{{short description|Surgical procedure}} {{cs1 config|name-list-style=vanc|display-authors=6}} {{Use dmy dates|date=January 2016}} {{Infobox medical intervention | synonym = Robotically-assisted surgery | image = Laproscopic Surgery Robot.jpg | caption = A robotically assisted surgical system used for prostatectomies, cardiac valve repair and gynecologic surgical procedures | alt = | pronounce = | specialty = <!-- from Wikidata, can be overwritten --> | synonyms = | ICD10 = | ICD9 = | ICD9unlinked = | CPT = | MeshID = | LOINC = | other_codes = | MedlinePlus = | eMedicine = }} '''Robotic surgery''' or '''robot-assisted surgery''' is any type of surgical procedure that is performed with the use of robotic systems. Robotically assisted surgery was developed with the primary goal of overcoming the limitations of pre-existing minimally invasive surgical procedures, alongside enhancing the capabilities (for example, increasing their work precision) of surgeons performing open surgeries.
In robotically assisted minimally-invasive surgery, the surgeon uses either a remote manipulator or a computer control system to perform dissection, hemostasis, and resection. * A telemanipulator (e.g. the da Vinci Surgical System) is a system of remotely controlled manipulators that enables a surgeon to perform the surgery in real-time under stereoscopic vision from a control console separate from the operating table. In this case, the surgical robot is docked next to the patient, while the robotic arms carry out endoscopy-like maneuvers via end-effectors inserted through specially designed trocars. A surgical assistant and a scrub nurse are often still needed scrubbed at the tableside to help switch effector instruments or provide additional suction or temporary tissue retraction using endoscopic grasping instruments. * In computer-controlled systems, the surgeon uses a computer system to relay control data and direct the robotic arms and their end-effectors, even though these systems still possess the ability to use telemanipulators for their input. One of the primary advantages of using the computerized method is that it does not require the surgeon to be physically present on campus to perform the procedure, leading to the possibility for remote surgery and even AI-assisted or automated procedures.
The capital barrier to robotic surgery has decreased as lower-cost, modular systems like Medtronic's Hugo and CMR Surgical's Versius enter the market as alternative offerings to existing platforms.<ref>{{Cite journal |last1=Katsimperis |first1=Stamatios |last2=Tzelves |first2=Lazaros |last3=Feretzakis |first3=Georgios |last4=Bellos |first4=Themistoklis |last5=Triantafyllou |first5=Panagiotis |last6=Arseniou |first6=Polyvios |last7=Skolarikos |first7=Andreas |date=2025-09-25 |title=Beyond Da Vinci: Comparative Review of Next-Generation Robotic Platforms in Urologic Surgery |journal=Journal of Clinical Medicine |language=en |volume=14 |issue=19 |pages=6775 |doi=10.3390/jcm14196775 |doi-access=free |issn=2077-0383 |pmc=12524596 |pmid=41095855}}</ref> While utilizing a robotic platform typically adds $1,500 to $3,000 in direct operating room expenses compared to traditional laparoscopy, health economic analyses evaluating the total episode of care suggest that this premium is often offset by downstream savings from shorter hospital stays, lower complication rates, and significantly reduced rates of conversion to open surgery.<ref>{{Cite journal |last1=Ricciardi |first1=Rocco |last2=Seshadri-Kreaden |first2=Usha |last3=Yankovsky |first3=Ana |last4=Dahl |first4=Douglas |last5=Auchincloss |first5=Hugh |last6=Patel |first6=Neera M. |last7=Hebert |first7=April E. |last8=Wright |first8=Valena |date=May 2025 |title=The COMPARE Study: Comparing Perioperative Outcomes of Oncologic Minimally Invasive Laparoscopic, da Vinci Robotic, and Open Procedures: A Systematic Review and Meta-analysis of the Evidence |journal=Annals of Surgery |language=en |volume=281 |issue=5 |pages=748–763 |doi=10.1097/SLA.0000000000006572 |pmid=39435549 |pmc=11974634 |issn=0003-4932}}</ref><ref>{{Cite journal |last1=Cool |first1=Christina L |last2=Jacofsky |first2=David J |last3=Seeger |first3=Kelly A |last4=Sodhi |first4=Nipun |last5=Mont |first5=Michael A |date=April 2019 |title=A 90-day episode-of-care cost analysis of robotic-arm assisted total knee arthroplasty |url=https://becarispublishing.com/doi/10.2217/cer-2018-0136 |journal=Journal of Comparative Effectiveness Research |language=en |volume=8 |issue=5 |pages=327–336 |doi=10.2217/cer-2018-0136 |pmid=30686022 |issn=2042-6305}}</ref><ref>{{Cite web |title=Cost of Robotic Surgery Remains Complex Equation |url=https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/2026/february-2026-volume-111-issue-2/cost-of-robotic-surgery-remains-complex-equation/ |access-date=2026-04-01 |website=ACS |language=en}}</ref>
==History== The concept of using standard hand grips to control manipulators and cameras of various sizes down to sub-miniature was described in the Robert Heinlein story 'Waldo' in August 1942, which also mentioned brain surgery. The first robot to assist in surgery was the ''Arthrobot'', which was developed in Canada by a team led by biomedical engineer James McEwen and UBC engineering physics gradudate Geof Auchinleck, in collaboration with orthopedic surgeon Dr. Brian Day, who played a foundational role in its development.<ref name=":0">{{cite journal | pmc=3941295 | date=2013 | title=Robotic surgery | journal=Journal of Oral Biology and Craniofacial Research | volume=3 | issue=1 | page=2 | doi=10.1016/j.jobcr.2013.03.002 | pmid=25737871 | vauthors = Mohammad S }}</ref><ref name=":1">{{Cite web|url=http://www.brianday.ca/imagez/1051_28738.pdf|title=Medical Post 23:1985|access-date=3 December 2014|archive-date=23 September 2015|archive-url=https://web.archive.org/web/20150923194508/http://www.brianday.ca/imagez/1051_28738.pdf|url-status=live}}</ref><ref name="Lauterbach_2017">{{cite journal | vauthors = Lauterbach R, Matanes E, Lowenstein L | title = Review of Robotic Surgery in Gynecology-The Future Is Here | journal = Rambam Maimonides Medical Journal | volume = 8 | issue = 2 | date = April 2017 | pages = e0019 | pmid = 28467761 | pmc = 5415365 | doi = 10.5041/rmmj.10296 }}</ref><ref name=":2">{{Cite web |title= |url=https://www.guinnessworldrecords.com/world-records/512174-first-robotic-surgery?}}</ref> The ''Arthrobot'' was first used by Dr. Day in surgery in Vancouver Canada in 1983.<ref name=":0" /><ref name=":1" /><ref name="Lauterbach_2017" /><ref name=":2" /><ref name=":3">{{Cite web |title=World's first surgical robot {{!}} Dr. Brian Day |url=https://brianday.ca/news/worlds-first-surgical-robot/ |access-date=2026-04-15 |website=brianday.ca}}</ref> Designed to assist in arthroscopic surgeries, the Arthrobot responded to the surgeon’s voice commands to manipulate and position the patient’s limb during surgical procedures.<ref name=":2" /><ref name=":3" /> Eventually, over 60 arthroscopic surgical procedures were performed over the period of the first 12 months (in the year 1985), and a National Geographic video, ''The Robotics Revolution'', featured the device. Furthermore, among other related robotic devices that were developed at the same time was a surgical scrub nurse robot, which handed operative instruments on voice command, and a medical laboratory robotic arm. A YouTube video entitled ''Arthrobot – the world's first surgical robot'' illustrates some of these in operation.<ref>{{cite web|date=2014-01-08|title=Arthrobot - the world's first surgical robot|url=https://www.youtube.com/watch?v=ca7JPD9pg-8 |archive-url=https://ghostarchive.org/varchive/youtube/20211221/ca7JPD9pg-8 |archive-date=2021-12-21 |url-status=live|access-date=2019-04-14|vauthors=Day B|website=YouTube}}{{cbignore}}</ref>
The next important milestone took place in 1985, when the first brain biopsy under CT guidance with the assistance of a robotic arm, PUMA560, was performed.<ref>{{cite journal | pmc=5415365 | date=2017 | title=Review of Robotic Surgery in Gynecology—The Future is Here | journal=Rambam Maimonides Medical Journal | volume=8 | issue=2 | pages=e0019 | doi=10.5041/RMMJ.10296 | pmid=28467761 | vauthors = Lauterbach R, Matanes E, Lowenstein L }}</ref>In 1985, a robot, the Unimation Puma 200, was used to orient a needle for a brain biopsy while under CT guidance during a neurological procedure.<ref>{{cite journal | vauthors = Kwoh YS, Hou J, Jonckheere EA, Hayati S | title = A robot with improved absolute positioning accuracy for CT guided stereotactic brain surgery | journal = IEEE Transactions on Bio-Medical Engineering | volume = 35 | issue = 2 | pages = 153–160 | date = February 1988 | pmid = 3280462 | doi = 10.1109/10.1354 | bibcode = 1988ITBE...35..153K }}</ref><ref name="Lauterbach_2017" /> In the late 1980s, Imperial College London developed a surgical robotic system, PROBOT, which was then used to perform prostatic surgery.<ref>{{Cite web |title=Probot |url=https://www.imperial.ac.uk/a-z-research/mechatronics-in-medicine/research/completed-projects/probot/ |access-date=2025-10-07 |website=Imperial College London |language=en-GB}}</ref> Some of the advantages of this robot included its relatively small size, accuracy, and an absence of fatigue for the surgeon. In the 1990s, computer-controlled surgical devices began to emerge, enabling greater precision and control in surgical procedures. One of the most significant milestones in this period was the development of the da Vinci Surgical System, which was approved by the Food and Drug Administration (FDA) for use in surgical procedures in 2000 (Intuitive Surgical, 2021).<ref>{{cite book |title=Pediatric Surgery |chapter=Advanced and Emerging Surgical Technologies and the Process of Innovation |date=2012 |pages=37–75 |doi=10.1016/B978-0-323-07255-7.00004-0 |isbn=978-0-323-07255-7 | vauthors = Dutta S, Woo RK, Krummel TM }}</ref> The da Vinci system utilizes robotic arms to manipulate surgical instruments, enabling surgeons to perform complex surgical procedures with a significantly higher level of accuracy and control.<ref>{{cite journal |last1=Andellini |first1=Martina |last2=Di Mauro |first2=Roxana |last3=Faggiano |first3=Francesco |last4=Derrico |first4=Pietro |last5=Ritrovato |first5=Matteo |title=PP187 Robotic Surgery, Any Updates? |journal=International Journal of Technology Assessment in Health Care |date=2019 |volume=35 |issue=S1 |page=72 |doi=10.1017/S0266462319002757 }}</ref> Additionally, in 1992, the ROBODOC was introduced, eventually revolutionizing orthopedic surgery by being able to assist with hip replacement surgeries.<ref>{{cite journal | vauthors = Paul HA, Bargar WL, Mittlestadt B, Musits B, Taylor RH, Kazanzides P, Zuhars J, Williamson B, Hanson W | title = Development of a surgical robot for cementless total hip arthroplasty | journal = Clinical Orthopaedics and Related Research | volume = 285 | issue = 285 | pages = 57–66 | date = December 1992 | pmid = 1446455 | doi = 10.1097/00003086-199212000-00010 }}</ref> The latter was the first surgical robot to receive the FDA's official approval, which occurred in 2008.<ref>{{cite journal | vauthors = Lanfranco AR, Castellanos AE, Desai JP, Meyers WC | title = Robotic surgery: a current perspective | journal = Annals of Surgery | volume = 239 | issue = 1 | pages = 14–21 | date = January 2004 | pmid = 14685095 | pmc = 1356187 | doi = 10.1097/01.sla.0000103020.19595.7d }}</ref> The ROBODOC from Integrated Surgical Systems (working closely with IBM) could mill out precise fittings in the femur for hip replacement.<ref>{{cite web|title=ROBODOC: Surgical Robot Success Story|url=http://www.robot.md/publications/robodoc-surgical-robot-sucess-story.pdf|access-date=25 June 2013|archive-date=29 September 2013|archive-url=https://web.archive.org/web/20130929033023/http://www.robot.md/publications/robodoc-surgical-robot-sucess-story.pdf|url-status=live}}</ref> The purpose of the ROBODOC was to replace the previous method of carving out a femur for an implant, the use of a mallet and broach/rasp.
