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Status of robotic assistance—a less traumatic and more accurate minimally invasive surgery?

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Abstract

Purpose

Robotic assistance is considered one innovation within abdominal surgery over the past decade that has the potential to compensate for the drawbacks of conventional laparoscopy, such as limited degree of freedom, 2D vision, fulcrum, and pivoting effect. Robotic systems provide corresponding solutions as 3D view, intuitive motion and enable additional degrees of freedom. This review provides an overview of the history of medical robotics, experimental studies, clinical state-of-the-art and economic impact.

Methods

The Medline database was searched for the terms “robot*, telemanipulat*, and laparoscop*.” A total of 2573 references were found. All references were considered for information on robotic assistance in advanced laparoscopy. Further references were obtained through cross-referencing the bibliography cited in each work.

Results

In experimental studies, current robotic systems showed superior handling and ergonomics compared to conventional laparoscopic techniques. In gynecology especially for hysterectomy and in urology especially for prostatectomy, two procedures formerly performed via an open approach, the robot enables a laparoscopic approach. This results in reduced need for pain medication, less blood loss, and shorter hospital stay. Within abdominal surgery, clinical studies were generally unable to prove a benefit of the robot. While the benefit still remains open to discussion, robotic systems are spreading and are available worldwide in tertiary centers.

Conclusion

Robotic assistance will remain an intensively discussed subject since clinical benefits for most procedures have not yet been proven. The most promising procedures are those in which the robot enables a laparoscopic approach where open surgery is usually required.

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References

  1. Assalia A, Gagner M (2004) Laparoscopic adrenalectomy. Br J Surg 91(10):1259–1274. doi:10.1002/bjs.4738

    Article  PubMed  CAS  Google Scholar 

  2. Catarci M, Gentileschi P, Papi C, Carrara A, Marrese R, Gaspari AL, Grassi GB (2004) Evidence-based appraisal of antireflux fundoplication. Ann Surg 239(3):325–337

    Article  PubMed  Google Scholar 

  3. Sauerland S, Angrisani L, Belachew M, Chevallier JM, Favretti F, Finer N, Fingerhut A, Garcia Caballero M, Guisado Macias JA, Mittermair R, Morino M, Msika S, Rubino F, Tacchino R, Weiner R, Neugebauer EA (2005) Obesity surgery: evidence-based guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc 19(2):200–221. doi:10.1007/s00464-004-9194-1

    Article  PubMed  CAS  Google Scholar 

  4. Gupta PK, Natarajan B, Pallati PK, Gupta H, Sainath J, Fitzgibbons RJ Jr (2011) Outcomes after laparoscopic adrenalectomy. Surg Endosc 25(3):784–794. doi:10.1007/s00464-010-1256-y

    Article  PubMed  Google Scholar 

  5. Keus F, de Jong JA, Gooszen HG, van Laarhoven CJ (2006) Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev (4):CD006231. doi:10.1002/14651858.CD006231

  6. Frede T, Stock C, Renner C, Budair Z, Abdel-Salam Y, Rassweiler J (1999) Geometry of laparoscopic suturing and knotting techniques. J Endourol 13(3):191–198

    Article  PubMed  CAS  Google Scholar 

  7. Kenngott HG, Muller-Stich BP, Reiter MA, Rassweiler J, Gutt CN (2008) Robotic suturing: technique and benefit in advanced laparoscopic surgery. Minim Invasive Ther Allied Technol 17(3):160–167. doi:10.1080/13645700802103381

    Article  PubMed  Google Scholar 

  8. Moravec H.-P. (2011) Robot. Encyclopaedia Britannica Online, Web edn. Encyclopaedia Britannica

  9. World Robotics 2010 Service Robots—statistics, market analysis, forecasts and case studies (2010). International Federation of Robotics Statistical Department, Frankfurt

  10. Hanly EJ, Talamini MA (2004) Robotic abdominal surgery. Am J Surg 188(4A Suppl):19S–26S. doi:10.1016/j.amjsurg.2004.08.020

    Article  PubMed  Google Scholar 

  11. Kwoh YS, Hou J, Jonckheere EA, Hayati S (1988) A robot with improved absolute positioning accuracy for CT guided stereotactic brain surgery. IEEE Trans Biomed Eng 35(2):153–160. doi:10.1109/10.1354

