Robot-assisted surgery

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Robot-assisted surgery
Laproscopic Surgery Robot.jpg
A robotically assisted surgical system used for prostatectomies, cardiac valve repair and gynecologic surgical procedures
Other namesRobotically-assisted surgery

Robot-assisted surgery or robotic surgery are any types of surgical procedures that are performed using robotic systems. Robotically assisted surgery was developed to try to overcome the limitations of pre-existing minimally-invasive surgical procedures and to enhance the capabilities of surgeons performing open surgery.

Contents

In the case of robotically assisted minimally-invasive surgery, instead of the surgeon directly moving the instruments, the surgeon uses one of two methods to perform dissection, hemostasis and resection, using a direct telemanipulator, or through computer control.

Memory devices play an essential role in preventing any inconveniences in the robot-assisted surgery. The memory storage solutions can perform multiple functions based on the patient's physical record. They can also indicate specific information to measure calibration offsets indicating misalignment of the storage drive system, life of the data, and so on.

Robotic surgery has been criticized for its expense, with the average costs in 2007 ranging from $5,607 to $45,914 per patient. [1] This technique has not been approved for cancer surgery as of 2019 as the safety and usefulness is unclear. [2]

History

The concept of using standard hand grips to control manipulators and cameras of various sizes down to sub-miniature was described in the Robert Heinlein story 'Waldo' in August 1942, which also mentioned brain surgery. The first robot to assist in surgery was the Arthrobot, which was developed and used for the first time in Vancouver in 1984. [3] [4] This robot assisted in being able to manipulate and position the patient's leg on voice command. Intimately involved were biomedical engineer James McEwen, Geof Auchinleck, a UBC engineering physics grad, and Dr. Brian Day as well as a team of engineering students. The robot was used in an orthopaedic surgical procedure on 12 March 1984, at the UBC Hospital in Vancouver. Over 60 arthroscopic surgical procedures were performed in the first 12 months, and a 1985 National Geographic video on industrial robots, The Robotics Revolution, featured the device. Other related robotic devices developed at the same time included a surgical scrub nurse robot, which handed operative instruments on voice command, and a medical laboratory robotic arm. A YouTube video entitled Arthrobot – the world's first surgical robot illustrates some of these in operation. [5]

In 1985 a robot, the Unimation Puma 200, was used to orient a needle for a brain biopsy while under CT guidance during a neurological procedure. [6] [4] In the late 1980s, Imperial College in London developed PROBOT, which was then used to perform prostatic surgery. The advantages to this robot was its small size, accuracy and lack of fatigue for the surgeon. In the 1990s, computer-controlled surgical devices began to emerge, enabling greater precision and control in surgical procedures. One of the most significant advancements in this period was the da Vinci Surgical System, which was approved by the FDA for use in surgical procedures in 2000 (Intuitive Surgical, 2021). The da Vinci system uses robotic arms to manipulate surgical instruments, allowing surgeons to perform complex procedures with greater accuracy and control. [7] In 1992, the ROBODOC was introduced and revolutionized orthopedic surgery by being able to assist with hip replacement surgeries. [8] The latter was the first surgical robot that was approved by the FDA in 2008. [9] The ROBODOC from Integrated Surgical Systems (working closely with IBM) could mill out precise fittings in the femur for hip replacement. [10] The purpose of the ROBODOC was to replace the previous method of carving out a femur for an implant, the use of a mallet and broach/rasp.

Further development of robotic systems was carried out by SRI International and Intuitive Surgical with the introduction of the da Vinci Surgical System and Computer Motion with the AESOP and the ZEUS robotic surgical system. [11] The first robotic surgery took place at The Ohio State University Medical Center in Columbus, Ohio under the direction of Robert E. Michler. [12]

AESOP was a breakthrough in robotic surgery when introduced in 1994, as it was the first laparoscopic camera holder to be approved by the FDA. NASA initially funded the company that produces AESOP, Computer Motion, due to its goal to create a robotic arm that can be used in space, but this project ended up becoming a camera used in laparoscopic procedures. Voice control was then added in 1996 with the AESOP 2000 and seven degrees of freedom to mimic a human hand was added in 1998 with the AESOP 3000. [13]