Further development of robotic systems was carried out by SRI International and Intuitive Surgical with the introduction of the da Vinci Surgical System and Computer Motion with the ''AESOP'' and the ZEUS robotic surgical system.<ref>{{cite journal |last1=Meadows |first1=Michelle |title=Computer-assisted surgery: an update |journal=FDA Consumer |date=2005 |volume=39 |issue=4 |pages=16–17 |pmid=16252396 |url=https://permanent.access.gpo.gov/lps1609/www.fda.gov/fdac/features/2005/405_computer.html }}</ref> The first robotic surgery was performed at The Ohio State University Medical Center in Columbus, Ohio, under the direction of a renowned American cardiothoracic surgeon, Robert E. Michler.<ref>{{cite journal|vauthors=McConnell PI, Schneeberger EW, Michler RE|date=2003|title=History and development of robotic cardiac surgery|journal=Problems in General Surgery|volume=20|issue=2|pages=20–30|doi=10.1097/01.sgs.0000081182.03671.6e|doi-access=free}}</ref>
When publicly introduced in 1994, AESOP represented a breakthrough in robotic surgery, as it was the first laparoscopic camera holder to be granted the FDA's approval for commercial use. Furthermore, the U.S. government space agency NASA was among companies, governmental institutions, and agencies that provided research funding to the company Computer Motion, which produced AESOP, due to its goal of creating a robotic arm that can be used in space; however, this project eventually moved in the direction of medical science, resulting in the development of a camera used in laparoscopic procedures. In 1996, a voice control system was installed in the AESOP 2000 surgical robot, followed in 1998 by the function of seven degrees of freedom (7 DOF), which enhanced the AESOP 3000 robotic system, effectively enabling it to mimic a functional human hand.<ref>{{cite journal | vauthors = Unger SW, Unger HM, Bass RT | title = AESOP robotic arm | journal = Surgical Endoscopy | volume = 8 | issue = 9 | page = 1131 | date = September 1994 | pmid = 7992194 | doi = 10.1007/BF00705739 }}</ref>
The ZEUS robotic surgical system was commercially introduced in 1998, marking the inception of telerobotics, also known as telepresence surgery, where the surgeon conducts the surgical procedure remotely, navigating the robot through a console, while the robot performs the procedure on the patient.<ref>{{cite journal | vauthors = Baek SJ, Kim SH | title = Robotics in general surgery: an evidence-based review | journal = Asian Journal of Endoscopic Surgery | volume = 7 | issue = 2 | pages = 117–123 | date = May 2014 | pmid = 24877247 | doi = 10.1111/ases.12087 | doi-access = free }}</ref> ZEUS was used for the first time during a gynecological surgery in 1997 to reconnect Fallopian tubes in Cleveland, Ohio.<ref name="Lauterbach_2017" /><ref>{{cite web|date=29 September 1999|title=ZEUS robot system reverses sterilization to enable birth of baby boy|url=http://www.hoise.com/vmw/99/articles/vmw/LV-VM-11-99-1.html|publisher=Virtual Medical Worlds Monthly|vauthors=Versweyveld L|access-date=17 October 2007|archive-date=20 September 2017|archive-url=https://web.archive.org/web/20170920021509/http://www.hoise.com/vmw/99/articles/vmw/LV-VM-11-99-1.html|url-status=live}}</ref> Afterwards, it was used on several other surgical procedures, including a beating heart coronary artery bypass graft in October 1999,<ref>{{cite web|date=6 October 1999|title=Robotics: the Future of Minimally Invasive Heart Surgery|url=https://biomed.brown.edu/Courses/BI108/BI108_2000_Groups/Heart_Surgery/Robotics.html|access-date=29 November 2011|publisher=Division of Biology and Medicine, Brown University |archive-url=https://web.archive.org/web/20020328150235/http://biomed.brown.edu/Courses/BI108/BI108_2000_Groups/Heart_Surgery/Robotics.html |archive-date=2002-03-28}}</ref> and the Lindbergh Operation, which was a cholecystectomy performed remotely in September 2001.<ref>{{cite web|title=Linbergh Operation – IRCAD/EITS Laparoscopic Center|url=http://www.ircad.fr/event/lindbergh/index.php?lng=en|access-date=19 January 2011|archive-date=21 July 2011|archive-url=https://web.archive.org/web/20110721001049/http://www.ircad.fr/event/lindbergh/index.php?lng=en}}</ref> In 2003, ZEUS made its most prominent mark in cardiac surgery after successfully harvesting the left internal mammary arteries in 19 patients, all of whom had very successful clinical outcomes.<ref>{{cite journal | vauthors = Boyd WD, Rayman R, Desai ND, Menkis AH, Dobkowski W, Ganapathy S, Kiaii B, Jablonsky G, McKenzie FN, Novick RJ | title = Closed-chest coronary artery bypass grafting on the beating heart with the use of a computer-enhanced surgical robotic system | journal = The Journal of Thoracic and Cardiovascular Surgery | volume = 120 | issue = 4 | pages = 807–809 | date = October 2000 | pmid = 11003767 | doi = 10.1067/mtc.2000.109541 | doi-access = free }}</ref><ref name="pmid120087632">{{cite journal | vauthors = Boyd WD, Kiaii B, Kodera K, Rayman R, Abu-Khudair W, Fazel S, Dobkowski WB, Ganapathy S, Jablonsky G, Novick RJ | title = Early experience with robotically assisted internal thoracic artery harvest | journal = Surgical Laparoscopy, Endoscopy & Percutaneous Techniques | volume = 12 | issue = 1 | pages = 52–57 | date = February 2002 | pmid = 12008763 | doi = 10.1097/00019509-200202000-00009 }}</ref>
The original telesurgery robotic system that the da Vinci was based on was developed at Stanford Research Institute International in Menlo Park, California, financially supported by DARPA and NASA.<ref>{{cite web|title=Telerobotic Surgery|url=http://www.sri.com/work/timeline-innovation/timeline.php?timeline=health#!&innovation=telerobotic-surgery|access-date=30 September 2013|publisher=SRI International|archive-date=19 November 2016|archive-url=https://web.archive.org/web/20161119182210/https://www.sri.com/work/timeline-innovation/timeline.php?timeline=health#!&innovation=telerobotic-surgery}}</ref> A demonstration of an open bowel anastomosis was given to the Association of Military Surgeons of the US (AMSUS).<ref>{{cite journal | vauthors = Satava RM | title = Surgical robotics: the early chronicles: a personal historical perspective | journal = Surgical Laparoscopy, Endoscopy & Percutaneous Techniques | volume = 12 | issue = 1 | pages = 6–16 | date = February 2002 | pmid = 12008765 | doi = 10.1097/00129689-200202000-00002 }}</ref> Although the telesurgical robot was originally intended to facilitate remotely performed surgery on the battlefield and in different remote locations or hardly accessible environments to reduce casualties, it turned out to be more useful for minimally invasive on-site surgery.<ref>{{cite journal | vauthors = George EI, Brand TC, LaPorta A, Marescaux J, Satava RM | title = Origins of Robotic Surgery: From Skepticism to Standard of Care | journal = Journal of the Society of Laparoendoscopic Surgeons | volume = 22 | issue = 4 | article-number = e2018.00039 | date = 2018 | pmid = 30524184 | pmc = 6261744 | doi = 10.4293/JSLS.2018.00039 }}</ref><ref name="Outpatient Robotic surgery: Conside">{{cite journal | vauthors = Tameze Y, Low YH | title = Outpatient Robotic surgery: Considerations for the Anesthesiologist | journal = Advances in Anesthesia | volume = 40 | issue = 1 | pages = 15–32 | date = December 2022 | pmid = 36333045 | pmc = 9626246 | doi = 10.1016/j.aan.2022.06.001 }}</ref> The patents for the early prototype were sold to Intuitive Surgical in Mountain View, California. The da Vinci senses the surgeon's hand movements and translates them electronically into scaled-down micro-movements to manipulate the tiny proprietary instruments. It also detects and filters out any tremors in the surgeon's hand movements, so that they are not duplicated robotically. The camera used in the system provides a true stereoscopic picture transmitted to a surgeon's console. Compared to the ZEUS, the da Vinci robot is attached to trocars to the surgical table, and can imitate the human wrist. In 2000, the da Vinci obtained FDA approval for general laparoscopic procedures and became the first operative surgical robot in the US.<ref>{{cite journal | vauthors = Sung GT, Gill IS | title = Robotic laparoscopic surgery: a comparison of the DA Vinci and Zeus systems | journal = Urology | volume = 58 | issue = 6 | pages = 893–898 | date = December 2001 | pmid = 11744453 | doi = 10.1016/s0090-4295(01)01423-6 }}</ref> Examples of using the da Vinci system include the first robotically assisted heart bypass (performed in Germany) in May 1998, and the first performed in the United States in September 1999;{{Citation needed|date=January 2011}} and the first all-robotic-assisted kidney transplant, performed in January 2009.<ref>{{cite news|date=22 June 2009|title=New Robot Technology Eases Kidney Transplants: N.J. Hospital Performs World's First All-Robotic Transplant |work=CBS News | vauthors = Gomez M |url=http://wcbstv.com/health/da.vinci.robot.2.1055154.html|access-date=8 July 2009 |archive-url=https://web.archive.org/web/20090804104220/http://wcbstv.com/health/da.vinci.robot.2.1055154.html |archive-date=2009-08-04}}</ref> The da Vinci Si was released in April 2009 and initially sold for $1.75 million.<ref>{{cite web|title=da Vinci Si Surgical System|url=http://www.intuitivesurgical.com/products/davinci_surgical_system/davinci_surgical_system_si/|access-date=30 September 2013|publisher=Intuitive Surgical|archive-date=21 October 2013|archive-url=https://web.archive.org/web/20131021222409/http://www.intuitivesurgical.com/products/davinci_surgical_system/davinci_surgical_system_si/|url-status=live}}</ref>