    Article  PubMed  CAS  Google Scholar 

  12. Reynolds W Jr (2001) The first laparoscopic cholecystectomy. JSLS 5(1):89–94

    PubMed  Google Scholar 

  13. Harris SJ, Arambula-Cosio F, Mei Q, Hibberd RD, Davies BL, Wickham JE, Nathan MS, Kundu B (1997) The Probot—an active robot for prostate resection. Proc Inst Mech Eng H 211(4):317–325

    PubMed  CAS  Google Scholar 

  14. Mantwill F, Schulz AP, Faber A, Hollstein D, Kammal M, Fay A, Jurgens C (2005) Robotic systems in total hip arthroplasty—is the time ripe for a new approach? Int J Med Robot 1(4):8–19. doi:10.1002/rcs.55

    Article  PubMed  CAS  Google Scholar 

  15. Marescaux J, Leroy J, Gagner M, Rubino F, Mutter D, Vix M, Butner SE, Smith MK (2001) Transatlantic robot-assisted telesurgery. Nature 413(6854):379–380. doi:10.1038/3509663635096636

    Article  PubMed  CAS  Google Scholar 

  16. Rassweiler J, Safi KC, Subotic S, Teber D, Frede T (2005) Robotics and telesurgery—an update on their position in laparoscopic radical prostatectomy. Minim Invasive Ther Allied Technol 14(2):109–122. doi:10.1080/13645700510010908

    Article  PubMed  CAS  Google Scholar 

  17. Carswell CM, Clarke D, Seales WB (2005) Assessing mental workload during laparoscopic surgery. Surg Innov 12(1):80–90

    Article  PubMed  Google Scholar 

  18. Breedveld P, Stassen HG, Meijer DW, Jakimowicz JJ (2000) Observation in laparoscopic surgery: overview of impeding effects and supporting aids. J Laparoendosc Adv Surg Tech A 10(5):231–241

    Article  PubMed  CAS  Google Scholar 

  19. Harrell AG, Heniford BT (2005) Minimally invasive abdominal surgery: lux et veritas past, present, and future. Am J Surg 190(2):239–243. doi:10.1016/j.amjsurg.2005.05.019

    Article  PubMed  Google Scholar 

  20. Berguer R, Smith WD, Chung YH (2001) Performing laparoscopic surgery is significantly more stressful for the surgeon than open surgery. Surg Endosc 15(10):1204–1207. doi:10.1007/s004640080030

    Article  PubMed  CAS  Google Scholar 

  21. Reza M, Maeso S, Blasco JA, Andradas E (2010) Meta-analysis of observational studies on the safety and effectiveness of robotic gynaecological surgery. Br J Surg 97(12):1772–1783. doi:10.1002/bjs.7269

    Article  PubMed  CAS  Google Scholar 

  22. Rocco B, Matei DV, Melegari S, Ospina JC, Mazzoleni F, Errico G, Mastropasqua M, Santoro L, Detti S, de Cobelli O (2009) Robotic vs. open prostatectomy in a laparoscopically naive centre: a matched-pair analysis. BJU Int 104(7):991–995. doi:10.1111/j.1464-410X.2009.08532.x

    Article  PubMed  Google Scholar 

  23. Lee G, Sutton E, Clanton T, Park A (2011) Higher physical workload risks with NOTES versus laparoscopy: a quantitative ergonomic assessment. Surg Endosc 25(5):1585–1593. doi:10.1007/s00464-010-1443-x

    Article  PubMed  Google Scholar 

  24. Blavier A, Gaudissart Q, Cadiere GB, Nyssen AS (2007) Comparison of learning curves and skill transfer between classical and robotic laparoscopy according to the viewing conditions: implications for training. Am J Surg 194(1):115–121. doi:10.1016/j.amjsurg.2006.10.014

    Article  PubMed  Google Scholar 

  25. Badani KK, Bhandari A, Tewari A, Menon M (2005) Comparison of two-dimensional and three-dimensional suturing: is there a difference in a robotic surgery setting? J Endourol 19(10):1212–1215. doi:10.1089/end.2005.19.1212

