Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Robot-assisted laparoscopy

Marie Fidela R Paraiso, MD, FACOG
Tommaso Falcone, MD, FRCSC, FACOG
Section Editors
William J Mann, Jr, MD
Jeffrey Marks, MD
Deputy Editor
Kristen Eckler, MD, FACOG


A surgical robot is a computer-controlled device that can be programmed to aid the positioning and manipulation of surgical instruments. Surgical robotics is typically used in laparoscopy rather than open surgical approaches. Since the 1980s, surgical robots have been developed to address the limitations of laparoscopy, including two-dimensional visualization, incomplete articulation of instruments, and ergonomic limitations. The goal of robot-assisted laparoscopic surgery is to help surgeons improve patient care by converting procedures that would have otherwise been performed by laparotomy into minimally invasive procedures. Robot-assisted laparoscopic surgery has all of the advantages of minimally invasive surgery include less postoperative pain, smaller and possibly more cosmetically appealing incisions, shorter hospital stay, shorter recovery time, and faster return to work.

In its initial phase, robotic procedures were performed almost exclusively by surgeons with advanced laparoscopic skills. However, since the da Vinci robot (one type of robotic surgical platform) was approved by the US Food and Drug Administration (FDA) for use in gynecologic surgery, there has been rapid adoption of robot-assisted laparoscopic procedures in gynecology by surgeons of all skill levels. Based upon data published in 2008 [1], there were more than 645 da Vinci systems in use worldwide and, since then, there continued to be an exponential rise in the use of these surgical systems to 3477 units by late 2014 [2]. Barriers to the adoption of robotics in surgery include the expense, training requirements for physicians and nurses, and lack of high quality data. Similar to conventional laparoscopy, robot-assisted laparoscopy has been widely adopted prior to emergence of data supporting efficacy and safety.

The role of robot-assisted laparoscopy in gynecologic surgery will be reviewed here. Related topics are discussed separately:

General principles of conventional laparoscopic surgery (see "Abdominal access techniques used in laparoscopic surgery")

Single port laparoscopy (see "Abdominal access techniques used in laparoscopic surgery", section on 'Single-incision surgery (SIS)')


