Do Costs of Robotic Surgery Matter?

Abstract

Although robots began as theoretical constructs devised from science fiction novels, they soon became a reality in the automobile industry in 1958 when general Motors introduced the Unimate to assist production (1). Since then robots have been used in a variety of applications including many industrial tasks, and deep-sea and space exploration (2). The first concept of surgical robotics was developed in the late 1980s at the National Aeronautics and Space Centre (NASA). Together with Stanford Research Institute, virtual reality and surgical robotics were integrated and the first steps toward telepresence surgery were made (3). The original model, known as the PUMA 560, was used for neurosurgical stereotactic maneuvers under computed tomographic guidance (2). Commercialisation of robotic surgery started in the early 1990s with the development of complete robotic systems HERMES (Computer Motion, Goleta, CA, USA) and AESOP (Computer Motion, Goleta, CA, USA) (2,4). These systems used voice recognition to control the laparoscopic camera, light source, insufflation and printer. They were designed to reduce surgeon fatigue and to offer a stable visual field. The ZEUS robotic system (Computer Motion, Goleta, CA, USA) and the Da Vinci robotic system (Intuitive Surgery, Mountain View, CA, USA) were introduced in the late 1990s (5,6). Both systems have remote manupilators that are controlled from a surgical workstation. In 2003, Computer Motion was acquired by Intuitive Surgery (6). Today the Zeus system is no longer commercially available and the Da Vinci system is the only telerobot on the market (6). The Da Vinci robot was approved for general surgery by the US Food and Drug Administration (FDA) in 2000, for the use in urology in 2001 and for gynecology in 2005 (6). The use of robotic assisted surgery has grown exponentially over the last few years as there is a clear trend in surgery, driven by patient demand, to develop less invasive approaches to common procedures (7). By the end of 2010 Intuitive Surgery had sold a total 1752 units. Robotic technology has gained popularity in various surgical specialities such as urology, gynecology, thoracic surgery, general surgery, and currently head and neck surgery.