In 2005, a surgical technique was documented in canine and cadaveric models called the transoral robotic surgery (TORS) for the da Vinci robot surgical system, as it was the only FDA-approved robot to perform head and neck surgery.<ref>{{cite journal | vauthors = Oliveira CM, Nguyen HT, Ferraz AR, Watters K, Rosman B, Rahbar R | title = Robotic surgery in otolaryngology and head and neck surgery: a review | journal = Minimally Invasive Surgery | volume = 2012 | article-number = 286563 | date = 2012 | pmid = 22567225 | pmc = 3337488 | doi = 10.1155/2012/286563 | doi-access = free }}</ref><ref name="Weinstein_20052">{{cite journal | vauthors = Weinstein GS, O'malley BW, Hockstein NG | title = Transoral robotic surgery: supraglottic laryngectomy in a canine model | journal = The Laryngoscope | volume = 115 | issue = 7 | pages = 1315–1319 | date = July 2005 | pmid = 15995528 | doi = 10.1097/01.MLG.0000170848.76045.47 }}</ref> In 2006, three patients underwent resection of the tongue using this technique.<ref name="Weinstein_20052" /> The results were more clear visualization of the cranial nerves, lingual nerves, and lingual artery, and the patients had a faster recovery to normal swallowing.<ref>{{cite journal | vauthors = Lee SY, Park YM, Byeon HK, Choi EC, Kim SH | title = Comparison of oncologic and functional outcomes after transoral robotic lateral oropharyngectomy versus conventional surgery for T1 to T3 tonsillar cancer | journal = Head & Neck | volume = 36 | issue = 8 | pages = 1138–1145 | date = August 2014 | pmid = 23836492 | doi = 10.1002/hed.23424 }}</ref> In May 2006, the first artificial intelligence doctor-conducted unassisted robotic surgery was successfully performed on a 34-year-old male to correct a heart arrhythmia. The surgery's outcome was rated as better than an above-average human surgeon. The machine had a database of 10,000 similar operations, and so, in the words of its designers, was "more than qualified to operate on any patient."<ref>{{cite news|date=19 May 2006|vauthors=Blass E|title=Autonomous Robotic Surgeon performs surgery on first live human|work=Engadget|url=https://www.engadget.com/2006-05-19-robot-surgeon-performs-worlds-first-unassisted-operation.html|access-date=30 November 2022|archive-date=30 November 2022|archive-url=https://web.archive.org/web/20221130005100/https://www.engadget.com/2006-05-19-robot-surgeon-performs-worlds-first-unassisted-operation.html|url-status=live}}</ref><ref>{{cite news|title=Robot surgeon carries out 9-hour operation by itself|url=http://www.physorg.com/news67222790.html|website=Phys.Org|date=May 19, 2006|access-date=21 July 2009|archive-date=6 June 2011|archive-url=https://web.archive.org/web/20110606210358/http://www.physorg.com/news67222790.html|url-status=live}}</ref> In August 2007, Dr. Sijo Parekattil of the Robotics Institute and Center for Urology (Winter Haven Hospital and University of Florida) performed the first robotic-assisted microsurgery procedure of denervation of the spermatic cord for chronic testicular pain.<ref>{{cite web|title=Robotic Infertility|url=http://www.roboticinfertility.com/|access-date=11 October 2012|vauthors=Parekattil S|archive-date=27 February 2024|archive-url=https://web.archive.org/web/20240227050703/https://avanturol.com/|url-status=live}}</ref> In February 2008, Dr. Mohan S. Gundeti of the University of Chicago Comer Children's Hospital performed the first robotic pediatric neurogenic bladder reconstruction.<ref>{{cite news|date=20 November 2008|title=Surgeons perform world's first pediatric robotic bladder reconstruction|publisher=Esciencenews.com|url=http://esciencenews.com/articles/2008/11/20/surgeons.perform.worlds.first.pediatric.robotic.bladder.reconstruction|access-date=29 November 2011|archive-date=22 November 2010|archive-url=https://web.archive.org/web/20101122112621/http://esciencenews.com/articles/2008/11/20/surgeons.perform.worlds.first.pediatric.robotic.bladder.reconstruction|url-status=live}}</ref>
On 12 May 2008, the first image-guided MR-compatible robotic neurosurgical procedure was performed at the University of Calgary by Dr. Garnette Sutherland using the NeuroArm.<ref>{{cite web|date=16 May 2008|title=neuroArm: revolutionary procedure a world first|url=https://www.ucalgary.ca/news/may2008/neuroArm|access-date=14 November 2012|publisher=ucalgary.ca|archive-date=2 May 2019|archive-url=https://web.archive.org/web/20190502165123/https://www.ucalgary.ca/news/may2008/neuroArm}}</ref> In June 2008, the German Aerospace Centre (DLR) presented a robotic system for minimally invasive surgery, the MiroSurge neurosurgical robotic system.<ref>{{cite book |last1=Hagn |first1=Ulrich |last2=Nickl |first2=Matthias |last3=Jörg |first3=Stephan |last4=Tobergte |first4=Andreas |last5=Kübler |first5=Bernhard |last6=Passig |first6=Georg |last7=Gröger |first7=Martin |last8=Fröhlich |first8=Florian |last9=Seibold |first9=Ulrich |last10=Konietschke |first10=Rainer |last11=Le-Tien |first11=Luc |last12=Albu-Schäffer |first12=Alin Olimpiu |last13=Grebenstein |first13=Markus |last14=Ortmaier |first14=Tobias |last15=Hirzinger |first15=Gerd |chapter=DLR MiroSurge -- towards versatility in surgical robotics |pages=143–146 |id={{CORE output|11151913}} |chapter-url=https://elib.dlr.de/76854/1/Curac_2008_MIROSURGE_Hagn.pdf |series=Proceedings of CURAC |title=7. Jahrestagung der Deutschen Gesellschaft für Computer- und Roboterassistierte Chirurgie e.V. |location=Leipzig |isbn=978-3-00-025798-8 }}</ref> In September 2010, the Eindhoven University of Technology announced the development of the Sofie surgical system, the first surgical robot to employ force feedback.<ref>{{cite web|date=27 September 2010|title=Beter opereren met nieuwe Nederlandse operatierobot Sofie|url=http://w3.wtb.tue.nl/nl/nieuws/artikel/?tx_ttnews%5Btt_news%5D=10041&tx_ttnews%5BbackPid%5D=465&cHash=ebb243e7ff|archive-url=https://web.archive.org/web/20110724171318/http://w3.wtb.tue.nl/nl/nieuws/artikel/?tx_ttnews%5Btt_news%5D=10041&tx_ttnews%5BbackPid%5D=465&cHash=ebb243e7ff|archive-date=24 July 2011|access-date=10 October 2010|publisher=TU/e|language=nl}}</ref> In September 2010, the first robotic operation on the femoral vasculature was performed at the University Medical Centre Ljubljana by a team of surgeons led by Dr. Borut Geršak.<ref name="FV_robo12">{{cite news|date=8 November 2010|title=V UKC Ljubljana prvič na svetu uporabili žilnega robota za posege na femoralnem žilju|language=sl|trans-title=The First Use of a Vascular Robot for Procedures on Femoral Vasculature|url=http://med.over.net/index.php?full=1&id=25545&title=V_UKC_Ljubljana_prvi___na_svetu_uporabili___ilnega_robota_za_posege_na_femoralnem___ilju|access-date=1 April 2011|archive-date=20 August 2011|archive-url=https://web.archive.org/web/20110820221055/http://med.over.net/index.php?full=1&id=25545&title=V_UKC_Ljubljana_prvi___na_svetu_uporabili___ilnega_robota_za_posege_na_femoralnem___ilju|url-status=live}}</ref><ref name="FV_robo22">{{cite news|date=30 March 2011|title=UKC Ljubljana kljub finančnim omejitvam uspešen v razvoju medicine|language=sl|trans-title=UMC Ljubljana Successfully Develops Medicine Despite Financial Limitations|url=http://www.dnevnik.si/novice/zdravje/1042434634|access-date=1 April 2011|archive-date=5 November 2011|archive-url=https://web.archive.org/web/20111105031951/http://www.dnevnik.si/novice/zdravje/1042434634|url-status=live}}</ref>
In 2017, the first robotic system designed specifically for microsurgery and supermicrosurgery, the [https://microsure.nl/musa/ MUSA system], developed by [https://microsure.nl/ Microsure] (Eindhoven, the Netherlands) was introduced. It was first used clinically at [https://www.mumc.nl/en Maastricht University Medical Center+] for lymphaticovenous anastomosis (LVA) procedures in patients with lymphedema.<ref>{{Cite journal |title=First-in-human robotic supermicrosurgery using a dedicated microsurgical robot for treating breast cancer-related lymphedema: a randomized pilot trial |url=https://www.nature.com/articles/s41467-019-14188-w |journal=Nature Communications |date=2020 |volume=11 |article-number=757 |doi=10.1038/s41467-019-14188-w |bibcode=2020NatCo..11..757V | vauthors = Van Mulken TJ, Schols RM, Scharmga AM, Winkens B, Cau R, Schoenmakers FB, Qiu SS, Van Der Hulst RR, Keuter XH, Lauwers TM, Piatkowski AA, Hommes JE, Deibel DS, Budo JE, Scheerhoorn J, Rijkx ME }}</ref>
In 2019 the Versius Surgical System was launched by the British medical device company CMR Surgical. It seeks to challenge the Da Vinci surgical system on the global market, claiming its products are more flexible and versatile, with independent modular arms that are "quick and easy to set up." Versius' small-scale design signifies that the system is suitable for virtually any operating theater and can be operated at either a standing or a sitting position.<ref>{{cite news |title=New Versius robot surgery system coming to NHS |url=https://www.bbc.co.uk/news/health-45370642 |access-date=8 October 2018 |publisher=BBC |date=3 September 2018 |archive-date=5 September 2018 |archive-url=https://web.archive.org/web/20180905204921/https://www.bbc.co.uk/news/health-45370642 |url-status=live }}</ref>
==Uses==
=== Ophthalmology === Although ophthalmology was long considered one of the frontiers for robotic-assisted surgeries, in recent decades, several breakthroughs in medicine and health technology paved the way for the development of advanced surgical robotic systems capable of successfully performing ophthalmologic surgeries.<ref name="de_Smet_2018">{{cite journal | vauthors = de Smet MD, Naus GJ, Faridpooya K, Mura M | title = Robotic-assisted surgery in ophthalmology | journal = Current Opinion in Ophthalmology | volume = 29 | issue = 3 | pages = 248–253 | date = May 2018 | pmid = 29553953 | doi = 10.1097/ICU.0000000000000476 }}</ref> * PRECEYES Surgical System is being used for vitreoretinal surgeries. This is a single-arm robot that is telemanipulated by a surgeon. This system attaches to the head of the operating room table and provides surgeons with increased precision with the assistance of the intuitive motion controller.<ref>{{Cite web|url=http://www.preceyes.nl/preceyes-surgical-system/|title=PRECEYES Surgical System – Preceyes BV|access-date=23 March 2021|archive-date=10 April 2021|archive-url=https://web.archive.org/web/20210410115512/http://www.preceyes.nl/preceyes-surgical-system/|url-status=live}}</ref> Preceyes is the only robotic instrument to be CE certified. Some other companies like Forsight Robotics,<ref>{{Cite web|url=https://www.forsightrobotics.com/oryom/|title=ORYOM™|website=Forsight Robotics|access-date=19 October 2022|archive-date=19 October 2022|archive-url=https://web.archive.org/web/20221019132240/https://www.forsightrobotics.com/oryom/|url-status=live}}</ref> Acusurgical <ref>{{Cite web|url=https://acusurgical.com/|title=Acusurgical is developing robots for retinal surgery|website=ACUSURGICAL|access-date=26 April 2023|archive-date=26 April 2023|archive-url=https://web.archive.org/web/20230426221927/https://acusurgical.com/|url-status=live}}</ref> that raised 5.75 M€ (France),<ref>{{cite news |url=https://www.businesswire.com/news/home/20210217005035/en/AcuSurgical-raises-%E2%82%AC5.75-Million-in-Series-A-financing-to-advance-its-robotic-ocular-microsurgery-platform. |title=AcuSurgical raises €5.75 Million in Series A financing, to advance its robotic ocular microsurgery platform. |work=Businesswire |date=18 February 2021 |access-date=7 April 2022 |archive-date=7 April 2022 |archive-url=https://web.archive.org/web/20220407135436/https://www.businesswire.com/news/home/20210217005035/en/AcuSurgical-raises-%E2%82%AC5.75-Million-in-Series-A-financing-to-advance-its-robotic-ocular-microsurgery-platform. |url-status=live }}</ref> and Horizon (US) are working in this field. * The da Vinci Surgical System, though not specifically designed for ophthalmic procedures, uses telemanipulation to perform pterygium repairs and ex vivo corneal surgeries.<ref name="de_Smet_2018" />