    Article  PubMed  Google Scholar 

  26. Byrn JC, Schluender S, Divino CM, Conrad J, Gurland B, Shlasko E, Szold A (2007) Three-dimensional imaging improves surgical performance for both novice and experienced operators using the da Vinci Robot System. Am J Surg 193(4):519–522. doi:10.1016/j.amjsurg.2006.06.042

    Article  PubMed  Google Scholar 

  27. Marecik SJ, Chaudhry V, Jan A, Pearl RK, Park JJ, Prasad LM (2007) A comparison of robotic, laparoscopic, and hand-sewn intestinal sutured anastomoses performed by residents. Am J Surg 193(3):349–355. doi:10.1016/j.amjsurg.2006.09.018, discussion 355

    Article  PubMed  Google Scholar 

  28. Knight CG, Lorincz A, Cao A, Gidell K, Klein MD, Langenburg SE (2005) Computer-assisted, robot-enhanced open microsurgery in an animal model. J Laparoendosc Adv Surg Tech A 15(2):182–185. doi:10.1089/lap.2005.15.182

    Article  PubMed  Google Scholar 

  29. Hubens G, Coveliers H, Balliu L, Ruppert M, Vaneerdeweg W (2003) A performance study comparing manual and robotically assisted laparoscopic surgery using the da Vinci system. Surg Endosc 17(10):1595–1599. doi:10.1007/s00464-002-9248-1

    Article  PubMed  CAS  Google Scholar 

  30. Garcia-Ruiz A, Smedira NG, Loop FD, Hahn JF, Miller JH, Steiner CP, Gagner M (1997) Robotic surgical instruments for dexterity enhancement in thoracoscopic coronary artery bypass graft. J Laparoendosc Adv Surg Tech A 7(5):277–283

    Article  PubMed  CAS  Google Scholar 

  31. Lee EC, Rafiq A, Merrell R, Ackerman R, Dennerlein JT (2005) Ergonomics and human factors in endoscopic surgery: a comparison of manual vs telerobotic simulation systems. Surg Endosc 19(8):1064–1070. doi:10.1007/s00464-004-8213-6

    Article  PubMed  CAS  Google Scholar 

  32. Binder J, Kramer W (2001) Robotically assisted laparoscopic radical prostatectomy. BJU Int 87(4):408–410. doi:bju115[pii]

    Article  PubMed  CAS  Google Scholar 

  33. Ahlering TE, Woo D, Eichel L, Lee DI, Edwards R, Skarecky DW (2004) Robot-assisted versus open radical prostatectomy: a comparison of one surgeon's outcomes. Urology 63(5):819–822. doi:10.1016/j.urology.2004.01.038

    Article  PubMed  Google Scholar 

  34. Menon M, Tewari A, Baize B, Guillonneau B, Vallancien G (2002) Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience. Urology 60(5):864–868

    Article  PubMed  Google Scholar 

  35. Ficarra V, Novara G, Fracalanza S, D'Elia C, Secco S, Iafrate M, Cavalleri S, Artibani W (2009) A prospective, non-randomized trial comparing robot-assisted laparoscopic and retropubic radical prostatectomy in one European institution. BJU Int 104(4):534–539. doi:10.1111/j.1464-410X.2009.08419.x

    Article  PubMed  Google Scholar 

  36. Van Velthoven R RE, Abbou CC, Rassweiler J, Lee D, Mottrie A, Gill IS, Erdogru T, Menon M, Sharecky D, Ahlering T (2007) Single knot anastomosis (SKA) for laparoscopic radical prostatectomy: an international multi-center outcome survey of 5235 cases. J Endourol 22:Suppl.; A54 (abstract No. MP08-59)

  37. Rozet F, Harmon J, Cathelineau X, Barret E, Vallancien G (2006) Robot-assisted versus pure laparoscopic radical prostatectomy. World J Urol 24(2):171–179. doi:10.1007/s00345-006-0065-3

    Article  PubMed  Google Scholar 

  38. Annual report 2010 (2011) Intuitive Surgical Inc.

  39. Fiorentino RP, Zepeda MA, Goldstein BH, John CR, Rettenmaier MA (2006) Pilot study assessing robotic laparoscopic hysterectomy and patient outcomes. J Minim Invasive Gynecol 13(1):60–63. doi:10.1016/j.jmig.2005.11.001

