first5=G. |last6=Stabilini |first6=C. |last7=Botteri |first7=E. |last8=Sodo |first8=M. |last9=Imperatore |first9=N. |last10=Peltrini |first10=R. |date=December 2021 |title=Transversus abdominis release (TAR) for ventral hernia repair: open or robotic? Short-term outcomes from a systematic review with meta-analysis |journal=Hernia: The Journal of Hernias and Abdominal Wall Surgery |volume=25 |issue=6 |pages=1471–1480 |doi=10.1007/s10029-021-02487-5 |issn=1248-9204 |pmc=8613152 |pmid=34491460}} As the robotic instruments have 6 degrees of articulation, freedom of movement and ergonomics are greatly improved compared to laparoscopy.

The first robotic inguinal hernia repairs were done in conjunction with prostatectomies in 2007.{{Cite journal |last1=Finley |first1=David S. |last2=Rodriguez |first2=Esequiel |last3=Ahlering |first3=Thomas E. |date=October 2007 |title=Combined inguinal hernia repair with prosthetic mesh during transperitoneal robot assisted laparoscopic radical prostatectomy: a 4-year experience |url=https://pubmed.ncbi.nlm.nih.gov/17698133/ |journal=The Journal of Urology |volume=178 |issue=4 Pt 1 |pages=1296–1299; discussion 1299–1300 |doi=10.1016/j.juro.2007.05.154 |issn=0022-5347 |pmid=17698133 |access-date=23 February 2024 |archive-date=23 February 2024 |archive-url=https://web.archive.org/web/20240223152032/https://pubmed.ncbi.nlm.nih.gov/17698133/ |url-status=live }} The first ventral hernia repairs were performed robotically in 2009.{{Cite journal |last1=Allison |first1=Nathan |last2=Tieu |first2=Ken |last3=Snyder |first3=Brad |last4=Pigazzi |first4=Alessio |last5=Wilson |first5=Erik |date=February 2012 |title=Technical feasibility of robot-assisted ventral hernia repair |url=https://pubmed.ncbi.nlm.nih.gov/22194031/ |journal=World Journal of Surgery |volume=36 |issue=2 |pages=447–452 |doi=10.1007/s00268-011-1389-8 |issn=1432-2323 |pmid=22194031 |access-date=23 February 2024 |archive-date=23 February 2024 |archive-url=https://web.archive.org/web/20240223152032/https://pubmed.ncbi.nlm.nih.gov/22194031/ |url-status=live }} Since then the field has rapidly expanded to include most types of reconstruction including anterior as well as posterior component separation.

With newer techniques such as direct access into the abdominal wall,{{Cite journal |last1=Belyansky |first1=Igor |last2=Daes |first2=Jorge |last3=Radu |first3=Victor Gheorghe |last4=Balasubramanian |first4=Ramana |last5=Reza Zahiri |first5=H. |last6=Weltz |first6=Adam S. |last7=Sibia |first7=Udai S. |last8=Park |first8=Adrian |last9=Novitsky |first9=Yuri |date=March 2018 |title=A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair |url=https://pubmed.ncbi.nlm.nih.gov/28916960/ |journal=Surgical Endoscopy |volume=32 |issue=3 |pages=1525–1532 |doi=10.1007/s00464-017-5840-2 |issn=1432-2218 |pmid=28916960 |s2cid=3299412 |access-date=23 February 2024 |archive-date=23 February 2024 |archive-url=https://web.archive.org/web/20240223152032/https://pubmed.ncbi.nlm.nih.gov/28916960/ |url-status=live }} major reconstruction of large hernias can be done without even entering the abdominal cavity. Due to its complexity, however, major reconstruction done robotically should be undertaken at advanced hernia centers such as the Columbia Hernia Center in New York City, NY, USA. The American Hernia Society and the European Hernia Society are moving towards specialty designation for hernia centers who are credentialed for complex hernia surgery, including robotic surgery.{{Cite journal |last1=Köckerling |first1=F. |last2=Sheen |first2=A. J. |last3=Berrevoet |first3=F. |last4=Campanelli |first4=G. |last5=Cuccurullo |first5=D. |last6=Fortelny |first6=R. |last7=Friis-Andersen |first7=H. |last8=Gillion |first8=J. F. |last9=Gorjanc |first9=J. |last10=Kopelman |first10=D. |last11=Lopez-Cano |first11=M. |last12=Morales-Conde |first12=S. |last13=Österberg |first13=J. |last14=Reinpold |first14=W. |last15=Simmermacher |first15=R. K. J. |date=April 2019 |title=Accreditation and certification requirements for hernia centers and surgeons: the ACCESS project |journal=Hernia: The Journal of Hernias and Abdominal Wall Surgery |volume=23 |issue=2 |pages=185–203 |doi=10.1007/s10029-018-1873-2 |issn=1248-9204 |pmc=6456484 |pmid=30671899}}

