Five historical innovations that have shaped modern urological surgery.

Throughout history, many innovations have contributed to the development of modern urological surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern urological surgery: External shockwave lithotripsy, transurethral resection of prostate, cystoscope, perioperative prostate-specific antigen and robotic surgery. The selection of innovations for inclusion in this article was meticulously determined through expert consensus and an extensive literature review. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of urological surgery and their ongoing relevance in contemporary and perioperative practice.

Future Platforms of Robotic Surgery.

Among the various robotic devices that exist for urologic surgery, the most common are synergistic telemanipulator systems. Several have achieved clinical feasibility and have been licensed for use in humans: the standard da Vinci, Avatera, Hinotori, Revo-i, Senhance, Versius, and Surgenius. Handheld and hands-on synergistic systems are also clinically relevant for use in urologic surgeries, including minimally invasive and endoscopic approaches. Future trends of robotic innovation include an exploration of more robust haptic systems that offer kinesthetic and tactile feedback; miniaturization and microrobotics; enhanced visual feedback with greater magnification and higher fidelity detail; and autonomous robots.

The history of robotic surgery and its evolution: when illusion becomes reality.

The term "robot" was concepted in the beginning of last century, coming originally from the Czech word "robota", meaning "labor". More recently, computer assistance and robotics based in the telepresence and virtual reality concept have been applied to surgical procedures. The application of robots in surgery dates approximately 35 years, experiencing significant growth in the last two decades fueled by the advent of advanced technologies. Despite its recent and brief status in surgery history, robotic technology has already proven its enhanced visualization, superior dexterity and precision during minimally invasive procedures. Currently, the worldwide diffused and predominant robot system used in surgery is Da Vinci by Intuitive Surgical, however robotic surgery evolution is far from over, with multiple potential competitors on the horizon pushing forward its paradigms. We aim to describe the history and evolution of robotic surgery in the last years as well as present its future perspectives.

Five thousand years of minimal access surgery: 1850 to 1990: Technological developments.

This is the second of a three-part series that charts the history of minimal access surgery from antiquity to current times. Although rapid developments in laparoscopic and robotic surgery have transformed surgical care over the last 30 years, our predecessors made significant advances in their time which set the principles for modern practice. Part I of this series described how ancient medical practitioners developed simple instruments, from metal or wood, for viewing body cavities. Improvements in the use of metal, glass and lighting allowed for inspection of deeper parts of the body. This second part of the series will show how advances in electrical technology allowed the development of improved lighting for endoscopy and laparoscopy along with the use of electrocautery for a wide range of therapeutic procedures.

Retzius-Sparing Robot-Assisted Robotic Prostatectomy: Past, Present, and Future.

Radical prostatectomy has undergone many adaptations since its inception, including the Retzius-sparing robotic-assisted radical prostatectomy approach. In this article, we review the origins of radical prostatectomy, the theoretic basis for Retzius-sparing robotic-assisted radical prostatectomy, and outline the key steps of the procedure. To date, there have been 9 studies comparing the outcomes of Retzius-sparing robotic-assisted radical prostatectomy with standard robotic-assisted radical prostatectomy, which have demonstrated improved continence outcomes for Retzius sparing robotic assisted radical prostatectomy within the first year and equivalent oncologic efficacy out to 18 months. Further research is needed to evaluate sexual function outcomes as well as long-term oncologic outcomes.

Historical Considerations and Surgical Quality Improvement in Robotic Prostatectomy.

Laparoscopic prostatectomy was technically challenging and not widely adopted. Robotics led to the widespread adoption of minimally invasive prostatectomy, which has been used heavily, supplanting the open and traditional laparoscopic approach. The benefits of robotic prostatectomy are disputed. Data suggest that robotic prostatectomy outcomes have improved over time.

Technologic Evolution of Navigation and Robotics in Spine Surgery: A Historical Perspective.

Spine surgery is continuously evolving. The synergy between medical imaging and advances in computation has allowed for stereotactic neuronavigation and its integration with robotic technology to assist in spine surgery. The discovery of x-rays in 1895, the development of image intensifiers in 1940, and then advancements in computational science and integration have allowed for the development of computed tomography. In combination with the advancements of stereotaxy in the late 1980s, and manipulation of volumetric and special data for 3-dimensional reconstruction in 1998, computed tomography has revolutionized neuronavigational systems. Integrating all these technologies, robotics in spine surgery was introduced in 2004. Since then, it has become a safe modality that can reproducibly place accurate pedicle screws. Robotics may have the added benefits of improving the surgical workflow and optimizing surgeon ergonomics. Growing at a rapid rate, the second-generation spinal robotics have overcome preliminary limitations and errors. However, comparatively, robotics in spine surgery remains in its infancy. By leveraging technologic advancements in medical imaging, computation, and stereotactic navigation, robotics in spine surgery will continue to mature and expand in utility.

