Robot-assisted surgery is the latest development in the larger movement of endoscopy, a type of minimally invasive surgery--the idea being that less invasive procedures translate into less trauma and pain for patients. Surgery through smaller incisions typically results in less scarring and faster recovery. It's not that robots are changing the basics of surgery. Surgeons are still cutting and sewing like they have been for decades. Robots represent a new computer-assisted tool that provides another way for surgeons to work.

Rather than cutting patients open, endoscopy allows surgeons to operate through small incisions by using an endoscope. This fiber optic instrument has a small video camera that gives doctors a magnified internal view of a surgical site on a television screen.

In abdominal endoscopy, known as laparoscopy, surgeons thread the fiber optic instrument into the abdomen. First performed in the late 1980s, laparoscopy is now routine for many procedures, such as surgery on the gallbladder and on female organs.

With robotic surgical systems, surgeons don't move endoscopic instruments directly with their hands. Instead, surgeons sit at a console several feet from the operating table and use joysticks similar to those used in video games. They perform surgical tasks by guiding the movement of the robotic arms in a process known as tele-manipulation.

The Food and Drug Administration reviews data on the safety and effectiveness of robotic software and hardware and requires manufacturers to implement training programs for surgeons. The FDA also monitors experimental uses for robotic applications, including clinical trials for robotic heart surgery. It's too soon to say for sure how far and how fast robotic surgery will grow, but experts say the future looks promising.

The benefits of robots

• Robotic arms don’t tremor.
• Ability to work with all kinds of angels, reach around and get to places that would be harder to get to otherwise.
• Improve depth perception, giving surgeons three-dimensional vision, compared with the two-dimensional vision they would normally get with endoscopic procedures.
• The surgical field can be magnified so that millimeter-sized veins appear as big as pencils.
• Compared with the long instruments used in endoscopy, robotic surgical systems use smaller instruments that provide increased range of motion.
• Robotics also offers motion scaling, which means that a surgeon's gross hand movements can be reduced to fine movements, allowing for accuracy in tight spaces.

Robotics and telesurgery

Robotic surgical systems make it possible for surgeons to perform robotic surgery across long distances. Surgeons from the European Institute of Technology used robots and high-speed telecommunications to perform the first complete long-distance robotic surgery last year. According to an article in the Sept. 27, 2001, issue of the journal Nature, the surgeons worked from New York to remove the gallbladder of a 68-year-old woman in Strasbourg, France.

The mean total time delay was 155 milliseconds, so surgeons could see the result of their commands a little more than one-tenth of a second later. The time to set up the robot was 16 minutes and the gallbladder was dissected in 54 minutes without complications.

Source "U.S. Food and Drug Administration"