===Heart=== Some examples of heart surgery being assisted by robotic surgery systems include: * Atrial septal defect repair<ref>{{cite journal | vauthors = Kim JE, Jung SH, Kim GS, Kim JB, Choo SJ, Chung CH, Lee JW | title = Surgical Outcomes of Congenital Atrial Septal Defect Using da VinciTM Surgical Robot System | journal = The Korean Journal of Thoracic and Cardiovascular Surgery | volume = 46 | issue = 2 | pages = 93–97 | date = April 2013 | pmid = 23614093 | pmc = 3631797 | doi = 10.5090/kjtcs.2013.46.2.93 }}</ref> – the repair of a hole between the two upper chambers of the heart, * Mitral valve repair<ref>{{cite journal | vauthors = Gillinov AM, Mihaljevic T, Javadikasgari H, Suri RM, Mick SL, Navia JL, Desai MY, Bonatti J, Khosravi M, Idrees JJ, Lowry AM, Blackstone EH, Svensson LG | title = Early results of robotically assisted mitral valve surgery: Analysis of the first 1000 cases | journal = The Journal of Thoracic and Cardiovascular Surgery | volume = 155 | issue = 1 | pages = 82–91.e2 | date = January 2018 | pmid = 28893396 | doi = 10.1016/j.jtcvs.2017.07.037 | doi-access = free }}</ref> – the repair of the valve that prevents blood from regurgitating back into the upper heart chambers during contractions of the heart, * Coronary artery bypass<ref>{{cite journal | vauthors = Halkos ME, Liberman HA, Devireddy C, Walker P, Finn AV, Jaber W, Guyton RA, Puskas JD | title = Early clinical and angiographic outcomes after robotic-assisted coronary artery bypass surgery | journal = The Journal of Thoracic and Cardiovascular Surgery | volume = 147 | issue = 1 | pages = 179–185 | date = January 2014 | pmid = 24172691 | doi = 10.1016/j.jtcvs.2013.09.010 | doi-access = free }}</ref> – rerouting of blood supply by bypassing blocked arteries that provide blood to the heart.
===Thoracic=== Robotic surgery has become more widespread in thoracic surgery for mediastinal pathologies, pulmonary pathologies, and, more recently, complex esophageal surgery.<ref>{{cite journal | vauthors = Melfi FM, Menconi GF, Mariani AM, Angeletti CA | title = Early experience with robotic technology for thoracoscopic surgery | journal = European Journal of Cardio-Thoracic Surgery | volume = 21 | issue = 5 | pages = 864–868 | date = May 2002 | pmid = 12062276 | doi = 10.1016/S1010-7940(02)00102-1 | doi-access = free }}</ref>
The da Vinci Xi system is used for lung and mediastinal mass resection. This minimally invasive approach is a comparable alternative to video-assisted thoracoscopic surgery (VATS) and the standard open thoracic surgery. Although VATS is the less expensive option, the robotic-assisted approach offers benefits such as 3D visualizations with seven degrees of freedom and improved dexterity while having equivalent perioperative outcomes.<ref>{{cite journal | vauthors = Latif MJ, Park BJ | title = Robotics in general thoracic surgery procedures | journal = Journal of Visualized Surgery | volume = 3 | page = 44 | date = 11 April 2017 | pmid = 29078607 | pmc = 5637743 | doi = 10.21037/jovs.2017.03.14 | doi-access = free }}</ref>
=== ENT === The first successful robot-assisted cochlear implantation in a person was performed in Bern, Switzerland, in 2017.<ref>{{Cite web |title=Patient is First to Undergo Robot-Assisted Cochlear Implantation |work=American Association for the Advancement of Science (AAAS) |url=https://www.aaas.org/news/patient-first-undergo-robot-assisted-cochlear-implantation |access-date=2021-10-06 |date=15 March 2017 |vauthors=Song J |language=en |archive-date=6 October 2021 |archive-url=https://web.archive.org/web/20211006150715/https://www.aaas.org/news/patient-first-undergo-robot-assisted-cochlear-implantation |url-status=live }}</ref> Surgical robots have been developed for use at various stages of cochlear implantation, including drilling through the mastoid bone, accessing the inner ear, and inserting the electrode into the cochlea.<ref>{{cite journal | vauthors = Panara K, Shahal D, Mittal R, Eshraghi AA | title = Robotics for Cochlear Implantation Surgery: Challenges and Opportunities | language = en-US | journal = Otology & Neurotology | volume = 42 | issue = 7 | pages = e825–e835 | date = August 2021 | pmid = 33993143 | doi = 10.1097/MAO.0000000000003165 }}</ref>
Advantages of robot-assisted cochlear implantation include improved accuracy,<ref>{{Cite web|date=2017-09-19|title=Robotic Cochlear Implantation|url=https://www.artorg.unibe.ch/research/igt/research/robotic_cochlear_implantation/index_eng.html|access-date=2021-10-06|website=ARTORG Center for Biomedical Engineering Research|archive-date=6 October 2021|archive-url=https://web.archive.org/web/20211006160727/https://www.artorg.unibe.ch/research/igt/research/robotic_cochlear_implantation/index_eng.html|url-status=live}}</ref> resulting in fewer mistakes during electrode insertion and better hearing outcomes for patients.<ref name="Choi_2017">{{Cite web|vauthors=Choi CQ|date=2017-03-15|title=Robo First: Bot Assists with Tricky Cochlear-Implant Surgery|url=https://www.livescience.com/58274-robot-assists-tricky-cochlear-implant-surgery.html|access-date=2021-10-06|website=livescience.com|language=en|archive-date=6 October 2021|archive-url=https://web.archive.org/web/20211006150716/https://www.livescience.com/58274-robot-assists-tricky-cochlear-implant-surgery.html|url-status=live}}</ref> The surgeon uses image-guided surgical planning to program the robot based on the patient's individual anatomy. This helps the implant team to predict where the contacts of the electrode array will be located within the cochlea, which can assist with audio processor fitting post-surgery.<ref>{{Cite web|title=The HEARO Procedure for cochlear implantation|url=https://www.entandaudiologynews.com/features/ent-features/post/the-hearo-procedure-for-cochlear-implantation|access-date=2021-10-06|website=ENT & Audiology News|language=en|date=3 December 2020|vauthors=Vedat T|archive-date=6 October 2021|archive-url=https://web.archive.org/web/20211006150717/https://www.entandaudiologynews.com/features/ent-features/post/the-hearo-procedure-for-cochlear-implantation|url-status=live}}</ref> The surgical robots also allow surgeons to reach the inner ear in a minimally invasive way.<ref name="Choi_2017"/>
Challenges that still need to be addressed include safety, time, efficiency, and cost.<ref name="Choi_2017" />
Surgical robots have also been shown to be useful for electrode insertion with pediatric patients.<ref>{{cite journal | vauthors = Jia H, Pan J, Gu W, Tan H, Chen Y, Zhang Z, Jiang M, Li Y, Sterkers O, Wu H | title = Robot-Assisted Electrode Array Insertion Becomes Available in Pediatric Cochlear Implant Recipients: First Report and an Intra-Individual Study | journal = Frontiers in Surgery | volume = 8 | article-number = 695728 | date = 2021-07-07 | pmid = 34307444 | pmc = 8294934 | doi = 10.3389/fsurg.2021.695728 | doi-access = free }}</ref>
===Dentistry and Orthodontics=== Over the past 25 years, the use of robotics in dentistry has flourished.<ref>{{cite news |last1=Pallardy |first1=Carrie |title=The Latest in Dental Robotics |url=https://www.agd.org/constituent/news/2023/04/17/the-latest-in-dental-robotics |work=Ontario Academy of General Dentistry |date=17 April 2023 }}</ref> The need for safer, more precise, and more time-efficient procedures has become a new pinnacle in the medical community and has called for further innovation and technology. With the successful incorporation of robotics in other fields, such as a stereotactic brain biopsy in 1985 and the RoboDoc for hip replacements used since 1992, companies and medical professionals all over the world have looked to create robotic technology for other medical areas.<ref>{{cite journal |last1=Hockstein |first1=N. G. |last2=Gourin |first2=C. G. |last3=Faust |first3=R. A. |last4=Terris |first4=D. J. |title=A history of robots: from science fiction to surgical robotics |journal=Journal of Robotic Surgery |date=July 2007 |volume=1 |issue=2 |pages=113–118 |doi=10.1007/s11701-007-0021-2 |pmid=25484946 |pmc=4247417 }}</ref> The ceaseless interest in medical technology has continuously galvanized research within the dental field.
The first proof-of-concept dental procedure<ref name="auto">{{cite journal |last1=Brief |first1=Jakob |last2=Haßfeld |first2=Stefan |last3=Boesecke |first3=Robert |last4=Vogele |first4=Michael |last5=Krempien |first5=Robert |last6=Treiber |first6=Martina |last7=Mühling |first7=Joachim |title=Robot assisted Dental Implantology |journal=International Poster Journal of Dentistry and Oral Medicine |date=2002 |volume=4 |issue=1 |page=109 |url=https://www.quintessence-publishing.com/kvm/en/article/856593/international-poster-journal-of-dentistry-and-oral-medicine/2002/01/robot-assisted-dental-implantology }}{{predatory}}</ref> was performed in 2002 in Germany at the University Hospital of Heidelberg. Haßfeld et al. worked to perform the first-ever mock dental implantation attempt by test drilling a phantom mandible. A series of 16 trials with a total of 48 drillings was performed on the phantom mandible representing a patient's head. The procedures had an average of 1-2mm imprecision throughout the drillings, which is relatively accurate when compared to the average imprecision of drillings done by hand. The proof of concept was considered successful and proved that with more dedication and focus by the global medical engineering community, robot-assisted and even autonomous dental procedures were not out of reach. Over the next 15 years, researchers from all over the globe dedicated a significant amount of time and effort to innovate upon the German 'TomoRob' Software<ref name="auto"/> that was used in the original proof of concept. Many of these companies have worked to improve the reliability of creating 3D models of patients' mouths, as well as the necessary digital technology and machines to properly assess a patient's needs and provide them with care.
