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Robot-assisted surgery - Wikipedia

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id="toc-Gynecology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Bone" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Bone"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.7</span> <span>Bone</span> </div> </a> <ul id="toc-Bone-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Spine" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Spine"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.8</span> <span>Spine</span> </div> </a> <ul id="toc-Spine-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Transplant_surgery" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Transplant_surgery"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.9</span> <span>Transplant surgery</span> </div> </a> <ul id="toc-Transplant_surgery-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-General_surgery" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#General_surgery"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.10</span> <span>General surgery</span> </div> </a> <ul id="toc-General_surgery-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Hernia_and_abdominal_wall_surgery" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Hernia_and_abdominal_wall_surgery"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.11</span> <span>Hernia and abdominal wall surgery</span> </div> </a> <ul id="toc-Hernia_and_abdominal_wall_surgery-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Urology" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Urology"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.12</span> <span>Urology</span> </div> </a> <ul id="toc-Urology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Pediatrics" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Pediatrics"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.13</span> <span>Pediatrics</span> </div> </a> <ul id="toc-Pediatrics-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Comparison_to_traditional_methods" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Comparison_to_traditional_methods"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Comparison to traditional methods</span> </div> </a> <ul id="toc-Comparison_to_traditional_methods-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Use_in_popular_media" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Use_in_popular_media"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Use in popular media</span> </div> </a> <ul id="toc-Use_in_popular_media-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" ><span class="vector-icon mw-ui-icon-listBullet mw-ui-icon-wikimedia-listBullet"></span> <span class="vector-dropdown-label-text">Toggle the table of contents</span> </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading"><span class="mw-page-title-main">Robot-assisted surgery</span></h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 26 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-26" aria-hidden="true" ><span class="vector-icon mw-ui-icon-language-progressive mw-ui-icon-wikimedia-language-progressive"></span> <span class="vector-dropdown-label-text">26 languages</span> </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D8%AC%D8%B1%D8%A7%D8%AD%D8%A9_%D8%B1%D9%88%D8%A8%D9%88%D8%AA%D9%8A%D8%A9" title="جراحة روبوتية – Arabic" lang="ar" hreflang="ar" data-title="جراحة روبوتية" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-be mw-list-item"><a href="https://be.wikipedia.org/wiki/%D0%A0%D0%B0%D0%B1%D0%B0%D1%82%D1%8B%D0%B7%D0%B0%D0%B2%D0%B0%D0%BD%D0%B0%D1%8F_%D1%85%D1%96%D1%80%D1%83%D1%80%D0%B3%D1%96%D1%8F" title="Рабатызаваная хірургія – Belarusian" lang="be" hreflang="be" data-title="Рабатызаваная хірургія" data-language-autonym="Беларуская" data-language-local-name="Belarusian" class="interlanguage-link-target"><span>Беларуская</span></a></li><li class="interlanguage-link interwiki-bg mw-list-item"><a href="https://bg.wikipedia.org/wiki/%D0%A0%D0%BE%D0%B1%D0%BE%D1%82%D0%B8%D0%B7%D0%B8%D1%80%D0%B0%D0%BD%D0%B0_%D1%85%D0%B8%D1%80%D1%83%D1%80%D0%B3%D0%B8%D1%8F" title="Роботизирана хирургия – Bulgarian" lang="bg" hreflang="bg" data-title="Роботизирана хирургия" data-language-autonym="Български" data-language-local-name="Bulgarian" class="interlanguage-link-target"><span>Български</span></a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Robotick%C3%A1_chirurgie" title="Robotická chirurgie – Czech" lang="cs" hreflang="cs" data-title="Robotická chirurgie" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target"><span>Čeština</span></a></li><li class="interlanguage-link interwiki-et mw-list-item"><a href="https://et.wikipedia.org/wiki/Meditsiinirobot" title="Meditsiinirobot – Estonian" lang="et" hreflang="et" data-title="Meditsiinirobot" data-language-autonym="Eesti" data-language-local-name="Estonian" class="interlanguage-link-target"><span>Eesti</span></a></li><li class="interlanguage-link interwiki-el mw-list-item"><a href="https://el.wikipedia.org/wiki/%CE%A1%CE%BF%CE%BC%CF%80%CE%BF%CF%84%CE%B9%CE%BA%CE%AE_%CF%87%CE%B5%CE%B9%CF%81%CE%BF%CF%85%CF%81%CE%B3%CE%B9%CE%BA%CE%AE" title="Ρομποτική χειρουργική – Greek" lang="el" hreflang="el" data-title="Ρομποτική χειρουργική" data-language-autonym="Ελληνικά" data-language-local-name="Greek" class="interlanguage-link-target"><span>Ελληνικά</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Cirug%C3%ADa_rob%C3%B3tica" title="Cirugía robótica – Spanish" lang="es" hreflang="es" data-title="Cirugía robótica" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D8%AC%D8%B1%D8%A7%D8%AD%DB%8C_%D8%B1%D8%A8%D8%A7%D8%AA%DB%8C%DA%A9" title="جراحی رباتیک – Persian" lang="fa" hreflang="fa" data-title="جراحی رباتیک" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EB%A1%9C%EB%B4%87_%EC%88%98%EC%88%A0" title="로봇 수술 – Korean" lang="ko" hreflang="ko" data-title="로봇 수술" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-hi mw-list-item"><a href="https://hi.wikipedia.org/wiki/%E0%A4%B0%E0%A5%8B%E0%A4%AC%E0%A5%8B%E0%A4%9F%E0%A4%BF%E0%A4%95_%E0%A4%B8%E0%A4%B0%E0%A5%8D%E0%A4%9C%E0%A4%B0%E0%A5%80" title="रोबोटिक सर्जरी – Hindi" lang="hi" hreflang="hi" data-title="रोबोटिक सर्जरी" data-language-autonym="हिन्दी" data-language-local-name="Hindi" class="interlanguage-link-target"><span>हिन्दी</span></a></li><li class="interlanguage-link interwiki-hr mw-list-item"><a href="https://hr.wikipedia.org/wiki/Robotska_kirurgija" title="Robotska kirurgija – Croatian" lang="hr" hreflang="hr" data-title="Robotska kirurgija" data-language-autonym="Hrvatski" data-language-local-name="Croatian" class="interlanguage-link-target"><span>Hrvatski</span></a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Pembedahan_yang_dibantu_robot" title="Pembedahan yang dibantu robot – Indonesian" lang="id" hreflang="id" data-title="Pembedahan yang dibantu robot" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target"><span>Bahasa Indonesia</span></a></li><li class="interlanguage-link interwiki-zu mw-list-item"><a href="https://zu.wikipedia.org/wiki/Ukuhlinzwa_ngosizo_lwesithununu" title="Ukuhlinzwa ngosizo lwesithununu – Zulu" lang="zu" hreflang="zu" data-title="Ukuhlinzwa ngosizo lwesithununu" data-language-autonym="IsiZulu" data-language-local-name="Zulu" class="interlanguage-link-target"><span>IsiZulu</span></a></li><li class="interlanguage-link interwiki-is mw-list-item"><a href="https://is.wikipedia.org/wiki/A%C3%B0ger%C3%B0a%C3%BEjarki" title="Aðgerðaþjarki – Icelandic" lang="is" hreflang="is" data-title="Aðgerðaþjarki" data-language-autonym="Íslenska" data-language-local-name="Icelandic" class="interlanguage-link-target"><span>Íslenska</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Chirurgia_robotica" title="Chirurgia robotica – Italian" lang="it" hreflang="it" data-title="Chirurgia robotica" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%9B%D7%99%D7%A8%D7%95%D7%A8%D7%92%D7%99%D7%94_%D7%A8%D7%95%D7%91%D7%95%D7%98%D7%99%D7%AA" title="כירורגיה רובוטית – Hebrew" lang="he" hreflang="he" data-title="כירורגיה רובוטית" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target"><span>עברית</span></a></li><li class="interlanguage-link interwiki-hu mw-list-item"><a href="https://hu.wikipedia.org/wiki/Robotseb%C3%A9szet" title="Robotsebészet – Hungarian" lang="hu" hreflang="hu" data-title="Robotsebészet" data-language-autonym="Magyar" data-language-local-name="Hungarian" class="interlanguage-link-target"><span>Magyar</span></a></li><li class="interlanguage-link interwiki-xmf mw-list-item"><a href="https://xmf.wikipedia.org/wiki/%E1%83%A0%E1%83%9D%E1%83%91%E1%83%9D%E1%83%A2%E1%83%A3%E1%83%9A%E1%83%98_%E1%83%A5%E1%83%98%E1%83%A0%E1%83%A3%E1%83%A0%E1%83%92%E1%83%98%E1%83%90" title="რობოტული ქირურგია – Mingrelian" lang="xmf" hreflang="xmf" data-title="რობოტული ქირურგია" data-language-autonym="მარგალური" data-language-local-name="Mingrelian" class="interlanguage-link-target"><span>მარგალური</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E3%83%AD%E3%83%9C%E3%83%83%E3%83%88%E6%94%AF%E6%8F%B4%E6%89%8B%E8%A1%93" title="ロボット支援手術 – Japanese" lang="ja" hreflang="ja" data-title="ロボット支援手術" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-ps mw-list-item"><a href="https://ps.wikipedia.org/wiki/%DA%A9%D9%85%D9%BE%DB%8C%D9%88%D9%BC%D8%B1%D9%8A_%D8%AC%D8%B1%D8%A7%D8%AD%D9%8A" title="کمپیوټري جراحي – Pashto" lang="ps" hreflang="ps" data-title="کمپیوټري جراحي" data-language-autonym="پښتو" data-language-local-name="Pashto" class="interlanguage-link-target"><span>پښتو</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Cirurgia_rob%C3%B3tica" title="Cirurgia robótica – Portuguese" lang="pt" hreflang="pt" data-title="Cirurgia robótica" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%A0%D0%BE%D0%B1%D0%BE%D1%82%D0%B8%D0%B7%D0%B8%D1%80%D0%BE%D0%B2%D0%B0%D0%BD%D0%BD%D0%B0%D1%8F_%D1%85%D0%B8%D1%80%D1%83%D1%80%D0%B3%D0%B8%D1%8F" title="Роботизированная хирургия – Russian" lang="ru" hreflang="ru" data-title="Роботизированная хирургия" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target"><span>Русский</span></a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/%D0%A0%D0%BE%D0%B1%D0%BE%D1%82%D1%81%D0%BA%D0%B0_%D1%85%D0%B8%D1%80%D1%83%D1%80%D0%B3%D0%B8%D1%98%D0%B0" title="Роботска