Robotic surgery in the field of urology has become common, especially in the United States.{{cite journal | vauthors = Lee DI | title = Robotic prostatectomy: what we have learned and where we are going | journal = Yonsei Medical Journal | volume = 50 | issue = 2 | pages = 177–181 | date = April 2009 | pmid = 19430547 | pmc = 2678689 | doi = 10.3349/ymj.2009.50.2.177 }}

There is inconsistent evidence of benefits compared to standard surgery to justify the increased costs.{{cite journal | vauthors = Williams SB, Prado K, Hu JC | title = Economics of robotic surgery: does it make sense and for whom? | journal = The Urologic Clinics of North America | volume = 41 | issue = 4 | pages = 591–596 | date = November 2014 | pmid = 25306170 | doi = 10.1016/j.ucl.2014.07.013 }} Some have found tentative evidence of more complete removal of cancer and fewer side effects from surgery for prostatectomy.{{cite journal | vauthors = Ramsay C, Pickard R, Robertson C, Close A, Vale L, Armstrong N, Barocas DA, Eden CG, Fraser C, Gurung T, Jenkinson D, Jia X, Lam TB, Mowatt G, Neal DE, Robinson MC, Royle J, Rushton SP, Sharma P, Shirley MD, Soomro N | title = Systematic review and economic modelling of the relative clinical benefit and cost-effectiveness of laparoscopic surgery and robotic surgery for removal of the prostate in men with localised prostate cancer | journal = Health Technology Assessment | volume = 16 | issue = 41 | pages = 1–313 | date = 2012 | pmid = 23127367 | pmc = 4780976 | doi = 10.3310/hta16410 }}

In 2000, the first robot-assisted laparoscopic radical prostatectomy was performed.{{cite journal | vauthors = Finkelstein J, Eckersberger E, Sadri H, Taneja SS, Lepor H, Djavan B | title = Open Versus Laparoscopic Versus Robot-Assisted Laparoscopic Prostatectomy: The European and US Experience | journal = Reviews in Urology | volume = 12 | issue = 1 | pages = 35–43 | date = 2010 | pmid = 20428292 | pmc = 2859140 }}

Robotic surgery has also been utilized in radical cystectomies. A 2013 review found less complications and better short term outcomes when compared to open technique.{{cite journal | vauthors = Li K, Lin T, Fan X, Xu K, Bi L, Duan Y, Zhou Y, Yu M, Li J, Huang J | title = Systematic review and meta-analysis of comparative studies reporting early outcomes after robot-assisted radical cystectomy versus open radical cystectomy | journal = Cancer Treatment Reviews | volume = 39 | issue = 6 | pages = 551–560 | date = October 2013 | pmid = 23273846 | doi = 10.1016/j.ctrv.2012.11.007 }}

Pediatric procedures are also benefiting from robotic surgical systems. The smaller abdominal size in pediatric patients limits the viewing field in most urology procedures. The robotic surgical systems help surgeons overcome these limitations. Robotic technology provides assistance in performing{{cite journal | vauthors = Song SH, Kim KS | title = Current status of robot-assisted laparoscopic surgery in pediatric urology | journal = Korean Journal of Urology | volume = 55 | issue = 8 | pages = 499–504 | date = August 2014 | pmid = 25132942 | pmc = 4131076 | doi = 10.4111/kju.2014.55.8.499 }}