ZEUS was introduced commercially in 1998, and started the idea of telerobotics or telepresence surgery where the surgeon is at a distance from the robot on a console and operates on the patient. [14] ZEUS was first used during a gynecological surgery in 1997 to reconnect Fallopian tubes in Cleveland Ohio, [4] [15] a beating heart coronary artery bypass graft in October 1999, [16] and the Lindbergh Operation, which was a cholecystectomy performed remotely in September 2001. [17] In 2003, ZEUS made its most prominent mark in cardiac surgery after successfully harvesting the left internal mammary arteries in 19 patients, all of which had very successful clinical outcomes. [18] [19]

The original telesurgery robotic system that the da Vinci was based on was developed at Stanford Research Institute International in Menlo Park with grant support from DARPA and NASA. [20] A demonstration of an open bowel anastomosis was given to the Association of Military Surgeons of the US. [21] Although the telesurgical robot was originally intended to facilitate remotely performed surgery in the battlefield to reduce casualties and to be used in other remote environments, it turned out to be more useful for minimally invasive on-site surgery. [22] [23] The patents for the early prototype were sold to Intuitive Surgical in Mountain View, California. The da Vinci senses the surgeon's hand movements and translates them electronically into scaled-down micro-movements to manipulate the tiny proprietary instruments. It also detects and filters out any tremors in the surgeon's hand movements, so that they are not duplicated robotically. The camera used in the system provides a true stereoscopic picture transmitted to a surgeon's console. Compared to the ZEUS, the da Vinci robot is attached to trocars to the surgical table, and can imitate the human wrist. In 2000, the da Vinci obtained FDA approval for general laparoscopic procedures and became the first operative surgical robot in the US. [24] Examples of using the da Vinci system include the first robotically assisted heart bypass (performed in Germany) in May 1998, and the first performed in the United States in September 1999;[ citation needed ] and the first all-robotic-assisted kidney transplant, performed in January 2009. [25] The da Vinci Si was released in April 2009 and initially sold for $1.75 million. [26]

In 2005, a surgical technique was documented in canine and cadaveric models called the transoral robotic surgery (TORS) for the da Vinci robot surgical system as it was the only FDA-approved robot to perform head and neck surgery. [27] [28] In 2006, three patients underwent resection of the tongue using this technique. [28] The results were more clear visualization of the cranial nerves, lingual nerves, and lingual artery, and the patients had a faster recovery to normally swallowing. [29] In May 2006 the first artificial intelligence doctor-conducted unassisted robotic surgery was on a 34-year-old male to correct heart arrhythmia. The results were rated as better than an above-average human surgeon. The machine had a database of 10,000 similar operations, and so, in the words of its designers, was "more than qualified to operate on any patient". [30] [31] In August 2007, Dr. Sijo Parekattil of the Robotics Institute and Center for Urology (Winter Haven Hospital and University of Florida) performed the first robotic-assisted microsurgery procedure denervation of the spermatic cord for chronic testicular pain. [32] In February 2008, Dr. Mohan S. Gundeti of the University of Chicago Comer Children's Hospital performed the first robotic pediatric neurogenic bladder reconstruction. [33]

On 12 May 2008, the first image-guided MR-compatible robotic neurosurgical procedure was performed at University of Calgary by Dr. Garnette Sutherland using the NeuroArm. [34] In June 2008, the German Aerospace Centre (DLR) presented a robotic system for minimally invasive surgery, the MiroSurge. [35] In September 2010, the Eindhoven University of Technology announced the development of the Sofie surgical system, the first surgical robot to employ force feedback. [36] In September 2010, the first robotic operation at the femoral vasculature was performed at the University Medical Centre Ljubljana by a team led by Borut Geršak. [37] [38]

In 2019 the Versius Surgical Robotic System was launched and is a rival of the Da Vinci surgical system and claims to be more flexible and versatile, having independent modular arms which are "quick and easy to set up". The small-scale design means that it is suitable for virtually any operating room and can be operated at either a standing or a sitting position. [39]

Uses

Ophthalmology

Ophthalmology is still part of the frontier for robotic-assisted surgeries. However, there are a couple of robotic systems that are capable of successfully performing surgeries. [40]

Heart

Some examples of heart surgery being assisted by robotic surgery systems include:

Thoracic

Robotic surgery has become more widespread in thoracic surgery for mediastinal pathologies, pulmonary pathologies and more recently complex esophageal surgery. [48]

The da Vinci Xi system is used for lung and mediastinal mass resection. This minimally invasive approach as a comparable alternative to video-assisted thoracoscopic surgery (VATS) and the standard open thoracic surgery. Although VATS is the less expensive option, the robotic-assisted approach offers benefits such as 3D visualizations with seven degrees of freedom and improved dexterity while having equivalent perioperative outcomes. [49]

