Over the past two decades, minimally invasive surgery (MIS) has gained rapid popularity both for patient comfort and for cost. A rising interest in robotic surgery has prompted the successful execution of complex procedures in a variety of surgical disciplines. Expansion of this technology into the various thoracic specialties can be expected to continue over time. As thoracic surgeons become technologically skilled in robotics, new techniques will emerge, and established techniques will continue to be refined.
In the 1990s, the use of computer-assisted surgical systems or surgical robotics was approved by the U.S. Food and Drug Administration. Initially, two companies, Computer Motion, Inc. (Santa Barbara, CA), and Intuitive Surgical, Inc. (Sunnyvale, CA), developed machines that provided similar features: three-dimensional vision, high-definition visual clarity, and tremorless instrument motion with multiple arcs of rotational freedom. Today, the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA) is the only commercially available surgical robotic system.
First introduced in 1999, the da Vinci System consists of three separate components: (1) a 4-arm mounted platform from which extends a single arm for the three-dimensional videoscope and three additional arms on which interchanging operative instruments are inserted, (2) the surgeon console, and (3) the integrative control cart, which provides communication between the surgeon console and the robotic arms (Fig. 141-1). The da Vinci System uses rotating multiarticulated instruments (EndoWrist, Intuitive Surgical, Inc., Sunnyvale, CA) that have 7 degrees of rotational freedom and simulate normal wrist movements, thus differentiating robotic instruments (Fig. 141-2) from standard videoscopic instruments. Additionally, the three-dimensional imaging provided by the double optic system mounted on the camera arm (Fig. 141-3) permits depth perception and precision movements, which are especially important when performing complex procedures.
Da Vinci components table. (Photo © 2008 Intuitive Surgical, Inc.)
Da Vinci instrument arm. (Photo © 2008 Intuitive Surgical, Inc.)
Da Vinci camera arm. (Photo © 2008 Intuitive Surgical, Inc.)
In 1998, Himpens and colleagues1 performed the first robotic operation, a cholecystectomy. Since that time, chest surgeons have been reluctant to adopt robotic procedures, and there are few reports on robotics in the general thoracic surgery literature. The cost of the technology and lack of tactile (haptic) feedback have been cited as major deterrents to acceptance of the da Vinci System. However, as robotic technology is integrated into surgical training, the need for haptic feedback becomes less of an issue.2,3
The reluctance of surgeons to accept technology that would appear to negate years of skill and training is understandable, yet there are sound physiologic and immunologic reasons for ...