Robotic Surgery: A Current Perspective

Anthony R. Lanfranco, BAS; Andres E. Castellanos, MD; Jaydev P. Desai, PhD; William C. Meyers, MD

Disclosures

Annals of Surgery. 2004;239(1) 

In This Article

The Future of Robotic Surgery

Robotic surgery is in its infancy. Many obstacles and disadvantages will be resolved in time and no doubt many other questions will arise. Many question have yet to be asked; questions such as malpractice liability, credentialing, training requirements, and interstate licensing for tele-surgeons, to name just a few.

Many of current advantages in robotic assisted surgery ensure its continued development and expansion. For example, the sophistication of the controls and the multiple degrees of freedom afforded by the Zeus and da Vinci systems allow increased mobility and no tremor without comprising the visual field to make micro anastomosis possible. Many have made the observation that robotic systems are information systems and as such they have the ability to interface and integrate many of the technologies being developed for and currently used in the operating room.[9] One exciting possibility is expanding the use of preoperative (computed tomography or magnetic resonance) and intraoperative video image fusion to better guide the surgeon in dissection and identifying pathology. These data may also be used to rehearse complex procedures before they are undertaken. The nature of robotic systems also makes the possibility of long-distance intraoperative consultation or guidance possible and it may provide new opportunities for teaching and assessment of new surgeons through mentoring and simulation. Computer Motion, the makers of the Zeus robotic surgical system, is already marketing a device called SOCRATES that allows surgeons at remote sites to connect to an operating room and share video and audio, to use a "telestrator" to highlight anatomy, and to control the AESOP endoscopic camera.

Technically, much remains to be done before robotic surgery's full potential can be realized. Although these systems have greatly improved dexterity, they have yet to develop the full potential in instrumentation or to incorporate the full range of sensory input. More standard mechanical tools and more energy directed tools need to be developed. Some authors also believe that robotic surgery can be extended into the realm of advanced diagnostic testing with the development and use of ultrasonography, near infrared, and confocal microscopy equipment.[10]

Much like the robots in popular culture, the future of robotics in surgery is limited only by imagination. Many future "advancements" are already being researched. Some laboratories, including the authors' laboratory, are currently working on systems to relay touch sensation from robotic instruments back to the surgeon.[15,16,17,18,19,32] Other laboratories are working on improving current methods and developing new devices for suture-less anastomoses.[33,34,35] When most people think about robotics, they think about automation. The possibility of automating some tasks is both exciting and controversial. Future systems might include the ability for a surgeon to program the surgery and merely supervise as the robot performs most of the tasks. The possibilities for improvement and advancement are only limited by imagination and cost.

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