In 2017, Neocis, the leading US-based dental robotics company from Miami, Florida,<ref>{{cite journal |last1=Ahmad |first1=Paras |last2=Alam |first2=Mohammad Khursheed |last3=Aldajani |first3=Ali |last4=Alahmari |first4=Abdulmajeed |last5=Alanazi |first5=Amal |last6=Stoddart |first6=Martin |last7=Sghaireen |first7=Mohammed G. |title=Dental Robotics: A Disruptive Technology |journal=Sensors |date=11 May 2021 |volume=21 |issue=10 |page=3308 |doi=10.3390/s21103308 |pmid=34064548 |pmc=8151353 |bibcode=2021Senso..21.3308A |doi-access=free }}</ref> was the first company to get government approval <ref>Press, Neocis. “Neocis Inc. Announces FDA Clearance for First Robotic System for Dental Implant Procedures.” Dotmed.com, 2017, https://www.dotmed.com/news/story/35884?lang=en Accessed 8 Oct. 2025.</ref><ref>---. “New Dental Product: Yomi Robotic Guidance System for Dental Implants from Neocis.” Dentalcompare.com, 6 Mar. 2017, https://www.dentalcompare.com/News/334730-New-Dental-Product-Yomi-Robotic-Guidance-System-for-Dental-Implants-from-Neocis/. Accessed 8 Oct. 2025.</ref> (By the United States FDA<ref>{{cite web |title=K161399 – Dental Stereotaxic Instrument – 510(k) Premarket Notification |url=https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K161399 |website=U.S. Food and Drug Administration }}{{vs|doesn't look like this really shows anything about first to get approval|date=October 2025}}</ref>) to work on developing machines and software for Computer-assisted surgery. In 2019 Neocis' FDA approval was extended to allow Neocis to use other dental resins and acrylic materials in Dental restoration such as a filling or a Crown (dental restoration). Some of the approved resins that Neocis and other companies like Perceptive and RemeBot have been interested in are Alike pattern resin, Triad C&B, and Cool Temp Natural. In 2020, the FDA gave Neocis clearance to use their technology to work on Full arch restoration procedures with YOMI. In 2022, the most recent FDA approval for Neocis was made<ref>---. “Neocis Receives FDA Clearance for Yomi Bone Reduction Procedure.” Dental Products Report, 15 Nov. 2022, https://www.dentalproductsreport.com/view/neocis-receives-fda-clearance-for-yomi-bone-reduction-procedure. Accessed 8 Oct. 2025.</ref>, allowing YOMI to be used for alveoloplasty (bone reduction). Neocis continues to provide dental research and innovate on YOMI technology and work to extend the list of procedures that can be completed by dental robotics. Another major development in 2017 was the first ever autonomous implant that was performed at Air Force Medical University in Xi'an, Shaanxi, China.<ref>{{cite news |title=First-ever robot-led dental surgery |url=https://www.dental-tribune.com/news/first-ever-robot-led-dental-surgery-performed-in-china/ |work=Dental Tribune International |date=28 September 2017 }}</ref> The procedure was a breakthrough in testing at the time, as the procedure itself was performed autonomously by the robot. Before the procedure, a CT scan was performed in order to get a dental graft and to assess how the procedure would be performed. The procedure was planned by the doctors present, but was performed by the robot without any doctor assistance.<ref>World first autonomous dental implant robot put into use in China. (2017). Www.gov.cn. https://english.www.gov.cn/news/video/2017/09/20/content_281475871495524.htm </ref> This procedure was a major breakthrough in dental robotics as it presents the possibility of fully autonomous dental procedures with higher accuracy and reliability than standard dental practices.<ref>{{cite journal |last1=Yang |first1=Jun |last2=Li |first2=Hainan |title=Accuracy assessment of robot-assisted implant surgery in dentistry: A systematic review and meta-analysis |journal=The Journal of Prosthetic Dentistry |date=October 2024 |volume=132 |issue=4 |pages=747.e1–747.e15 |doi=10.1016/j.prosdent.2023.12.003 |pmid=38195255 }}</ref> After the success of the autonomous dental implant in China, a competitor for Neocis, RemeBot, emerged, and in 2018, it was the first robot-assistant dental company to get National Medical Products Administration certification to publish their dental-implantology machines and sell them to the public sector of dentistry.<ref>{{cite journal |last1=Yang |first1=Shuo |last2=Chen |first2=Jiahao |last3=Li |first3=An |last4=Li |first4=Ping |last5=Xu |first5=Shulan |title=Autonomous Robotic Surgery for Immediately Loaded Implant-Supported Maxillary Full-Arch Prosthesis: A Case Report |journal=Journal of Clinical Medicine |date=7 November 2022 |volume=11 |issue=21 |page=6594 |doi=10.3390/jcm11216594 |doi-access=free |pmid=36362819 |pmc=9654167 }}</ref> Since the success of RemeBot in China and Neocis in the US, many other upcoming companies, such as Straumann <ref>EQS Newsfeed. (2025, March 25). Straumann Group to present its advanced digital dentistry end-to-end workflow at the International Dental Show. PharmiWeb.com. https://www.pharmiweb.com/press-release/2025-03-25/straumann-group-to-present-its-advanced-digital-dentistry-end-to-end-workflow-at-the-international-d </ref>in Switzerland and Yakebot<ref>"雅客智慧口腔种植系统，安全、精准、高效、微创的数字化口腔医疗机器人！." Yakebot.com, 2025, https://www.yakebot.com/home.html Accessed 6 Oct. 2025. </ref> in China, have been developing technology and machines to compete with RemeBot and Neocis. Both of these upcoming companies have seen success in the dental robotics field and are currently working to pass regulatory requirements and get approval to be publicly published and used by dental offices.<ref>{{cite journal |last1=Wang |first1=Wenxue |last2=Xu |first2=Hao |last3=Mei |first3=Dongmei |last4=Zhou |first4=Chen |last5=Li |first5=Xiaojing |last6=Han |first6=Ze'yu |last7=Zhou |first7=Xiaobin |last8=Li |first8=Xin |last9=Zhao |first9=Baodong |title=Accuracy of the Yakebot dental implant robotic system versus fully guided static computer-assisted implant surgery template in edentulous jaw implantation: A preliminary clinical study |journal=Clinical Implant Dentistry and Related Research |date=April 2024 |volume=26 |issue=2 |pages=309–316 |doi=10.1111/cid.13278 |pmid=37728030 }}</ref>
As dental robotics gradually advances and develops worldwide, with an increasing number of countries attempting to design their own versions of robotic dental implantology, there has been a drastic increase of dental offices who are directing their attention to the potential of this new technology. With children and adults alike having a heightened "Dental fear" compared to other medical offices,<ref>{{cite journal |last1=Saatchi |first1=Masoud |last2=Abtahi |first2=Mansoureh |last3=Mohammadi |first3=Golshan |last4=Mirdamadi |first4=Motahare |last5=Binandeh |first5=Elham Sadaat |title=The prevalence of dental anxiety and fear in patients referred to Isfahan Dental School, Iran |journal=Dental Research Journal |date=2015 |volume=12 |issue=3 |pages=248–253 |pmid=26005465 |pmc=4432608 }}</ref><ref>{{cite journal |last1=Beaton |first1=Laura |last2=Freeman |first2=Ruth |last3=Humphris |first3=Gerry |title=Why Are People Afraid of the Dentist? Observations and Explanations |journal=Medical Principles and Practice |date=2014 |volume=23 |issue=4 |pages=295–301 |doi=10.1159/000357223 |pmid=24356305 |pmc=5586885 }}</ref> it will be interesting to see how the general public will view the shift from standard dental practices to the potential of robot-assisted or even autonomous dental procedures.
