The da Vinci robotic system for general surgical applications: a critical interim appraisal.

PRINCIPLES

The recently introduced robotic surgical systems were developed to overcome the limitations of conventional minimally invasive surgery. We analyse the impact of the da Vinci robotic system on general surgery.

METHODS

The da Vinci operating robot is a telemanipulation system consisting of a surgical arm cart, a master console and a conventional monitor cart. Since its purchase in June 2001, 128 patients have undergone surgery using the da Vinci robot in our department. The mean age of the 78 female and 50 male patients was 52 (range 18-78) years.

RESULTS

The procedures included 29 cholecystectomies, 16 partial fundoplications, 16 extended thymectomies, 14 colonic interventions, 10 splenectomies, 10 bariatric procedures, 7 hernioplasties, 6 oesophageal interventions, 5 adrenalectomies, 5 lower lobectomies, 4 neurinomectomies and 6 others. 122 of 128 procedures (95%) were completed successfully with the da Vinci robot. Open conversion proved necessary in 4 patients due to surgical problems, and two other procedures were completed by conventional laparoscopy due to robot system technical errors. 30-day mortality was 0%, one redo-operation was necessary and two lower complications not requiring surgical re-intervention occurred. The resection margins of all tumour specimens were histologically tumour free.

CONCLUSIONS

Various general surgical procedures have proved feasible and safe when performed with the da Vinci robot. The advantage of the system is best seen in tiny areas difficult of access and when dissecting delicate, vulnerable anatomical structures. However, in view of longer operating times, higher costs and the lack of adequate instruments, robotic surgery does not at the moment represent a general alternative to conventional minimally invasive surgery.