ENT

The first successful robot-assisted cochlear implantation in a person took place in Bern, Switzerland in 2017. [50] Surgical robots have been developed for use at various stages of cochlear implantation, including drilling through the mastoid bone, accessing the inner ear and inserting the electrode into the cochlea. [51]

Advantages of robot-assisted cochlear implantation include improved accuracy, [52] resulting in fewer mistakes during electrode insertion and better hearing outcomes for patients. [53] The surgeon uses image-guided surgical planning to program the robot based on the patient's individual anatomy. This helps the implant team to predict where the contacts of the electrode array will be located within the cochlea, which can assist with audio processor fitting post-surgery. [54] The surgical robots also allow surgeons to reach the inner ear in a minimally invasive way. [53]

Challenges that still need to be addressed include safety, time, efficiency and cost. [53]

Surgical robots have also been shown to be useful for electrode insertion with pediatric patients. [55]

Gastrointestinal

Multiple types of procedures have been performed with either the 'Zeus' or da Vinci robot systems, [4] including bariatric surgery and gastrectomy [56] for cancer. Surgeons at various universities initially published case series demonstrating different techniques and the feasibility of GI surgery using the robotic devices. [57] Specific procedures have been more fully evaluated, specifically esophageal fundoplication for the treatment of gastroesophageal reflux [58] and Heller myotomy for the treatment of achalasia. [59] [60]

Robot-assisted pancreatectomies have been found to be associated with "longer operating time, lower estimated blood loss, a higher spleen-preservation rate, and shorter hospital stay[s]" than laparoscopic pancreatectomies; there was "no significant difference in transfusion, conversion to open surgery, overall complications, severe complications, pancreatic fistula, severe pancreatic fistula, ICU stay, total cost, and 30-day mortality between the two groups." [61]

Gynecology

The first report of robotic surgery in gynecology was published in 1999 from the Cleveland Clinic. [62] The adoption of robotic surgery has contributed to the increase in minimally invasive surgery for gynecologic disease. [63] Gynecologic procedures may take longer with robot-assisted surgery and the rate of complications may be higher, but there are not enough high-quality studies to know at the present time. [63] In the United States, robotic-assisted hysterectomy for benign conditions was shown to be more expensive than conventional laparoscopic hysterectomy in 2015, with no difference in overall rates of complications. [64]

This includes the use of the da Vinci surgical system in benign gynecology and gynecologic oncology. Robotic surgery can be used to treat fibroids, abnormal periods, endometriosis, ovarian tumors, uterine prolapse, and female cancers. [63] Using the robotic system, gynecologists can perform hysterectomies, myomectomies, and lymph node biopsies. [65] The Hominis robotic system developed by Momentis Surgical™ [66] is aimed to provide a robotic platform for natural orifice transluminal endoscopic surgery (NOTES) for myomectomy through the vagina. [67]

A 2017 review of surgical removal of the uterus and cervix for early cervical cancer robotic and laparoscopic surgery resulted in similar outcomes with respect to the cancer. [68]

Bone

Robots are used in orthopedic surgery. [69]

ROBODOC is the first active robotic system that performs some of the surgical actions in a total hip arthroplasty (THA). It is programmed preoperatively using data from computer tomography (CT) scans. This allows for the surgeon to choose the optimal size and design for the replacement hip. [70] [71]

Acrobot and Rio are semi-active robotic systems that are used in THA. It consists of a drill bit that is controlled by the surgeon however the robotic system does not allow any movement outside the predetermined boundaries. [70]

Mazor X is used in spinal surgeries to assist surgeons with placing pedicle screw instrumentation. Inaccuracy when placing a pedicle screw can result in neurovascular injury or construct failure. Mazor X functions by using templating imaging to locate itself to the target location of where the pedicle screw is needed. [72]

Spine

Robotic devices started to be used in minimally invasive spine surgery starting in the mid-2000s. [73] As of 2014, there were too few randomized clinical trials to judge whether robotic spine surgery is more or less safe than other approaches. [73]

As of 2019, the application of robotics in spine surgery has mainly been limited to pedicle screw insertion for spinal fixation. [74] In addition, the majority of studies on robot-assisted spine surgery have investigated lumbar or lumbosacral vertebrae only. [74] Studies on use of robotics for placing screws in the cervical and thoracic vertebrae are limited. [74]

