Hello, we are the group 3a and we are going to talk about laparoscopy and robotic surgery.

First of
all, we will make an introduction in which we will explain briefly the evolution of minimal invasive
surgery, then we will present both techniques. After that, we will do a discussion and finally conclude.

Introduction
Let’s have a brief look at the historical evolution of minimally invasive techniques.

The interest to observe the inner parts of the human body comes from the Greek and the Egyptian
Antique Culture. However, it was much later in the 18th century when Philipp Bozzini designed the
first endoscope.

Sadly, the development of this instrument was impeded by technical and social issues: the light source
was too weak and the religious convictions didn’t support a medical investigation.

In the next century, lots of pioneers participated in the improvement of this technique like Nitze,
which improved the system of light, Kelling, who described how to realize the first laparoscopy with
a cystoscope and an insufflator or Zollikoffer, who was the first to diffuse the benefits of CO2 against
conventional air.
It was then that laparoscopy became a diagnostic instrument.

After the Second World War, two significant facts allowed the laparoscopic instrument evolution to
surgery: the improvements on lenses and the incorporation of a system to transmit cold light.
In addition, multiple instruments and devices were developed.

Technology kept evolving until the appearance of robotic surgery. Computer Motion, Inc and
Integrated Surgical Systems were the two main companies. Here we can see the most representative
robotic models of both.

Some time later, they merged, and their DaVinci became the most well-known and used robotic
system nowadays.

2. Minimally Invasive Techniques

2.1. Laparoscopy
Laparoscopy is a minimally invasive surgery technique which consists in the usage of several
incisions called ports to perform a procedure in the abdominal and pelvic area. These ports allow
small specialized instruments as well as a special camera (laparoscope) to be inserted in the patient’s
cavity through tubular instruments named trocars.
Here are the applications of this type of surgery. (diapo)

The equipment consists in:

- The laparoscope, which is connected to a video processor device.
- Gas insufflators (usually CO2), in order to create the cavity necessary to perform the procedure.

1
- Veress needle: to create the initial pneumoperitoneum
- Trocars: are the ports for support of the instrumentation

• Instrumentation
The different instruments used in laparoscopic surgery are basically the same that are used in
conventional surgery but with a specific design that allows them to be inserted through the trocars.
Some of the instruments are shown here. (diapo)

2.2. Robotic surgery

Robotic surgery is minimally invasive surgery that uses very small tools attached to a robotic arm
controlled by the surgeon with a computer. This technique allows the surgeon to do small and precise
movements, which could not be achieved neither in laparoscopy or open surgery.

The most advanced surgical system at the moment is the da Vinci.

The Da Vinci has three components (that are separated but connected)
Components:
- The tower or patient cart. It is positioned directly over the patient, contains the robot’s four arms,
three of them hold different surgical instruments and the fourth one holds the 3D cameras

- The surgeon console: where the surgeon sits and controls the robot

- Vision cart: It makes communication between components possible and supports the 3D high-
definition vision system

3. Discussion
Both laparoscopy and robotic surgery, which are minimally invasive surgery techniques, have
changed the paradigm of surgical treatments for their many advantages. In this section, the use of
laparoscopy and robotic surgery techniques are compared, highlighting its advantages and drawbacks.
Main future considerations will also be exposed.

3.1. Laparoscopy
Laparoscopy is, nowadays, widely used as it presents multiple advantages like faster wound healing,
faster postoperative recovery time and better outcomes.

The drawbacks are: once the trocar it’s placed, you can’t work from other locations. The vision of the
area to be operated depends exclusively on the one optic introduced in a trocar, and can’t substitute
open surgery as it has limitations, for example in spatial range.
Being the main drawback the vision, it is the area where more innovations have been done. For
example, when doing resections, two longitudes of wave of light can be used, one of them enhancing
blood. 3D technologies are also being incorporated.

2
In a more futuristic way, it could be proposed to implement 360 degrees cameras to have full
perspective of the laparoscopy cavity.

3.2. Robotic surgery

its main advantages with respect to laparoscopy is the total control of the surgical tools by the surgeon:
up to 4 instruments, two for each of his/her hands. A pedal system to change the instrument makes it
possible. Moreover, any tremor is corrected by the robot. 3D vision of the procedure and comfortable
position of the surgeon are other advantages.

One of the main drawbacks is that robots don’t have haptic feedback, however, this major
disadvantage is being studied and it looks like in future releases of the robot, this will be incorporated.
Also, the instruments used have to remain the same all along the surgery. In case of need of a different
one, another trocar can be added manually and will have to be managed this way too, causing risks
for the patient such as infection, bleeding or delays.

Improvements that could be done would be, for example, to implement more than one instrument per
trocar. They could be controlled independently, and the number of incisions would be reduced to just
one.
Also, 360 degrees camera could be integrated and perform the procedure in a mixed reality
environment. The improvements in resection for laparoscopy could be also implemented here.

4. Conclusions
For now, it cannot be demonstrated that robotic surgery presents enough advantages with respect to
laparoscopy (or other standard techniques) to justify its use, as it is clearly more expensive.
However, at the beginning, the same situation occurred for laparoscopy, and by keeping performing
surgeries this way, advantages such as a lower number of infections or less hospitalization time were
demonstrated, and the technique was a turning point in surgery history.

The same is expected to happen with robotic surgery. In the actual situation, the Hospital Clínic
performs robotic surgeries every week to train its surgeons and have enough surgical treatments
performed to carry out an accurate study. That’s why more time is needed.

Having said that, due to the future perspectives of robotic surgery, it seems that this field will continue
growing and will expand to cover all surgical areas. If all the presumptions are proved right, in the
near future there will be a revolution that will change the way surgical procedures as known now.