Robotic applications in abdominal surgery: their limitations and future developments

Background In the past 20 years, the technical aspects of abdominal surgery have changed dramatically. Operations are now routinely performed by laparoscopic techniques utilizing small abdominal incisions, with less patient discomfort, earlier recovery, improved cosmesis, and in many cases reduced economic burden on the healthcare provider. These benefits have largely been seen in the application of laparoscopic techniques to relatively straightforward procedures. It is not clear whether the same benefits carry through to more which are more technically demanding and complex abdominal operations, for which current laparoscopic instrumentation is less well adapted. The aim of surgical robotics is to address these problems and allow the advantages of minimal access surgery to be seen in a greater range of operations. Methods A literature search was performed to ascertain the current state of the art in surgical robotics for the abdomen, and the technologies emerging within this field. The reference lists of the sourced articles were also searched for further relevant papers. Results Currently available robotic devices for abdominal surgery are limited to large, costly 'slave -master' or telemanipulator systems, such as the da Vinci (R) (Intuitive Surgical, Sunny Vale, CA). In addition to their size and expense, these systems share the same limitation, by virtue of the fulcrum effect on instrument manipulation inherent in the use of ports by which external instruments gain access to the abdominal cavity. In order to overcome these limitations several smaller telemanipulator systems are being developed, and progress towards freely mobile intracorporeal devices is being made. Conclusions While current robotic systems have considerable advantages over conventional laparoscopic techniques, they are not without limitations. Miniaturisation of robotic components and systems is feasible and necessary to allow minimally invasive techniques to reach full potential. The ultimate extrapolation of this progress is the development of intracorporeal robotics, the feasibility of which has been demonstrated. Copyright (C) 2006 John Wiley & Sons, Ltd.