Transplant surgery

The first fully robotic kidney transplantations were performed in the late 2000s. It may allow kidney transplantations in people who are obese who could not otherwise have the procedure. [75] Weight loss however is the preferred initial effort. [75]

General surgery

With regards to robotic surgery, this type of procedure is currently best suited for single-quadrant procedures, [76] in which the operations can be performed on any one of the four quadrants of the abdomen. Cost disadvantages are applied with procedures such as a cholecystectomy and fundoplication, but are suitable opportunities for surgeons to advance their robotic surgery skills. [65]

Hernia and Abdominal Wall Surgery

A surgeon at the Columbia Hernia Center operates on a patient with a large hernia using the robotic platform. Columbia Hernia Center.jpg
A surgeon at the Columbia Hernia Center operates on a patient with a large hernia using the robotic platform.

Over the past several decades, there have been great advances in the field of abdominal wall and hernia surgery especially when it comes to robotic-assisted surgery. Unlike laparoscopic surgery, the robotic platform allows for the correction of large hernia defects with specialized techniques that would traditionally only be performed via an open approach. Compared to open surgery, robotic surgery for hernia repair can reduce pain, length of hospital stay, and improve outcomes. [77] As the robotic instruments have 6 degrees of articulation, freedom of movement and ergonomics are greatly improved compared to laparoscopy.

The first robotic inguinal hernia repairs were done in conjunction with prostatectomies in 2007. [78] The first ventral hernia repairs were performed robotically in 2009. [79] Since then the field has rapidly expanded to include most types of reconstruction including anterior as well as posterior component separation.

With newer techniques such as direct access into the abdominal wall, [80] major reconstruction of large hernias can be done without even entering the abdominal cavity. Due to its complexity, however, major reconstruction done robotically should be undertaken at advanced hernia centers such as the Columbia Hernia Center in New York City, NY, USA. The American Hernia Society and the European Hernia Society are moving towards specialty designation for hernia centers who are credentialed for complex hernia surgery, including robotic surgery. [81]

Urology

Robotic surgery in the field of urology has become common, especially in the United States. [82]

There is inconsistent evidence of benefits compared to standard surgery to justify the increased costs. [83] Some have found tentative evidence of more complete removal of cancer and fewer side effects from surgery for prostatectomy. [84]

In 2000, the first robot-assisted laparoscopic radical prostatectomy was performed. [85]

Robotic surgery has also been utilized in radical cystectomies. A 2013 review found less complications and better short term outcomes when compared to open technique. [86]

Pediatrics

Pediatric procedures are also benefiting from robotic surgical systems. The smaller abdominal size in pediatric patients limits the viewing field in most urology procedures. The robotic surgical systems help surgeons overcome these limitations. Robotic technology provides assistance in performing [65]

Comparison to traditional methods

Major advances aided by surgical robots have been remote surgery, minimally invasive surgery and unmanned surgery. Due to robotic use, the surgery is done with precision, miniaturization, smaller incisions; decreased blood loss, less pain, and quicker healing time. Articulation beyond normal manipulation and three-dimensional magnification help to result in improved ergonomics. Due to these techniques, there is a reduced duration of hospital stays, blood loss, transfusions, and use of pain medication. [23] [87] The existing open surgery technique has many flaws such as limited access to the surgical area, long recovery time, long hours of operation, blood loss, surgical scars, and marks. [88]

The robot's costs range from $1 million to $2.5 million for each unit, [1] and while its disposable supply cost is normally $1,500 per procedure, the cost of the procedure is higher. [89] Additional surgical training is needed to operate the system. [85] Numerous feasibility studies have been done to determine whether the purchase of such systems are worthwhile. As it stands, opinions differ dramatically. Surgeons report that, although the manufacturers of such systems provide training on this new technology, the learning phase is intensive and surgeons must perform 150 to 250 procedures to become adept in their use. [1] During the training phase, minimally invasive operations can take up to twice as long as traditional surgery, leading to operating room tie-ups and surgical staffs keeping patients under anesthesia for longer periods. Patient surveys indicate they chose the procedure based on expectations of decreased morbidity, improved outcomes, reduced blood loss and less pain. [87] Higher expectations may explain higher rates of dissatisfaction and regret. [85]

