Robotic-assisted Laparoscopic Renal and Adrenal Surgery

The worldwide evolution of robotic surgery continues to advance at a staggering pace. In less than 20 years, the technology has grown exponentially from theoretical military application to daily use in operating rooms around the globe. In fact, the overwhelming success of robotic surgery with regards to invention, innovation, and adaptation is an excellent example of collaboration between surgeons, industry, and government. While the first robotic device to be used clinically dates back to computerized tomography-guided stereotactic neurosurgery by Kwoh et al in 1988 1, the first urological application in a human was not described until Davies et al2 used a modified industrial robotic arm to perform a transurethral resection of the prostate three years later. The first commercial application in laparoscopy did not come until the Automated Endoscopic System for Optimal Positioning (AESOPTM) was FDA approved in the United States in 19937. Originally designed by the U.S. military, the table-mounted device could precisely guide a laparoscope and was later put into production by Computer Motion Inc. (Santa Barbara, California).3 Computer Motion Inc. would later introduce the ZEUSTM robotic system onto the U.S. market in 1998, just months after the unveiling of another surgical robot, the da Vinci® (Intuitive Surgical, Sunnyvale, California). The da Vinci® system was born out of technology designed by NASA, also originally intended for use by the U.S. military, but quickly adopted for civilian use. In 2003, Intuitive Surgical took over Computer Motion Inc., thereby paving the way for the da Vinci® robot, along with it’s newly FDA approved EndoWristTM, to dominate surgical robotic use worldwide.3 Today, the vast majority of published literature on robotic-assisted renal surgery has employed the use of the da Vinci® system, and it is the only commercially available master-slave robotic system in production today. Few studies have addressed the comparative performance and efficiency between the three most cited robotic platforms, namely AESOP, ZEUS and da Vinci®. Sung et al4 initially looked at this question in a porcine model, and we later compared our results in a cohort of patients undergoing pyeloplasty for ureteropelvic junction obstruction (UPJO).5 Both groups concluded that the da Vinci® system was superior in terms of shorter operative time, quicker anastomotic time, and flatter learning curve. We also found the majority of technical manoeuvering inherently more intuitive with the da Vinci® system compared to the ZEUS system. There does exist some earlier reports of experience with the ZEUS O pe n A cc es s D at ab as e w w w .ite ch on lin e. co m