Minnesota Anesthesia Services

Clinical Applications of Robotic Surgery

As technology advances, surgery adopts progressively less invasive techniques to improve patient outcomes. Minimally invasive methods such as laparoscopic surgery have resulted in reduced pain, decreased scarring, and shortened inpatient time. However, these methods can be limited by their 2D vision, ergonomics, limited range of motion, and steep learning curve. Consequently, robotic surgery has evolved to enhance laparoscopic methods while enhancing functionality and has a growing number of clinical applications.

The first robotic-assisted surgery was performed in 1997 with the Mona system, the precursor to the da Vinci system.1 The concept of 3D viewing was groundbreaking, and it motivated developers to enhance the Mona system and create the da Vinci robot, which was cleared for general surgery in 2000. Since then, clinical applications of robotic surgery to abdominal and pelvic surgeries, neurosurgery, and endovascular procedures have revolutionized those fields.

Surgical robots designed for soft tissue procedures aim to augment laparoscopic methods with increased dexterity and improved ergonomics for the operator. The da Vinci robot was first approved by the FDA for use in Nissen fundoplication and cholecystectomy. Over the past 20 years, the system has undergone various modifications and enhancements for a range of different surgical procedures. First introduced in 2009, the da Vinci Si includes finger-based clutching, infrared vision using fluorescent dye, and other optical enhancements. This version also includes dual-console capabilities, creating the opportunity for teaching and training.2 The da Vinci Xi update brought thinner arms with modified articulations, reducing arm clashes during operation. Port standardization enabled heightened visualization abilities, and laser guidance technology allowed optimal positioning to maximize space.3

The Versius Robot, first released in 2019, is designed for colorectal, upper GI, gynecological, and urological surgery. Its design enables haptic feedback through the controller, and allows for the use of smaller instruments, leading to the ability to maneuver in smaller cavities.4

The MicroHand S and SII models have a compact design and have been used in intra-abdominal oncological resections, benign repairs of abdominal organs, and more.5 MicroHand models have also been successfully used to perform remote surgeries on swine models at a distance of 3000 km.

Excelsius GPS, first approved by the FDA in 2017, provides augmented navigation abilities for spinal surgery. It allows for pre-operative and intraoperative imaging, such as fluoroscopy and CT scans. This improves real-time navigation and strengthens imaging versatility.6 In 2015, researchers from Worcester Polytechnic Institute developed a magnetic resonance imaging (MRI)-guided, robotically actuated, stereotactic neural intervention for deep brain stimulation (DBS) electrode placement. The in-situ experiment demonstrated the system could achieve low signal-to-noise variation and minimal geometric distortion without affecting the imaging usability.7

Robotic surgery platforms offer precision and control during complex surgical procedures and have demonstrated their benefits in many clinical applications across endovascular and endoluminal procedures. The Corpath 200 achieved lower radiation exposure for the operator compared to traditional percutaneous coronary intervention (PCI). Further upgrades to the CorPath system included enhanced functional control, faster guide-wire rotation, and a third joystick for guide-catheter manipulations.8 Additionally, the Monarch system was designed for minimally invasive endoluminal interventions, especially in the lungs. The system includes a flexible robotic bronchoscope that is equipped with a high-resolution camera and various medical instruments, as well as a workstation that allows the operating physician to control and maneuver the robot. In a 2018 study on cadavers, the Monarch system showed further reach into distal airways compared to conventional bronchoscopy.

Robotic surgery has transformed the landscape of modern medicine by addressing the limitations of traditional laparoscopic techniques. With continuous innovation, robotic systems have expanded the capabilities of minimally invasive procedures across numerous specialties, including soft tissue, spine, endovascular, and neurosurgery. These advancements have led to increased precision, better ergonomics, and improved patient outcomes. As technology continues to evolve, robotic platforms will likely play an even greater role in shaping the future of surgical care.

References

  1. George, E.I., Brand, T.C., LaPorta, A., et al.,“Origins of Robotic Surgery: From Skepticism to Standard of Care.” Journal of the Society of Laparoscopic and Robotic Surgeons, 22(4), 2018. https://doi.org/10.4293/JSLS.2018.00039
  2. Crusco, S., Jackson, T., Advincula, A., “Comparing the da Vinci Si Single Console and Dual Console in Teaching Novice Surgeons Suturing Techniques.” Journal of the Society of Laparoscopic and Robotic Surgeons, 18(3), 2014. https://doi.org/10.4293/JSLS-D-13-0021
  3. Rassweiler, J.J., Autorino, R., Klein, J., et al., “Future of Robotic Surgery in Urology.” British Journal of Urology, 120(6), 822–841. 2017, https://doi.org/10.1111/bju.13851
  4. Thomas, B.C., Slack, M., Hussain, M., et al., “Preclinical Evaluation of the Versius Surgical System, a New Robot-Assisted Surgical Device for Use in Minimal Access Renal and Prostate Surgery.” European Urology Focus, 7(2), 444–452. 2021 https://doi.org/10.1016/j.euf.2020.01.011
  5. Yao, Y,. Liu, Y., Li, Z., et al., “Chinese Surgical Robot Micro Hand S: A Consecutive Case Series in General Surgery.” Internal Journal of Surgery, 75, 55–59. 2020, https://doi.org/10.1016/j.ijsu.2020.01.013
  6. Bhimreddy, M., et al., “Accuracy of Pedicle Screw Placement Using the Excelsius GPS Robotic Navigation Platform: An Analysis of 728 Screws.” International Journal of Spine Surgery, 18(6), 2024, 712–20, https://doi.org/10.14444/8660
  7. Li, Gang, et al., “Robotic System for MRI-Guided Stereotactic Neurosurgery.” IEEE Transactions on Biomedical Engineering, 62(4), 2015, 1077–88, https://doi.org/10.1109/TBME.2014.2367233
  8. Weisz, G., Metzger, D.C., Caputo, R.P., et al., “Safety and Feasibility of Robotic Percutaneous Coronary Intervention.” Journal of the American College of Cardiology, 61(15), 1596–1600, 2013. https://doi.org/10.1016/j.jacc.2012. 12.045
  9. Chen, A.C., Gillespie, C.T., “Robotic Endoscopic Airway Challenge: REACH Assessment.” Annals of Thoracic Surgery, 106(1), 293–297, 2018, https://doi.org/10.1016/j.athoracsur.2018.01.051

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