Robotics in General Surgery

TLDR

Robotic surgery is the most advanced form of minimally invasive surgery, yet its clinical use still faces unresolved issues, unclear indications, and uncertain cost‑benefit ratios. This report aims to provide a foundation for a future prospective, randomized trial of robotic surgery in general surgery. The authors retrospectively analyzed 193 patients (207 robotic procedures) performed at Misericordia Hospital between October 2000 and November 2002, including abdominal, thoracic, and vascular operations, with 179 single and 14 double procedures. The cohort had a 3.6 % conversion rate, 9.3 % peri‑operative morbidity, 1.5 % mortality, and 3.1 % re‑operation rate, demonstrating that robotic surgery is feasible, safe, and expands minimally invasive options.

Abstract

Robotic technology is the most advanced development of minimally invasive surgery, but there are still some unresolved issues concerning its use in a clinical setting.The study describes the clinical experience of the Department of General Surgery, Misericordia Hospital, Grosseto, Italy, in robot-assisted surgery using the da Vinci Surgical System.Between October 2000 and November 2002, 193 patients underwent a minimally invasive robotic procedure (74 men and 119 women; mean age, 55.9 years [range, 16-91 years]). A total of 207 robotic surgical operations, including abdominal, thoracic and vascular procedures, were performed; 179 were single procedures, and 14 were double (2 operations on the same patient). There were 4 conversions to open surgery and 3 to conventional laparoscopy (conversion rate, 3.6%; 7 of 193 patients). The perioperative morbidity rate was 9.3% (18 of 193 patients), and 6 patients (3.1%) required a reoperation. The postoperative mortality rate was 1.5% (3 of 193 patients).Our preliminary experience at a large community hospital suggests that robotic surgery is feasible in a clinical setting. Its daily use is safe and easily managed, and it expands the applications of minimally invasive surgery. However, the best indications still have to be defined, and the cost-benefit ratio must be evaluated. This report could serve as a basis for a future prospective, randomized trial.