The first minimally invasive surgery was a laparoscopic cholecystectomy that was performed in 1987. Since then, laparoscopy has gained widespread acceptance, and today it is used in a wide variety of procedures. The current technology behind robotic surgery was aided largely by the United States Army (Department of Defense). They desired a system that would allow surgeons to treat soldiers on the battlefield from a safe distance, that is, the concept of telerobotic surgery. The technologies of telerobotic surgery and laparoscopic surgery were eventually developed into two tele-manipulative robotic systems, the da Vinci Robotic Surgical System and the Zeus Robotic Surgical System. The two systems were developed in parallel until the manufacturer of the da Vinci system (Intuitive Surgical) acquired the rights to the Zeus robotic system. They continue to support existing Zeus robotic systems which are still used in Europe and other countries. The only full-scale robot system available and currently in use in the United States is the da Vinci system.

Today robotic assistance is being used in a wide variety of surgeries and specialties including urologic, cardiac, thoracic, otorhinolaryngologic, orthopedic, gynecologic, and pediatric surgery (Table 48.2). The first robotic-assisted surgery was performed by Kwoh et al., who used the PUMA 560 to perform neurosurgical biopsies. Internal mammary artery harvesting was successfully performed thoracoscopically by Nataf in 1997. The first reported endoscopic coronary artery bypass surgery was performed in 1998 by Loulmet. Since then, robotic-assisted cardiac surgery has expanded to include mitral valve repairs, patent ductus arteriosus ligations, and atrial septal defect closures. As of 2008, more than 80,000 robotic procedures have been performed.

The da Vinci robot (Fig. 48.1) consists of three main parts: the master console, an optical tower, and the surgical cart. The control console is where the surgeon sits and controls the robot. It consists of a 3-D screen that projects an image from the intraoperative camera. The surgeon controls the robot using hand controls, three robotic arms, and foot pedals. The right and left hand controls control the right and left arms of the robot respectively, while the third arm controls the endoscopic camera. Foot pedals control electrocautery and ultrasonic instruments and adjust the camera.

The robotic system allows for ergonomic anatomic control of the instruments which mimic the movement of the human wrist. The instruments have seven degrees of motion versus four degrees of motion with the standard laparoscope. The robotic system has motion scaling that can be adjusted from 1:1 up to 5:1 that allows the system to be set up to compensate for surgeon’s hand tremor and when required a larger movement by the surgeon for a smaller movement in the operating field. The optical tower projects the images from the field and displays it for the operating room and also has the capability to record. The surgical cart, or robot itself, has 3–4 arms and must be manually wheeled in close vicinity to the patient.