A narrative review of the role of robotics in cancer surgery

Abstract

: In recent times the use of minimally invasive laparoscopic surgery has greatly expanded, becoming increasingly developed since its advent. This technical innovation has allowed more complex procedures to be undertaken. Standard laparoscopic surgery has several limitations, for example positioning of the camera being operator dependent, mostly only providing two-dimensional views and restricted instrument movements for the surgeon. Robotic-assisted surgery allows improved control of the instruments over traditional laparoscopic instruments, more able to achieve the movements that the operator requires thus permitting more and more technically challenging procedures to be accomplished. Advantages of robotic surgery are that it integrates into enhanced recovery after surgery (ERAS) programmes through enabling faster recovery for patients with a shorter length of hospital stay, reduced postoperative pain, fewer wound complications, better cosmetic outcome and reduced blood loss. Robotic surgery also offers three-dimensional views with magnification and surgical instruments capable of increasing degrees of freedom thus replicating hand movements with greater precision. The use of robotics has implications for the anaesthetist including the potential for more restricted access to the patient’s airway. This article explores the history of robotic surgery and reviews the literature available for several surgical specialities as well as an insight into areas for the future development of robotics.