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: May 31, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Kim YT, Kim SW, Jung YW. Robotic surgery in gynecologic field. Yonsei Med J 2008; 49:886.
  2. Intuitive Surgical-Investor FAQ http://phx.corporate-ir.net/phoenix.zhtml?c=122359&p=irol-faq (Accessed on October 14, 2015).
  3. Dharia SP, Falcone T. Robotics in reproductive medicine. Fertil Steril 2005; 84:1.
  4. Smith AL, Scott EM, Krivak TC, et al. Dual-console robotic surgery: a new teaching paradigm. J Robot Surg 2013; 7:113.
  5. Satava RM. Robotic surgery: from past to future--a personal journey. Surg Clin North Am 2003; 83:1491.
  6. Falcone T, Goldberg J, Garcia-Ruiz A, et al. Full robotic assistance for laparoscopic tubal anastomosis: a case report. J Laparoendosc Adv Surg Tech A 1999; 9:107.
  7. Hung AJ, Abreu AL, Shoji S, et al. Robotic transrectal ultrasonography during robot-assisted radical prostatectomy. Eur Urol 2012; 62:341.
  8. Berguer R, Forkey DL, Smith WD. Ergonomic problems associated with laparoscopic surgery. Surg Endosc 1999; 13:466.
  9. Kho RM, Hilger WS, Hentz JG, et al. Robotic hysterectomy: technique and initial outcomes. Am J Obstet Gynecol 2007; 197:113.e1.
  10. Hur HC, Donnellan N, Mansuria S, et al. Vaginal cuff dehiscence after different modes of hysterectomy. Obstet Gynecol 2011; 118:794.
  11. AAGL Advancing Minimally Invasive Gynecology Worldwide. AAGL position statement: Robotic-assisted laparoscopic surgery in benign gynecology. J Minim Invasive Gynecol 2013; 20:2.
  12. Liu H, Lu D, Wang L, et al. Robotic surgery for benign gynaecological disease. Cochrane Database Syst Rev 2012; :CD008978.
  13. Reza M, Maeso S, Blasco JA, Andradas E. Meta-analysis of observational studies on the safety and effectiveness of robotic gynaecological surgery. Br J Surg 2010; 97:1772.
  14. Herron DM, Marohn M, SAGES-MIRA Robotic Surgery Consensus Group. A consensus document on robotic surgery. Surg Endosc 2008; 22:313.
  15. Oppenheimer P, Weghorst S, MacFarlane M, Sinanan M. Immersive surgical robotic interfaces. Stud Health Technol Inform 1999; 62:242.
  16. Usui S, Inoue H, Yoshida T, et al. Preliminary report of multi degrees of freedom forceps for endoscopic surgery. Surg Laparosc Endosc Percutan Tech 2004; 14:66.
  17. Stylopoulos N, Rattner D. Robotics and ergonomics. Surg Clin North Am 2003; 83:1321.
  18. Sroga J, Patel SD, Falcone T. Robotics in reproductive medicine. Front Biosci 2008; 13:1308.
  19. Sackier JM, Wang Y. Robotically assisted laparoscopic surgery. From concept to development. Surg Endosc 1994; 8:63.
  20. Jacobs LK, Shayani V, Sackier JM. Determination of the learning curve of the AESOP robot. Surg Endosc 1997; 11:54.
  21. Ballantyne GH. Robotic surgery, telerobotic surgery, telepresence, and telementoring. Review of early clinical results. Surg Endosc 2002; 16:1389.
  22. Mettler L, Ibrahim M, Jonat W. One year of experience working with the aid of a robotic assistant (the voice-controlled optic holder AESOP) in gynaecological endoscopic surgery. Hum Reprod 1998; 13:2748.
  23. Swan K, Kim J, Advincula AP. Advanced uterine manipulation technologies. Surg Technol Int 2010; 20:215.
  24. Ballantyne GH, Moll F. The da Vinci telerobotic surgical system: the virtual operative field and telepresence surgery. Surg Clin North Am 2003; 83:1293.
  25. Haber GP, White MA, Autorino R, et al. Novel robotic da Vinci instruments for laparoendoscopic single-site surgery. Urology 2010; 76:1279.
  26. Einarsson JI, Hibner M, Advincula AP. Side docking: an alternative docking method for gynecologic robotic surgery. Rev Obstet Gynecol 2011; 4:123.
  27. Haluck RS, Krummel TM. Computers and virtual reality for surgical education in the 21st century. Arch Surg 2000; 135:786.
  28. Whitehurst SV, Lockrow EG, Lendvay TS, et al. Comparison of two simulation systems to support robotic-assisted surgical training: a pilot study (Swine model). J Minim Invasive Gynecol 2015; 22:483.
  29. Micali S, Virgili G, Vannozzi E, et al. Feasibility of telementoring between Baltimore (USA) and Rome (Italy): the first five cases. J Endourol 2000; 14:493.
  30. Panait L, Rafiq A, Tomulescu V, et al. Telementoring versus on-site mentoring in virtual reality-based surgical training. Surg Endosc 2006; 20:113.
  31. Sebajang H, Trudeau P, Dougall A, et al. The role of telementoring and telerobotic assistance in the provision of laparoscopic colorectal surgery in rural areas. Surg Endosc 2006; 20:1389.
  32. Rashid HH, Leung YY, Rashid MJ, et al. Robotic surgical education: a systematic approach to training urology residents to perform robotic-assisted laparoscopic radical prostatectomy. Urology 2006; 68:75.
  33. Anvari M, McKinley C, Stein H. Establishment of the world's first telerobotic remote surgical service: for provision of advanced laparoscopic surgery in a rural community. Ann Surg 2005; 241:460.
  34. Anvari M, Broderick T, Stein H, et al. The impact of latency on surgical precision and task completion during robotic-assisted remote telepresence surgery. Comput Aided Surg 2005; 10:93.
  35. Robot-assisted surgery. ACOG Technology Assessment in Obstetrics and Gynecology No. 6. American College of Obstetricians and Gynecologists. Obstet Gynecol 2009; 114:1153.
  36. Siddiqui NY, Galloway ML, Geller EJ, et al. Validity and reliability of the robotic Objective Structured Assessment of Technical Skills. Obstet Gynecol 2014; 123:1193.
  37. Whiteside JL. Robotic gynecologic surgery: a brave new world? Obstet Gynecol 2008; 112:1198.
  38. Woelk JL, Casiano ER, Weaver AL, et al. The learning curve of robotic hysterectomy. Obstet Gynecol 2013; 121:87.
  39. Artibani W, Fracalanza S, Cavalleri S, et al. Learning curve and preliminary experience with da Vinci-assisted laparoscopic radical prostatectomy. Urol Int 2008; 80:237.
  40. Vlaovic PD, Sargent ER, Boker JR, et al. Immediate impact of an intensive one-week laparoscopy training program on laparoscopic skills among postgraduate urologists. JSLS 2008; 12:1.
  41. Kaul S, Shah NL, Menon M. Learning curve using robotic surgery. Curr Urol Rep 2006; 7:125.
  42. Payne TN, Dauterive FR. A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice. J Minim Invasive Gynecol 2008; 15:286.
  43. Seamon LG, Cohn DE, Richardson DL, et al. Robotic hysterectomy and pelvic-aortic lymphadenectomy for endometrial cancer. Obstet Gynecol 2008; 112:1207.
  44. Lenihan JP Jr, Kovanda C, Seshadri-Kreaden U. What is the learning curve for robotic assisted gynecologic surgery? J Minim Invasive Gynecol 2008; 15:589.
  45. Liberman D, Trinh QD, Jeldres C, Zorn KC. Is robotic surgery cost-effective: yes. Curr Opin Urol 2012; 22:61.