The history of robotic surgery and its evolution: when illusion becomes reality / Evolução e história da cirurgia robótica: da ilusão à realidade

ABSTRACT The term "robot" was concepted in the beginning of last century, coming originally from the Czech word "robota", meaning "labor". More recently, computer assistance and robotics based in the telepresence and virtual reality concept have been applied to surgical procedures. The application of robots in surgery dates approximately 35 years, experiencing significant growth in the last two decades fueled by the advent of advanced technologies. Despite its recent and brief status in surgery history, robotic technology has already proven its enhanced visualization, superior dexterity and precision during minimally invasive procedures. Currently, the worldwide diffused and predominant robot system used in surgery is Da Vinci by Intuitive Surgical, however robotic surgery evolution is far from over, with multiple potential competitors on the horizon pushing forward its paradigms. We aim to describe the history and evolution of robotic surgery in the last years as well as present its future perspectives.

RESUMO O termo "robô" foi concebido no início do século passado, derivado originalmente da palavra tcheca "robota", que significa "trabalho". Mais recentemente, a tecnologia de computação associada à robótica, baseada no conceito de telepresença e realidade virtual, têm sido aplicadas aos procedimentos cirúrgicos. A aplicação de robôs em cirurgia data de aproximadamente 35 anos, experimentando um crescimento significativo nas últimas duas décadas impulsionado pelo advento de novas tecnologias e seus resultados. Apesar de seu status breve comparado à longevidade da história da cirurgia, a tecnologia robótica já provou seus potenciais benefícios com visualização aprimorada, destreza superior e maior precisão durante procedimentos minimamente invasivos. Atualmente, a plataforma robótica mundialmente difundida e predominantemente usada em cirurgia é o modelo Da Vinci da empresa Intuitive Surgical, e a evolução desse novo conceito de cirurgia está longe de terminar, com inúmeros competidores potenciais no horizonte impulsionando a quebra de paradigmas. Nosso objetivo nesta revisão é descrever a história e evolução da cirurgia robótica nos últimos anos, bem como apresentar suas perspectivas futuras.

Laparoscopy & robotics: a historical parallel.

The evolution of robotic platforms has brought up ethical, economic, educational, and clinical applicability issues that refer to the early 1990s, when laparoscopy began its dissemination as a technology that would revolutionize surgery. Introduced in Brazil since 1990, laparoscopy has received a lot of resistance from different sectors, including the medical academy itself. The technique was considered expensive, complex, poorly available and with limited clinical applications. However, in a short time, it was established as the gold standard for the treatment of most diseases in different organ systems and surgical specialties. At this time, similarly to laparoscopy, robotic surgery is expressed as a disruptive technology, determining an important breakdown of paradigms, and moving the wheel of history forward. The author draws a parallel in relation to the use of both technologies in the surgeon's armamentarium. The fear of the "new technology", seen when laparoscopy appeared, is repeated with the advent of robotic surgery. Laparoscopy and robotic surgery, at the same time, imposed new knowledge challenges for surgeons, anesthetists, nurses, engineers - the need to learn again, to develop new skills. The previous experience of implementing laparoscopy should always be remembered and considered, optimizing the current scenario of the robotic platform, in its introduction and dissemination with the surgical community. The advent of the "robotic era" and its evolutionary potential will continue to assist surgeons in their mission to serve their patients with quality and safety.

Robotic spine surgery: a review of the present status.

With technological advancements being introduced and dominating many fields, spine surgery is no exception. In view of the patient safety and surgeon's comfort, robotics has been introduced in spine surgery. Due to small corridors for work, little room for inaccuracy, lengthy and tedious procedures, spine surgery is an ideal scenario for robotics to establish as the standard of care. Spine robotics received their first FDA clearance in 2004. New generation of spine robotics with integrated navigation systems has become available now. The primary role of spine robotics, at present, is to aid pedicle screw fixation. High quality studies have been performed to establish its role in increasing the accuracy of pedicle fixation. Studies have also reported decreased radiation and decreased operative time with spine robotics. However, few studies have reported otherwise. It is still in its nascent stage in both industrial view and surgeon familiarity. Continued research to overcome the challenges such as high cost and steep learning curve is crucial for its widespread use. Also, expanding the scope of spine robotics beyond pedicle screw fixation such as osteotomies and dural procedures would be an area for potential research. This review is intended to provide an overview of various studies in the field of robotic spine surgery and its present status.

A brief history of artificial intelligence and robotic surgery in orthopedics & traumatology and future expectations.

