Each author will cover the existing literature, preoperative planning, room and patient setup, steps of the procedure, and postoperative care. The second section of this textbook, Robotic Procedures, will contain a comprehensive catalogue of procedures that have been performed robotically in general surgery, gynecology, urology, plastic surgery, cardiothoracic, and otolaryngology. The chapter on legal issues will have specific instances of robotic surgery-related lawsuits and their outcomes, a first for robotic surgery texts. Surgeons will also find this background valuable to their practice, to give context to their procedures so they can better counsel their patients, help with advocating for robotic platform purchases, and proactively prepare themselves for medico-legal issues. The first section of this textbook, Surgical Robots, covers the history, economics, training, and medico-legal aspects of robotic surgery that will be of interest to students, residents, fellows, surgical staff, and administrators or public health specialists who seek to gain a comprehensive background on robotic surgery, or justification for purchasing a robotic system for their institution.
The current state of data suggests equivalency in most procedures with regard to traditional outcome measures, equal or somewhat elevated costs, with specific areas of superiority. However, with over 3000 world-wide systems in use, and over 6000 peer-reviewed research articles, the impact of robotic surgery cannot be ignored. This has come with controversy – as the dominant manufacturer of robotic assisted devices, Intuitive Surgical, and their generations of da Vinci surgical platforms, holds enough market share to spur cries of monopoly and financial excess. Beginning with insufflators, videoscopy, and energy devices, that evolution has continued into the development of tele-surgical devices that feature full articulation of instruments, high-resolution 3-D optics, and computer assisted movement. Integral to the rise of minimal access and therapeutic techniques in surgery has been the growth of technological improvements over time. The total economic benefit may be unfathomable when looked at comprehensively.
The hard science has demonstrated that decrease in wound complications and recovery time has created the biggest gap with open approaches to surgery. Minimally invasive surgery has impacted the outcomes of surgery more than any technology since the development of sterile technique.
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