Telerobotic gastrointestinal surgery: phase 2--safety and efficacy.
BACKGROUND
The Federal Drug Administration (FDA) approved the da Vinci surgical system for all abdominal operations in July 2000. In the past 6 years, virtually all gastrointestinal operations have been accomplished using telerobotic techniques. The purpose of this review is to summarize the short-term outcomes achieved with telerobotic gastrointestinal operations.


METHODS
All case series of telerobotic gastrointestinal operations identified by PubMed searches are included in this review.


RESULTS
Case series document the safety and efficacy of telerobotic cholecystectomy, fundoplication, Heller myotomy, gastric bypass, colectomy, gastrectomy, and pancreatectomy. The procedures were accomplished with low rates of conversion to laparoscopic operations, mortality, and morbidity. When comparison groups were available, the analysis shows that telerobotic operations required more time than the laparoscopic operations, although for telerobotic cholecystectomy and telerobotic fundoplication, this difference disappeared in 10 to 20 operations. Specific patient advantages were not identified for telerobotic operations compared with laparoscopic operations, except for a decreased esophageal perforation rate during telerobotic Heller myotomy. Surgeons benefited from the three-dimensional imaging, the handlike motions of the robotic instruments, and an ergonomically comfortable position.


CONCLUSIONS
All telerobotic gastrointestinal operations are feasible and can be performed with safety and efficacy. It is difficult to demonstrate patient-specific advantages of telerobotic surgery over laparoscopic operations. Nonetheless, telerobotic surgical systems offer distinct advantages to surgeons and may facilitate an increase in the number of surgeons performing advanced laparoscopic gastrointestinal operations. In addition, telerobotics offer a digital information platform that enables surgical simulation and augmented-reality surgery.
Ballantyne
G H
GH
Section of Minimally Invasive and Telerobotic Surgery, Hackensack University Medical Center, Hackensack, New Jersey 07601, USA. ghb@lapsurgery.com
D017322:Clinical Trials, Phase II as Topic; D013505:Digestive System Surgical Procedures / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D010149:Postoperative Pain / Q000517:prevention & control*; D018570:Risk Assessment; D012371:Robotics; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014481:United States; D014486:United States Food and Drug Administration