Robotic Instrumentation and Operating Room Setup

Abstract

Since the introduction of minimally invasive surgery in the 1980s, there have been countless advances in technology culminating in the development of the field of robotic-assisted surgery. The field of urology has been at the forefront of robotic-assisted surgery dating back to 1989 when the PROBOT was used to assist with transurethral resection of the prostate.^1,2 Further devices were designed for transrectal ultrasound-guided prostate biopsy and percutaneous nephrolithotomy.^3,4 In the early 1990s, several companies began to develop “master–slave systems,” where the surgeon controls the robotic instrument arms remotely from a console. The purpose of these systems was to eliminate physiologic tremor and to increase surgical dexterity and precision. Subsequent refinement in these systems led to the introduction of the da Vinci^® Surgical System (Intuitive Surgical, Sunnyvale, CA). Since the first robotic-assisted prostatectomy in 2000 and subsequent Federal Drug Administration approval, the da Vinci^® has been used in a vast array of urologic surgeries and surgical techniques have now been described for almost every genitourinary organ.5 A proper understanding of robotic instrumentation is pivotal to the implementation of a successful robotics program. This chapter will review fundamental principles of robotic instrumentation using the da Vinci^® Surgical System, surgical team, operating room setup, and basic principles of robotic-assisted surgery.