хирургија – Serbian" lang="sr" hreflang="sr" data-title="Роботска хирургија" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target"><span>Српски / srpski</span></a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/Leikkausrobotti" title="Leikkausrobotti – Finnish" lang="fi" hreflang="fi" data-title="Leikkausrobotti" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target"><span>Suomi</span></a></li><li class="interlanguage-link interwiki-uk mw-list-item"><a href="https://uk.wikipedia.org/wiki/%D0%A0%D0%BE%D0%B1%D0%BE%D1%82%D0%B8%D0%B7%D0%BE%D0%B2%D0%B0%D0%BD%D0%B0_%D1%85%D1%96%D1%80%D1%83%D1%80%D0%B3%D1%96%D1%8F" title="Роботизована хірургія – Ukrainian" lang="uk" hreflang="uk" data-title="Роботизована хірургія" data-language-autonym="Українська" data-language-local-name="Ukrainian" class="interlanguage-link-target"><span>Українська</span></a></li><li class="interlanguage-link interwiki-bat-smg mw-list-item"><a href="https://bat-smg.wikipedia.org/wiki/Medec%C4%97n%C4%97n%C4%93_ruobuot%C4%81" title="Medecėnėnē ruobuotā – Samogitian" lang="sgs" hreflang="sgs" data-title="Medecėnėnē ruobuotā" data-language-autonym="Žemaitėška" data-language-local-name="Samogitian" 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.mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox"><tbody><tr><th colspan="2" class="infobox-above" style="background-color: lightblue">Robot-assisted surgery</th></tr><tr><td colspan="2" class="infobox-image"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:Laproscopic_Surgery_Robot.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/0/0d/Laproscopic_Surgery_Robot.jpg/280px-Laproscopic_Surgery_Robot.jpg" decoding="async" width="280" height="407" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/0/0d/Laproscopic_Surgery_Robot.jpg/420px-Laproscopic_Surgery_Robot.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/0/0d/Laproscopic_Surgery_Robot.jpg/560px-Laproscopic_Surgery_Robot.jpg 2x" data-file-width="891" data-file-height="1296" /></a></span><div class="infobox-caption">A robotically assisted surgical system used for prostatectomies, cardiac valve repair and gynecologic surgical procedures</div></td></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data">Robotically-assisted surgery</td></tr><tr class="noprint"><td colspan="2" class="infobox-full-data"><div style="text-align: right;">&#91;<a href="https://www.wikidata.org/wiki/Q942348" class="extiw" title="d:Q942348">edit on Wikidata</a>]</div></td></tr></tbody></table> <p><b>Robot-assisted surgery</b> or <b>robotic surgery</b> are any types of <a href="/wiki/Surgical_procedures" class="mw-redirect" title="Surgical procedures">surgical procedures</a> that are performed using <a href="/wiki/Robot" title="Robot">robotic</a> systems. Robotically assisted surgery was developed to try to overcome the limitations of pre-existing <a href="/wiki/Minimally-invasive_procedures" class="mw-redirect" title="Minimally-invasive procedures">minimally-invasive surgical procedures</a> and to enhance the capabilities of surgeons performing open surgery. </p><p>In the case of robotically assisted minimally-invasive surgery, instead of the surgeon directly moving the instruments, the surgeon uses one of two methods to perform <a href="/wiki/Dissection" title="Dissection">dissection</a>, <a href="/wiki/Hemostasis" title="Hemostasis">hemostasis</a> and <a href="/wiki/Resection_(surgery)" class="mw-redirect" title="Resection (surgery)">resection</a>, using a direct <a href="/wiki/Remote_manipulator" title="Remote manipulator">telemanipulator</a>, or through computer control. </p> <ul><li>A telemanipulator (e.g. the <a href="/wiki/Da_Vinci_Surgical_System" title="Da Vinci Surgical System">da Vinci Surgical System</a>) is a system of remotely controlled <a href="/wiki/Manipulator_(device)" title="Manipulator (device)">manipulators</a> that allows the surgeon to operate real-time under <a href="/wiki/Stereoscopic_vision" class="mw-redirect" title="Stereoscopic vision">stereoscopic vision</a> from a control console separate from the <a href="/wiki/Operating_table" title="Operating table">operating table</a>. The robot is docked next to the patient, and <a href="/wiki/Robotic_arm" title="Robotic arm">robotic arms</a> carry out endoscopy-like maneuvers via <a href="/wiki/Robot_end_effector" title="Robot end effector">end-effectors</a> inserted through specially designed <a href="/wiki/Trocar" title="Trocar">trocars</a>. A <a href="/wiki/Surgical_assistant" class="mw-redirect" title="Surgical assistant">surgical assistant</a> and a <a href="/wiki/Scrub_nurse" class="mw-redirect" title="Scrub nurse">scrub nurse</a> are often still needed <a href="/wiki/Aseptic_technique" class="mw-redirect" title="Aseptic technique">scrubbed</a> at the tableside to help switch effector instruments or provide additional <a href="/wiki/Suction_(medicine)" title="Suction (medicine)">suction</a> or temporary tissue retraction using endoscopic grasping instruments.</li> <li>In computer-controlled systems, the surgeon uses a <a href="/wiki/Computer_system" class="mw-redirect" title="Computer system">computer system</a> to relay control data and direct the robotic arms and its end-effectors, though these systems can also still use telemanipulators for their input. One advantage of using the computerized method is that the surgeon does not have to be present on campus to perform the procedure, leading to the possibility for <a href="/wiki/Remote_surgery" title="Remote surgery">remote surgery</a> and even <a href="/wiki/AI" class="mw-redirect" title="AI">AI</a>-assisted or automated procedures.</li></ul> <p>Robotic surgery has been criticized for its expense, with the average costs in 2007 ranging from $5,607 to $45,914 per patient.<sup id="cite_ref-Barbash_2010_1-0" class="reference"><a href="#cite_note-Barbash_2010-1"><span class="cite-bracket">&#91;</span>1<span class="cite-bracket">&#93;</span></a></sup> This technique has not been approved for cancer surgery as of 2019 as the safety and usefulness is unclear.<sup id="cite_ref-2" class="reference"><a href="#cite_note-2"><span class="cite-bracket">&#91;</span>2<span class="cite-bracket">&#93;</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="History">History</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Robot-assisted_surgery&amp;action=edit&amp;section=1" title="Edit section: History"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The concept of using standard hand grips to control manipulators and cameras of various sizes down to sub-miniature was described in the Robert Heinlein story '<a href="/wiki/Waldo_(short_story)" title="Waldo (short story)">Waldo</a>' in August 1942, which also mentioned brain surgery. The first robot to assist in surgery was the <i>Arthrobot</i>, which was developed and used for the first time in <a href="/wiki/Vancouver" title="Vancouver">Vancouver</a> in 1984.<sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">&#91;</span>3<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-Lauterbach_2017_4-0" class="reference"><a href="#cite_note-Lauterbach_2017-4"><span class="cite-bracket">&#91;</span>4<span class="cite-bracket">&#93;</span></a></sup> This robot assisted in being able to manipulate and position the patient's leg on voice command. Intimately involved were <a href="/wiki/Biomedical_engineering" title="Biomedical engineering">biomedical engineer</a> <a href="/wiki/James_McEwen_(engineer)" title="James McEwen (engineer)">James McEwen</a>, Geof Auchinleck, a UBC <a href="/wiki/Engineering_physics" title="Engineering physics">engineering physics</a> grad, and <a href="/wiki/Brian_Day" title="Brian Day">Dr. Brian Day</a> as well as a team of engineering students. The robot was used in an <a href="/wiki/Orthopaedy" class="mw-redirect" title="Orthopaedy">orthopaedic</a> surgical procedure on 12 March 1984, at the <a href="/wiki/UBC_Hospital" title="UBC Hospital">UBC Hospital</a> in Vancouver. Over 60 <a href="/wiki/Arthroscopy" title="Arthroscopy">arthroscopic</a> surgical procedures were performed in the first 12 months, and a 1985 <a href="/wiki/National_Geographic_Society" title="National Geographic Society">National Geographic</a> video on industrial robots, <i>The Robotics Revolution</i>, featured the device. Other related robotic devices developed at the same time included a surgical <a href="/wiki/Scrub_nurse" class="mw-redirect" title="Scrub nurse">scrub nurse</a> robot, which handed operative instruments on voice command, and a medical laboratory robotic arm. A YouTube video entitled <i>Arthrobot – the world's first surgical robot</i> illustrates some of these in operation.<sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">&#91;</span>5<span class="cite-bracket">&#93;</span></a></sup> </p><p>In 1985 a robot, the <a href="/wiki/Programmable_Universal_Machine_for_Assembly" title="Programmable Universal Machine for Assembly">Unimation Puma 200</a>, was used to orient a needle for a brain biopsy while under CT guidance during a neurological procedure.<sup id="cite_ref-6" class="reference"><a href="#cite_note-6"><span class="cite-bracket">&#91;</span>6<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-Lauterbach_2017_4-1" class="reference"><a href="#cite_note-Lauterbach_2017-4"><span class="cite-bracket">&#91;</span>4<span class="cite-bracket">&#93;</span></a></sup> In the late 1980s, Imperial College in London developed PROBOT, which was then used to perform prostatic surgery. The advantages to this robot was its small size, accuracy and lack of fatigue for the surgeon. In the 1990s, computer-controlled surgical devices began to emerge, enabling greater precision and control in surgical procedures. One of the most significant advancements in this period was the da Vinci Surgical System, which was approved by the <a href="/wiki/Food_and_Drug_Administration" title="Food and Drug Administration">FDA</a> for use in surgical procedures in 2000 (Intuitive Surgical, 2021). The da Vinci system uses robotic arms to manipulate surgical instruments, allowing surgeons to perform complex procedures with greater accuracy and control.<sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">&#91;</span>7<span class="cite-bracket">&#93;</span></a></sup> In 1992, the ROBODOC was introduced and revolutionized orthopedic surgery by being able to assist with hip replacement surgeries.<sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">&#91;</span>8<span class="cite-bracket">&#93;</span></a></sup> The latter was the first surgical robot that was approved by the FDA in 2008.<sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">&#91;</span>9<span class="cite-bracket">&#93;</span></a></sup> The ROBODOC from Integrated Surgical Systems (working closely with <a href="/wiki/IBM" title="IBM">IBM</a>) could mill out precise fittings in the <a href="/wiki/Femur" title="Femur">femur</a> for hip replacement.<sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">&#91;</span>10<span class="cite-bracket">&#93;</span></a></sup> The purpose of the ROBODOC was to replace the previous method of carving out a femur for an implant, the use of a mallet and broach/rasp. </p><p>Further development of robotic systems was carried out by <a href="/wiki/SRI_International" title="SRI International">SRI International</a> and <a href="/wiki/Intuitive_Surgical" title="Intuitive Surgical">Intuitive Surgical</a> with the introduction of the <a href="/wiki/Da_Vinci_Surgical_System" title="Da Vinci Surgical System">da Vinci Surgical System</a> and <a href="/wiki/Computer_Motion" class="mw-redirect" title="Computer Motion">Computer Motion</a> with the <i>AESOP</i> and the <a href="/wiki/ZEUS_robotic_surgical_system" title="ZEUS robotic surgical system">ZEUS robotic surgical system</a>.<sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span class="cite-bracket">&#91;</span>11<span class="cite-bracket">&#93;</span></a></sup> The first robotic surgery took place at <a href="/wiki/The_Ohio_State_University_Medical_Center" class="mw-redirect" title="The Ohio State University Medical Center">The Ohio State University Medical Center</a> in <a href="/wiki/Columbus,_Ohio" title="Columbus, Ohio">Columbus</a>, Ohio under the direction of <a href="/wiki/Robert_E._Michler" title="Robert E. Michler">Robert E. Michler</a>.<sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">&#91;</span>12<span class="cite-bracket">&#93;</span></a></sup> </p><p>AESOP was a breakthrough in robotic surgery when introduced in 1994, as it was the first laparoscopic camera holder to be approved by the FDA. NASA initially funded the company that produces AESOP, Computer Motion, due to its goal to create a robotic arm that can be used in space, but this project ended up becoming a camera used in laparoscopic procedures. Voice control was then added in 1996 with the AESOP 2000 and seven degrees of freedom to mimic a human hand was added in 1998 with the AESOP 3000.<sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span class="cite-bracket">&#91;</span>13<span class="cite-bracket">&#93;</span></a></sup> </p><p>ZEUS was introduced commercially in 1998, and started the idea of telerobotics or telepresence surgery where the surgeon is at a distance from the robot on a console and operates on the patient.<sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">&#91;</span>14<span class="cite-bracket">&#93;</span></a></sup> ZEUS was first used during a gynecological surgery in 1997 to reconnect Fallopian tubes in Cleveland Ohio,<sup id="cite_ref-Lauterbach_2017_4-2" class="reference"><a href="#cite_note-Lauterbach_2017-4"><span class="cite-bracket">&#91;</span>4<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">&#91;</span>15<span class="cite-bracket">&#93;</span></a></sup> a <i>beating heart</i> coronary artery bypass graft in October 1999,<sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">&#91;</span>16<span class="cite-bracket">&#93;</span></a></sup> and the <a href="/wiki/Lindbergh_Operation" class="mw-redirect" title="Lindbergh Operation">Lindbergh Operation</a>, which was a <a href="/wiki/Cholecystectomy" title="Cholecystectomy">cholecystectomy</a> performed remotely in September 2001.<sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span class="cite-bracket">&#91;</span>17<span class="cite-bracket">&#93;</span></a></sup> In 2003, ZEUS made its most prominent mark in cardiac surgery after successfully harvesting the left internal mammary arteries in 19 patients, all of which had very successful clinical outcomes.<sup id="cite_ref-18" class="reference"><a href="#cite_note-18"><span class="cite-bracket">&#91;</span>18<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-pmid120087632_19-0" class="reference"><a href="#cite_note-pmid120087632-19"><span class="cite-bracket">&#91;</span>19<span class="cite-bracket">&#93;</span></a></sup> </p><p>The original telesurgery robotic system that the da Vinci was based on was developed at Stanford Research Institute International in Menlo Park with grant support from <a href="/wiki/Defense_Advanced_Research_Projects_Agency" class="mw-redirect" title="Defense Advanced Research Projects Agency">DARPA</a> and <a href="/wiki/NASA" title="NASA">NASA</a>.<sup id="cite_ref-20" class="reference"><a href="#cite_note-20"><span class="cite-bracket">&#91;</span>20<span class="cite-bracket">&#93;</span></a></sup> A demonstration of an open bowel anastomosis was given to the Association of Military Surgeons of the US.<sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">&#91;</span>21<span class="cite-bracket">&#93;</span></a></sup> Although the telesurgical robot was originally intended to facilitate remotely performed surgery in the battlefield to reduce casualties and to be used in other remote environments, it turned out to be more useful for minimally invasive on-site surgery.<sup id="cite_ref-22" class="reference"><a href="#cite_note-22"><span class="cite-bracket">&#91;</span>22<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-Outpatient_Robotic_surgery:_Conside_23-0" class="reference"><a href="#cite_note-Outpatient_Robotic_surgery:_Conside-23"><span class="cite-bracket">&#91;</span>23<span class="cite-bracket">&#93;</span></a></sup> The patents for the early prototype were sold to Intuitive Surgical in Mountain View, California. The da Vinci senses the surgeon's hand movements and translates them electronically into scaled-down micro-movements to manipulate the tiny proprietary instruments. It also detects and filters out any tremors in the surgeon's hand movements, so that they are not duplicated robotically. The camera used in the system provides a true stereoscopic picture transmitted to a surgeon's console. Compared to the ZEUS, the da Vinci robot is attached to trocars to the surgical table, and can imitate the human wrist. In 2000, the da Vinci obtained FDA approval for general laparoscopic procedures and became the first operative surgical robot in the US.<sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">&#91;</span>24<span class="cite-bracket">&#93;</span></a></sup> Examples of using the da Vinci system include the first robotically assisted <a href="/wiki/Heart_bypass" class="mw-redirect" title="Heart bypass">heart bypass</a> (performed in Germany) in May 1998, and the first performed in the United States in September 1999;<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">&#91;<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (January 2011)">citation needed</span></a></i>&#93;</sup> and the first all-robotic-assisted <a href="/wiki/Kidney_transplant" class="mw-redirect" title="Kidney transplant">kidney transplant</a>, performed in January 2009.<sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">&#91;</span>25<span class="cite-bracket">&#93;</span></a></sup> The da Vinci Si was released in April 2009 and initially sold for $1.75&#160;million.<sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">&#91;</span>26<span class="cite-bracket">&#93;</span></a></sup> </p><p>In 2005, a surgical technique was documented in canine and cadaveric models called the transoral robotic surgery (TORS) for the da Vinci robot surgical system as it was the only FDA-approved robot to perform head and neck surgery.<sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">&#91;</span>27<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-Weinstein_20052_28-0" class="reference"><a href="#cite_note-Weinstein_20052-28"><span class="cite-bracket">&#91;</span>28<span class="cite-bracket">&#93;</span></a></sup> In 2006, three patients underwent resection of the tongue using this technique.<sup id="cite_ref-Weinstein_20052_28-1" class="reference"><a href="#cite_note-Weinstein_20052-28"><span class="cite-bracket">&#91;</span>28<span class="cite-bracket">&#93;</span></a></sup> The results were more clear visualization of the cranial nerves, lingual nerves, and lingual artery, and the patients had a faster recovery to normally swallowing.<sup id="cite_ref-29" class="reference"><a href="#cite_note-29"><span class="cite-bracket">&#91;</span>29<span class="cite-bracket">&#93;</span></a></sup> In May 2006 the first <a href="/wiki/Artificial_intelligence" title="Artificial intelligence">artificial intelligence</a> doctor-conducted unassisted robotic surgery was on a 34-year-old male to correct <a href="/wiki/Heart_arrythmia" class="mw-redirect" title="Heart arrythmia">heart arrhythmia</a>. The results were rated as better than an above-average human surgeon. The machine had a <a href="/wiki/Database" title="Database">database</a> of 10,000 similar operations, and so, in the words of its designers, was "more than qualified to operate on any patient".<sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">&#91;</span>30<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-31" class="reference"><a href="#cite_note-31"><span class="cite-bracket">&#91;</span>31<span class="cite-bracket">&#93;</span></a></sup> In August 2007, Dr. Sijo Parekattil of the Robotics Institute and Center for Urology (Winter Haven Hospital and University of Florida) performed the first robotic-assisted microsurgery procedure denervation of the spermatic cord for chronic testicular pain.