Compared with other minimally invasive surgery approaches, robot-assisted surgery gives the surgeon better control over the surgical instruments and a better view of the surgical site. In addition, surgeons no longer have to stand throughout the surgery and do not get tired as quickly. Naturally occurring hand tremors are filtered out by the robot's computer software. Finally, the surgical robot can continuously be used by rotating surgery teams. [90] Laparoscopic camera positioning is also significantly steadier with less inadvertent movements under robotic controls than compared to human assistance. [91]

There are some issues in regards to current robotic surgery usage in clinical applications. There is a lack of haptics in some robotic systems currently in clinical use, which means there is no force feedback, or touch feedback. No interaction between the instrument and the patient is felt. However, recently the Senhance robotic system by Asensus Surgical was developed with haptic feedback in order to improve the interaction between the surgeon and the tissue. [92]

The robots can also be very large, have instrumentation limitations, and there may be issues with multi-quadrant surgery as current devices are solely used for single-quadrant application. [93]

Critics of the system, including the American Congress of Obstetricians and Gynecologists, [94] say there is a steep learning curve for surgeons who adopt the use of the system and that there's a lack of studies that indicate long-term results are superior to results following traditional laparoscopic surgery. [89] Articles in the newly created Journal of Robotic Surgery tend to report on one surgeon's experience. [89]

Complications related to robotic surgeries range from converting the surgery to open, re-operation, permanent injury, damage to viscera and nerve damage. From 2000 to 2011, out of 75 hysterectomies done with robotic surgery, 34 had permanent injury, and 49 had damage to the viscera. [ citation needed ] Prostatectomies were more prone to permanent injury, nerve damage and visceral damage as well. Very minimal surgeries in a variety of specialties had to actually be converted to open or be re-operated on, but most did sustain some kind of damage or injury. For example, out of seven coronary artery bypass grafting, one patient had to go under re-operation. It is important that complications are captured, reported and evaluated to ensure the medical community is better educated on the safety of this new technology. [95] If something was to go wrong in a robot-assisted surgery, it is difficult to identify culpability, and the safety of the practice will influence how quickly and widespread these practices are used.[ citation needed ]

One drawback of the use of robotic surgery is the risk of mechanical failure of the system and instruments. A study from July 2005 to December 2008 was conducted to analyze the mechanical failures of the da Vinci Surgical System at a single institute. During this period, a total of 1797 robotic surgeries were performed used 4 da Vinci surgical systems. There were 43 cases (2.4%) of mechanical failure, including 24 (1.3%) cases of mechanical failure or malfunction and 19 (1.1%) cases of instrument malfunction. Additionally, one open and two laparoscopic conversions (0.17%) were performed. Therefore, the chance of mechanical failure or malfunction was found to be rare, with the rate of converting to an open or laparoscopic procedure very low. [96]

There are also current methods of robotic surgery being marketed and advertised online. Removal of a cancerous prostate has been a popular treatment through internet marketing. Internet marketing of medical devices are more loosely regulated than pharmaceutical promotions. Many sites that claim the benefits of this type of procedure had failed to mention risks and also provided unsupported evidence. There is an issue with government and medical societies promotion a production of balanced educational material. [97] In the US alone, many websites promotion robotic surgery fail to mention any risks associated with these types of procedures, and hospitals providing materials largely ignore risks, overestimate benefits and are strongly influenced by the manufacturer. [98]

See also

Related Research Articles

<span class="mw-page-title-main">Urology</span> Medical specialty

Urology, also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of the urinary-tract system and the reproductive organs. Organs under the domain of urology include the kidneys, adrenal glands, ureters, urinary bladder, urethra, and the male reproductive organs.

<span class="mw-page-title-main">Laparoscopy</span> Minimally invasive operations within the abdominal or pelvic cavities

Laparoscopy is an operation performed in the abdomen or pelvis using small incisions with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.

<span class="mw-page-title-main">Hysterectomy</span> Surgical removal of the uterus

Hysterectomy is the surgical removal of the uterus and cervix. Supracervical hysterectomy refers to removal of the uterus while the cervix is spared. These procedures may also involve removal of the ovaries (oophorectomy), fallopian tubes (salpingectomy), and other surrounding structures. The term “partial” or “total” hysterectomy are lay-terms that incorrectly describe the addition or omission of oophorectomy at the time of hysterectomy. These procedures are usually performed by a gynecologist. Removal of the uterus renders the patient unable to bear children and has surgical risks as well as long-term effects, so the surgery is normally recommended only when other treatment options are not available or have failed. It is the second most commonly performed gynecological surgical procedure, after cesarean section, in the United States. Nearly 68 percent were performed for conditions such as endometriosis, irregular bleeding, and uterine fibroids. It is expected that the frequency of hysterectomies for non-malignant indications will continue to fall given the development of alternative treatment options.

