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Minimally Invasive Surgery: Evolution, Benefits, and Future Trends

  • Writer: Tiago Miguel Figueira
    Tiago Miguel Figueira
  • Apr 19
  • 5 min read

By Dr Tiago Miguel Figueira / Member of RCSI - Royal College of Surgeons of Ireland



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Focusing on Laparoscopic and Robotic Procedures, with Patient Outcome and Recovery Comparisons

Over the past few decades, minimally invasive surgery (MIS) has transformed the surgical landscape. What began as a novel alternative to traditional open surgery has now evolved into a highly refined practice, offering patients reduced trauma, shorter recovery times, improved precision, and better quality of life. Among MIS techniques, laparoscopic and robotic-assisted surgery (RAS) stand out for their continued advancement and increasing adoption across multiple medical specialties.

📜 The Evolution of MIS: From Laparoscopy to Robotics

Laparoscopy emerged in the late 20th century as a pioneering approach to abdominal and pelvic procedures. It uses small incisions and a camera to guide instruments, drastically reducing the need for large surgical openings. While highly effective, laparoscopy has limitations in dexterity and visualization, especially in complex surgeries.

Robotic surgery, introduced more recently, has pushed these boundaries even further. With enhanced 3D visualization, superior range of motion, greater instrument stability, and improved ergonomics for surgeons, robotic platforms like the da Vinci Surgical System have become integral in disciplines such as urology, gynecology, and colorectal surgery (Miller et al., 2016).

🏥📅 Historical Milestones in Robotic Surgery

🔹 The First Robotic Surgical Intervention

The first robotic-assisted surgical procedure occurred in 1985 when the PUMA 560 robotic system was used to perform a neurosurgical biopsy (Satava, 2002). This marked the beginning of a new era in surgical precision.

🔹 Evolution of Robotic Surgical Systems

In the 1990s, advancements led to the development of AESOP, the first FDA-approved voice-controlled robotic device, followed by ZEUS and the da Vinci Surgical System, which revolutionized surgery by providing 3D visualization and wristed instruments (Marescaux et al., 2001; Khan et al., 2023).

🏥 Robotic Surgery in Colorectal, Biliary, and Appendiceal Procedures

🔹 Colorectal Surgery

Robotic colorectal surgery gained prominence in the early 2000s, with benefits including reduced conversion rates to open surgery and improved pelvic nerve preservation (Trastulli et al., 2015).

🔹 Biliary (Gallbladder) Surgery

The first robotic cholecystectomy was performed in 1997 in Belgium using the da Vinci system, showing its efficacy in precise gallbladder removal (Henriksen et al., 2009).

🔹 Appendiceal Surgery

Robotic appendectomy has emerged as a feasible option, especially in teaching and complex cases, though laparoscopy remains more common (Al-Thani et al., 2022).

🇮🇪 Robotic Surgery Applications in Ireland and the EU

🔹 Ireland

Major hospitals such as St. Vincent’s and University Hospital Galway utilize da Vinci systems for colorectal and general surgeries, with expanding programs across the country.

🔹 European Union

In the EU, robotic surgery is widely used in Germany, France, Italy, and the UK. NHS hospitals in the UK, for example, use robotic systems to manage surgical backlogs (The Times, 2023).

📈 Patient Outcomes & Recovery

Recent research provides compelling evidence for the advantages of robotic surgery, particularly in postoperative recovery and hospital resource utilization:

  • Foregut Surgery: Robotic-assisted surgeries reduced hospital stays to 1.54 days vs. 2.7 days with laparoscopy (Aminian et al., 2022).

  • Rectal Surgery: RAS patients stayed 11.5 days vs. 17.2 (laparoscopic) and 17.9 (open) (Villegas-Tovar & Wexner, 2024).

  • Urology: AP-HP hospitals saved 5,390 hospital days, mostly through robotic prostatectomy and nephrectomy (Darracq et al., 2024).

  • Bladder Cancer: Hospital stays of 8 days (robotic) vs. 10 days (open), with lower readmission rates (Catto et al., 2022).

 

💖 Quality of Life Improvements

Robotic-assisted surgery has also been associated with enhanced quality of life:

  • Rectal Cancer: Better emotional and social functioning, faster recovery of urinary and sexual function (Smith et al., 2018).

  • Endometrial Cancer: Higher quality of life scores and less postoperative pain compared to laparoscopic and open surgery (Jones et al., 2018).

  • Multi-specialty RAS: Notable improvement in mental and physical health by 6 weeks and 6 months (Brown et al., 2023).

  • Long-term Results: Decreased anxiety and stable long-term quality of life (Lee et al., 2023).

 

✨ Surgical Precision & Innovation

Robotic systems are known for their advanced precision:

  • Autonomous Suturing: The Smart Tissue Autonomous Robot (STAR) achieved better consistency and suture quality than manual techniques (Kim et al., 2016).

  • Meta-analysis: Over 30 years of robotic surgery data show reduced blood loss and complications versus other methods (Miller et al., 2016).

 

⚠️ Disadvantages of Robotic-Assisted Surgery

Despite its many advantages, robotic-assisted surgery presents some drawbacks:

  • Increased Operative Time: RAS often requires longer setup and surgery durations compared to laparoscopy, especially during the early adoption phase (Slabodkin, 2021).

  • Higher Costs: Robotic systems involve significant acquisition, maintenance, and training expenses, often without a proportional gain in outcomes (CADTH, 2011).

  • Steep Learning Curve: Studies indicate that full proficiency in robotic techniques (e.g., prostatectomy) may require between 20 and 250 cases (NCBI, 2011).

  • Limited Access: Robotic systems are often restricted to large, urban hospitals, reducing accessibility for patients in rural or underfunded settings (RoboticsBiz, 2020).

  • Technical Malfunctions: Though rare, robotic failures can disrupt surgery and require conversion to open procedures (Verywell Health, 2020).

These factors highlight the importance of balanced decision-making when considering robotic-assisted options over traditional laparoscopic surgery.

 

🚀 Future Trends in MIS

Research continues to expand the frontiers of MIS:

  • Magnetically Guided Micro-Robots: Nikita Greenidge (University of Leeds) is leading research on a robot for bowel cancer screening, capable of performing unsedated biopsies (Greenidge et al., 2024).

  • Robotics, Imaging, and Sensing Fusion: Giulio Dagnino and Dennis Kundrat (University of Twente) have explored how smart integration can improve navigation and safety in MIS (Dagnino & Kundrat, 2024).

  • AI-Powered Surgical Scene Recognition: Ufaq Khan et al. are developing foundation AI models for precision phase detection and instrument tracking in surgery (Khan et al., 2024).

  • Augmented Reality (AR) Guidance: Ishikawa et al. demonstrated that the Uteraug system can enhance laparoscopic performance using AI-based image analysis (Ishikawa et al., 2023).


🌐 Conclusion

The shift from open to minimally invasive, and now robotic surgery, represents a major advancement in modern healthcare. While robotic surgery offers clear benefits in terms of precision, recovery, and quality of life, it also presents challenges related to cost, access, and training. Ongoing innovation in AI, robotics, and imaging is making MIS safer and more effective, though accessibility and resource equity remain essential considerations.

 

 

Global Health supports integrating such technologies to improve outcomes and equity in patient care.

 

📚 References

 

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