<sup id="cite_ref-32" class="reference"><a href="#cite_note-32"><span class="cite-bracket">&#91;</span>32<span class="cite-bracket">&#93;</span></a></sup> In February 2008, Dr. Mohan S. Gundeti of the <a href="/wiki/University_of_Chicago_Comer_Children%27s_Hospital" class="mw-redirect" title="University of Chicago Comer Children&#39;s Hospital">University of Chicago Comer Children's Hospital</a> performed the first robotic pediatric neurogenic bladder reconstruction.<sup id="cite_ref-33" class="reference"><a href="#cite_note-33"><span class="cite-bracket">&#91;</span>33<span class="cite-bracket">&#93;</span></a></sup> </p><p>On 12 May 2008, the first image-guided MR-compatible robotic neurosurgical procedure was performed at <a href="/wiki/University_of_Calgary" title="University of Calgary">University of Calgary</a> by Dr. Garnette Sutherland using the <a href="/wiki/NeuroArm" title="NeuroArm">NeuroArm</a>.<sup id="cite_ref-34" class="reference"><a href="#cite_note-34"><span class="cite-bracket">&#91;</span>34<span class="cite-bracket">&#93;</span></a></sup> In June 2008, the <a href="/wiki/German_Aerospace_Centre" class="mw-redirect" title="German Aerospace Centre">German Aerospace Centre</a> (DLR) presented a robotic system for minimally invasive surgery, the <a href="/wiki/MiroSurge" title="MiroSurge">MiroSurge</a>.<sup id="cite_ref-35" class="reference"><a href="#cite_note-35"><span class="cite-bracket">&#91;</span>35<span class="cite-bracket">&#93;</span></a></sup> In September 2010, the <a href="/wiki/Eindhoven_University_of_Technology" title="Eindhoven University of Technology">Eindhoven University of Technology</a> announced the development of the <a href="/wiki/Sofie_(surgical_robot)" title="Sofie (surgical robot)">Sofie</a> surgical system, the first surgical robot to employ <a href="/wiki/Haptic_technology#Force_feedback" title="Haptic technology">force feedback</a>.<sup id="cite_ref-36" class="reference"><a href="#cite_note-36"><span class="cite-bracket">&#91;</span>36<span class="cite-bracket">&#93;</span></a></sup> In September 2010, the first robotic operation at the <a href="/wiki/Femoral_vasculature" class="mw-redirect" title="Femoral vasculature">femoral vasculature</a> was performed at the <a href="/wiki/University_Medical_Centre_Ljubljana" class="mw-redirect" title="University Medical Centre Ljubljana">University Medical Centre Ljubljana</a> by a team led by <a href="/w/index.php?title=Borut_Ger%C5%A1ak&amp;action=edit&amp;redlink=1" class="new" title="Borut Geršak (page does not exist)">Borut Geršak</a>.<sup id="cite_ref-FV_robo12_37-0" class="reference"><a href="#cite_note-FV_robo12-37"><span class="cite-bracket">&#91;</span>37<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-FV_robo22_38-0" class="reference"><a href="#cite_note-FV_robo22-38"><span class="cite-bracket">&#91;</span>38<span class="cite-bracket">&#93;</span></a></sup> </p><p>In 2019 the <a href="/wiki/CMR_Surgical" title="CMR Surgical">Versius Surgical Robotic System</a> was launched and is a rival of the Da Vinci surgical system and claims to be more flexible and versatile, having independent modular arms which are "quick and easy to set up". The small-scale design means that it is suitable for virtually any operating room and can be operated at either a standing or a sitting position.<sup id="cite_ref-39" class="reference"><a href="#cite_note-39"><span class="cite-bracket">&#91;</span>39<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Uses">Uses</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Robot-assisted_surgery&amp;action=edit&amp;section=2" title="Edit section: Uses"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Ophthalmology">Ophthalmology</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Robot-assisted_surgery&amp;action=edit&amp;section=3" title="Edit section: Ophthalmology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Ophthalmology" title="Ophthalmology">Ophthalmology</a> is still part of the frontier for robotic-assisted surgeries. However, there are a couple of robotic systems that are capable of successfully performing <a href="/wiki/Surgery" title="Surgery">surgeries</a>.<sup id="cite_ref-de_Smet_2018_40-0" class="reference"><a href="#cite_note-de_Smet_2018-40"><span class="cite-bracket">&#91;</span>40<span class="cite-bracket">&#93;</span></a></sup> </p> <ul><li>PRECEYES Surgical System is being used for vitreoretinal surgeries. This is a single arm robot, that is tele manipulated by a surgeon. This system attaches to the head of the <a href="/wiki/Operating_room" class="mw-redirect" title="Operating room">operating room</a> table and provides surgeons with increased precision with the help of the intuitive motion controller.<sup id="cite_ref-41" class="reference"><a href="#cite_note-41"><span class="cite-bracket">&#91;</span>41<span class="cite-bracket">&#93;</span></a></sup> Preceyes is the only robotic instrument to be CE certified. Some other companies like Forsight Robotics,<sup id="cite_ref-42" class="reference"><a href="#cite_note-42"><span class="cite-bracket">&#91;</span>42<span class="cite-bracket">&#93;</span></a></sup> Acusurgical <sup id="cite_ref-43" class="reference"><a href="#cite_note-43"><span class="cite-bracket">&#91;</span>43<span class="cite-bracket">&#93;</span></a></sup> that raised 5.75 M€ (France),<sup id="cite_ref-44" class="reference"><a href="#cite_note-44"><span class="cite-bracket">&#91;</span>44<span class="cite-bracket">&#93;</span></a></sup> and Horizon (US) are working in this field.</li> <li>The <a href="/wiki/Da_Vinci_Surgical_System" title="Da Vinci Surgical System">da Vinci Surgical System</a>, though not specifically designed for ophthalmic procedures, uses telemanipulation to perform <a href="/wiki/Pterygium" title="Pterygium">pterygium</a> repairs and ex-vivo corneal surgeries.<sup id="cite_ref-de_Smet_2018_40-1" class="reference"><a href="#cite_note-de_Smet_2018-40"><span class="cite-bracket">&#91;</span>40<span class="cite-bracket">&#93;</span></a></sup></li></ul> <div class="mw-heading mw-heading3"><h3 id="Heart">Heart</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Robot-assisted_surgery&amp;action=edit&amp;section=4" title="Edit section: Heart"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Some examples of heart surgery being assisted by robotic surgery systems include: </p> <ul><li><a href="/wiki/Atrial_septal_defect" title="Atrial septal defect">Atrial septal defect</a> repair<sup id="cite_ref-45" class="reference"><a href="#cite_note-45"><span class="cite-bracket">&#91;</span>45<span class="cite-bracket">&#93;</span></a></sup> – the repair of a hole between the two upper chambers of the heart,</li> <li><a href="/wiki/Mitral_valve_repair" title="Mitral valve repair">Mitral valve repair</a><sup id="cite_ref-46" class="reference"><a href="#cite_note-46"><span class="cite-bracket">&#91;</span>46<span class="cite-bracket">&#93;</span></a></sup> – the repair of the valve that prevents blood from regurgitating back into the upper heart chambers during contractions of the heart,</li> <li><a href="/wiki/Coronary_artery_bypass" class="mw-redirect" title="Coronary artery bypass">Coronary artery bypass</a><sup id="cite_ref-47" class="reference"><a href="#cite_note-47"><span class="cite-bracket">&#91;</span>47<span class="cite-bracket">&#93;</span></a></sup> – rerouting of blood supply by bypassing blocked arteries that provide blood to the heart.</li></ul> <div class="mw-heading mw-heading3"><h3 id="Thoracic">Thoracic</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Robot-assisted_surgery&amp;action=edit&amp;section=5" title="Edit section: Thoracic"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Robotic surgery has become more widespread in thoracic surgery for <a href="/wiki/Mediastinum" title="Mediastinum">mediastinal</a> pathologies, pulmonary pathologies and more recently complex esophageal surgery.<sup id="cite_ref-48" class="reference"><a href="#cite_note-48"><span class="cite-bracket">&#91;</span>48<span class="cite-bracket">&#93;</span></a></sup> </p><p>The <a href="/wiki/Da_Vinci_Surgical_System" title="Da Vinci Surgical System">da Vinci Xi system</a> is used for <a href="/wiki/Lung" title="Lung">lung</a> and <a href="/wiki/Mediastinum" title="Mediastinum">mediastinal</a> mass resection. This minimally invasive approach as a comparable alternative to <a href="/wiki/Video-assisted_thoracoscopic_surgery" title="Video-assisted thoracoscopic surgery">video-assisted thoracoscopic surgery</a> (VATS) and the standard <a href="/wiki/Thoracic_surgery" class="mw-redirect" title="Thoracic surgery">open thoracic surgery</a>. Although VATS is the less expensive option, the robotic-assisted approach offers benefits such as 3D visualizations with seven degrees of freedom and improved dexterity while having equivalent perioperative outcomes.<sup id="cite_ref-49" class="reference"><a href="#cite_note-49"><span class="cite-bracket">&#91;</span>49<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="ENT">ENT</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Robot-assisted_surgery&amp;action=edit&amp;section=6" title="Edit section: ENT"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The first successful robot-assisted <a href="/wiki/Cochlear_implant" title="Cochlear implant">cochlear implantation</a> in a person took place in <a href="/wiki/Bern" title="Bern">Bern</a>, <a href="/wiki/Switzerland" title="Switzerland">Switzerland</a> in 2017.<sup id="cite_ref-50" class="reference"><a href="#cite_note-50"><span class="cite-bracket">&#91;</span>50<span class="cite-bracket">&#93;</span></a></sup> Surgical robots have been developed for use at various stages of cochlear implantation, including drilling through the <a href="/wiki/Mastoid_part_of_the_temporal_bone" title="Mastoid part of the temporal bone">mastoid bone</a>, accessing the <a href="/wiki/Inner_ear" title="Inner ear">inner ear</a> and inserting the electrode into the <a href="/wiki/Cochlea" title="Cochlea">cochlea</a>.