A consensus document on robotic surgery

Contained in this edition of Surgical Endoscopy is an important document entitled ‘‘A Consensus Document on Robotic Surgery.’’ For those involved with or interested in robotics in surgery, this is a long-awaited and important development. It represents the combined efforts of the two societies whose members have been most involved in developing the field of robotics in surgery: the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and MIRA. The work was supported by The Department of Defense, which has a keen interest in such technologies. A critical contribution of a document such as this is the common set of definitions and nomenclature it establishes. The document defines robotic surgery as ‘‘technology that places a computer-assisted electromechanical device in the path between the surgeon and the patient.’’ Other specialties have already placed more or less similar devices in this path. Radiology uses computer-dependant scanners: magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET). Interventional cardiologists use computer-dependant imaging and injecting machinery. It is clear that surgical patients have much to gain from the addition of computer capability to our current capacity. Clearly, this still is a field early in its development, but it is growing. Without a doubt, this arena requires further study. The current body of data is sufficient to establish that robotics as we currently know it is safe, and that the perceived advantages (which seem obvious to the robotic ‘‘believers’’) may exist. The literature is rich with case reports, series, and technical articles. However, there is little in the way of level 1 data with regard to the potential advantages and costs of these systems as compared with standard laparoscopic or open surgery. The reason for the paucity of these data is clear. Such studies are expensive and time consuming to undertake, and there is no ready funding source. Nevertheless, such data are important for continued study. An important and interesting feature of robotics development is the variety of contributors necessary to bring these devices to reality. In the distant past, surgeons were the sole innovators of new ways to do surgery. At one stage, operating rooms had their own instrument labs, in which individual tools could be created for surgeons. In contrast, the development of modern surgical technology, specifically robotics, has required a legion of participants. But the most critical and most examined of these involve the relationship of industry and surgeons. Although these relationships are currently under great scrutiny, it is critical to realize that significant developments such as robotics simply could not take place without surgeon/industry collaboration. The technology and the machines have clearly arrived. Based on the success of the da Vinci system, it is safe to assume that other robotic systems will follow. They may or may not mimic da Vinci. Many envision robotic systems that are smaller, cheaper, and more individually suited to specific types of operations. Now that computer-assisted surgery is a reality, the applicability of the technology likely will broaden. Perhaps this will mean future systems that can detect minute levels of specific molecules (robots that can ‘‘smell’’) or take far greater advantage of the electromagnetic spectrum (robots that can see infrared, M. A. Talamini (&) Department of Surgery, University of California San Diego, San Diego, California 92103, USA e-mail: talamini@ucsd.edu