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Feature Surgery

Robots in theatre: tomorrow’s world?

BMJ 2011; 343 doi: (Published 18 October 2011) Cite this as: BMJ 2011;343:d6624
  1. Geoff Watts, freelance journalist
  1. 1London, UK
  1. geoff{at}

Geoff Watts looks at how surgeons are beginning to use robots and what they might be able to do in future

Submit to any kind of robotic surgery and the machine performing it will almost certainly be called, rather charmingly, a da Vinci. Designed to assist in laparoscopic procedures, the da Vinci robot dominates the market and, unlike its human namesake in renaissance Italy, has few challengers. But although today’s robots wield the knife in only a tiny proportion of all operations, the engineers and scientists of the Hamlyn Centre for Robotic Surgery at Imperial College are already thinking ahead. Tellingly, perhaps, the centre’s da Vinci is in its museum.

But that’s the nature of technology: always striving for the next generation of cheaper, smaller, faster, smarter devices. The question this imperative sometimes raises is one of direction. So, in the context of medicine and medical technology, does the robotic approach seem to represent the future of surgery? Or is it destined to remain an adjunct at the margins rather than a revolutionary change at the core?

In appearance almost all industrial robots, whether for building cars or, as here, for performing intricate surgery, are a deep disappointment. A century of fictional robots has bred the expectation that they should be humanoid. Almost none is. And this includes the da Vinci surgical system. Manufactured by the US company Intuitive Surgical, it comprises three components: a trolley equipped with four mobile arms that wield the instruments and camera; a console with hand grips, by which the surgeon controls the movement and action of these arms; and a high definition 3D vision system to allow the operator to see the operating site.

The essential difference between this and conventional laparoscopic surgery is that the surgeon’s control of the instruments is indirect. Although …

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