University of Central Florida Undergraduate Research Journal - A Practicality Analysis Pertaining to Minimally <br/> Invasive Robot-Assisted Urologic Surgery
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Introduction

Modern urologic surgery traces back to 1947 when Millin described the first retropubic approach to radical prostatectomy.1 Although surgeons continued to improve on their outcomes, it was not until 1991 that Clayman first described and utilized techniques needed to perform the first laparoscopic nephrectomy.2 With newfound hope for patients, an opportunity arose for further advancement of minimally invasive surgery with the advent of surgical robots in the late 1990s. The traditional challenges of urologic surgery appear to offer an apt avenue for displaying the benefits of minimally invasive robot-assisted surgery. Since the introduction of robotassisted surgery, surgeons have wondered whether there was a place for such revolutionary methods. For some time, robotic surgery was seen as a gimmick and an unrealistic option for the masses. However, the introduction of da Vinci® System has helped to gain acceptance for robotic surgery within the last ten years, allowing for a variety of procedures to be performed using minimally invasive techniques. The current viewpoint has shifted, as leaders in the medical field have incorporated robotic surgery into their repertoire, and have found it to be a viable and sometimes more successful option than traditional laparoscopy.

Using robots for medical or surgical purposes is a relatively recent development, with the first known application of a surgical robotic device, Programmable Universal Manipulation Arm (PUMA), used in 1985 to orientate a needle for a radiologically guided brain biopsy.3 As of 2010, more than 800 U.S. hospitals and 2500 surgeons have acquired and incorporated at least one robot into their surgical techniques.4 The field of surgical robotics has seen numerous technological developments in its brief history in medicine, including the development of several different revolutionary machines, most notably the da Vinci® by Intuitive Surgical Inc. The da Vinci® is a high definition and three-dimensional tremor-eliminating System with the ability to decrease the learning curve of a new surgeon.5 It is currently in widespread use in several different subspecialties, such as urology, cardiothoracic surgery, and gynecology. There are a number of docu- mented peri-operative advantages generally observed with surgeries performed with the da Vinci®, including decreased blood loss, decreased pain, and shorter hospitalizations. Frequently observed disadvantages of the da Vinci® System include the costs associated with the initial purchase ($1.6 million) and the annual maintenance, which totals over $100,000 per year.6 Another major concern is the loss of the surgeon's tactile sensation, an issue to which surgeons with more experience on the robotic platform have been able to adapt.7-9 Overall, the da Vinci's® versatility has allowed for further exploration into the field of Minimally Invasive Surgery and could expand surgical treatment methods beyond what was once conceivable.10

The da Vinci® Surgical System >>