Perspective of robotic surgery in Colombia, are we doing well?

摘要

Robotics is a branch of artificial intelligence that studies the design and construction of equipment capable of performing specific tasks of the human being through programmed and mechanized processes1. It has been implemented in different areas, including medicine, specifically in the surgical field; robotic surgery is nothing more than a procedure performed through a computer, which an experienced surgeon directs. It is currently considered the future of surgery worldwide due to its significant impacts and the multiple advances presented in the last decades2,3. In the mid-1980s, it began with the production of robots, one of them called Zeus, whose construction was completed in 1995. Two years later, they finished the prototype called “Mona,” a precursor robot of the currently known Da Vinci, which uses the master-slave system, which emerged in 1999 and is considered the most advanced robot so far. This robot has the validation of the Foods and Drugs Administration (FDA) obtained in 2000 for performing procedures in abdominal surgery laparoscopically4. There are 3 types of robotic systems for the surgical field that are in use; active, semi-active, and master-slave systems. Active systems work autonomously, performing tasks preprogrammed by the surgeon. Semiactive systems allow elements of the surgeon to be combined with preprogrammed features, and the master-slave system lacks preprogrammed elements of autonomy; that is, they depend entirely on the surgeon5. Worldwide, there are many comments on the relevance of robotic surgery. Therefore, an overview of the advantages and disadvantages of using this technology in surgical procedures is essential (Table 1)6. Table 1 - Advantages and disadvantages of using robotic surgery6. Advantages Disadvantages Three-dimensional vision, with an image up to 20 times sharper Decrease in the surgeon’s haptics Greater precision in the movements, which are ordered by the surgeon In places where robotic surgery is not usually practiced, it may have a longer surgical time compared with laparoscopic surgery or open surgery It grants greater freedom of movement, allowing greater ease at the time of sutures and tying knots Higher maintenance cost and requires a greater learning curve Decreases time of stay, reincorporation in a period of <7 d approximately Decrease in the hiring of human talent specialized in the surgical area, therefore, a higher unemployment rate It shortens the time of convalescence, because of the reduction of intraoperative complications Surgical procedures remotely Low incidence at the operative site The surgical areas are composed of multiple specialties and subspecialties, having robust criteria for indicating a surgical procedure. That is why it is important to know the indications of robotic surgery, consider the type of procedure, and offer a fast, effective, safe, and reproducible surgical procedure. Currently, no international guidelines expose the absolute indications for robotic surgery; however, in Table 2, we will disclose the surgical procedures most frequently performed by the Da Vinci surgical system (endorsed by the FDA)7. Table 2 - Most frequent procedures performed with Da Vinci. Surgical Specialty Procedures Gynecological surgery Hysterectomy, colposacropexy, myomectomy, and verse-vaginal fistula repair Urological surgery Prostatectomy, nephrectomy, kidney transplantation, ureteropelvic obstruction, and cystectomy General surgery Cholecystectomy, colorectal surgery, bariatric surgery, pancreatic surgery, hepatectomy, and adrenalectomy Head and neck surgery Transoral surgery, parathyroidectomy, and thyroidectomy Considering the above context and affirming the importance of implementing new surgical systems for the performance of robotic surgery, we searched for the research carried out in Latin America and, more specifically, in Colombia related to robotic surgery. Internationally, the most used surgical system is the Da Vinci System robot. The country in L