Robotic surgery

Abstract

Over the past decade, there has been an exponential growth of robot-assisted procedures and of publications concerning roboticassisted laparoscopic surgery. From a review of the available literature, it becomes apparent that this technology is safe and allows more complex procedures in many fields of surgery, be it at relatively high costs. Although randomised controlled trials in gynaecology are lacking, available evidence suggests that particularly in gynaecology robotic surgery might not only reduce morbidity but also be cost effective if performed in high-volume centres. Training in robotic surgery and programs for safe and effective implementation are necessary.

Do Costs of Robotic Surgery Matter?

“…Robotic-assisted and laparoscopic surgery eliminates the need for large morbid and less esthetical incisions and often decreases blood loss, post-operative pain, use of pain medication and length of hospital stay (2,6), especially when compared to open surgery. Advantages of robotic surgery compared to laparoscopy and open surgery are: improved dexterity, more precise movements and tremor reduction, and better visualisation of the operating field (magnification and 3D).…”

“…The robotic digital process allows scaling down the surgeons's hand movements to a level at which microvascular or microscopic procedures are feasible. Difficult, minimal invasive surgery is accesable for surgeons without advanced laparoscopic training as it has a short learning curve (6,9). Fatigue and frustration become less of a limiting factor for the robotic surgeon compared to the laparoscopic surgeon (10).…”

“…These savings can compensate for added expenses in the operating room and result in cost superiority of some procedures. It is important to realize that the costs of hospitals beds vary between hospital, especially between community hospitals and academic medical centres (6). Up to now, there have not been any publications demonstrating an advantage of a robotic-assisted laparoscopic approach over 'pure' laparoscopic approach in terms of rooms and board (11).…”

“…Therefore the crucial question is whether robotic surgery, being more expensive, is better than comparable traditional video-endoscopic and open surgery. Generally most robotic and laparoscopic procedures have less short term morbidity, blood loss, intensive care unit and hospital stay then open surgery (6,11,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). Up to now no major differences have been found between robot-assisted and classic videoassisted procedures for these factors.…”

Validation of a Novel Virtual Reality Simulator for Robotic Surgery

“…The field of robot-assisted minimal invasive surgery is still expanding and currently involves many specialties, including urology, general surgery, cardiothoracic surgery, paediatric surgery, and gynaecology. Current and future developments will further increase the uptake of robot-assisted procedures for minimal invasive surgery [2].…”