At IEO two of Da Vinci™ operating robots (Surgical Intuitive, Inc., Mountain View, CA) are active, the first one since October 2006. The main technological advantages of this system are realistic 3-D imaging, motion-scaling and tremor filtration, facilitating more precise and accurate endoscopic surgery. It makes difficult and previously inaccessible body areas easier for surgeons to access and may lead to decreased morbidity for patients. Various surgical procedures have proved feasible and safe when performed with the da Vinci™ robot.

Perspectives

Robotic surgery was originally developed to render possible a kind of telesurgery bridging thousands of kilometers or even continents. Although the feasibility of this aspect was proven and gained some media attention, it is not the future of robotic surgery. More probable opportunities for robots are image fusion and surgical training.

At this stage the superposition of different radiologic imaging systems permits more precise and detailed surgical planning. The da Vinci™ system is able to implement this technique in the operating room itself by flashing a patient’s scan images into the virtual three-dimensional view on the console. This will enable the surgeon to more easily detect and identify hidden anatomical structures, and in this way robotic surgery will help to make minimally invasive surgery safer. Another great potential for the da Vinci™ robot probably lies in its impact on surgical training. It is possible to carry out a particular patient’s complete surgical procedure using his CT scans and robotic virtual-reality training programs. Thus, similar to a pilot on a flight simulator, surgeons in training will perform new operations only after performing them successfully in virtual reality.

Conclusions

With the da Vinci surgical robot surgery regains two fundamental tools of surgical procedures: intuitive control over the surgical instruments and steric perception of the operative field. Only several centers are currently using surgical robots and publishing data. There is an agreement in the effectiveness of robotic surgery in the treatment of malignant tumours of the pelvis (prostate, uterus, mainly in obese patients, and rectum), and the indication of this procedure together with the
laparoscopic surgery is reported in several guidelines (NCNN and guidelines of the Gynecological and urological societies).