The first documented use of a robot assisted surgical procedure occurred in 1985 when the PUMA 560 robotic surgical arm was used in a delicate neurosurgical biopsy, a non-laparoscopic surgery.  The robotic system allowed for a successful procedure and the potential for greater precision when used in minimally invasive surgeries, such as laparoscopies which typically utilize flexible fiber optic cameras.  The 1985 procedure lead to the first laparoscopic procedure involving a robotic system, a cholescystecotomy, in 1987.  The following year the same PUMA system was used to perform a transurethral resection.  In 1990 the AESOP system produced by Computer Motion became the first system approved by the Food and Drug Administration (FDA) for its endoscopic surgical procedure.  

The da Vinci robotic surgery system broke new ground by becoming the first system approved by the FDA for general laparoscopic surgery in 2000.  This approval made da Vinci the first FDA approved robotic surgical system.  That is to say that with the da Vinci system, for the first time the FDA approved a system which is all-encompassing of surgical instruments and camera/scopic utensils.  Its predecessors all relied upon the use of endoscopes and numerous surgical assistants to perform surgery.  The da Vinci system’s truly three dimensional magnification capable view screen allows the surgeon to view the incision area in the clarity of high resolution.  The one centimeter diameter surgical arms represent a significant advancement in robotic surgery from the early large armed systems such as the PUMA 560.  With such miniaturized operating arms, the da Vinci system has been able to remove the need for using the tissue of the incision walls in the patient for leverage.  This advancement allows for less contact between exposed interior tissue and the surgical device, which greatly reduces risk of infection.  The “Endo-wrist” features of the operating arms on the da Vinci system replicate precisely the skilled movements of the surgeon at its controls.  This allows for highly precise movements within a small operating space.  The da Vinci system has been approved by the FDA for use in both adult and pediatric procedures in the following areas:

Applications for Robotic Surgery
The possible applications of robotic surgical systems are as extensive as the uses of minimally invasive surgery.  This is because robotic surgery is at the cutting edge of precision and miniaturization in the realm of medical advance.  Robotic surgery has already become a successful option in neurological, urological, gynecological, cardiothoracic, and numerous general surgical procedures.  Intuitive Surgical, makers of the da Vinci system, have released upgrades in the number of operating arms which eliminates the need for one surgical assistant.  This may allow for the expansion of the systems clinical applications.  

Procedures performed in Europe, particularly those done by German surgeons, have advanced the field of robotic medicine greatly.  Smith & Nephews in conjunction with URS Orthopedic Systems have created software to be used with robotic surgical systems such as da Vinci to perform knee repair and replacement surgeries.  Clinical testing is underway in hospitals throughout Germany to explore the orthopedic applications of robotic surgery.       

The Future of Robotic Surgery
The future of robotic surgery is nearly as promising as the human will to invent better ways of accomplishing delicate medical procedures.  It is reasonable to assume that the current advantages provided by robotic surgical systems will be expanded upon in the next generation of medical robotics.  The separation of patient from human contact during surgery, which reduces infection risks, may be taken to the next level with systems capable of functioning at greater distances between surgeons control console and the patient side table robotics.  This would allow surgeries to be conducted with patients in a near by “clean room” which could nearly completely eliminate infection during the operation.  Next generation medical robotics may allow for the surgery prep work to be conducted via remote as well.  

Other advancements may come in making more robotic systems more capable of replicating the tactile feel and sense which has been a criticism of the technology.  If the control consoles could implement a system which recreates the tactile information for the surgeon, which more invasive traditional hands on procedures naturally afforded, it would give the surgeon the best of both worlds.  The surgeon would gain all the precision and advantage of minimally invasive procedure without loosing the information acquired through his or her sense of feel to make judgment call based upon.