Leonardo da Vinci, the master artist, is credited for one of the early concepts of robots in the late 1400’s. His genius propelled the idea of a mechanical device with the capability of automation, repetitive motion and wristed joints. While his idea of a mechanical knight was primitive, the concept led to a landslide of innovations. This concept was subsequently introduced into manufacturing in the early 1800’s when Joseph Jacquard, in France, created a loom to weave repetitive patterns into cloth. This was the first use of programmable machinery in a field of industry. Nevertheless, the application of this robotic technology in surgery occurred only in 1985, when the first truly robotic flexible arm (PUMA 560) was used to orientate a needle for a guided brain biopsy. Soon after, the robot was utilized in different surgical procedures, including transurethral resection of the prostate and hip replacement, changing forever the role of robotics in medicine. The contemporary generation of surgical robots consists of a ‘master-slave’ system. The basic principle involves control of robotic arms by a surgeon sitting at a console, which provides 3D 10x magnified vision, wristed instrumentation, tremor filtration, and motion scaling. The system produces an immersive telerobotic environment ideally suited for surgical precision and reconstructive applications. The introduction of this technology into the modern day operating theatre has revolutionized the very essence of how surgical procedures are approached today. Robotic assisted surgery is now a standard concept in the United States with over 700 robotic surgical systems and is beginning to grow worldwide. While initially, the daVinci robot was designed for cardiac surgery, it was the prostate that led to its ascent. The first robotic prostatectomy was performed in 1999, by Binder and colleagues, and at present, ten years after, is the most common robotic surgery worldwide, with more than 300,000 procedures performed. The device is now growing into other surgical specialties such as Gynecology and GI surgery. Since the approval of the daVinci surgical system for gynecologic surgeries by the FDA in 2005, this technology has been applied to a number of different conditions, including robotic hysterectomy, myomectomy, tubal reanastomoses, pelvic and paraaortic lymph node dissection, and sacrocolpopexy. In the field of general surgery, procedures for which the daVinci surgical system may be of particular value include: esophageal myotomy, paraesophageal hernia repair, gastric bypass, transhiatal esophagectomy, transthoracic esophageal surgery and others. Dr Patel’s personal experience has been in robotic radical prostatectomy over the last seven years. 3000 cases later, he has learned to appreciate the continuing evolution of the technology and the unending bounds of its capability. The ”robot” has evolved into and now is becoming the ”tool” that Leonardo first dreamed in the 1400’s. To realize the future of robotics in medicine fully we will need multidisciplinary collaboration. Physicians and engineers will work collectively to understand the effusive potential of the human-system interface. The potential for enhancing patient care is unrestricted. This issue of The Scandinavian Journal of Surgery is dedicated to robotics in surgery.The respected experts in varying fields of surgery will share their expertise and knowledge in several well written review articles. The possibilities, but also the weaknesses, of the contemporary robotics systems will be elaborated.
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