Use of a robotic system as surgical first assistant in advanced laparoscopic surgery

To date, the use of robotic systems has concentrated on enhancing the dexterity of the individual surgeon performing advanced laparoscopic surgery. Surgical assistants must still be present. We present a clinical experience using a robotic system as a surgical first assistant, enabling the performance of solo surgery in increasingly complex procedures. Laparoscopic fundoplication was selected as an advanced laparoscopic procedure that has routinely required a human assistant. Between January and April 2001, 10 patients with gastroesophageal reflux disease underwent laparoscopic antireflux surgery. The Zeus Robotic Surgical System (Computer Motion) was used to perform all functions typically handled by surgical assistants. The system was manipulated solely by the surgeon at all times with controls draped within the sterile field. This control console remained at the surgeon’s side and at no time did the surgeon leave the sterile field. The presence of the robotic system did not interfere with access to the patient. Among 10 operations, 8 were performed completely without the need or use of any human assistance. Set-up of the robotic system averaged 28 minutes per patient, including sterile draping. Operative times ranged from 68 to 155 minutes. There were no adverse events noted in the perioperative period. All patients were discharged the day after the procedure without any complications. Robotic assistance to facilitate solo surgery in advanced laparoscopic procedures appears to be a feasible and safe technique. More importantly, this experience seems to demonstrate a potential for the Zeus robotic system for telementoring applications. Given a real-time communication system, a distant mentor could manipulate the robotic arms and guide a local, novice laparoscopic surgeon through an advanced procedure. Additional instrumentation must be available and more study is needed to quantify the clinical usefulness, safety, and efficacy of this new tool.