Remote surgery is the ability for a doctor to perform surgery on a patient even though they are not physically in the same location. It is a form of telepresence. A robot surgical system generally consists of one or more arms, a master controller (console), and a sensory system giving feedback to the user. Remote surgery combines elements of robotics, telecommunications such as high-speed data connections and elements of management information systems. While the field of robotic surgery is fairly well established, most of these robots are controlled by surgeons at the location of the surgery. Remote surgery is remote work for surgeons, where the physical distance between the surgeon and the patient is less relevant. It promises to allow the expertise of specialized surgeons to be available to patients worldwide, without the need for patients to travel beyond their local hospital.

<span class="mw-page-title-main">Nissen fundoplication</span> Surgical procedure to treat gastric reflux and hiatal hernia

A Nissen fundoplication, or laparoscopic Nissen fundoplication when performed via laparoscopic surgery, is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatal hernia. In GERD, it is usually performed when medical therapy has failed; but, with a Type II (paraesophageal) hiatus hernia, it is the first-line procedure. The Nissen fundoplication is total (360°), but partial fundoplications known as Thal, Belsey, Dor, Lind, and Toupet fundoplications are alternative procedures with somewhat different indications and outcomes.

<span class="mw-page-title-main">Prostatectomy</span> Surgical removal of all or part of the prostate gland

Prostatectomy is the surgical removal of all or part of the prostate gland. This operation is done for benign conditions that cause urinary retention, as well as for prostate cancer and for other cancers of the pelvis.

<span class="mw-page-title-main">Spigelian hernia</span> Surgical condition

A Spigelian is the type of ventral hernia where aponeurotic fascia pushes through a hole in the junction of the linea semilunaris and the arcuate line, creating a bulge. It appears in the lower quadrant of the abdomen between an area of dense fibrous tissue and abdominal wall muscles causing a.

<span class="mw-page-title-main">Laparoscopic radical prostatectomy</span>

Laparoscopic radical prostatectomy (LRP) is a form of radical prostatectomy, an operation for prostate cancer. Contrasted with the original open form of the surgery, it does not make a large incision but instead uses fiber optics and miniaturization.

Computer-assisted surgery (CAS) represents a surgical concept and set of methods, that use computer technology for surgical planning, and for guiding or performing surgical interventions. CAS is also known as computer-aided surgery, computer-assisted intervention, image-guided surgery, digital surgery and surgical navigation, but these are terms that are more or less synonymous with CAS. CAS has been a leading factor in the development of robotic surgery.

Single-port laparoscopy (SPL) is a recently developed technique in laparoscopic surgery. It is a minimally invasive surgical procedure in which the surgeon operates almost exclusively through a single entry point, typically the patient's navel. Unlike a traditional multi-port laparoscopic approach, SPL leaves only a single small scar.

Urology Robotics, or URobotics, is a new interdisciplinary field for the application of robots in urology and for the development of such systems and novel technologies in this clinical discipline. Urology is among the medical fields with the highest rate of technology advances, which for several years has included the use medical robots.

da Vinci Surgical System Robotic surgical system

The da Vinci Surgical System is a robotic surgical system that uses a minimally invasive surgical approach. The system is manufactured by the company Intuitive Surgical. The system is used for prostatectomies, increasingly for cardiac valve repair and for renal and gynecologic surgical procedures.

<span class="mw-page-title-main">Mani Menon</span>

Mani Menon, born 9 July 1948 in Trichur, India, is an American surgeon whose work has helped to lay the foundation for modern Robotic Cancer Surgery. He is the founding director and the Raj and Padma Vattikuti Distinguished Chair of the Vattikuti Urology Institute at the Henry Ford Hospital in Detroit, MI, where he established the first cancer-oriented robotics program in the world. Menon is widely regarded for his role in the development of robotic surgery techniques for the treatment of patients with prostate, kidney, and bladder cancers, as well as for the development of robotic kidney transplantation.
Menon is the recipient of the Gold Cystoscope award, Hugh Hampton Young award, the Keyes Medal, the prestigious B.C. Roy award.

