Current status of robotics in general surgery

Abstract

Telesurgical systems have met with a great degree of acceptance in urology but indications are not yet that clear in the field of general surgery. The surgical robot overcomes certain limitations of conventional laparoscopy by offering three-dimensional, high definition vision, and seven degrees of freedom to the articulating instruments. Newer robots provide image integration, telestration and the dual-console capability for training purposes. According to our experiencs indications for robotic surgery are: the need for intracorporeal suturing, the expectant narrow surgical field, the expectant difficult dissection and/or adhesiolysis, especially in the upper abdomen, near the hiatus or very low in the pelvis. Although the use of robotic systems for simple laparoscopic cases is generally opposed on the basis of its increased operative time and cost, most teams accept that the beginning of the learning curve in robotic surgery must rely upon simple procedures such as cholecystectomies and Nissen fundoplications. Recent studies show more indications for robotic approach of cholecystectomies, such as in the setting of a reoperative, hostile abdomen following gangrenous cholecystitis, or in completion cholecystectomy.Robotic surgery constitutes a revolutionary stage in the evolution of surgery. Current systems aim to overcome certain limitations of laparoscopy. More advanced forms of robotic assistance are expected in the future, incorporating special software for intraoperational navigation and augmented reality guidance, help with the decision-making process, and smart "robotic-assistants" with artificial intelligence and autonomy. Integration of this technology will determine the definite role of robotics in the operating theater.