Robotics Training and Simulation

Minimally invasive surgery (MIS) originated in the 1970s in Germany where Kurt Semm, a gynecologist and engineer at the University of Kiel, headed a team that constructed laparoscopic instrumentation to successfully perform various laparoscopic gynecological procedures, as well as the first “endoscopic appendectomy” in 1982. The general surgery community adopted this early laparoscopic technology and successfully performed the first laparoscopic cholecystectomy in 1985. Ultimately, with the advent of video recording and widespread transmission, general surgeons were able to create significant headway in the global adoption and advancement of laparoscopic surgery [1]. Compared to an open approach, advantages to MIS are well established and include reduced postoperative wound infections, blood loss, length of hospital course, postoperative analgesic requirement, and improved wound aesthetics. Disadvantages to MIS include the fulcrum effect, which requires the inversion of hand-instrument movements. In addition, there is restricted hepatic feedback, loss of depth perception, and at times, challenging ergonomics, all of which create a significant learning curve to overcome [2, 3]. With its approval in 2000 by the United States Food and Drug Administration (FDA), the da Vinci surgical system was implemented in an attempt to overcome many of the MIS limitations; its innovative design incorporated high definition three-dimensional (3D) vision, optimal visualization with 10 times magnification, elimination of the fulcrum effect, reduction of hand tremor, and vastly improved surgeon ergonomics [4]. The system is currently in its fourth generation (da Vinci Xi) and includes the following components: a surgeon console that allows the surgeon to view the operative area and manipulate the robotic instruments, a patient side cart that maintains the camera and endowrist instruments with seven degrees of freedom via articulated arms, and a 3D visualization cart [5, 6].