<sup id="cite_ref-51" class="reference"><a href="#cite_note-51"><span class="cite-bracket">&#91;</span>51<span class="cite-bracket">&#93;</span></a></sup> </p><p>Advantages of robot-assisted cochlear implantation include improved accuracy,<sup id="cite_ref-52" class="reference"><a href="#cite_note-52"><span class="cite-bracket">&#91;</span>52<span class="cite-bracket">&#93;</span></a></sup> resulting in fewer mistakes during electrode insertion and better hearing outcomes for patients.<sup id="cite_ref-Choi_2017_53-0" class="reference"><a href="#cite_note-Choi_2017-53"><span class="cite-bracket">&#91;</span>53<span class="cite-bracket">&#93;</span></a></sup> The surgeon uses image-guided surgical planning to program the robot based on the patient's individual anatomy. This helps the implant team to predict where the contacts of the electrode array will be located within the cochlea, which can assist with audio processor fitting post-surgery.<sup id="cite_ref-54" class="reference"><a href="#cite_note-54"><span class="cite-bracket">&#91;</span>54<span class="cite-bracket">&#93;</span></a></sup> The surgical robots also allow surgeons to reach the inner ear in a minimally invasive way.<sup id="cite_ref-Choi_2017_53-1" class="reference"><a href="#cite_note-Choi_2017-53"><span class="cite-bracket">&#91;</span>53<span class="cite-bracket">&#93;</span></a></sup> </p><p>Challenges that still need to be addressed include safety, time, efficiency and cost.<sup id="cite_ref-Choi_2017_53-2" class="reference"><a href="#cite_note-Choi_2017-53"><span class="cite-bracket">&#91;</span>53<span class="cite-bracket">&#93;</span></a></sup> </p><p>Surgical robots have also been shown to be useful for electrode insertion with pediatric patients.<sup id="cite_ref-55" class="reference"><a href="#cite_note-55"><span class="cite-bracket">&#91;</span>55<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Gastrointestinal">Gastrointestinal</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Robot-assisted_surgery&amp;action=edit&amp;section=7" title="Edit section: Gastrointestinal"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Multiple types of procedures have been performed with either the 'Zeus' or <a href="/wiki/Da_Vinci_Surgical_System" title="Da Vinci Surgical System">da Vinci</a> robot systems,<sup id="cite_ref-Lauterbach_2017_4-3" class="reference"><a href="#cite_note-Lauterbach_2017-4"><span class="cite-bracket">&#91;</span>4<span class="cite-bracket">&#93;</span></a></sup> including <a href="/wiki/Bariatric_surgery" title="Bariatric surgery">bariatric surgery</a> and <a href="/wiki/Gastrectomy" title="Gastrectomy">gastrectomy</a><sup id="cite_ref-56" class="reference"><a href="#cite_note-56"><span class="cite-bracket">&#91;</span>56<span class="cite-bracket">&#93;</span></a></sup> for cancer. Surgeons at various universities initially published case series demonstrating different techniques and the feasibility of GI surgery using the robotic devices.<sup id="cite_ref-Talamini_M_1524_57-0" class="reference"><a href="#cite_note-Talamini_M_1524-57"><span class="cite-bracket">&#91;</span>57<span class="cite-bracket">&#93;</span></a></sup> Specific procedures have been more fully evaluated, specifically esophageal fundoplication for the treatment of <a href="/wiki/Gastroesophageal_reflux_disease" title="Gastroesophageal reflux disease">gastroesophageal reflux</a><sup id="cite_ref-58" class="reference"><a href="#cite_note-58"><span class="cite-bracket">&#91;</span>58<span class="cite-bracket">&#93;</span></a></sup> and <a href="/wiki/Heller_myotomy" title="Heller myotomy">Heller myotomy</a> for the treatment of <a href="/wiki/Esophageal_achalasia" title="Esophageal achalasia">achalasia</a>.<sup id="cite_ref-59" class="reference"><a href="#cite_note-59"><span class="cite-bracket">&#91;</span>59<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-60" class="reference"><a href="#cite_note-60"><span class="cite-bracket">&#91;</span>60<span class="cite-bracket">&#93;</span></a></sup> </p><p>Robot-assisted <a href="/wiki/Pancreatectomy" title="Pancreatectomy">pancreatectomies</a> have been found to be associated with "longer operating time, lower estimated blood loss, a higher spleen-preservation rate, and shorter hospital stay[s]" than laparoscopic pancreatectomies; there was "no significant difference in transfusion, conversion to open surgery, overall complications, severe complications, <a href="/wiki/Pancreatic_fistula" title="Pancreatic fistula">pancreatic fistula</a>, severe pancreatic fistula, ICU stay, total cost, and 30-day mortality between the two groups."<sup id="cite_ref-61" class="reference"><a href="#cite_note-61"><span class="cite-bracket">&#91;</span>61<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Gynecology">Gynecology</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Robot-assisted_surgery&amp;action=edit&amp;section=8" title="Edit section: Gynecology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The first report of robotic surgery in <a href="/wiki/Gynecology" class="mw-redirect" title="Gynecology">gynecology</a> was published in 1999 from the Cleveland Clinic.<sup id="cite_ref-62" class="reference"><a href="#cite_note-62"><span class="cite-bracket">&#91;</span>62<span class="cite-bracket">&#93;</span></a></sup> The adoption of robotic surgery has contributed to the increase in minimally invasive surgery for gynecologic disease.<sup id="cite_ref-Lawrie_2019_63-0" class="reference"><a href="#cite_note-Lawrie_2019-63"><span class="cite-bracket">&#91;</span>63<span class="cite-bracket">&#93;</span></a></sup> Gynecologic procedures may take longer with robot-assisted surgery and the rate of complications may be higher, but there are not enough high-quality studies to know at the present time.<sup id="cite_ref-Lawrie_2019_63-1" class="reference"><a href="#cite_note-Lawrie_2019-63"><span class="cite-bracket">&#91;</span>63<span class="cite-bracket">&#93;</span></a></sup> In the United States, robotic-assisted hysterectomy for benign conditions was shown to be more expensive than conventional laparoscopic hysterectomy in 2015, with no difference in overall rates of complications.<sup id="cite_ref-64" class="reference"><a href="#cite_note-64"><span class="cite-bracket">&#91;</span>64<span class="cite-bracket">&#93;</span></a></sup> </p><p>This includes the use of the da Vinci surgical system in benign gynecology and gynecologic <a href="/wiki/Oncology" title="Oncology">oncology</a>. Robotic surgery can be used to treat <a href="/wiki/Fibroma" title="Fibroma">fibroids</a>, abnormal periods, <a href="/wiki/Endometriosis" title="Endometriosis">endometriosis</a>, <a href="/wiki/Ovarian_tumor" title="Ovarian tumor">ovarian tumors</a>, <a href="/wiki/Uterine_prolapse" title="Uterine prolapse">uterine prolapse</a>, and female cancers.<sup id="cite_ref-Lawrie_2019_63-2" class="reference"><a href="#cite_note-Lawrie_2019-63"><span class="cite-bracket">&#91;</span>63<span class="cite-bracket">&#93;</span></a></sup> Using the robotic system, gynecologists can perform <a href="/wiki/Hysterectomy" title="Hysterectomy">hysterectomies</a>, myomectomies, and <a href="/wiki/Lymph_node" title="Lymph node">lymph node</a> biopsies.<sup id="cite_ref-Song_2014_65-0" class="reference"><a href="#cite_note-Song_2014-65"><span class="cite-bracket">&#91;</span>65<span class="cite-bracket">&#93;</span></a></sup> The <i>Hominis robotic system</i> developed by <a href="/w/index.php?title=Momentis_Surgical%E2%84%A2&amp;action=edit&amp;redlink=1" class="new" title="Momentis Surgical™ (page does not exist)">Momentis Surgical™</a><sup id="cite_ref-memic_66-0" class="reference"><a href="#cite_note-memic-66"><span class="cite-bracket">&#91;</span>66<span class="cite-bracket">&#93;</span></a></sup> is aimed to provide a robotic platform for <a href="/wiki/Natural_orifice_transluminal_endoscopic_surgery" title="Natural orifice transluminal endoscopic surgery">natural orifice transluminal endoscopic surgery</a> (NOTES) for <a href="/wiki/Uterine_fibroid" title="Uterine fibroid">myomectomy</a> through the vagina.<sup id="cite_ref-pmid29490530_67-0" class="reference"><a href="#cite_note-pmid29490530-67"><span class="cite-bracket">&#91;</span>67<span class="cite-bracket">&#93;</span></a></sup> </p><p>A 2017 review of surgical removal of the uterus and cervix for early <a href="/wiki/Cervical_cancer" title="Cervical cancer">cervical cancer</a> robotic and laparoscopic surgery resulted in similar outcomes with respect to the cancer.<sup id="cite_ref-68" class="reference"><a href="#cite_note-68"><span class="cite-bracket">&#91;</span>68<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Bone">Bone</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Robot-assisted_surgery&amp;action=edit&amp;section=9" title="Edit section: Bone"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Robots are used in orthopedic surgery.<sup id="cite_ref-69" class="reference"><a href="#cite_note-69"><span class="cite-bracket">&#91;</span>69<span class="cite-bracket">&#93;</span></a></sup> </p><p>ROBODOC is the first active robotic system that performs some of the surgical actions in a total hip <a href="/wiki/Hip_replacement" title="Hip replacement">arthroplasty</a> (THA). It is programmed preoperatively using data from <a href="/wiki/CT_scan" title="CT scan">computer tomography</a> (CT) scans. This allows for the surgeon to choose the optimal size and design for the replacement hip.<sup id="cite_ref-Sugano_2013_70-0" class="reference"><a href="#cite_note-Sugano_2013-70"><span class="cite-bracket">&#91;</span>70<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-71" class="reference"><a href="#cite_note-71"><span class="cite-bracket">&#91;</span>71<span class="cite-bracket">&#93;</span></a></sup> </p><p>Acrobot and Rio are semi-active robotic systems that are used in THA. It consists of a drill bit that is controlled by the surgeon however the robotic system does not allow any movement outside the predetermined boundaries.