• Pyeloplasty - alternative to the conventional open dismembered pyeloplasty (Anderson-Hynes). Pyeloplasty is the most common robotic-assisted procedures in children.
• Ureteral reimplantation - alternative to the open intravesical or extravesical surgery.
• Ureteroureterostomy - alternative to the transperitoneal approach.
• Nephrectomy and heminephrectomy - Traditionally done with laparoscopy, it is not likely that a robotic procedure offers significant advantage due to its high cost.

Major advances aided by surgical robots have been remote surgery, minimally invasive surgery and unmanned surgery. Due to robotic use, the surgery is done with precision, miniaturization, smaller incisions; decreased blood loss, less pain, and quicker healing time. Articulation beyond normal manipulation and three-dimensional magnification help to result in improved ergonomics. Due to these techniques, there is a reduced duration of hospital stays, blood loss, transfusions, and use of pain medication.{{cite journal | vauthors = Estey EP | title = Robotic prostatectomy: The new standard of care or a marketing success? | journal = Canadian Urological Association Journal | volume = 3 | issue = 6 | pages = 488–490 | date = December 2009 | pmid = 20019980 | pmc = 2792423 | doi = 10.5489/cuaj.1182 }}

The existing open surgery technique has many flaws such as limited access to the surgical area, long recovery time, long hours of operation, blood loss, surgical scars, and marks.{{cite journal | vauthors = O'toole MD, Bouazza-Marouf K, Kerr D, Gooroochurn M, Vloeberghs M | doi = 10.1017/S0263574709990658 | title = A methodology for design and appraisal of surgical robotic systems | journal = Robotica | volume = 28 | issue = 2 | pages = 297–310 | date = 2009 | s2cid = 8279869 | url = https://figshare.com/articles/journal_contribution/A_methodology_for_design_and_appraisal_of_surgical_robotic_systems/9576539/1/files/17210684.pdf | url-access = | url-status = live | archive-url = https://web.archive.org/web/20240227044854/https://s3-eu-west-1.amazonaws.com/pstorage-loughborough-53465/coversheet/17210684/1/repo_A71ifPvD.pdf?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Credential=AKIAJGXP3DOPNGAZIK6Q/20240227/eu-west-1/s3/aws4_request&X-Amz-Date=20240227T044853Z&X-Amz-Expires=10&X-Amz-SignedHeaders=host&X-Amz-Signature=4446b70e77b68c27b4bf2ee206772fb7c605e27777d95357f1ac2fcba3d63a16 | archive-date = 27 February 2024 | access-date = 6 December 2023 }} {{closed access}}

The robot's costs range from $1 million to $2.5 million for each unit, and while its disposable supply cost is normally $1,500 per procedure, the cost of the procedure is higher.{{cite news|url=https://www.nytimes.com/2010/02/14/health/14robot.html|title=Results Unproven, Robotic Surgery Wins Converts|vauthors=Kolata G|date=13 February 2010|work=The New York Times|access-date=11 March 2010|archive-date=9 April 2023|archive-url=https://web.archive.org/web/20230409201825/https://www.nytimes.com/2010/02/14/health/14robot.html|url-status=live}} Additional surgical training is needed to operate the system. Numerous feasibility studies have been done to determine whether the purchase of such systems are worthwhile. As it stands, opinions differ dramatically. Surgeons report that, although the manufacturers of such systems provide training on this new technology, the learning phase is intensive and surgeons must perform 150 to 250 procedures to become adept in their use. During the training phase, minimally invasive operations can take up to twice as long as traditional surgery, leading to operating room tie-ups and surgical staffs keeping patients under anesthesia for longer periods. Patient surveys indicate they chose the procedure based on expectations of decreased morbidity, improved outcomes, reduced blood loss and less pain. Higher expectations may explain higher rates of dissatisfaction and regret.