===Gastrointestinal=== Multiple types of procedures have been performed with either the 'Zeus' or da Vinci robot systems,<ref name="Lauterbach_2017" /> including bariatric surgery and gastrectomy<ref>{{cite journal | vauthors = Hyun MH, Lee CH, Kim HJ, Tong Y, Park SS | title = Systematic review and meta-analysis of robotic surgery compared with conventional laparoscopic and open resections for gastric carcinoma | journal = The British Journal of Surgery | volume = 100 | issue = 12 | pages = 1566–1578 | date = November 2013 | pmid = 24264778 | doi = 10.1002/bjs.9242 | doi-access = free }}</ref> for cancer. Surgeons at various universities initially published case series demonstrating different techniques and the feasibility of GI surgery using the robotic devices.<ref name="Talamini M 1524">{{cite journal | vauthors = Talamini MA, Chapman S, Horgan S, Melvin WS | title = A prospective analysis of 211 robotic-assisted surgical procedures | journal = Surgical Endoscopy | volume = 17 | issue = 10 | pages = 1521–1524 | date = October 2003 | pmid = 12915974 | doi = 10.1007/s00464-002-8853-3 }}</ref> Specific procedures have been more fully evaluated, specifically esophageal fundoplication for the treatment of gastroesophageal reflux<ref>{{cite journal | vauthors = Melvin WS, Needleman BJ, Krause KR, Schneider C, Ellison EC | title = Computer-enhanced vs. standard laparoscopic antireflux surgery | journal = Journal of Gastrointestinal Surgery | volume = 6 | issue = 1 | pages = 11–15; discussion 15–16 | date = 2002 | pmid = 11986012 | doi = 10.1016/S1091-255X(01)00032-4 }}</ref> and Heller myotomy for the treatment of achalasia.<ref>{{cite journal | vauthors = Melvin WS, Dundon JM, Talamini M, Horgan S | title = Computer-enhanced robotic telesurgery minimizes esophageal perforation during Heller myotomy | journal = Surgery | volume = 138 | issue = 4 | pages = 553–558; discussion 558–559 | date = October 2005 | pmid = 16269282 | doi = 10.1016/j.surg.2005.07.025 }}</ref><ref>{{cite journal | vauthors = Shaligram A, Unnirevi J, Simorov A, Kothari VM, Oleynikov D | title = How does the robot affect outcomes? A retrospective review of open, laparoscopic, and robotic Heller myotomy for achalasia | journal = Surgical Endoscopy | volume = 26 | issue = 4 | pages = 1047–1050 | date = April 2012 | pmid = 22038167 | doi = 10.1007/s00464-011-1994-5 }}</ref>
Robot-assisted pancreatectomies have been found to be associated with "longer operating time, lower estimated blood loss, a higher spleen-preservation rate, and shorter hospital stay[s]" than laparoscopic pancreatectomies; there was "no significant difference in transfusion, conversion to open surgery, overall complications, severe complications, pancreatic fistula, severe pancreatic fistula, ICU stay, total cost, and 30-day mortality between the two groups."<ref>{{cite journal | vauthors = Zhou JY, Xin C, Mou YP, Xu XW, Zhang MZ, Zhou YC, Lu C, Chen RG | title = Robotic versus Laparoscopic Distal Pancreatectomy: A Meta-Analysis of Short-Term Outcomes | journal = PLOS ONE | volume = 11 | issue = 3 | article-number = e0151189 | date = 2016 | pmid = 26974961 | pmc = 4790929 | doi = 10.1371/journal.pone.0151189 | doi-access = free | bibcode = 2016PLoSO..1151189Z }}</ref> ===Gynecology=== The first report of robotic surgery in gynecology was published in 1999 by the Cleveland Clinic.<ref>{{cite journal | vauthors = Falcone T, Goldberg J, Garcia-Ruiz A, Margossian H, Stevens L | title = Full robotic assistance for laparoscopic tubal anastomosis: a case report | journal = Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A | volume = 9 | issue = 1 | pages = 107–113 | date = February 1999 | pmid = 10194702 | doi = 10.1089/lap.1999.9.107 }}</ref> The adoption of robotic surgery has contributed to the increase in minimally invasive surgery for gynecologic disease.<ref name="Lawrie_2019">{{cite journal |last1=Lawrie |first1=Theresa A |last2=Liu |first2=Hongqian |last3=Lu |first3=DongHao |last4=Dowswell |first4=Therese |last5=Song |first5=Huan |last6=Wang |first6=Lei |last7=Shi |first7=Gang |title=Robot-assisted surgery in gynaecology |journal=Cochrane Database of Systematic Reviews |date=15 April 2019 |volume=2019 |issue=11 |article-number=CD011422 |doi=10.1002/14651858.CD011422.pub2 |pmid=30985921 |pmc=6464707 }}</ref> Gynecologic procedures may take longer with robot-assisted surgery, and the rate of complications may be higher, but there are not enough high-quality studies to know at the present time.<ref name="Lawrie_2019" /> In the United States, robotic-assisted hysterectomy for benign conditions was shown to be more expensive than conventional laparoscopic hysterectomy in 2015, with little to no difference in overall complication rate.<ref>{{cite journal | vauthors = | title = Committee opinion no. 628: robotic surgery in gynecology | journal = Obstetrics and Gynecology | volume = 125 | issue = 3 | pages = 760–767 | date = March 2015 | pmid = 25730256 | doi = 10.1097/01.AOG.0000461761.47981.07 | doi-access = free }}</ref>
This includes the use of the da Vinci surgical system in benign gynecology and gynecologic oncology. Robotic surgery can be used to treat fibroids, abnormal periods, endometriosis, ovarian tumors, uterine prolapse, and female cancers.<ref name="Lawrie_2019" /> Using the robotic system, gynecologists can perform hysterectomies, myomectomies, and lymph node biopsies.<ref name="Song_2014" /> The ''Hominis robotic system'' developed by Momentis Surgical™<ref name="memic">{{cite web |title=FDA approves first robotic device for transvaginal procedures |url=https://www.medicaldevice-network.com/news/memic-hominis/ |website=Medical Device Network |access-date=19 February 2022 |date=2 March 2021 |archive-date=20 January 2022 |archive-url=https://web.archive.org/web/20220120053356/https://www.medicaldevice-network.com/news/memic-hominis/ |url-status=live }}</ref> is aimed to provide a robotic platform for natural orifice transluminal endoscopic surgery (NOTES) for myomectomy through the vagina.<ref name="pmid29490530">{{cite journal | vauthors = Wang T, Tang H, Xie Z, Deng S | title = Robotic-assisted vs. laparoscopic and abdominal myomectomy for treatment of uterine fibroids: a meta-analysis | journal = Minimally Invasive Therapy & Allied Technologies | volume = 27 | issue = 5 | pages = 249–264 | date = October 2018 | pmid = 29490530 | doi = 10.1080/13645706.2018.1442349 }}</ref>
A 2017 review of surgical removal of the uterus and cervix for early cervical cancer concluded that robotic and laparoscopic surgical procedures resulted in similar outcomes with respect to the cancer.<ref>{{cite journal | vauthors = Zanagnolo V, Garbi A, Achilarre MT, Minig L | title = Robot-assisted Surgery in Gynecologic Cancers | journal = Journal of Minimally Invasive Gynecology | volume = 24 | issue = 3 | pages = 379–396 | date = 16 January 2017 | pmid = 28104497 | doi = 10.1016/j.jmig.2017.01.006 }}</ref>
===Bone=== Robots are used in orthopedic surgery.<ref>{{cite book|title = Computer and robotic assisted hip and knee surgery| veditors = DiGioia AM, Jaramaz B, Picard F, Nolte LP |publisher = Oxford University Press|date = 2004|isbn = 978-0-19-850943-1|pages = 127–156}}</ref>
ROBODOC is the first active robotic system that performs some of the surgical actions in a total hip arthroplasty (THA). It is programmed preoperatively using data from computer tomography (CT) scans. This allows the surgeon to choose the optimal size and design for the replacement hip.<ref name="Sugano_2013">{{cite journal | vauthors = Sugano N | title = Computer-assisted orthopaedic surgery and robotic surgery in total hip arthroplasty | language = English | journal = Clinics in Orthopedic Surgery | volume = 5 | issue = 1 | pages = 1–9 | date = March 2013 | pmid = 23467021 | pmc = 3582865 | doi = 10.4055/cios.2013.5.1.1 }}</ref><ref>{{cite journal | vauthors = Kiefer H, Löchel J, Sambo K, Leder B, Wassilew GI | title = Anterior pelvic plane registration accuracy and cup position measurement using ultrasound- and pointer-based navigation in primary total hip arthroplasty | journal = Technology and Health Care | volume = 28 | issue = 3 | pages = 315–323 | date = 2020-05-20 | pmid = 31658073 | doi = 10.3233/THC-191888 }}</ref>
Acrobot and Rio are semi-active robotic systems that are used in THA. It consists of a drill bit that is controlled by the surgeon; however, the robotic system does not allow any movement outside the predetermined boundaries.<ref name="Sugano_2013" />
Mazor X is used in spinal surgeries to assist surgeons with placing pedicle screw instrumentation. Inaccuracy when placing a pedicle screw can result in neurovascular injury or construct failure. Mazor X functions by using templating imaging to locate itself to the target location of where the pedicle screw is needed.<ref>{{cite journal | vauthors = Sayari AJ, Pardo C, Basques BA, Colman MW | title = Review of robotic-assisted surgery: what the future looks like through a spine oncology lens | journal = Annals of Translational Medicine | volume = 7 | issue = 10 | page = 224 | date = May 2019 | pmid = 31297389 | pmc = 6595200 | doi = 10.21037/atm.2019.04.69 | doi-access = free }}</ref>
===Spine=== Robotic devices started to be used in minimally invasive spine surgery starting in the mid-2000s.<ref name="Shweikeh2014rev">{{cite journal | vauthors = Shweikeh F, Amadio JP, Arnell M, Barnard ZR, Kim TT, Johnson JP, Drazin D | title = Robotics and the spine: a review of current and ongoing applications | journal = Neurosurgical Focus | volume = 36 | issue = 3 | pages = E10 | date = March 2014 | pmid = 24580002 | doi = 10.3171/2014.1.focus13526 | doi-access = free }}</ref> As of 2014, there were too few randomized clinical trials to judge whether robotic spine surgery is more or less safe than other approaches.<ref name="Shweikeh2014rev" />
As of 2019, the application of robotics in spine surgery has mainly been limited to pedicle screw insertion for spinal fixation.<ref name="Huang2019">{{cite journal | vauthors = Berni G, Cagnoli L, Lagi A | title = [Goodpasture's syndrome. Case report] | journal = Recenti Progressi in Medicina | volume = 59 | issue = 5 | pages = 465–478 | date = November 1975 | pmid = 1243701 | doi = 10.1007/s11701-019-00983-6 }}</ref> In addition, the majority of studies on robot-assisted spine surgery have investigated lumbar or lumbosacral vertebrae only.<ref name="Huang2019" /> Studies on use of robotics for placing screws in the cervical and thoracic vertebrae are limited.<ref name="Huang2019" />
==={{anchor|Transplant surgery}}Transplant surgery=== The first fully robotic kidney transplantations were performed in the late 2000s. It may allow kidney transplantations in people who are obese who could not otherwise have the procedure.<ref name="Ham2018" /> Weight loss, however, is the preferred initial effort.<ref name="Ham2018">{{cite journal | vauthors = Hameed AM, Yao J, Allen RD, Hawthorne WJ, Pleass HC, Lau H | title = The Evolution of Kidney Transplantation Surgery Into the Robotic Era and Its Prospects for Obese Recipients | journal = Transplantation | volume = 102 | issue = 10 | pages = 1650–1665 | date = October 2018 | pmid = 29916987 | doi = 10.1097/TP.0000000000002328 | doi-access = free }}</ref>
In 2021, the team at Cedars-Sinai Medical Center in Los Angeles, California, completed the world's first robotic lung transplant, allowing a minimally invasive approach to the procedure.<ref>{{Cite journal |last1=Emerson |first1=Dominic |last2=Catarino |first2=Pedro |last3=Rampolla |first3=Reinaldo |last4=Chikwe |first4=Joanna |last5=Megna |first5=Dominick |date=January 2024 |title=Robotic-assisted lung transplantation: First in man |journal=The Journal of Heart and Lung Transplantation|volume=43 |issue=1 |pages=158–161 |doi=10.1016/j.healun.2023.09.019 |pmid=37778524 }}</ref>
=== General surgery === With regards to robotic surgery, this type of procedure is currently best suited for single-quadrant procedures,<ref>{{cite journal | vauthors = Thomas DJ | title = 3D white light interferometry assessment of robotic laser scalpel assisted surgery to minimise scar tissue formation | journal = International Journal of Surgery | volume = 38 | pages = 117–118 | date = February 2017 | pmid = 28027996 | doi = 10.1016/j.ijsu.2016.12.037 | doi-access = }}</ref> in which the operations can be performed on any one of the four quadrants of the abdomen. Cost disadvantages are applied with procedures such as a cholecystectomy and fundoplication, but they are suitable opportunities for surgeons to advance their robotic surgery skills.<ref name="Song_2014" />
=== Hernia and abdominal wall surgery === thumb|A surgeon at the Columbia Hernia Center operates on a patient with a large hernia using the robotic platform. Over the past several decades, there have been great advances in the field of abdominal wall and hernia surgery, especially when it comes to robotic-assisted surgery. Unlike laparoscopic surgery, the robotic platform allows for the correction of large hernia defects with specialized techniques that would traditionally only be performed via an open approach. Compared to open surgery, robotic surgery for hernia repair can reduce pain, length of hospital stay, and improve outcomes.<ref>{{Cite journal |last1=Bracale |first1=U. |last2=Corcione |first2=F. |last3=Neola |first3=D. |last4=Castiglioni |first4=S. |last5=Cavallaro |first5=G. |last6=Stabilini |first6=C. |last7=Botteri |first7=E. |last8=Sodo |first8=M. |last9=Imperatore |first9=N. |last10=Peltrini |first10=R. |date=December 2021 |title=Transversus abdominis release (TAR) for ventral hernia repair: open or robotic? Short-term outcomes from a systematic review with meta-analysis |journal=Hernia: The Journal of Hernias and Abdominal Wall Surgery |volume=25 |issue=6 |pages=1471–1480 |doi=10.1007/s10029-021-02487-5 |pmc=8613152 |pmid=34491460}}</ref> As the robotic instruments have 6 degrees of articulation, freedom of movement and ergonomics are significantly improved compared to laparoscopy.