<sup id="cite_ref-Sugano_2013_70-1" class="reference"><a href="#cite_note-Sugano_2013-70"><span class="cite-bracket">&#91;</span>70<span class="cite-bracket">&#93;</span></a></sup> </p><p><a href="/wiki/Mazor_Robotics" title="Mazor Robotics">Mazor</a> X is used in spinal surgeries to assist surgeons with placing <a href="/wiki/Vertebra" title="Vertebra">pedicle</a> screw instrumentation. Inaccuracy when placing a pedicle screw can result in neurovascular injury or construct failure. Mazor X functions by using templating imaging to locate itself to the target location of where the pedicle screw is needed.<sup id="cite_ref-72" class="reference"><a href="#cite_note-72"><span class="cite-bracket">&#91;</span>72<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Spine">Spine</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Robot-assisted_surgery&amp;action=edit&amp;section=10" title="Edit section: Spine"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Robotic devices started to be used in <a href="/wiki/Minimally_Invasive_Spine_Surgery" class="mw-redirect" title="Minimally Invasive Spine Surgery">minimally invasive spine surgery</a> starting in the mid-2000s.<sup id="cite_ref-Shweikeh2014rev_73-0" class="reference"><a href="#cite_note-Shweikeh2014rev-73"><span class="cite-bracket">&#91;</span>73<span class="cite-bracket">&#93;</span></a></sup> As of 2014, there were too few randomized clinical trials to judge whether robotic spine surgery is more or less safe than other approaches.<sup id="cite_ref-Shweikeh2014rev_73-1" class="reference"><a href="#cite_note-Shweikeh2014rev-73"><span class="cite-bracket">&#91;</span>73<span class="cite-bracket">&#93;</span></a></sup> </p><p>As of 2019, the application of robotics in spine surgery has mainly been limited to pedicle screw insertion for spinal fixation.<sup id="cite_ref-Huang2019_74-0" class="reference"><a href="#cite_note-Huang2019-74"><span class="cite-bracket">&#91;</span>74<span class="cite-bracket">&#93;</span></a></sup> In addition, the majority of studies on robot-assisted spine surgery have investigated lumbar or lumbosacral vertebrae only.<sup id="cite_ref-Huang2019_74-1" class="reference"><a href="#cite_note-Huang2019-74"><span class="cite-bracket">&#91;</span>74<span class="cite-bracket">&#93;</span></a></sup> Studies on use of robotics for placing screws in the cervical and thoracic vertebrae are limited.<sup id="cite_ref-Huang2019_74-2" class="reference"><a href="#cite_note-Huang2019-74"><span class="cite-bracket">&#91;</span>74<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Transplant_surgery"><span class="anchor" id="Transplant_surgery"></span>Transplant surgery</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Robot-assisted_surgery&amp;action=edit&amp;section=11" title="Edit section: Transplant surgery"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The first fully robotic kidney transplantations were performed in the late 2000s. It may allow kidney transplantations in people who are obese who could not otherwise have the procedure.<sup id="cite_ref-Ham2018_75-0" class="reference"><a href="#cite_note-Ham2018-75"><span class="cite-bracket">&#91;</span>75<span class="cite-bracket">&#93;</span></a></sup> Weight loss however is the preferred initial effort.<sup id="cite_ref-Ham2018_75-1" class="reference"><a href="#cite_note-Ham2018-75"><span class="cite-bracket">&#91;</span>75<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="General_surgery">General surgery</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Robot-assisted_surgery&amp;action=edit&amp;section=12" title="Edit section: General surgery"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>With regards to robotic surgery, this type of procedure is currently best suited for single-<a href="/wiki/Quadrant_(abdomen)" class="mw-redirect" title="Quadrant (abdomen)">quadrant</a> procedures,<sup id="cite_ref-76" class="reference"><a href="#cite_note-76"><span class="cite-bracket">&#91;</span>76<span class="cite-bracket">&#93;</span></a></sup> in which the operations can be performed on any one of the four quadrants of the abdomen. Cost disadvantages are applied with procedures such as a <a href="/wiki/Cholecystectomy" title="Cholecystectomy">cholecystectomy</a> and <a href="/wiki/Nissen_fundoplication" title="Nissen fundoplication">fundoplication</a>, but are suitable opportunities for surgeons to advance their robotic surgery skills.<sup id="cite_ref-Song_2014_65-1" class="reference"><a href="#cite_note-Song_2014-65"><span class="cite-bracket">&#91;</span>65<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Hernia_and_abdominal_wall_surgery">Hernia and abdominal wall surgery</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Robot-assisted_surgery&amp;action=edit&amp;section=13" title="Edit section: Hernia and abdominal wall surgery"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Columbia_Hernia_Center.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/3/3f/Columbia_Hernia_Center.jpg/220px-Columbia_Hernia_Center.jpg" decoding="async" width="220" height="165" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/3/3f/Columbia_Hernia_Center.jpg/330px-Columbia_Hernia_Center.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/3/3f/Columbia_Hernia_Center.jpg/440px-Columbia_Hernia_Center.jpg 2x" data-file-width="1600" data-file-height="1200" /></a><figcaption>A surgeon at the Columbia Hernia Center operates on a patient with a large hernia using the robotic platform.</figcaption></figure> <p>Over the past several decades, there have been great advances in the field of abdominal wall and <a href="/wiki/Hernia_surgery" class="mw-redirect" title="Hernia surgery">hernia surgery</a> especially when it comes to robotic-assisted surgery. Unlike <a href="/wiki/Laparoscopy" title="Laparoscopy">laparoscopic surgery</a>, the robotic platform allows for the correction of large hernia defects with specialized techniques that would traditionally only be performed via an open approach. Compared to open surgery, robotic surgery for hernia repair can reduce pain, length of hospital stay, and improve outcomes.<sup id="cite_ref-77" class="reference"><a href="#cite_note-77"><span class="cite-bracket">&#91;</span>77<span class="cite-bracket">&#93;</span></a></sup> As the robotic instruments have 6 degrees of articulation, freedom of movement and ergonomics are greatly improved compared to laparoscopy. </p><p>The first robotic <a href="/wiki/Inguinal_hernia" title="Inguinal hernia">inguinal hernia</a> repairs were done in conjunction with prostatectomies in 2007.<sup id="cite_ref-78" class="reference"><a href="#cite_note-78"><span class="cite-bracket">&#91;</span>78<span class="cite-bracket">&#93;</span></a></sup> The first <a href="/wiki/Incisional_hernia" title="Incisional hernia">ventral hernia</a> repairs were performed robotically in 2009.<sup id="cite_ref-79" class="reference"><a href="#cite_note-79"><span class="cite-bracket">&#91;</span>79<span class="cite-bracket">&#93;</span></a></sup> Since then the field has rapidly expanded to include most types of reconstruction including anterior as well as posterior component separation. </p><p>With newer techniques such as direct access into the abdominal wall,<sup id="cite_ref-80" class="reference"><a href="#cite_note-80"><span class="cite-bracket">&#91;</span>80<span class="cite-bracket">&#93;</span></a></sup> major reconstruction of large hernias can be done without even entering the abdominal cavity. Due to its complexity, however, major reconstruction done robotically should be undertaken at advanced hernia centers such as the Columbia Hernia Center in New York City, NY, USA. The American Hernia Society and the European Hernia Society are moving towards specialty designation for hernia centers who are credentialed for complex hernia surgery, including robotic surgery.<sup id="cite_ref-81" class="reference"><a href="#cite_note-81"><span class="cite-bracket">&#91;</span>81<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Urology">Urology</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Robot-assisted_surgery&amp;action=edit&amp;section=14" title="Edit section: Urology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Robotic surgery in the field of urology has become common, especially in the United States.<sup id="cite_ref-82" class="reference"><a href="#cite_note-82"><span class="cite-bracket">&#91;</span>82<span class="cite-bracket">&#93;</span></a></sup> </p><p>There is inconsistent evidence of benefits compared to standard surgery to justify the increased costs.<sup id="cite_ref-83" class="reference"><a href="#cite_note-83"><span class="cite-bracket">&#91;</span>83<span class="cite-bracket">&#93;</span></a></sup> Some have found tentative evidence of more complete removal of cancer and fewer side effects from surgery for <a href="/wiki/Prostatectomy" title="Prostatectomy">prostatectomy</a>.<sup id="cite_ref-84" class="reference"><a href="#cite_note-84"><span class="cite-bracket">&#91;</span>84<span class="cite-bracket">&#93;</span></a></sup> </p><p>In 2000, the first robot-assisted laparoscopic <a href="/wiki/Radical_prostatectomy" class="mw-redirect" title="Radical prostatectomy">radical prostatectomy</a> was performed.<sup id="cite_ref-ORPvsRALRP_85-0" class="reference"><a href="#cite_note-ORPvsRALRP-85"><span class="cite-bracket">&#91;</span>85<span class="cite-bracket">&#93;</span></a></sup> </p><p>Robotic surgery has also been utilized in <a href="/wiki/Cystectomy" title="Cystectomy">radical cystectomies</a>. A 2013 review found less complications and better short term outcomes when compared to open technique.<sup id="cite_ref-86" class="reference"><a href="#cite_note-86"><span class="cite-bracket">&#91;</span>86<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Pediatrics">Pediatrics</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Robot-assisted_surgery&amp;action=edit&amp;section=15" title="Edit section: Pediatrics"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Pediatrics" title="Pediatrics">Pediatric</a> procedures are also benefiting from robotic surgical systems. The smaller <a href="/wiki/Abdomen" title="Abdomen">abdominal</a> size in pediatric patients limits the viewing field in most urology procedures. The robotic surgical systems help surgeons overcome these limitations. Robotic technology provides assistance in performing<sup id="cite_ref-Song_2014_65-2" class="reference"><a href="#cite_note-Song_2014-65"><span class="cite-bracket">&#91;</span>65<span class="cite-bracket">&#93;</span></a></sup> </p> <ul><li><a href="/wiki/Pyeloplasty" title="Pyeloplasty">Pyeloplasty</a> - alternative to the conventional open dismembered pyeloplasty (Anderson-Hynes). Pyeloplasty is the most common robotic-assisted procedures in children.