Intuitive Surgical, Inc. (Sunnyvale, CA), which manufactures the daVinci Surgical Robot, had been given seed money by the U.S. Government to develop a robot to assist in the surgical care of our soldiers.  It was originally intended to provide these surgical services remotely from behind enemy lines.  This technology has, in fact, been used demonstratively across the Atlantic Ocean, with surgeon on one side and patient (and the rest of the surgical team) on the other side.  The focus of the company evolved, however, to improve the qualitative experience of surgeons engaged in laparoscopic surgery.  The company, and surgeons with interest in this technology, was more concerned with enhancing control of events during laparoscopic surgery.  We want a system that makes laparoscopic surgery easier, safer, and expands the possibilities of what can be done using closed techniques.    

In the time since the first prototype of the daVinci was launched, the daVinci has evolved into a more compact machine, with more arms (4 now), longer reach within the body, and a wider range of motion. Software upgrades have been made (eg, better filtration of the manipulators in order to read the surgeon's intention to move).  High definition TV technology has been adopted, and picture-in-picture technology has been incorporated as well.  This allows for the surgeon to view radiographic images concurrent with surgery.

One of the criticisms of the technology, as it exists, is that tactile feedback is lost.  As it stands, the surgeon loses manual feel of the tissues and depends entirely on visual cues.  Future robots are likely to restore this information in some capacity.

There will be a day when preoperative 3D radiographic imaging will be synchronized with intra-operative findings.  The computer will calculate distances between structures during surgery, track tissues and predict the emergence of important structures.  In essence, future robots will likely help the surgeon sort through the anatomy.

There are multiple factors which promote surgical infections.  Reducing incision size is a great leap forward in their prevention.  Reducing traffic of people in the operating room, and minimizing human contact would be another.  Future operating rooms will be more automated to dispense surgical materials, and surgical robots are likely to be incorporated into this greater system.

The future of robotics is a matter of human imagination.  It has made an indelible impact upon laparoscopic surgery, and in the world of urology, it has upended standards of care in procedures such as prostatectomy, pyeloplasty and partial nephrectomy.  Ultimately, the methods that bring the best cure rates with the least side effects mark progress in medicine.  Robotic surgery has already proven its need for many years to come.