The first robotic inguinal hernia repairs were done in conjunction with prostatectomies in 2007.<ref>{{Cite journal |last1=Finley |first1=David S. |last2=Rodriguez |first2=Esequiel |last3=Ahlering |first3=Thomas E. |date=October 2007 |title=Combined inguinal hernia repair with prosthetic mesh during transperitoneal robot assisted laparoscopic radical prostatectomy: a 4-year experience |journal=The Journal of Urology |volume=178 |issue=4 Pt 1 |pages=1296–1299; discussion 1299–1300 |doi=10.1016/j.juro.2007.05.154 |pmid=17698133 }}</ref> The first ventral hernia repairs were performed robotically in 2009.<ref>{{Cite journal |last1=Allison |first1=Nathan |last2=Tieu |first2=Ken |last3=Snyder |first3=Brad |last4=Pigazzi |first4=Alessio |last5=Wilson |first5=Erik |date=February 2012 |title=Technical feasibility of robot-assisted ventral hernia repair |journal=World Journal of Surgery |volume=36 |issue=2 |pages=447–452 |doi=10.1007/s00268-011-1389-8 |pmid=22194031 }}</ref> Since then, the field has rapidly expanded to include most types of reconstruction, including anterior as well as posterior component separation.
With newer techniques such as direct access into the abdominal wall,<ref>{{Cite journal |last1=Belyansky |first1=Igor |last2=Daes |first2=Jorge |last3=Radu |first3=Victor Gheorghe |last4=Balasubramanian |first4=Ramana |last5=Reza Zahiri |first5=H. |last6=Weltz |first6=Adam S. |last7=Sibia |first7=Udai S. |last8=Park |first8=Adrian |last9=Novitsky |first9=Yuri |date=March 2018 |title=A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair |journal=Surgical Endoscopy |volume=32 |issue=3 |pages=1525–1532 |doi=10.1007/s00464-017-5840-2 |pmid=28916960 }}</ref> major reconstruction of large hernias can be done without even entering the abdominal cavity. Due to its complexity, however, major reconstruction done robotically should be undertaken at advanced hernia centers such as the Columbia Hernia Center in New York City, NY, USA. The American Hernia Society and the European Hernia Society are moving towards specialty designation for hernia centers that are credentialed for complex hernia surgery, including robotic surgery.<ref>{{Cite journal |last1=Köckerling |first1=F. |last2=Sheen |first2=A. J. |last3=Berrevoet |first3=F. |last4=Campanelli |first4=G. |last5=Cuccurullo |first5=D. |last6=Fortelny |first6=R. |last7=Friis-Andersen |first7=H. |last8=Gillion |first8=J. F. |last9=Gorjanc |first9=J. |last10=Kopelman |first10=D. |last11=Lopez-Cano |first11=M. |last12=Morales-Conde |first12=S. |last13=Österberg |first13=J. |last14=Reinpold |first14=W. |last15=Simmermacher |first15=R. K. J. |date=April 2019 |title=Accreditation and certification requirements for hernia centers and surgeons: the ACCESS project |journal=Hernia: The Journal of Hernias and Abdominal Wall Surgery |volume=23 |issue=2 |pages=185–203 |doi=10.1007/s10029-018-1873-2 |pmc=6456484 |pmid=30671899}}</ref>
===Urology=== Robotic surgery in the field of urology has become common, especially in the United States.<ref>{{cite journal | vauthors = Lee DI | title = Robotic prostatectomy: what we have learned and where we are going | journal = Yonsei Medical Journal | volume = 50 | issue = 2 | pages = 177–181 | date = April 2009 | pmid = 19430547 | pmc = 2678689 | doi = 10.3349/ymj.2009.50.2.177 }}</ref>
There is inconsistent evidence of benefits compared to standard surgery to justify the increased costs.<ref>{{cite journal | vauthors = Williams SB, Prado K, Hu JC | title = Economics of robotic surgery: does it make sense and for whom? | journal = The Urologic Clinics of North America | volume = 41 | issue = 4 | pages = 591–596 | date = November 2014 | pmid = 25306170 | doi = 10.1016/j.ucl.2014.07.013 }}</ref> Some have found tentative evidence of a more complete removal of cancer and fewer side effects from surgery for prostatectomy.<ref>{{cite journal | vauthors = Ramsay C, Pickard R, Robertson C, Close A, Vale L, Armstrong N, Barocas DA, Eden CG, Fraser C, Gurung T, Jenkinson D, Jia X, Lam TB, Mowatt G, Neal DE, Robinson MC, Royle J, Rushton SP, Sharma P, Shirley MD, Soomro N | title = Systematic review and economic modelling of the relative clinical benefit and cost-effectiveness of laparoscopic surgery and robotic surgery for removal of the prostate in men with localised prostate cancer | journal = Health Technology Assessment | volume = 16 | issue = 41 | pages = 1–313 | date = 2012 | pmid = 23127367 | pmc = 4780976 | doi = 10.3310/hta16410 }}</ref>
In 2000, the first robot-assisted laparoscopic radical prostatectomy was performed.<ref name="ORPvsRALRP">{{cite journal | vauthors = Finkelstein J, Eckersberger E, Sadri H, Taneja SS, Lepor H, Djavan B | title = Open Versus Laparoscopic Versus Robot-Assisted Laparoscopic Prostatectomy: The European and US Experience | journal = Reviews in Urology | volume = 12 | issue = 1 | pages = 35–43 | date = 2010 | pmid = 20428292 | pmc = 2859140 }}</ref>
Robotic surgery has also been utilized in radical cystectomies. A 2013 review found fewer complications and better short-term outcomes when compared to open technique.<ref>{{cite journal | vauthors = Li K, Lin T, Fan X, Xu K, Bi L, Duan Y, Zhou Y, Yu M, Li J, Huang J | title = Systematic review and meta-analysis of comparative studies reporting early outcomes after robot-assisted radical cystectomy versus open radical cystectomy | journal = Cancer Treatment Reviews | volume = 39 | issue = 6 | pages = 551–560 | date = October 2013 | pmid = 23273846 | doi = 10.1016/j.ctrv.2012.11.007 }}</ref>
=== Pediatrics === Pediatric procedures are also benefiting from robotic surgical systems, considering that a smaller abdominal size in pediatric patients limits the viewing field in most urology procedures. Therefore, robotic surgical systems enable surgeons to overcome these limitations effectively. Robotic technology provides assistance in performing:<ref name="Song_2014">{{cite journal | vauthors = Song SH, Kim KS | title = Current status of robot-assisted laparoscopic surgery in pediatric urology | journal = Korean Journal of Urology | volume = 55 | issue = 8 | pages = 499–504 | date = August 2014 | pmid = 25132942 | pmc = 4131076 | doi = 10.4111/kju.2014.55.8.499 }}</ref> * Pyeloplasty – an alternative to the conventional open dismembered pyeloplasty (Anderson-Hynes). Pyeloplasty is the most common robotic-assisted procedure in children.<ref name="Song_2014" /> * Ureteral reimplantation – an alternative to the open intravesical or extravesical surgery.<ref name="Song_2014" /> * Ureteroureterostomy – alternative to the transperitoneal approach.<ref name="Song_2014" /> * Nephrectomy and heminephrectomy – Traditionally done with laparoscopy, it is not likely that a robotic procedure offers a significant advantage due to its high cost.<ref name="Song_2014" />
==Comparison to traditional methods== Major advances aided by surgical robots have been remote surgery, minimally invasive surgery, and unmanned surgery. Due to robotic use, the surgery is performed with precision, miniaturization, smaller incisions; decreased blood loss, less pain, and quicker healing time. Articulation beyond normal manipulation and three-dimensional magnification help to result in improved ergonomics. Due to these techniques, there is a reduced duration of hospital stays, blood loss, transfusions, and use of pain medication.<ref name="Outpatient Robotic surgery: Conside"/><ref name=Estey>{{cite journal | vauthors = Estey EP | title = Robotic prostatectomy: The new standard of care or a marketing success? | journal = Canadian Urological Association Journal | volume = 3 | issue = 6 | pages = 488–490 | date = December 2009 | pmid = 20019980 | pmc = 2792423 | doi = 10.5489/cuaj.1182 }}</ref> The existing open surgery technique has many flaws, such as limited access to the surgical area, long recovery time, long hours of operation, blood loss, surgical scars, and marks.<ref>{{cite journal |last1=O'Toole |first1=Michael D. |last2=Bouazza-Marouf |first2=Kaddour |last3=Kerr |first3=David |last4=Gooroochurn |first4=Mahendra |last5=Vloeberghs |first5=Michael |title=A methodology for design and appraisal of surgical robotic systems |journal=Robotica |date=March 2010 |volume=28 |issue=2 |pages=297–310 |doi=10.1017/S0263574709990658 |url=https://dspace.lboro.ac.uk/2134/5887 }}</ref>
The robot's costs range from $1 million to $2.5 million for each unit,<ref name="Barbash_2010">{{cite journal | vauthors = Barbash GI, Glied SA | title = New technology and health care costs--the case of robot-assisted surgery | journal = The New England Journal of Medicine | volume = 363 | issue = 8 | pages = 701–704 | date = August 2010 | pmid = 20818872 | doi = 10.1056/nejmp1006602 }}</ref> and while its disposable supply cost is normally $1,500 per procedure, the cost of the procedure is higher.<ref name="kolata">{{cite news|url=https://www.nytimes.com/2010/02/14/health/14robot.html|title=Results Unproven, Robotic Surgery Wins Converts|vauthors=Kolata G|date=13 February 2010|work=The New York Times|access-date=11 March 2010|archive-date=9 April 2023|archive-url=https://web.archive.org/web/20230409201825/https://www.nytimes.com/2010/02/14/health/14robot.html|url-status=live}}</ref> Additional surgical training is needed to operate the system.<ref name=ORPvsRALRP/> Numerous feasibility studies have been done to determine whether the purchase of such systems is worthwhile. As it stands, opinions differ dramatically. Surgeons report that, although manufacturers of such systems provide training on this new technology, the learning phase is intensive and surgeons must perform 150 to 250 procedures to become adept in their use.<ref name="Barbash_2010" /> Moreover, during the training phase, minimally invasive operations can take up to twice as long as traditional surgery, leading to operating room tie-ups and surgical staff keeping patients under anesthesia for longer periods. Patient surveys indicate they chose the procedure based on expectations of decreased morbidity, improved outcomes, reduced blood loss, and less pain.<ref name=Estey/> Additionally, higher expectations may explain higher rates of dissatisfaction and regret.<ref name=ORPvsRALRP/>
