Applications and Economics Aspects of Robotic Surgery

Abstract

rates of surgical complications compared to conventional or even laparoscopic surgery. In general, there is a common opinion about the needs of years of training and experience to perform procedures using remote technology. The literature suggests advantages over other forms of surgical access, including superior visualization of the operative field with images in three dimensions compared to traditional laparoscopy and better surgical ergonomics; and present as disadvantages the size of materials, the lack of flexibility of power devices and the difficulty to perform operations that use different quadrants or surgical sites. This technology is not yet widely available to all surgeons and training is still not accessible. Pelvic SurgeryPerhaps the greatest enthusiasm in robotic surgery points to pelvic surgery because of its good mobility and performance in a restricted confined field when compared to conventional or laparoscopic surgery. In 2009, a report about the acceptance of robotic surgery showed that 795 units of Da Vinci  were sold in December 2007, mostly in North America and Europe, and in the same period 50,000 radical prostatectomies were performed in the US, with 60% of penetrance of these surgeries in the US market, with an increase of 50% over the previous year. Despite its advantages, high costs and longer operative time were disadvantages found about this technology [1,2]. Randomized and non-randomized studies have confirmed the benefits of laparoscopy in rectal cancer surgery. However, due to long learning curve and high conversion rate, the global impact of the use of this method is still modest, especially in obese male patients. It is estimated that only 10% of colorectal cancer surgeries are currently treated by laparoscopy, with increasingly use of robotic platforms added to the perspective of visualization improvement, exposure and dissection of important structures in narrow space, such as the pelvic cavity. Besides all that, the great mobility of instruments, capable to rotate from 180° to 540° allows better performance in the pelvic cavity [3]. There are even better results in the quality of oncological resection with clearer margins, higher number of lymph nodes resection and decrement of surgical complications as the learning curve is exceeded

Outpatient Robot-assisted Radical Prostatectomy: A Feasibility Study

“…Robot-assisted radical prostatectomy (RARP) has become a method of choice, with 50,000 surgeries performed in 2007 in the US 5 . When compared with laparoscopic surgery, the proofs of the benefit of RARP are scarce in the literature.…”