Feasibility of robotic laparoscopic surgery: 146 cases

Theoretically, in laparoscopic surgery, a computer interface in command of a mechanical system (robot) allows the surgeon: (1) to recover a number a n umber of lost degrees of freedom, thanks to intraabdominal articulations; ( 2) to obtain better visual control of instrument manipulation, thanks to th ree-dimensional vision; (3) to modulate the amplitude of surgical motions b y downscaling and stabilization; (4) to work at a distance from the patient . These advances improve the quality of surgical tasks in a perfect ergonom ic position. The purpose of this paper is to evaluate the feasibility of ut ilizing a robot in laparoscopic surgery. The first robot-assisted procedure in humans was performed in March 1997 by our team. One hundred forty-six p atients underwent robot-assisted laparoscopic surgery. Between March 1997 a nd February 2001 a nonconsecutive series was performed of 39 antireflux pro cedures, 48 cholecystectomies, 28 tubal reanastomoses, 10 gastroplasties fo r obesity, 3 inguinal hernias, 3 intrarectal procedures, 2 hysterectomies, 2 cardiac procedures, 2 prostactectomies, 2 arteriovenous fistulas, I lumba r sympathectomy, I appendectomy, 1 laryngeal exploration, I varicocele liga tion, 1 endometriosis cure, 1 neosalpingostomy, 1 deferent canal. The robot (Da Vinci system, Intuitive Surgical, Mountain View, CA), consists of a co nsole and a cart with three articulated robot arms. The surgeon sits in fro nt of the console, manipulating joysticklike handles while observing the op erative field through binoculars that provide a three-dimensional picture. This computer is capable of modulating these data by eliminating physiologi c tremor and by downscaling the amplitude of motions by a factor 5 or 3 to one. This study has demonstrated the feasibility of several laparoscopic ro botic procedures. There is no morbidity related to the system. Operating ti me and the hospital stay were within acceptable limits. The system seems mo st beneficial in intra-abdominal microsurgery or for manipulations in a ver y small space. Optimized ergonomics and increased mobility of the instrumen t tips are beneficial in many steps of abdominal surgical procedures.