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Robotic versus laparoscopic surgery: perspectives for tailoring an optimal surgical option

Minimally invasive, patient-friendly approaches based on rapid technological advances have revolutionized surgery. A decade after the approval of the Da Vinci Surgical System (DVSS; Intuitive Surgical Inc., CA, USA) by the US FDA and two decades after the introduction of laparoscopic surgery, increasing evidence for the superiority of minimally invasive approaches progressively replaces traditional open surgery. The potential advantages of the DVSS over conventional laparoscopic surgery (CLS) include its greater precision, lower error rates, reduced bleeding, shorter hospital stays, more rapid patient recovery and reduced pain [1]. In this article, we discuss whether evidence for the safety and efficacy superiority of the DVSS over CLS, also considering cost–effectiveness aspects, encourages wider use in a day-to-day clinical practice for all or only specific surgical procedures. Expectations and limitations, particularly for improving outcomes of patients with solid cancer, are also described. The DVSS is an emerging minimal invasive technology. The surgeon directs the robotic arms of the system through a console by means of hand controls and pedals, making use of a stereoscopic viewing system. DVSS is currently being used in general, urological, gynecologic and cardiothoracic surgery.