Compared with other minimally invasive surgery approaches, robot-assisted surgery gives the surgeon better control over the surgical instruments and a better view of the surgical site. In addition, surgeons no longer have to stand throughout the surgery and do not get tired as quickly. Naturally occurring hand tremors are filtered out by the robot's computer software. Finally, the surgical robot can continuously be used by rotating surgery teams.{{cite journal | vauthors = Gerhardus D | title = Robot-assisted surgery: the future is here | journal = Journal of Healthcare Management | volume = 48 | issue = 4 | pages = 242–251 | date = July–August 2003 | pmid = 12908224 | doi = 10.1097/00115514-200307000-00008 }} Laparoscopic camera positioning is also significantly steadier with less inadvertent movements under robotic controls than compared to human assistance.{{cite journal | vauthors = Kavoussi LR, Moore RG, Adams JB, Partin AW | title = Comparison of robotic versus human laparoscopic camera control | journal = The Journal of Urology | volume = 154 | issue = 6 | pages = 2134–2136 | date = December 1995 | pmid = 7500476 | doi = 10.1016/S0022-5347(01)66715-6 }} The use of mixed reality to support robot-assisted surgery was developed at the Air Force Research Laboratory in 1992 through the creation of "virtual fixtures" that overlay virtual boundaries or guides that assist the human operator and has become a common method for increasing safety and precision.{{Cite journal |last1=Liu |first1=Tangyou |last2=Wang |first2=Jiaole |last3=Wong |first3=Shing |last4=Razjigaev |first4=Andrew |last5=Beier |first5=Susann |last6=Peng |first6=Shuhua |last7=Do |first7=Thanh Nho |last8=Song |first8=Shuang |last9=Chu |first9=Dewei |last10=Wang |first10=Chun Hui |last11=Lovell |first11=Nigel H. |last12=Wu |first12=Liao |date=November 2024 |title=A Review on the Form and Complexity of Human–Robot Interaction in the Evolution of Autonomous Surgery |journal=Advanced Intelligent Systems |language=en |volume=6 |issue=11 |doi=10.1002/aisy.202400197 |issn=2640-4567|doi-access=free }}{{Cite book |last1=Park |first1=Shinsuk |last2=Howe |first2=Robert D. |last3=Torchiana |first3=David F. |date=2001 |editor-last=Niessen |editor-first=Wiro J. |editor2-last=Viergever |editor2-first=Max A. |chapter=Virtual Fixtures for Robotic Cardiac Surgery |chapter-url=https://link.springer.com/chapter/10.1007/3-540-45468-3_252 |title=Medical Image Computing and Computer-Assisted Intervention – MICCAI 2001 |series=Lecture Notes in Computer Science |volume=2208 |language=en |location=Berlin, Heidelberg |publisher=Springer |pages=1419–1420 |doi=10.1007/3-540-45468-3_252 |isbn=978-3-540-45468-7}}Rosenberg, Louis B. "The use of virtual fixtures as perceptual overlays to enhance operator performance in remote environments." Air force material command (1992): 1-42. Technical Report AL/CF-TR-1994-0089 [https://apps.dtic.mil/sti/pdfs/ADA292450.pdf]{{Cite journal |last1=Seetohul |first1=Jenna |last2=Shafiee |first2=Mahmood |last3=Sirlantzis |first3=Konstantinos |date=2023 |title=Augmented Reality (AR) for Surgical Robotic and Autonomous Systems: State of the Art, Challenges, and Solutions |journal=Sensors |language=en |volume=23 |issue=13 |pages=6202 |doi=10.3390/s23136202 |doi-access=free |issn=1424-8220 |pmc=10347167 |pmid=37448050|bibcode=2023Senso..23.6202S }}

