Robot-assisted abdominal surgery.

Abstract

Robotic assistance or telemanipulation is the latest technological advance in minimally invasive surgery. Its future implementation will depend on the advantages that it can provide over standard laparoscopy or open surgery. All Medline-cited papers (from case reports to reviews) about telemanipulators used in visceral surgery were assessed. The data in each paper were analysed to enable an up-to-date review of robot-assisted abdominal surgery by the most advanced telemanipulator (da Vinci). Most papers presented case series demonstrating the feasibility of robotic technology in performing a specific procedure. Comparative studies of robot-assisted surgery versus standard laparoscopic or open surgery were usually matched cohort studies. They generally showed an increased operating time for robot-assisted procedures but with similar rates of conversion, intraoperative and postoperative complications, and mortality in comparison to those of laparoscopic surgery. Consistent long-term follow-up data were missing and only one randomized clinical trial was conducted. Robot-assisted surgery appears safe and feasible for certain standard surgical procedures. However, at its current level of development, it offers no clear, significant advantage over standard laparoscopic techniques.