Robotic-assisted surgery and related abdominal entry

Abstract

Because laparoscopic surgery has revolutionized the concept of minimally invasive surgery for the last three decades [1], new equipment, cameras, and energy sources were developed that have enabled surgeons to perform more complex surgeries that were once only performed by laparotomies [1]. In the field of pelvic surgery, almost all types of cases now can be performed through a laparoscope, depending on the skill and experience of the surgeon and the availability of proper instrumentation [1]. Robotic-assisted surgery is one of the latest of the innovations in minimally invasive surgery. By the twentieth century, advances in task-specific surgical instrumentations, optics, and digital video equipment, as well as computer and robotic technology opened a new frontier for minimally invasive laparoscopic surgery. The recent introduction of advanced robotic devices, such as da Vinci surgical system, to the field of pelvic surgery has added new hope that operative times as well as the learning curve for minimally invasive surgery may be reduced. The surgeon now is able to operate, suture, and dissect with the facility of the human wrist and in addition, the superior three-dimensional view offered by this robotic system provides surgeons with an unprecedented view of the anatomy. The three-dimensional view is a significant advantage of the robotic surgical system that improves visualization and allows greater precision and accuracy. Furthermore, the surgeon seated at the surgical console performs the dissection with wristlike motions of the master controls, which provides finer, more delicate manipulation of tissue and facilitates procedures that are considered more difficult by conventional laparoscopy. The motions of the surgeon at the console unit are replicated by the robotic arms placed within the patient. During robotic surgery, an assistant is available at the operating table. The assistant performs robot-related tasks, including alignment and exchange of robotic instruments, operative maneuvers with conventional instruments such as organ manipulation, tissue countertraction, suction, and irrigation, and any necessary alterations in the position of the intrauterine manipulator. The presence of the scrubbed assistant is also crucial in the event that an emergency conversion to a laparotomy is required. Robotic technology is used mainly in pelvic surgery because the difficult access to the pelvic cavity is greatly facilitated by the use of robotic arms. In fact, a robot is used in both the urological and gynecological fields. More specifically, robotic-assisted surgery has been applied in many urological surgical procedures, such as for radical prostatectomy, partial nephrectomy, and cystectomy. In the same way, gynecological surgery has been improved by robotic-assisted surgery, both in the treatment of benign and malignant diseases. Robotic-assisted surgery is strictly linked to traditional laparoscopic techniques, with the advantages and disadvantages of minimally invasive surgery.