There are some issues in regards to current robotic surgery usage in clinical applications. There is a lack of haptics in some robotic systems currently in clinical use, which means there is no force feedback, or touch feedback. No interaction between the instrument and the patient is felt. However, recently the Senhance robotic system by Asensus Surgical was developed with haptic feedback in order to improve the interaction between the surgeon and the tissue.{{cite journal | vauthors = Spinelli A, David G, Gidaro S, Carvello M, Sacchi M, Montorsi M, Montroni I | title = First experience in colorectal surgery with a new robotic platform with haptic feedback | journal = Colorectal Disease | volume = 20 | issue = 3 | pages = 228–235 | date = September 2017 | pmid = 28905524 | doi = 10.1111/codi.13882 | s2cid = 11253068 }}

The robots can also be very large, have instrumentation limitations, and there may be issues with multi-quadrant surgery as current devices are solely used for single-quadrant application.{{cite journal | vauthors = Herron DM, Marohn M | title = A consensus document on robotic surgery | journal = Surgical Endoscopy | volume = 22 | issue = 2 | pages = 313–325; discussion 311–312 | date = February 2008 | pmid = 18163170 | doi = 10.1007/s00464-007-9727-5 | s2cid = 6880837 }}

Critics of the system, including the American Congress of Obstetricians and Gynecologists,{{cite web | vauthors = Breeden JT | url = http://www.acog.org/About-ACOG/News-Room/News-Releases/2013/Statement-on-Robotic-Surgery | title = Statement on Robotic Surgery | date = 14 March 2013 | work = American Congress of Obstetricians and Gynecologists (ACOG) | access-date = 5 February 2015 | archive-date = 5 February 2015 | archive-url = https://web.archive.org/web/20150205225138/http://www.acog.org/About-ACOG/News-Room/News-Releases/2013/Statement-on-Robotic-Surgery | url-status = live }} say there is a steep learning curve for surgeons who adopt the use of the system and that there's a lack of studies that indicate long-term results are superior to results following traditional laparoscopic surgery. Articles in the newly created Journal of Robotic Surgery tend to report on one surgeon's experience.

Complications related to robotic surgeries range from converting the surgery to open, re-operation, permanent injury, damage to viscera and nerve damage. From 2000 to 2011, out of 75 hysterectomies done with robotic surgery, 34 had permanent injury, and 49 had damage to the viscera. {{Citation needed|date=July 2019}} Prostatectomies were more prone to permanent injury, nerve damage and visceral damage as well. Very minimal surgeries in a variety of specialties had to actually be converted to open or be re-operated on, but most did sustain some kind of damage or injury. For example, out of seven coronary artery bypass grafting, one patient had to go under re-operation. It is important that complications are captured, reported and evaluated to ensure the medical community is better educated on the safety of this new technology.{{cite journal | vauthors = | title = Robotic Surgery: Risks vs. Rewards | journal = AORN Journal | volume = 106 | issue = 2 | pages = 186–157 | date = August 2017 | pmid = 28755672 | doi = 10.1016/j.aorn.2017.05.007 }}{{Page needed|date=October 2022}} If something was to go wrong in a robot-assisted surgery, it is difficult to identify culpability, and the safety of the practice will influence how quickly and widespread these practices are used.{{citation needed|date=January 2022}}

One drawback of the use of robotic surgery is the risk of mechanical failure of the system and instruments. A study from July 2005 to December 2008 was conducted to analyze the mechanical failures of the da Vinci Surgical System at a single institute. During this period, a total of 1797 robotic surgeries were performed used 4 da Vinci surgical systems. There were 43 cases (2.4%) of mechanical failure, including 24 (1.3%) cases of mechanical failure or malfunction and 19 (1.1%) cases of instrument malfunction. Additionally, one open and two laparoscopic conversions (0.17%) were performed. Therefore, the chance of mechanical failure or malfunction was found to be rare, with the rate of converting to an open or laparoscopic procedure very low.{{cite journal | vauthors = Kim WT, Ham WS, Jeong W, Song HJ, Rha KH, Choi YD | title = Failure and malfunction of da Vinci Surgical systems during various robotic surgeries: experience from six departments at a single institute | journal = Urology | volume = 74 | issue = 6 | pages = 1234–1237 | date = December 2009 | pmid = 19716587 | doi = 10.1016/j.urology.2009.05.071 }}