Recently, the rate of the production and renewal of information makes it almost impossible to be updated. It is quite difficult to process and interpret large amounts of data by human beings. Unlimited memory capacities, learning abilities, artificial intelligence (AI) applications, and robotic surgery techniques cause orthopedic surgeons to be concerned about losing their jobs. The idea of AI, which was first introduced in 1956, has evolved over time by revealing deep learning and evolutionary plexus that can mimic the human neuron cell. Image processing is the leading improvement in developed algorithms. Theoretically, these algorithms appear to be quite successful in interpreting medical images and orthopedic decision support systems for preoperative evaluation. Robotic surgeons have emerged as significant competitors in carrying out the taken decisions. The first robotic applications of orthopedic surgery started in 1992 with the ROBODOC system. Applications started with hip arthroplasty continued with knee arthroplasty. Publications indicate that problems such as blood loss and infection caused by the long operation time in the early stages have been overcome in time with the help of learning systems. Comparative studies conducted with humans indicate that robots are better than humans in providing limb lengthening, patient satisfaction, and cost. As in all new technologies, the developments in both AI applications and robotics surgery indicate that technology is in favor in terms of cost/benefit analyses. Although studies indicate that new technologies are more successful than humans, the replacement of technology with experience and long-term results with traditional methods will not be observed in the near future.

Is ovarian cancer surgery stuck in the dark ages?: a commentary piece reviewing surgical technologies.

Ovarian cancer surgery endeavours to remove all visible tumour deposits, and surgical technologies could potentially facilitate this aim. However, there appear to be barriers around the adoption of new technologies, and we hope this article provokes discussion within the specialty to encourage a forward-thinking approach to new-age surgical gynaecological oncology.

Past, Present, and Future of Robotic Surgery.

Robotic-assisted surgery embodies the latest in technological advancement and is being applied to operative management of patients. The current concept of robotic surgery involves performance of surgical procedures by using small wristed instruments attached to a robotic arm. Its extension to otolaryngology is only natural, because it allows for precise surgery through anatomic orifices, often allowing for preservation of critical anatomic structures and functions. Transoral robotic surgery is an effective and safe tool for head and neck surgeons. Its speed of recent growth and the imminent addition of innovative technology could signal the advent of a new era in surgery.

History and Acceptance of Transoral Robotic Surgery.

The development and acceptance of transoral robotic surgery from an experimental procedure to widespread acceptance in the management of head and neck cancers and other disease states occurred over the course of about a decade, from 2005 to 2015. Transoral robotic surgery has cemented its' place in the treatment of pharyngeal and laryngeal cancer. Education and training was key to broad use and acceptance. This article traces the history and evolution of transoral robotic surgery to its current practice. The process of surgical innovation in this arena is followed from early cadaveric studies to recent large systemic reviews of outcomes.

Intelligent, Autonomous Machines in Surgery.

Surgeons perform two primary tasks: operating and engaging patients and caregivers in shared decision-making. Human dexterity and decision-making are biologically limited. Intelligent, autonomous machines have the potential to augment or replace surgeons. Rather than regarding this possibility with denial, ire, or indifference, surgeons should understand and steer these technologies. Closer examination of surgical innovations and lessons learned from the automotive industry can inform this process. Innovations in minimally invasive surgery and surgical decision-making follow classic S-shaped curves with three phases: (1) introduction of a new technology, (2) achievement of a performance advantage relative to existing standards, and (3) arrival at a performance plateau, followed by replacement with an innovation featuring greater machine autonomy and less human influence. There is currently no level I evidence demonstrating improved patient outcomes using intelligent, autonomous machines for performing operations or surgical decision-making tasks. History suggests that if such evidence emerges and if the machines are cost effective, then they will augment or replace humans, initially for simple, common, rote tasks under close human supervision and later for complex tasks with minimal human supervision. This process poses ethical challenges in assigning liability for errors, matching decisions to patient values, and displacing human workers, but may allow surgeons to spend less time gathering and analyzing data and more time interacting with patients and tending to urgent, critical-and potentially more valuable-aspects of patient care. Surgeons should steer these technologies toward optimal patient care and net social benefit using the uniquely human traits of creativity, altruism, and moral deliberation.

History of Computer-Assisted Surgery.

Robotic surgery is growing rapidly, with more than 5000 units in operation worldwide. The most widely used robotic surgery system originated from the concept of telepresence, which led to government-sponsored research and development. The resulting work was taken over by private industry, which led to Food and Drug Administration clearance of the first systems in 2000 to 2001. Robotic surgery offers significant advantages over open surgery; its most important feature is the introduction of a computer into the operating room, with the resulting potential for data collection and analysis that will shape surgical practice in the future.