The use of robots in surgery has steadily increased over the past few decades. While the first documented use of a robot to assist in surgery was in 1985, robotic surgery has become much more common and advanced since the late 1990s and early 2000s.
Early History of Robotic Surgery
The first published account of a robot being used for surgery was in 1985 when the PUMA 560 robotic surgical arm was used in a neurosurgical biopsy. This rudimentary robotic system allowed the surgeons to operate from a separate room using a computer interface to control the robotic arm that performed the actual surgery.
In the late 1980s and into the 1990s, researchers began exploring the use of robotic surgery for other applications beyond neurosurgery biopsies. The U.S. military had an interest in developing robotic telesurgery to allow surgeons to operate on wounded soldiers from remote locations. Meanwhile, academic researchers worked on their own early robotic surgical systems for applications like orthopedic surgery.
While the earliest robotic surgical systems showed promise, they had limitations. The lack of 3D visualization and haptic feedback made them awkward to use. However, the field of robotics was progressing rapidly in the 1990s thanks to computer technology improvements and investments from companies and the military.
The da Vinci Surgical System
The first major breakthrough in surgical robots came in the late 1990s with the introduction of the da Vinci Surgical System. This pioneering robotic surgery system was developed by a company called Intuitive Surgical, which was founded in 1995.
The da Vinci system addressed some of the big limitations of earlier robots. It has a 3D high definition viewer that gives surgeons an immersive experience and enhanced visualization of the surgical site. The da Vinci also introduced miniature EndoWrist instruments that can articulate and rotate similar to the human hand, giving surgeons unprecedented dexterity and control.
The Food and Drug Administration (FDA) approved the da Vinci in 2000 for general laparoscopic surgery. This marked the first time that robotic surgical systems were commercially available.
The da Vinci has become by far the most commonly used robotic surgical system. As of 2018, over 5 million procedures worldwide have been performed with the help of the da Vinci robot.
Growth of Robotic Surgery in the 2000s
Since the FDA approval of the da Vinci in 2000, the use of surgical robots has grown enormously. By 2012, one study estimated about 1 out of 3 surgeries were performed using robot assistance in the U.S.
Some key events that propelled the growth of robotic surgery include:
- 2001 – First robotic cardiac procedure performed
- 2005 – FDA approves the da Vinci for thoracoscopic and prostate surgeries
- 2008 – da Vinci used for first single-incision gallbladder removal
- 2009 – FDA approves da Vinci for hysterectomies
The da Vinci received FDA approval for an ever-widening range of procedures during the 2000s from cardiac surgery to hysterectomies. Surgeons adopted robotic systems quickly, with Intuitive reporting sales of the da Vinci doubling nearly every year in the late 2000s.
Current Uses of Robotic Surgery
Today, surgical robots are used in just about every major field of surgery. Some of the most common robotic surgery procedures include:
| Specialty | Common Procedures |
|---|---|
| Urology | Prostatectomy, Cystectomy, Nephrectomy |
| Gynecology | Hysterectomy, Myomectomy, Oophorectomy |
| General Surgery | Hernia repair, Cholecystectomy, Bariatrics |
| Colorectal | Low anterior resection, Abdominoperineal resection |
| Thoracic | Lobectomy, Esophagectomy |
Robotic systems provide several advantages over traditional open and laparoscopic surgery:
- Enhanced 3D visualization with up to 10x magnification
- Greater dexterity and control using EndoWrist instruments
- Smaller incisions for less pain and scarring
- Shorter hospital stays and recovery times
- Lower risk of infection
- More precision and accuracy
These advantages have led to rapid adoption of robotic surgical systems by hospitals worldwide. Over 3700 da Vinci systems had been installed globally as of 2015.
Limits of Robotic Surgery
While robotic surgery has exploded in popularity, the technology does have some limitations currently:
- High cost – da Vinci systems cost over $1 million plus maintenance expenses
- Large size – Operating room must have space for large apparatus
- Limited tactile feedback
- Lengthy set up time
- Need for specially trained surgical staff
- Potential for technical complications
The lack of tactile feedback and room for technical errors are perhaps the biggest current disadvantages. Surgeons must rely on visual cues only when manipulating tissue. Hardware or software problems can also interfere with the procedure when using a complex robotic system.
The Future of Robotic Surgery
While widespread adoption of robotic surgical systems already represents a major advancement in healthcare technology, the future possibilities are even more transformative. Ongoing research and new companies aim to improve robotic surgery in areas like:
- Virtual reality – Even more immersive 3D environments using VR headsets
- Haptics – Tactile feedback for doctors to “feel” tissue they are manipulating
- AI and machine learning – Smart surgical robots that can adapt, precision targeting
- Microbots – Tiny robots that can operate inside the human body
- Remote surgery – Doctors performing operations from across the globe on patients
As these enhancements are realized, robotic surgery has the potential to fundamentally transform medicine. Procedures could become minimally invasive or even non-invasive, reducing complications and costs.
Conclusion
Robotic surgery has progressed from early experimental research in the 1980s to a multi-billion dollar industry today. Over 5 million major surgical procedures have been performed with the assistance of the da Vinci and other robotic systems. Robotic surgery is now established as a key technology for improving patient outcomes in a wide range of specialties.
Ongoing innovation in virtual reality, haptics, AI, microbots and other areas will continue advancing robotic surgery. This field that was once just a vision of science fiction seems poised to further revolutionize healthcare in the coming decades.