There are also current methods of robotic surgery being marketed and advertised online. Removal of a cancerous prostate has been a popular treatment through internet marketing. Internet marketing of medical devices are more loosely regulated than pharmaceutical promotions. Many sites that claim the benefits of this type of procedure had failed to mention risks and also provided unsupported evidence. There is an issue with government and medical societies promotion a production of balanced educational material.{{cite journal | vauthors = Mirkin JN, Lowrance WT, Feifer AH, Mulhall JP, Eastham JE, Elkin EB | title = Direct-to-consumer Internet promotion of robotic prostatectomy exhibits varying quality of information | journal = Health Affairs | volume = 31 | issue = 4 | pages = 760–769 | date = April 2012 | pmid = 22492893 | pmc = 3897330 | doi = 10.1377/hlthaff.2011.0329 }} In the US alone, many websites promotion robotic surgery fail to mention any risks associated with these types of procedures, and hospitals providing materials largely ignore risks, overestimate benefits and are strongly influenced by the manufacturer.{{cite journal | vauthors = Basto M, Cooperberg MR, Murphy DG | title = Proton therapy websites: information anarchy creates confusion | journal = BJU International | volume = 115 | issue = 2 | pages = 183–185 | date = February 2015 | pmid = 25756133 | doi = 10.1111/bju.12667 | s2cid = 10565914 | url = https://escholarship.org/uc/item/4mq2r8dz | access-date = 9 August 2023 | archive-date = 9 September 2023 | archive-url = https://web.archive.org/web/20230909154131/https://escholarship.org/uc/item/4mq2r8dz | url-status = live }}

Since April 2018, medical insurance coverage was expanding in Japan, so doctors were considering promoting the procedure for cardiac surgery, as it has the advantage of reducing the burden on the patient. Japanese drama Black Pean takes on this challenge, showing both sides' point of view. Two University Hospitals are competing to be the best in the Cardiac Surgery Department. One, Tojo, has the best traditional surgeons, while the other, Teika, is all about researching and implementing the most recent technology. With this, Teika sends its technical specialist to Tojo to try to convince them to update their techniques, including the use of the Da Vinci robot (named in the drama as Darwin). Newhart Watanabe International Hospital, a pioneer in da Vinci surgery for the heart in Japan, was used as background for the drama, with Dr. Gou Watanabe providing technical support.{{Cite web |date=11 May 2018 |title=『ブラックペアン』ドラマ史上初、手術支援ロボ・ダビンチが登場 |url=https://www.oricon.co.jp/news/2111207/full/ |archive-url=https://web.archive.org/web/20240613041704/https://www.oricon.co.jp/news/2111207/full/ |archive-date=13 June 2024 |access-date=13 June 2024 |website=Oricon |language=Japanese}}{{Cite web |title=第５話から登場する手術支援ロボット・ダーウィン(※)。最先端の"ロボット手術"について、監修先生のお話を基に紐解いていきます。 |url=https://www.tbs.co.jp/blackpean_tbs/2018/robot/1.html |archive-url=https://web.archive.org/web/20240613045059/https://www.tbs.co.jp/blackpean_tbs/2018/robot/1.html |archive-date=13 June 2024 |access-date=13 June 2024 |website=TBS Black Pean official site |language=Japanese}}

{{columns-list|colwidth=30em|

• Bone segment navigation
• Computer-assisted surgery
• Diagnostic robot
• Minimally invasive surgery
• Patient registration
• Stereolithography (medicine)
• Surgical Segment Navigator
• Telemedicine

}}

{{Reflist|30em}}

{{Commons category|Surgical robots}}

{{emerging technologies|topics=yes|biomed=yes}}

{{DEFAULTSORT:Robotic Surgery}}

Category:Computer-assisted surgery

Category:Telemedicine

Category:Health informatics