Introduction: The surgeon’s perspective on robotic surgery

Since approval by the Food and Drug Administration was obtained in 2000, the robotic platform has revolutionized the advancement of minimally invasive surgery across all surgical specialties. Originally intended by NASA as a modality to replace the surgeon's physical presence and provide remote access care to astronauts or to soldiers in battlefields, the development of the first generation of robotic platforms started in the mid-1980s. Only after the evolution of the second and current generation of robotic systems, set up in a “master–slave” configuration, this new technique became clinical reality. The concept is as intriguing as it is radical: the “master” unit (the surgeon's console) controls a separate “slave” unit (several robotic arms with multiple degrees of freedom). The feasibility of the physical absence of the surgeon at the operating table was first proven in 2001 when a transcontinental robotic cholecystectomy was performed on a patient in Strasbourg, France, by surgeons located in New York City. As of December 2015, the da Vinci surgical system (Intuitive Surgical, Inc., Sunnyvale, CA, USA) was the market leader in robotic platforms with 3,597 da Vinci surgical systems installed worldwide. According to a recent report (Wintergreen Research Company), robotic surgical systems collectively marketed $3.4 billion in 2014 and are anticipated to reach $20 billion by 2021. After the first laparoscopic cholecystectomy was performed in 1985, laparoscopic techniques conquered the globe across all surgical fields because they resulted in shorter hospitalization, less postoperative pain, and quicker return to normal activity due to small incisions and limited tissue dissections. Over time, the limitations of laparoscopic surgery became apparent: decreased motion range of laparoscopic instruments (when compared to the human hand), impaired hand–eye coordination with the use of only two-dimensional screens, and an uncomfortable posture with increased ergonometric strain for the surgeon. In comparison to conventional laparoscopy, robotic surgery propelled minimally invasive surgery to a higher level of performance through the introduction of three-dimensional stereoscopic vision, elimination of hand tremor, better ergonomics for the surgeon, and increased dexterity, maneuverability, and precision via the Endo-Wrist technology. The wider application of robotic technologies is also the result of greater ease of use and comfort than with the laparoscopic setup once the operating staff is familiar and competent with the robotic platform.