    Article  PubMed  Google Scholar 

  40. Advincula AP, Xu X, St G, Ransom SB (2007) Robot-assisted laparoscopic myomectomy versus abdominal myomectomy: a comparison of short-term surgical outcomes and immediate costs. J Minim Invasive Gynecol 14(6):698–705. doi:10.1016/j.jmig.2007.06.008

    Article  PubMed  Google Scholar 

  41. Elliott DS, Krambeck AE, Chow GK (2006) Long-term results of robotic assisted laparoscopic sacrocolpopexy for the treatment of high grade vaginal vault prolapse. J Urol 176(2):655–659. doi:10.1016/j.juro.2006.03.040

    Article  PubMed  Google Scholar 

  42. Muller-Stich BP, Reiter MA, Wente MN, Bintintan VV, Koninger J, Buchler MW, Gutt CN (2007) Robot-assisted versus conventional laparoscopic fundoplication: short-term outcome of a pilot randomized controlled trial. Surg Endosc 21(10):1800–1805. doi:10.1007/s00464-007-9268-y

    Article  PubMed  CAS  Google Scholar 

  43. Baik SH, Ko YT, Kang CM, Lee WJ, Kim NK, Sohn SK, Chi HS, Cho CH (2008) Robotic tumor-specific mesorectal excision of rectal cancer: short-term outcome of a pilot randomized trial. Surg Endosc 22(7):1601–1608. doi:10.1007/s00464-008-9752-z

    Article  PubMed  CAS  Google Scholar 

  44. Hubens G, Balliu L, Ruppert M, Gypen B, Van Tu T, Vaneerdeweg W (2008) Roux-en-Y gastric bypass procedure performed with the da Vinci robot system: is it worth it? Surg Endosc 22(7):1690–1696. doi:10.1007/s00464-007-9698-6

    Article  PubMed  CAS  Google Scholar 

  45. Mirnezami AH, Mirnezami R, Venkatasubramaniam AK, Chandrakumaran K, Cecil TD, Moran BJ (2010) Robotic colorectal surgery: hype or new hope? A systematic review of robotics in colorectal surgery. Colorectal Dis 12(11):1084–1093. doi:10.1111/j.1463-1318.2009.01999.x

    Article  PubMed  CAS  Google Scholar 

  46. Link RE, Bhayani SB, Kavoussi LR (2006) A prospective comparison of robotic and laparoscopic pyeloplasty. Ann Surg 243(4):486–491. doi:10.1097/01.sla.0000205626.71982.32

    Article  PubMed  Google Scholar 

  47. Lotan Y, Cadeddu JA, Gettman MT (2004) The new economics of radical prostatectomy: cost comparison of open, laparoscopic and robot assisted techniques. J Urol 172(4 Pt 1):1431–1435

    Article  PubMed  Google Scholar 

  48. Bolenz C, Gupta A, Hotze T, Ho R, Cadeddu JA, Roehrborn CG, Lotan Y (2010) Cost comparison of robotic, laparoscopic, and open radical prostatectomy for prostate cancer. Eur Urol 57(3):453–458. doi:10.1016/j.eururo.2009.11.008

    Article  PubMed  Google Scholar 

  49. Morino M, Pellegrino L, Giaccone C, Garrone C, Rebecchi F (2006) Randomized clinical trial of robot-assisted versus laparoscopic Nissen fundoplication. Br J Surg 93(5):553–558. doi:10.1002/bjs.5325

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of General, Abdominal and Transplant Surgery, Heidelberg University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    H. G. Kenngott, L. Fischer, F. Nickel & B. P. Müller-Stich

  2. Department of Gynecology and Obstetrics, Heidelberg University, Heidelberg, Germany

    J. Rom

  3. Department of Urology, SLK Kliniken Heilbronn, Heidelberg University, Heilbronn, Germany

    J. Rassweiler

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  1. H. G. Kenngott
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  2. L. Fischer
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Correspondence to B. P. Müller-Stich.

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Kenngott, H.G., Fischer, L., Nickel, F. et al. Status of robotic assistance—a less traumatic and more accurate minimally invasive surgery?. Langenbecks Arch Surg 397, 333–341 (2012). https://doi.org/10.1007/s00423-011-0859-7

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  • DOI: https://doi.org/10.1007/s00423-011-0859-7

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