Innovations in robotic technology are transforming the way surgeons operate in the 21st century. Robotic surgical platforms grant surgeons access to modern-world defining robotic engineering and computer programming, which enhance the surgeon’s operative view and augment his or her manual dexterity.1-3 These surgical tools were developed with the goal of helping surgeons overcome the limitations of laparoscopy and to facilitate the broader adaptation of minimally invasive surgery to include more complex abdominal procedures.4-8 The technologic superiority of robotic surgical platforms over existing open and laparoscopic instruments is undisputed, with the potential to harvest significant advantages for the surgeon and, ultimately, translate them for improved patient outcomes.
As with all new technology, however, robotic surgery poses novel challenges for general surgeons as we begin to define its role in our clinical practices, discern its optimal application for our patients, and determine its benefits and disadvantages.9-11 Familiarity with robotic surgical systems, the current uses, its optimum utilization, and potential future applications can facilitate the employment of the robotic surgical platforms for gastrointestinal procedures. In this chapter, we will cover the development of the robotic surgical technology and the inherent advantages of the da Vinci Surgical Systems (Intuitive Surgical, Sunnyvale, CA). The chapter will explore how surgeons can exploit specific technologic innovations of the da Vinci robotic surgical platforms in robotic Heller myotomy with fundoplication, radical gastrectomy with lymphadenectomy, and robotic colorectal resections with total mesorectal excision. We will review the results of existing studies focusing on the clinical outcomes of these select robotic gastrointestinal surgeries alone and in comparison to open and laparoscopic approaches. Finally, the chapter will highlight a few distinct features of robotic surgery and possible future applications.
EVOLUTION OF THE ROBOTIC SURGICAL SYSTEMS
Development of Robotic Surgical Technology
Robotic surgery is the utilization of specifically designed robotic surgical platforms to perform minimally invasive surgical procedures. The foundation of the robotic surgical technology is derived from the innovations of a military project endorsed by the National Aeronautics and Space Administration (NASA). The Defense Advanced Research Project Administration (DARPA) funded the research project in the 1970s.3,12 At the time, the aim of the surgical robotics project was to enable telesurgery—to create a robot that could be manipulated to care for astronauts in space aircrafts and soldiers in the battlefield without the physical presence of a surgeon alongside the patient. In 2002, the first robot-assisted telesurgery on a human, a cholecystectomy, was performed using the ZEUS system (Computer Motion, Goleta, CA).13 The surgeon, Dr. Jacques Marescaux, was seated at the “surgeon-side” subsystems located in New York City with a “patient-side” robot with the patient in Strasbourg, France.
Although the Zeus Robotic Surgical System is no longer used, several companies continued to develop surgical robotics; and currently, all robotic gastrointestinal operations are performed with the da Vinci Surgical Systems.14-17 They ...