Robotic surgery: applications, limitations, and impact on surgical education.

摘要

The 1990s have witnessed the so-called laparoscopic revolution in which many operations were adapted from the traditional open surgery to the minimal access technique.[1] Shorter hospital stays, reduced postoperative pain, lower incidence of wound infections, and better cosmetic outcomes have made operations, such as laparoscopic cholecystectomy, the standard of care for cholelethiasis.[1–4] Favorable results prompted surgeons to attempt to develop minimally invasive techniques for most surgical procedures. However, many complex procedures (eg, pancreatectomy) proved difficult to learn and to perform laparoscopically due to technical limitations inherent in laparoscopic surgery.[1] For example, the video camera held by the assistant was unstable and gave a limited 2-dimensional vision of the field, and the primary surgeon was forced to adopt awkward positions to operate with straight laparoscopic instruments, limiting maneuvering.[1,2,5] At some point, the growth of the laparoscopic field reached its ostensible plateau, and it seemed that only a new technologic leap could spur further development. Since the beginning of the 21st century, the emergence of innovative technologies made further advances in minimal access surgery possible. Robotic surgery and telepresence surgery effectively addressed the limitations of laparoscopic and thoracoscopic procedures, thus revolutionizing minimal access surgery.[1,2] Robotic surgery is expected to continue to comprise a growing part of surgery.[6,7] It is envisaged that “almost all surgery can and will be performed by robotic surgery in the future.[5]” Thus, robotic surgery will not only require special training; it will also change the existing surgical training pattern and reshape the learning curve of residents by offering new solutions, such as robotic surgical simulators and robotic telementoring.[1,8]