<span class="mw-page-title-main">Ashutosh Tewari</span> American urologist, oncologist

Ashutosh K. Tewari is the chairman of urology at the Icahn School of Medicine at Mount Sinai Hospital in New York City. He is a board certified American urologist, oncologist, and principal investigator. Before moving to the Icahn School of Medicine in 2013, he was the founding director of both the Center for Prostate Cancer at Weill Cornell Medical College and the LeFrak Center for Robotic Surgery at NewYork–Presbyterian Hospital. Dr. Tewari was the Ronald P. Lynch endowed Chair of Urologic Oncology and the hospital's Director of Robotic Prostatectomy, treating patients with prostate, urinary bladder and other urological cancers. He is the current President of the Society for Urologic Robotic Surgeons (SURS) and the Committee Chair of the Prostate Program. Dr. Tewari is a world leading urological surgeon, and has performed over 10,000 robotically assisted procedures using the da Vinci Surgical System. Academically, he is recognized as a world-renowned expert on urologic oncology with over 250 peer reviewed published papers to his credit; he is on such lists as America's Top Doctors, New York Magazine's Best Doctors, and Who's Who in the World. In 2012, he was given the American Urological Association Gold Cystoscope Award for "outstanding contributions to the field of urologic oncology, most notably the treatment of prostate cancer and the development of novel techniques to improve the outcomes of robotic prostatectomy."

<span class="mw-page-title-main">Inguinal hernia surgery</span> Medical procedure

Inguinal hernia surgery is an operation to repair a weakness in the abdominal wall that abnormally allows abdominal contents to slip into a narrow tube called the inguinal canal in the groin region.

<span class="mw-page-title-main">Roger Kirby</span> British surgeon

Roger Sinclair Kirby FRCS(Urol), FEBU is a British retired prostate surgeon and professor of urology, researcher, writer on men's health and prostate disease, founding editor of the journal Prostate Cancer and Prostatic Diseases and Trends in Urology and Men's Health and a fundraiser for prostate disease charities, best known for his use of the da Vinci surgical robot for laparoscopic prostatectomy in the treatment of prostate cancer. He is a co-founder and president of the charity The Urology Foundation (TUF), vice-president of the charity Prostate Cancer UK, trustee of the King Edward VII's Hospital and as of 2020 is president of the Royal Society of Medicine (RSM), London.

<span class="mw-page-title-main">Michael Stifelman</span> American physician and urologist

Michael D. Stifelman Michael D. Stifelman, M.D., is Chair of Urology at Hackensack University Medical Center, Director of Robotic Surgery at Hackensack Meridian Health, and Professor and Inaugural Chair of Urology at Hackensack Meridian School of Medicine.

<span class="mw-page-title-main">Vipul Patel</span>

Vipul R. Patel, FACS is the founder and Medical Director of the Florida Hospital Global Robotics Institute, founder and Vice President of the Society of Robotic Surgery, and founder and Editor Emeritus of The Journal of Robotic Surgery. He is board certified by the American Urological Association and specializes in robotic surgery for prostate cancer. As of June, 2023 he performed his 17,000th robotic-assisted prostatectomy. The large volume of prostatectomies he has performed has enabled him to amass a large amount of statistical evidence regarding the efficacy of robotic techniques which has been used in developing and refining techniques. Patel credits the use of robotic assisted surgery with helping surgeons achieve better surgical outcomes with the "trifecta" of cancer control, continence and sexual function. In the course of his career Patel has led and participated in studies that have resulted in developing improved outcomes for robotic surgery and urologic treatment.

<span class="mw-page-title-main">Ben Challacombe</span> British urological surgeon

Benjamin James Challacombe is a British consultant urological surgeon at Guy's & St Thomas' Hospitals, and at King’s College London, who specialises in the treatment of kidney and prostatic disease using robotic surgery. In 2005, he was part of the team that published the results of a randomised controlled trial of human versus telerobotics in the field of urology and renal transplant, one of the first of its kind.

Declan G. Murphy, FRACS, FRCS, is a urologist, director of the unit for genitourinary oncology and robotic surgery at the Peter MacCallum Cancer Centre in Melbourne, Australia, professor at the Sir Peter MacCallum Department of Oncology at the University of Melbourne, and associate editor of the British Journal of Urology International. In 2010 he introduced robotic surgery for urology to the public sector health services in Victoria, Australia.

References

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