Robot Ergonomic Analysis
The robot, named "da Vinci" in honor of Leonardo da Vinci who invented the first robot, consists of an console. For the surgeon and a device on the patient side equipped with three or four manipulator arms:
One for the high-definition 3D camera, the other three for the miniature articulated instruments slipped into the trocars, as for a normal laparoscopy. The manipulator arms, with "Endo" instruments, have seven degrees of freedom, similar to the human wrist and offering a joint of 180 ° and 720 ° of rotation.
For minimally invasive surgery technique, many of them have not received practical training with simulators resembling Laparoscopic Needle Driver.
The surgeon operates from a console that has two manual controls, with seven pedals at his feet and an enlarged, 3D image of the operating field on the screen. With his levers, the surgeon directs the instruments. The movements of the fingers, the arms but also the wrists, performed by the surgeon at the robot's control console miniaturized reproduced with extreme precision by the surgical instruments in the patient's abdomen.
International Development
From 2000, experiments organized all over the world. In 2001, the first operations carried out using the da Vinci. In July 2000, then in June 2001, the Administration authorized the use of da Vinci for a certain number of operations: cholecystectomy, prostatectomy, etc. In March 2001, the use of da Vinci for operations on the abdomen and thorax.
Almost 1,400 copies acquired in early 2010, including more than 1,000. In April 2011, Intuitive Surgical, the manufacturing company, indicates that 1,750 units are in service worldwide. In 2013, there were 3,500 worldwide. Initially used in urology and gynecology, the robot has seen its indications broaden to include thoracic, digestive, ENT, cervico-facial and vascular surgery.
The use of the robot in colorectal surgery in 2014-2015 experienced a rather hesitant development with a single center carried out more than 20 operations. At the Clinics, our team has performed 14 procedures since the start in robotic surgery in October 2015.
Clear Advantages
While there are clear advantages to using the robot from the point of view of surgical technique, the literature does not yet show any advantages over laparoscopy. This undoubtedly linked to the learning period for all colorectal robotics surgeons. Several studies have reported the feasibility and safety of proctectomy with total mesorectal resection (TME) for rectal cancer by robot-assisted laparoscopy in terms of oncological outcomes.
Several systematic reviews and Meta-analyzes have compared the results of robotic procedures versus conventional laparoscopy for rectal cancer. These studies show a significant difference in favor of conventional laparoscopy in terms of cost and operating time and in favor of robot-assisted laparoscopy in terms of morbidity. However, by analyzing the randomized studies alone, we do not detect a clear advantage in terms of morbidity. These studies also indicate that there is no clear difference in the length of hospital stay.
Robotic Versus Laparoscopic Resection
Due to the lack of data from prospective randomized controlled trials to support robot-assisted surgery for rectal cancer, the international trial “Robotic versus Laparoscopic Resection for Rectal cancer -” designed to answer this question. This is an international, multicenter, prospective, randomized, and controlled, single-blind study of robotic-assisted surgery versus laparoscopic surgery for the curative treatment of rectal cancer.
Conclusion
The main short-term results include the assessment of the technical ease of the operation and the improvement of the oncological outcome. In addition, a quality of life assessment and cost-effectiveness analysis will carried out. Long-term results will focus on the oncological aspects of the disease, analysis of overall and disease-free survival and local recurrence rate at 3 years of follow-up. These results currently analyzed.
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