Telerobotic Surgery for Right and Sigmoid Colectomy

Abstract

Surgery, unlike modern medicine, retains its link with ancient traditions. Human anatomy has not changed and the surgical approach to many diseases has remained the same for decades, even centuries. However, the techniques have evolved. For centuries, the sole approach to the disease was a large incision. Laparoscopic surgery ushered in a new era. Small incisions promised shorter hospital stays, less postoperative pain, better cosmesis, and a quicker return to normal activity. Patients now desire a minimally invasive surgical approach to their disease if at all possible. The benefits to the patient were bought with the price of surgeons losing maneuverability in the operative field and having only a two-dimensional instead of a three-dimensional view. For many the transition was difficult. The learning curve was steep. In a short time, though, some procedures such as a laparoscopic cholecystectomy became the gold standard and basic laparoscopic skills were incorporated into general surgery training programs. The next major advance in minimally invasive surgery was the development of telemanipulation systems, also referred to as robots. Originally spearheaded in the United States by the Department of Defense, these robotic devices were intended for surgeons to operate from a remote location. These systems restored pitch and yaw at the end of the instruments, the two degrees of freedom lost with the use of traditional laparoscopic instruments. They also added other benefits such as tremor reduction, motion scaling, surgeon camera control, comfortable ergonomics, and a three-dimensional view of the operative field. The first robotic system approved for intraabdominal surgery in the United States by the Food and Drug Administration (FDA) was the AESOP (Automated Endoscopic System for Optimal Position) system in 1993 AESOP (Computer Motion, Goleta, California) is a computerized robotic camera assistant for laparoscopic surgery. It has gone through several modifications since then and is still available today as a voice-activated, surgeon-controlled, camera assistant. It offers a stable camera platform but has no arm for direct manipulation or dissection of the tissues. The first robotic system approved for intraabdominal surgery that did offer direct manipulation and dissection capabilities was the da Vinci system (Intitive Surgical, Inc., Sunnyvale, California).