Minimally invasive surgery has impacted the outcomes of surgery
more than any technology since the development of sterile
technique. The hard science has demonstrated that decrease in wound
complications and recovery time has created the biggest gap with
open approaches to surgery. The total economic benefit may be
unfathomable when looked at comprehensively. Integral to the rise
of minimal access and therapeutic techniques in surgery has been
the growth of technological improvements over time. Beginning with
insufflators, videoscopy, and energy devices, that evolution has
continued into the development of tele-surgical devices that
feature full articulation of instruments, high-resolution 3-D
optics, and computer assisted movement. This has come with
controversy - as the dominant manufacturer of robotic assisted
devices, Intuitive Surgical, and their generations of da Vinci
surgical platforms, holds enough market share to spur cries of
monopoly and financial excess. However, with over 3000 world-wide
systems in use, and over 6000 peer-reviewed research articles, the
impact of robotic surgery cannot be ignored. The current state of
data suggests equivalency in most procedures with regard to
traditional outcome measures, equal or somewhat elevated costs,
with specific areas of superiority. The first section of this
textbook, Surgical Robots, covers the history, economics, training,
and medico-legal aspects of robotic surgery that will be of
interest to students, residents, fellows, surgical staff, and
administrators or public health specialists who seek to gain a
comprehensive background on robotic surgery, or justification for
purchasing a robotic system for their institution. Surgeons will
also find this background valuable to their practice, to give
context to their procedures so they can better counsel their
patients, help with advocating for robotic platform purchases, and
proactively prepare themselves for medico-legal issues. The chapter
on legal issues will have specific instances of robotic
surgery-related lawsuits and their outcomes, a first for robotic
surgery texts. The second section of this textbook, Robotic
Procedures, will contain a comprehensive catalogue of procedures
that have been performed robotically in general surgery,
gynecology, urology, plastic surgery, cardiothoracic, and
otolaryngology. Each author will cover the existing literature,
preoperative planning, room and patient setup, steps of the
procedure, and postoperative care. Standardized room maps and port
placement will help the student, resident, fellow, surgeon or OR
Staff to quickly reference these before cases. Each chapter will
also cover the specific equipment needs and expected complexity of
the procedures, allowing administrators to better gauge how to
prepare for, or ration, use or their robotic resources. The final
section, Future of Robotics, will give the entire scope of audience
a look into what exciting advancements in the field are on the
horizon. This textbook is a complete resource for robotic-assisted
minimally invasive surgery, covering the history, current state,
technical and clinical aspects, and future considerations that may
be of interest to any who has a role, stake, or curiosity regarding
robotic surgery.
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