Use of minimally invasive techniques in today’s surgery is the most important development for the modern surgery and offers many advantages over classical open surgical techniques. Current surgical and technological developments allow surgeons to perform many complicated surgical interventions with minimally invasive method. Laparoscopic surgery has many advantages over open surgery including shorter hospital stay, decreased morbidity and faster recovery period. Laparoscopic surgery has become popular in, and a standard procedure for, many abdominal and pelvic operations.

Robotic surgical systems were first used in 1996 then introduced into intra-abdominal surgery in 2000 when the Da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA, USA) was approved by FDA. The primary advantages of robotic surgical systems include obtaining there dimensional natural images that give a sense of depth; ability of mechanical wrists (EndoWrists) attached to the end of robotic arms to precisely move in six axes; and minimized vibration. Robotic surgical procedures have been widely used in the world and considered the age of surgery after laparoscopy.

What are the advantages of Robotic Surgery?

In addition to classical advantages of laparoscopic surgery, the most important advantages of robotic surgery include the followings:

• Less pain due to less traumatic approach to skin and muscles
• Less risk for infection
• Significantly less risk for infection than in an open surgery because the intra-abdominal organs come into contact with minimum air in the operating room.
• Safer surgery
• A three dimensional and magnified image allows better displaying blood vessels and nerves. For example, loss of blood is less during a robotic surgery.
• Less marked scar
• An incision 1-1.5 cm in size leaves a less marked scar than an incision 20-25 in size in an open surgery.
• Faster recovery, earlier postoperative mobilization and oral intake allow a patient to recover faster.
• Shorter hospital stay
• Most patients are discharged on the 3rd or 4th day.
• Patients get back to the work and daily life quicker.
• Areas where robot is used in general surgery

Despite being mostly used in urologic surgery over the last decade the robotic surgery has been increasingly used for general surgical procedures. It offers technical advantages over laparoscopic surgery when working in deep areas that are difficult to reach such as abdominal surgeries, stomach hernia, esophagus, and rectum. It is mostly used in colorectal surgery in the general surgery. The areas where robotic systems are used are listed below.

Robotic Colorectal Surgery

Robotic surgical systems are successfully used in surgical treatment of many colorectal diseases including colon cancer, rectal cancers, diverticulitis and its complications, and inflammatory intestinal diseases. Minimally invasive interventions have significant advantages in colorectal cancers over open surgeries (e.g., laparoscopy, robotic surgery). In open surgeries, postoperative mobilization and oral feeding of patients is prolonged (4-6 days) thus they stay in the hospital longer (6-8 days) and return to daily activities later.

In robotic colorectal surgeries, postoperative pain is less due to incisions 1-1.5 cm in size, and period for oral feeding (2-3 days) and hospital stay (4-5 days) is shorter.

Robotic surgical surgeries are successfully used in treatment of any colorectal diseases. Because of anatomic features, robotic surgical systems become more important for narrow and deep areas, e.g. pelvis, in operations performed for rectum cancer in particular. During a lymphatic dissection compatible with oncologic surgical rules, conservation of blood vessels and nerve packets, which perform sexual and urinary functions, is possible and much safer with robotic surgical systems. Quality of life of the patients is improved and the rate of local recurrence is decreased after this surgery. Patients start physical activities and oral feeding earlier. Thus, hospital stay and return to daily life is shorter.

Antireflux and Stomach Hernia with Robotic Surgery

• Nissen fundoplication for treatment of stomach hernia and associated reflux.
• Esophageal procedures with Robotic Surgery
• Esophageal cancers
• Achalasia
• Robotic Surgery for stomach and small intestines
• Subtotal and total gastrectomy for stomach cancers
• Robotic Surgery for pancreas and other solid organs
• Pancreatic tumors
• Benign and malignant cysts of pancreas
• Robotic Surgery for the liver and biliary tract
• Cholecystectomy
• Liver resections and biliary tract surgery
• Endocrinal Robotic Surgery
• Surgeries of suprarenal gland (adrenals)
• Thyroid surgery
• Bariatric Robotic Surgery
• Gastric bypass
• Sleeve gastrectomy (Tube stomach)

With future technological developments in the robotic surgical systems, robotic surgery is expected to replace classical laparoscopic surgery in complex cases, and robotic single incision laparoscopy will become a standard procedure for simpler cases.