<sup id="cite_ref-Song_2014_65-3" class="reference"><a href="#cite_note-Song_2014-65"><span class="cite-bracket">&#91;</span>65<span class="cite-bracket">&#93;</span></a></sup></li> <li>Ureteral reimplantation - alternative to the open intravesical or extravesical surgery.<sup id="cite_ref-Song_2014_65-4" class="reference"><a href="#cite_note-Song_2014-65"><span class="cite-bracket">&#91;</span>65<span class="cite-bracket">&#93;</span></a></sup></li> <li><a href="/wiki/Ureteroureterostomy" title="Ureteroureterostomy">Ureteroureterostomy</a> - alternative to the transperitoneal approach.<sup id="cite_ref-Song_2014_65-5" class="reference"><a href="#cite_note-Song_2014-65"><span class="cite-bracket">&#91;</span>65<span class="cite-bracket">&#93;</span></a></sup></li> <li><a href="/wiki/Nephrectomy" title="Nephrectomy">Nephrectomy</a> and heminephrectomy - Traditionally done with <a href="/wiki/Laparoscopy" title="Laparoscopy">laparoscopy</a>, it is not likely that a robotic procedure offers significant advantage due to its high cost.<sup id="cite_ref-Song_2014_65-6" class="reference"><a href="#cite_note-Song_2014-65"><span class="cite-bracket">&#91;</span>65<span class="cite-bracket">&#93;</span></a></sup></li></ul> <div class="mw-heading mw-heading2"><h2 id="Comparison_to_traditional_methods">Comparison to traditional methods</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Robot-assisted_surgery&amp;action=edit&amp;section=16" title="Edit section: Comparison to traditional methods"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Major advances aided by surgical robots have been <a href="/wiki/Remote_surgery" title="Remote surgery">remote surgery</a>, <a href="/wiki/Minimally_invasive_surgery" class="mw-redirect" title="Minimally invasive surgery">minimally invasive surgery</a> and unmanned surgery. Due to robotic use, the surgery is done with precision, miniaturization, smaller incisions; decreased blood loss, less pain, and quicker healing time. Articulation beyond normal manipulation and three-dimensional magnification help to result in improved ergonomics. Due to these techniques, there is a reduced duration of hospital stays, blood loss, transfusions, and use of pain medication.<sup id="cite_ref-Outpatient_Robotic_surgery:_Conside_23-1" class="reference"><a href="#cite_note-Outpatient_Robotic_surgery:_Conside-23"><span class="cite-bracket">&#91;</span>23<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-Estey_87-0" class="reference"><a href="#cite_note-Estey-87"><span class="cite-bracket">&#91;</span>87<span class="cite-bracket">&#93;</span></a></sup> The existing open surgery technique has many flaws such as limited access to the surgical area, long recovery time, long hours of operation, blood loss, surgical scars, and marks.<sup id="cite_ref-88" class="reference"><a href="#cite_note-88"><span class="cite-bracket">&#91;</span>88<span class="cite-bracket">&#93;</span></a></sup> </p><p>The robot's costs range from $1 million to $2.5 million for each unit,<sup id="cite_ref-Barbash_2010_1-1" class="reference"><a href="#cite_note-Barbash_2010-1"><span class="cite-bracket">&#91;</span>1<span class="cite-bracket">&#93;</span></a></sup> and while its disposable supply cost is normally $1,500 per procedure, the cost of the procedure is higher.<sup id="cite_ref-kolata_89-0" class="reference"><a href="#cite_note-kolata-89"><span class="cite-bracket">&#91;</span>89<span class="cite-bracket">&#93;</span></a></sup> Additional surgical training is needed to operate the system.<sup id="cite_ref-ORPvsRALRP_85-1" class="reference"><a href="#cite_note-ORPvsRALRP-85"><span class="cite-bracket">&#91;</span>85<span class="cite-bracket">&#93;</span></a></sup> Numerous feasibility studies have been done to determine whether the purchase of such systems are worthwhile. As it stands, opinions differ dramatically. Surgeons report that, although the manufacturers of such systems provide training on this new technology, the learning phase is intensive and surgeons must perform 150 to 250 procedures to become adept in their use.<sup id="cite_ref-Barbash_2010_1-2" class="reference"><a href="#cite_note-Barbash_2010-1"><span class="cite-bracket">&#91;</span>1<span class="cite-bracket">&#93;</span></a></sup> During the training phase, minimally invasive operations can take up to twice as long as traditional surgery, leading to operating room tie-ups and surgical staffs keeping patients under anesthesia for longer periods. Patient surveys indicate they chose the procedure based on expectations of decreased morbidity, improved outcomes, reduced blood loss and less pain.<sup id="cite_ref-Estey_87-1" class="reference"><a href="#cite_note-Estey-87"><span class="cite-bracket">&#91;</span>87<span class="cite-bracket">&#93;</span></a></sup> Higher expectations may explain higher rates of dissatisfaction and regret.<sup id="cite_ref-ORPvsRALRP_85-2" class="reference"><a href="#cite_note-ORPvsRALRP-85"><span class="cite-bracket">&#91;</span>85<span class="cite-bracket">&#93;</span></a></sup> </p><p>Compared with other minimally invasive surgery approaches, robot-assisted surgery gives the surgeon better control over the surgical instruments and a better view of the surgical site. In addition, surgeons no longer have to stand throughout the surgery and do not get tired as quickly. Naturally occurring hand tremors are filtered out by the robot's computer software. Finally, the surgical robot can continuously be used by rotating surgery teams.<sup id="cite_ref-90" class="reference"><a href="#cite_note-90"><span class="cite-bracket">&#91;</span>90<span class="cite-bracket">&#93;</span></a></sup> Laparoscopic camera positioning is also significantly steadier with less inadvertent movements under robotic controls than compared to human assistance.<sup id="cite_ref-91" class="reference"><a href="#cite_note-91"><span class="cite-bracket">&#91;</span>91<span class="cite-bracket">&#93;</span></a></sup> The use of <a href="/wiki/Mixed_reality" title="Mixed reality">mixed reality</a> to support robot-assisted surgery was developed at the <a href="/wiki/Air_Force_Research_Laboratory" title="Air Force Research Laboratory">Air Force Research Laboratory</a> in 1992 through the creation of "virtual fixtures" that overlay virtual boundaries or guides that assist the human operator and has become a common method for increasing safety and precision.<sup id="cite_ref-92" class="reference"><a href="#cite_note-92"><span class="cite-bracket">&#91;</span>92<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-93" class="reference"><a href="#cite_note-93"><span class="cite-bracket">&#91;</span>93<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-94" class="reference"><a href="#cite_note-94"><span class="cite-bracket">&#91;</span>94<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-95" class="reference"><a href="#cite_note-95"><span class="cite-bracket">&#91;</span>95<span class="cite-bracket">&#93;</span></a></sup> </p><p>There are some issues in regards to current robotic surgery usage in clinical applications. There is a lack of haptics in some robotic systems currently in clinical use, which means there is no <a href="/wiki/Haptic_technology#Force_feedback" title="Haptic technology">force feedback</a>, or touch feedback. No interaction between the instrument and the patient is felt. However, recently the Senhance robotic system by Asensus Surgical was developed with haptic feedback in order to improve the interaction between the surgeon and the tissue.<sup id="cite_ref-96" class="reference"><a href="#cite_note-96"><span class="cite-bracket">&#91;</span>96<span class="cite-bracket">&#93;</span></a></sup> </p><p>The robots can also be very large, have instrumentation limitations, and there may be issues with multi-quadrant surgery as current devices are solely used for single-quadrant application.<sup id="cite_ref-Herron_2008_97-0" class="reference"><a href="#cite_note-Herron_2008-97"><span class="cite-bracket">&#91;</span>97<span class="cite-bracket">&#93;</span></a></sup> </p><p>Critics of the system, including the American Congress of Obstetricians and Gynecologists,<sup id="cite_ref-98" class="reference"><a href="#cite_note-98"><span class="cite-bracket">&#91;</span>98<span class="cite-bracket">&#93;</span></a></sup> say there is a steep learning curve for surgeons who adopt the use of the system and that there's a lack of studies that indicate long-term results are superior to results following traditional <a href="/wiki/Laparoscopic_surgery" class="mw-redirect" title="Laparoscopic surgery">laparoscopic surgery</a>.<sup id="cite_ref-kolata_89-1" class="reference"><a href="#cite_note-kolata-89"><span class="cite-bracket">&#91;</span>89<span class="cite-bracket">&#93;</span></a></sup> Articles in the newly created <i><a href="/wiki/Journal_of_Robotic_Surgery" title="Journal of Robotic Surgery">Journal of Robotic Surgery</a></i> tend to report on one surgeon's experience.<sup id="cite_ref-kolata_89-2" class="reference"><a href="#cite_note-kolata-89"><span class="cite-bracket">&#91;</span>89<span class="cite-bracket">&#93;</span></a></sup> </p><p>Complications related to robotic surgeries range from converting the surgery to open, re-operation, permanent injury, damage to viscera and nerve damage. From 2000 to 2011, out of 75 hysterectomies done with robotic surgery, 34 had permanent injury, and 49 had damage to the viscera. <sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">&#91;<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (July 2019)">citation needed</span></a></i>&#93;</sup> Prostatectomies were more prone to permanent injury, nerve damage and visceral damage as well. Very minimal surgeries in a variety of specialties had to actually be converted to open or be re-operated on, but most did sustain some kind of damage or injury. For example, out of seven coronary artery bypass grafting, one patient had to go under re-operation. It is important that complications are captured, reported and evaluated to ensure the medical community is better educated on the safety of this new technology.