RESUMEN
Given recent advancements in artificial intelligence and robotic surgery, attention has now been paid to the concept of autonomous surgery. As robotic surgery has developed and matured, examples of autonomous surgery have arisen through the assistance of artificial intelligence. As with any new technology, ethical and legal considerations also arise, and there are special considerations that should be taken into account with the adaptation of new technology involving patient care. In this paper, we will describe autonomous surgery used in general surgery and lower extremity joint arthroplasty, and we will highlight the current ethical and legal considerations associated with this technology.
RESUMEN
Barbed sutures became available in the mid-1960's, when a popular bidirectional barbed suture was primarily used by plastic surgeons for skin closure. As laparoscopic surgery became more commonplace, so did the need for intracorporeal sewing, but the challenges of tying sutures under tension became apparent. While surgical devices such as the Endostich™ (Covidien, Dublin, Ireland) aided in overcoming the learning curve for laparoscopic sewing, over time, the introduction of a unidirectional barbed suture helped minimally invasive surgeons overcome the challenges of sewing laparoscopically. It is particularly difficult to secure knots under tension using commonly available monofilament and multifilament sutures. Barbed sutures allow for the distribution of tension along the suture closure without the need for securing knots. However, with the introduction of the daVinci™ robot by Intuitive (Sunnyvale, CA) in 2001, sewing has become easier and more popular with the availability of a 3-dimensional, high-definition view and wristed instruments. As robotic general surgery has become increasingly accepted, it is fitting that the use of a barbed suture in hernia surgery has become critical for primary fascia closure of the hernia defect and various layer closures.