Robotic surgery's applications expanding.(Gynecology)

SAN DIEGO -- When precision matters, robotic surgery offers visual features that are "unparalleled by any other laparoscopic or open operation," William E. Kelley Jr., M.D., said at an international congress of the Society of Laparoendoscopic Surgeons.

But cost and patient benefits need to be considered before adopting robotic surgery on a widespread basis in any surgical discipline, advised Dr. Kelley, a general surgeon who practices in Richmond, Va.

Dr. Kelley, who chairs the society's special interest group committee on robotic surgery, considers the term to be an unfortunate one. "Robotic surgery is not performed by robots, which are independently operated, pre-programmed machines ... This is computer-enhanced minimally invasive surgery. It's truly three-dimensional, and it's under the surgeon's control."

Computer-enhanced surgery has been used for the last 10-12 years in orthopedic surgery for drilling the femoral shaft with a precision that is "about 10 times" better than that achievable by a surgeon without computer assistance," he said.

In addition, the devices are equipped with electronic filtering, "which means no matter how late the surgeon's been up, no matter how many cups of coffee the surgeon's had that day, and no matter how many operations [he's] done, there is zero tremor in the instrument," Dr. Kelley said.

The devices also have motion scaling, "so the very forced movement of the surgeon's hand can become translated into a very fine motion at the incident tip," he explained. "There's forearm support, and it's a 3-D magnifying field with six degrees of freedom: up-down, side-to-side, in and out, rotation, pitch, and yaw."

Traditional surgery cannot achieve the flexibility of the instrumentation. "The movements are simultaneous and fluid. It's direct and intuitive. It also conveys true ambidexterity to almost any surgeon within minutes of sitting down at the instrument," he said.