<sup id="cite_ref-99" class="reference"><a href="#cite_note-99"><span class="cite-bracket">&#91;</span>99<span class="cite-bracket">&#93;</span></a></sup> If something was to go wrong in a robot-assisted surgery, it is difficult to identify culpability, and the safety of the practice will influence how quickly and widespread these practices are used.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">&#91;<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (January 2022)">citation needed</span></a></i>&#93;</sup> </p><p>One drawback of the use of robotic surgery is the risk of mechanical failure of the system and instruments. A study from July 2005 to December 2008 was conducted to analyze the mechanical failures of the da Vinci Surgical System at a single institute. During this period, a total of 1797 robotic surgeries were performed used 4 da Vinci surgical systems. There were 43 cases (2.4%) of mechanical failure, including 24 (1.3%) cases of mechanical failure or malfunction and 19 (1.1%) cases of instrument malfunction. Additionally, one open and two laparoscopic conversions (0.17%) were performed. Therefore, the chance of mechanical failure or malfunction was found to be rare, with the rate of converting to an open or laparoscopic procedure very low.<sup id="cite_ref-100" class="reference"><a href="#cite_note-100"><span class="cite-bracket">&#91;</span>100<span class="cite-bracket">&#93;</span></a></sup> </p><p>There are also current methods of robotic surgery being marketed and advertised online. Removal of a cancerous prostate has been a popular treatment through internet marketing. Internet marketing of medical devices are more loosely regulated than pharmaceutical promotions. Many sites that claim the benefits of this type of procedure had failed to mention risks and also provided unsupported evidence. There is an issue with government and medical societies promotion a production of balanced educational material.<sup id="cite_ref-101" class="reference"><a href="#cite_note-101"><span class="cite-bracket">&#91;</span>101<span class="cite-bracket">&#93;</span></a></sup> In the US alone, many websites promotion robotic surgery fail to mention any risks associated with these types of procedures, and hospitals providing materials largely ignore risks, overestimate benefits and are strongly influenced by the manufacturer.<sup id="cite_ref-102" class="reference"><a href="#cite_note-102"><span class="cite-bracket">&#91;</span>102<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Use_in_popular_media">Use in popular media</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Robot-assisted_surgery&amp;action=edit&amp;section=17" title="Edit section: Use in popular media"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Since April 2018, medical insurance coverage was expanding in Japan, so doctors were considering promoting the procedure for cardiac surgery, as it has the advantage of reducing the burden on the patient. Japanese drama <a href="/wiki/Black_Pean" class="mw-redirect" title="Black Pean">Black Pean</a> takes on this challenge, showing both sides' point of view. Two University Hospitals are competing to be the best in the Cardiac Surgery Department. One, Tojo, has the best traditional surgeons, while the other, Teika, is all about researching and implementing the most recent technology. With this, Teika sends its technical specialist to Tojo to try to convince them to update their techniques, including the use of the <a href="/wiki/Da_Vinci_Surgical_System" title="Da Vinci Surgical System">Da Vinci robot</a> (named in the drama as Darwin). Newhart Watanabe International Hospital, a pioneer in da Vinci surgery for the heart in Japan, was used as background for the drama, with Dr. Gou Watanabe providing technical support.<sup id="cite_ref-103" class="reference"><a href="#cite_note-103"><span class="cite-bracket">&#91;</span>103<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-104" class="reference"><a href="#cite_note-104"><span class="cite-bracket">&#91;</span>104<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Robot-assisted_surgery&amp;action=edit&amp;section=18" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1184024115">.mw-parser-output .div-col{margin-top:0.3em;column-width:30em}.mw-parser-output .div-col-small{font-size:90%}.mw-parser-output .div-col-rules{column-rule:1px solid #aaa}.mw-parser-output .div-col dl,.mw-parser-output .div-col ol,.mw-parser-output .div-col ul{margin-top:0}.mw-parser-output .div-col li,.mw-parser-output .div-col dd{page-break-inside:avoid;break-inside:avoid-column}</style><div class="div-col" style="column-width: 30em;"> <ul><li><a href="/wiki/Bone_segment_navigation" title="Bone segment navigation">Bone segment navigation</a></li> <li><a href="/wiki/Computer-assisted_surgery" title="Computer-assisted surgery">Computer-assisted surgery</a></li> <li><a href="/wiki/Diagnostic_robot" title="Diagnostic robot">Diagnostic robot</a></li> <li><a href="/wiki/Minimally_invasive_surgery" class="mw-redirect" title="Minimally invasive surgery">Minimally invasive surgery</a></li> <li><a href="/wiki/Patient_registration" title="Patient registration">Patient registration</a></li> <li><a href="/wiki/Stereolithography_(medicine)" class="mw-redirect" title="Stereolithography (medicine)">Stereolithography (medicine)</a></li> <li><a href="/wiki/Surgical_Segment_Navigator" class="mw-redirect" title="Surgical Segment Navigator">Surgical Segment Navigator</a></li> <li><a href="/wiki/Telemedicine" class="mw-redirect" title="Telemedicine">Telemedicine</a></li></ul></div> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Robot-assisted_surgery&amp;action=edit&amp;section=19" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist reflist-columns references-column-width" style="column-width: 30em;"> <ol class="references"> <li id="cite_note-Barbash_2010-1"><span class="mw-cite-backlink">^ <a href="#cite_ref-Barbash_2010_1-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Barbash_2010_1-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Barbash_2010_1-2"><sup><i><b>c</b></i></sup></a></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFBarbashGlied2010" class="citation journal cs1">Barbash GI, Glied SA (August 2010). "New technology and health care costs--the case of robot-assisted surgery". <i>The New England Journal of Medicine</i>. <b>363</b> (8): 701–704. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1056%2Fnejmp1006602">10.1056/nejmp1006602</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a>&#160;<a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/20818872">20818872</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a>&#160;<a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:15596885">15596885</a>.</cite><span title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.jtitle=The+New+England+Journal+of+Medicine&amp;rft.atitle=New+technology+and+health+care+costs--the+case+of+robot-assisted+surgery&amp;rft.volume=363&amp;rft.issue=8&amp;rft.pages=701-704&amp;rft.date=2010-08&amp;rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A15596885%23id-name%3DS2CID&amp;rft_id=info%3Apmid%2F20818872&amp;rft_id=info%3Adoi%2F10.1056%2Fnejmp1006602&amp;rft.aulast=Barbash&amp;rft.aufirst=GI&amp;rft.au=Glied%2C+SA&amp;rfr_id=info%3Asid%2Fen.wikipedia.org%3ARobot-assisted+surgery" class="Z3988"></span></span> </li> <li id="cite_note-2"><span class="mw-cite-backlink"><b><a href="#cite_ref-2">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFCenter_for_Devices_and_Radiological_Health" class="citation web cs1">Center for Devices and Radiological Health. <a rel="nofollow" class="external text" href="https://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm632142.htm">"Safety Communications – Caution When Using Robotically-Assisted Surgical Devices in Women's Health including Mastectomy and Other Cancer-Related Surgeries: FDA Safety Communication"</a>. <i>www.fda.gov</i>. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20190331062225/https://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm632142.htm">Archived</a> from the original on 31 March 2019<span class="reference-accessdate">. Retrieved <span class="nowrap">6 March</span> 2019</span>. <q>Understand that the FDA has not cleared or approved any robotically-assisted surgical device based on cancer-related outcomes such as overall survival, recurrence, and disease-free survival.... The safety and effectiveness of robotically-assisted surgical devices for use in mastectomy procedures or prevention or treatment of cancer has not been established.</q></cite><span title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=unknown&amp;rft.jtitle=www.fda.gov&amp;rft.atitle=Safety+Communications+%E2%80%93+Caution+When+Using+Robotically-Assisted+Surgical+Devices+in+Women%27s+Health+including+Mastectomy+and+Other+Cancer-Related+Surgeries%3A+FDA+Safety+Communication&amp;rft.au=Center+for+Devices+and+Radiological+Health&amp;rft_id=https%3A%2F%2Fwww.fda.gov%2FMedicalDevices%2FSafety%2FAlertsandNotices%2Fucm632142.htm&amp;rfr_id=info%3Asid%2Fen.wikipedia.org%3ARobot-assisted+surgery" class="Z3988"></span></span> </li> <li id="cite_note-3"><span class="mw-cite-backlink"><b><a href="#cite_ref-3">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://www.brianday.ca/imagez/1051_28738.pdf">"Medical Post 23:1985"</a> <span class="cs1-format">(PDF)</span>. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20150923194508/http://www.brianday.ca/imagez/1051_28738.pdf">Archived</a> <span class="cs1-format">(PDF)</span> from the original on 23 September 2015<span class="reference-accessdate">. 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