Compared with other minimally invasive surgery approaches, robot-assisted surgery gives the surgeon better control over the surgical instruments and a better view of the surgical site. In addition, surgeons no longer have to stand throughout the surgery and do not get tired as quickly. Naturally occurring hand tremors are filtered out by the robot's computer software. Finally, the surgical robot can continuously be used by rotating surgery teams.<ref>{{cite journal | vauthors = Gerhardus D | title = Robot-assisted surgery: the future is here | journal = Journal of Healthcare Management | volume = 48 | issue = 4 | pages = 242–251 | date = July–August 2003 | pmid = 12908224 | doi = 10.1097/00115514-200307000-00008 }}</ref> Laparoscopic camera positioning is also significantly steadier with less inadvertent movements under robotic controls than compared to human assistance.<ref>{{cite journal | vauthors = Kavoussi LR, Moore RG, Adams JB, Partin AW | title = Comparison of robotic versus human laparoscopic camera control | journal = The Journal of Urology | volume = 154 | issue = 6 | pages = 2134–2136 | date = December 1995 | pmid = 7500476 | doi = 10.1016/S0022-5347(01)66715-6 }}</ref> The use of mixed reality to support robot-assisted surgery was developed at the Air Force Research Laboratory in 1992 through the creation of "virtual fixtures" that overlay virtual boundaries or guides that assist the human operator and has become a common method for increasing safety and precision.<ref>{{Cite journal |last1=Liu |first1=Tangyou |last2=Wang |first2=Jiaole |last3=Wong |first3=Shing |last4=Razjigaev |first4=Andrew |last5=Beier |first5=Susann |last6=Peng |first6=Shuhua |last7=Do |first7=Thanh Nho |last8=Song |first8=Shuang |last9=Chu |first9=Dewei |last10=Wang |first10=Chun Hui |last11=Lovell |first11=Nigel H. |last12=Wu |first12=Liao |date=November 2024 |title=A Review on the Form and Complexity of Human–Robot Interaction in the Evolution of Autonomous Surgery |journal=Advanced Intelligent Systems |language=en |volume=6 |issue=11 |article-number=2400197 |doi=10.1002/aisy.202400197 |doi-access=free }}</ref><ref>{{cite book |title=Medical Image Computing and Computer-Assisted Intervention – MICCAI 2001 |chapter=Virtual Fixtures for Robotic Cardiac Surgery |series=Lecture Notes in Computer Science |date=2001 |volume=2208 |pages=1419–1420 |doi=10.1007/3-540-45468-3_252 |isbn=978-3-540-42697-4 | vauthors = Park S, Howe RD, Torchiana DF }}</ref><ref>{{cite report |id={{DTIC|ADA292450}} |last1=Rosenberg |first1=Louis B. |date=September 1992 |title=The Use of Virtual Fixtures as Perceptual Overlays to Enhance Operator Performance in Remote Environments }}</ref><ref>{{Cite journal |last1=Seetohul |first1=Jenna |last2=Shafiee |first2=Mahmood |last3=Sirlantzis |first3=Konstantinos |date=2023 |title=Augmented Reality (AR) for Surgical Robotic and Autonomous Systems: State of the Art, Challenges, and Solutions |journal=Sensors |language=en |volume=23 |issue=13 |page=6202 |doi=10.3390/s23136202 |doi-access=free |pmc=10347167 |pmid=37448050 |bibcode=2023Senso..23.6202S }}</ref>
There are some issues in regards to current robotic surgery usage in clinical applications. There is a lack of haptics in some robotic systems currently in clinical use, which means there is no force feedback, or touch feedback. No interaction between the instrument and the patient is felt. However, recently the Senhance robotic system by Asensus Surgical was developed with haptic feedback in order to improve the interaction between the surgeon and the tissue.<ref>{{cite journal | vauthors = Spinelli A, David G, Gidaro S, Carvello M, Sacchi M, Montorsi M, Montroni I | title = First experience in colorectal surgery with a new robotic platform with haptic feedback | journal = Colorectal Disease | volume = 20 | issue = 3 | pages = 228–235 | date = September 2017 | pmid = 28905524 | doi = 10.1111/codi.13882 }}</ref>
The robots can also be very large, have instrumentation limitations, and there may be issues with multi-quadrant surgery as current devices are solely used for single-quadrant application.<ref name="Herron_2008">{{cite journal | vauthors = Herron DM, Marohn M | title = A consensus document on robotic surgery | journal = Surgical Endoscopy | volume = 22 | issue = 2 | pages = 313–325; discussion 311–312 | date = February 2008 | pmid = 18163170 | doi = 10.1007/s00464-007-9727-5 }}</ref>
Critics of the system, including the American Congress of Obstetricians and Gynecologists,<ref>{{cite web | vauthors = Breeden JT | url = http://www.acog.org/About-ACOG/News-Room/News-Releases/2013/Statement-on-Robotic-Surgery | title = Statement on Robotic Surgery | date = 14 March 2013 | work = American Congress of Obstetricians and Gynecologists (ACOG) | access-date = 5 February 2015 | archive-date = 5 February 2015 | archive-url = https://web.archive.org/web/20150205225138/http://www.acog.org/About-ACOG/News-Room/News-Releases/2013/Statement-on-Robotic-Surgery | url-status = live }}</ref> say there is a steep learning curve for surgeons who adopt the use of the system and that there's a lack of studies that indicate long-term results are superior to results following traditional laparoscopic surgery.<ref name="kolata"/> Articles in the newly created ''Journal of Robotic Surgery'' tend to report on one surgeon's experience.<ref name=kolata/>
Complications related to robotic surgeries range from converting the surgery to open, re-operation, permanent injury, damage to viscera and nerve damage. From 2000 to 2011, out of 75 hysterectomies done with robotic surgery, 34 had permanent injury, and 49 had damage to the viscera.{{Citation needed|date=July 2019}} Prostatectomies were more prone to permanent injury, nerve damage and visceral damage as well. Very minimal surgeries in a variety of specialties had to actually be converted to open or be re-operated on, but most did sustain some kind of damage or injury. For example, out of seven coronary artery bypass grafting, one patient had to go under re-operation. It is important that complications are captured, reported and evaluated to ensure the medical community is better educated on the safety of this new technology.<ref>{{cite journal | vauthors = | title = Robotic Surgery: Risks vs. Rewards | journal = AORN Journal | volume = 106 | issue = 2 | pages = 186–157 | date = August 2017 | pmid = 28755672 | doi = 10.1016/j.aorn.2017.05.007 }}</ref> If something was to go wrong in a robot-assisted surgery, it is difficult to identify culpability, and the safety of the practice will influence how quickly and widespread these practices are used.{{citation needed|date=January 2022}}
One drawback of the use of robotic surgery is the risk of mechanical failure of the system and instruments. A study from July 2005 to December 2008 was conducted to analyze the mechanical failures of the da Vinci Surgical System at a single institute. During this period, a total of 1797 robotic surgeries were performed used 4 da Vinci surgical systems. There were 43 cases (2.4%) of mechanical failure, including 24 (1.3%) cases of mechanical failure or malfunction and 19 (1.1%) cases of instrument malfunction. Additionally, one open and two laparoscopic conversions (0.17%) were performed. Therefore, the chance of mechanical failure or malfunction was found to be rare, with the rate of converting to an open or laparoscopic procedure very low.<ref>{{cite journal | vauthors = Kim WT, Ham WS, Jeong W, Song HJ, Rha KH, Choi YD | title = Failure and malfunction of da Vinci Surgical systems during various robotic surgeries: experience from six departments at a single institute | journal = Urology | volume = 74 | issue = 6 | pages = 1234–1237 | date = December 2009 | pmid = 19716587 | doi = 10.1016/j.urology.2009.05.071 }}</ref>
There are also current methods of robotic surgery being marketed and advertised online. Removal of a cancerous prostate has been a popular treatment through internet marketing. Internet marketing of medical devices are more loosely regulated than pharmaceutical promotions. Many sites that claim the benefits of this type of procedure had failed to mention risks and also provided unsupported evidence. There is an issue with government and medical societies promotion a production of balanced educational material.<ref>{{cite journal | vauthors = Mirkin JN, Lowrance WT, Feifer AH, Mulhall JP, Eastham JE, Elkin EB | title = Direct-to-consumer Internet promotion of robotic prostatectomy exhibits varying quality of information | journal = Health Affairs | volume = 31 | issue = 4 | pages = 760–769 | date = April 2012 | pmid = 22492893 | pmc = 3897330 | doi = 10.1377/hlthaff.2011.0329 }}</ref> In the US alone, many websites promotion robotic surgery fail to mention any risks associated with these types of procedures, and hospitals providing materials largely ignore risks, overestimate benefits and are strongly influenced by the manufacturer.<ref>{{cite journal | vauthors = Basto M, Cooperberg MR, Murphy DG | title = Proton therapy websites: information anarchy creates confusion | journal = BJU International | volume = 115 | issue = 2 | pages = 183–185 | date = February 2015 | pmid = 25756133 | doi = 10.1111/bju.12667 }}</ref>
== In popular culture == The expansion of medical insurance coverage for robotic cardiac surgery in Japan was a central plot point in the 2018 Japanese television drama Black Pean. The show dramatized the conflict between traditional surgical techniques and the adoption of modern surgical technology, using the name "Darwin" to represent the da Vinci surgical system. Dr. Gou Watanabe of the Newhart Watanabe International Hospital, a pioneer of heart surgery in Japan, provided technical medical support for the series.<ref>{{Cite web |date=11 May 2018 |title=『ブラックペアン』ドラマ史上初、手術支援ロボ・ダビンチが登場 |url=https://www.oricon.co.jp/news/2111207/full/ |archive-url=https://web.archive.org/web/20240613041704/https://www.oricon.co.jp/news/2111207/full/ |archive-date=13 June 2024 |access-date=13 June 2024 |website=Oricon |language=Japanese}}</ref><ref>{{Cite web |title=第５話から登場する手術支援ロボット・ダーウィン(※)。最先端の"ロボット手術"について、監修先生のお話を基に紐解いていきます。 |url=https://www.tbs.co.jp/blackpean_tbs/2018/robot/1.html |archive-url=https://web.archive.org/web/20240613045059/https://www.tbs.co.jp/blackpean_tbs/2018/robot/1.html |archive-date=13 June 2024 |access-date=13 June 2024 |website=TBS Black Pean official site |language=Japanese}}</ref>
The final level of the 2016 stealth game Hitman takes place in an advanced medical center, with one of the targets undergoing surgery through a telemanipulator.
== See also == {{columns-list|colwidth=30em| * Bone segment navigation * Computer-assisted surgery * Diagnostic robot * Minimally invasive surgery * Patient registration * Stereolithography (medicine) * Surgical Segment Navigator * Telemedicine * Neuralink }}
== References == {{Reflist|30em}}
== External links == {{Commons category|Surgical robots}} {{Surgery}} {{emerging technologies|topics=yes|biomed=yes}}
{{DEFAULTSORT:Robotic Surgery}} Category:Computer-assisted surgery Category:Surgical robots Category:Telemedicine Category:Health informatics