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Original article
Robotic surgery: History and teaching impact
Cirugía robótica: Historia e impacto en la enseñanza
R. Valeroa,b,c, Y.H. Koa,d, S. Chauhana, O. Schatloffa, A. Sivaramana, R.F. Coelhoa,e, F. Ortegaf,c, K.J. Palmera,b, R. Sanchez-Salasf,b, H. Davilab, X. Cathelineauf, V.R. Patela,
Corresponding author
vipul.patel.md@flhosp.org

Corresponding author.
a Global Robotics Institute, Florida Hospital Celebration Health, Celebration, FL, United States
b Departamento de Urología, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela
c Robotic Fellow, Confederación Americana de Urología (CAU), Miami, FL, United States
d Departamento de Urología, Escuela Universitaria Coreana de Medicina, Seúl, South Korea
e Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Divisão de Urologia, São Paulo, Brazil
f Departamento de Urología, L¿Institut Mutualiste Montsouris, París, France
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        "titulo" => "Cirug&#237;a rob&#243;tica&#58; Historia e impacto en la ense&#241;anza"
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Leonardo da Vinci&#39;s &#8220;Metal-Plated Warrior&#8221;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Robotic surgery has been considered by some authors as the future of surgery due to the dramatic changes and impact that it has shown in the last two decades&#46; It has had a rapid development and has shown numerous advantages of enhancing surgical techniques&#44; which&#44; in turn&#44; is changing the way we practice and teach surgery&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The da Vinci<span class="elsevierStyleSup">&#174;</span> Robotic Surgical System &#40;Intuitive Surgical Sunnyvale&#44; CA&#41; is the only one of its kind to be approved by the Food and Drugs Administration &#40;FDA&#41;&#46; It offers several advantages over conventional laparoscopic surgery&#44; such as 3D vision&#44; dexterity&#44; articulated instruments&#44; increased range of motion&#44; elimination of fulcrum effect&#44; tremor filtration and an ergonomic position for the surgeon&#46; These advantages translate into a more delicate treatment of tissues&#44; precision surgery and improved results for patients&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The purpose of this article is to describe the history of robotic surgery including its evolution and improvements in teaching and practicing surgery&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Robotic history</span><p id="par0020" class="elsevierStylePara elsevierViewall">Karel Capek in 1921 introduced the notion and the term robot in his play Rossom&#39;s Universal Robots&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> The word robot comes from the Czech word &#8220;robota&#8221;&#44; meaning &#8220;labor&#8221;&#46; Later&#44; in 1942&#44; Isaac Asimov inspired by Capek&#39;s works defined the term &#8220;robotics&#8221; and wrote the three rules of robotics in his books Runaround and I Robot&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a> Though robotics is a relatively new term&#44; autonomously operated machines can be dated from 400 BC when Archytas of Arentum developed a steam-driven&#44; self-propelling wooden bird capable of flying 200<span class="elsevierStyleHsp" style=""></span>m&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">However&#44; the first robot that imitated human movements of the jaw&#44; arms and neck was designed by Leonardo da Vinci in 1495 and was named the Metal-Plated Warrior &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; This invention served as an inspiration to Gianello Torriano&#44; who created a robotic mandolin-playing lady in 1540&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">&#8220;The Writer&#8221;&#44; developed by Jaquet-Droz in 1772&#44; was the first robot with a programmable wheel used to write whatever the user desired&#46; Attaching this wheel to a feather pen&#44; &#8220;The Writer&#8221; was able to make complete sentences&#44; spacing between words and lines&#44; and even place periods after sentences&#44; replicating a task previously only performed by humans<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The impact of robotics on medicine has created new aspects of medicine such as telesurgery &#40;surgery performed with the surgeon and the patient in different locations&#41;&#46; In 2001&#44; Dr&#46; Marescaux performed the first telerobotic surgery &#40;telerobotic<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>surgeon console and patient cart are not in the same place&#41; using ZEUS<span class="elsevierStyleSup">&#174;</span> surgical system&#58; a transatlantic operation performing a cholecystectomy in a 62 year-old patient with cholelithiasis with the surgeons in New York &#40;EEUU&#41; and the patient in Strasbourg &#40;France&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Current robots</span><p id="par0040" class="elsevierStylePara elsevierViewall">The modern history of robotics in surgery begins with the Puma 560<span class="elsevierStyleSup">&#174;</span>&#44; a robot used to perform neurosurgical biopsies by Kwoh et al&#46; in 1985 in a very precise way&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;10</span></a> Later in 1988&#44; Davies et al&#46; performed a transurethral resection of the prostate using the same system&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Integrated Surgical Supplies Ltd&#46; of Sacramento&#44; created two models with similar characteristics&#58; PROBOT<span class="elsevierStyleSup">&#174;</span>&#44; a robot designed specifically for transurethral resection of the prostate and ROBODOC<span class="elsevierStyleSup">&#174;</span>&#44; a robotic system designed to machine the femur with greater precision in hip replacement surgeries&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This last one was the first surgical robot approved by the FDA&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Today&#44; many robots and robot enhancements are being researched and developed&#46; When we talk about robotics&#44; we must emphasize and focus on the major robotic surgical systems that have contributed in the development of current systems&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">AESOP<span class="elsevierStyleSup">&#174;</span></span><p id="par0055" class="elsevierStylePara elsevierViewall">The Automated Endoscopy System for Optimal Positioning &#40;AESOP<span class="elsevierStyleSup">&#174;</span>&#41; was the first robot to be approved by the FDA for abdominal surgical procedures&#44;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13&#44;3</span></a> designed by Computer Motion&#44; Santa Barbara&#44; CA and approved in 1994&#46; It is basically a robotic arm that holds a laparoscopic camera and can be controlled by voice commands&#46; The latest generations added seven degrees of freedom to mimic the human hand<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">ZEUS<span class="elsevierStyleSup">&#174;</span></span><p id="par0060" class="elsevierStylePara elsevierViewall">The Zeus<span class="elsevierStyleSup">&#174;</span> system &#40;Computer Motion&#44; Santa Barbara&#44; CA&#44; USA&#41; is another type of current robot that became commercial in 1998 and introduced the idea of telerobotics or telepresence to robotic surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> It is composed of a surgeon control console with a 3D imaging system which is at a distance from the robot and 3 table-mounted robotic arms with 4 degrees of freedom&#46; The right and left robotic arms replicate the arms of the surgeon&#44; and the third arm is an AESOP<span class="elsevierStyleSup">&#174;</span> voice-controlled robotic endoscope for visualization&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The main disadvantage of the ZEUS<span class="elsevierStyleSup">&#174;</span> system was the large size of the robotic arms&#44; which limited space in operating rooms&#59; it also caused collision of the arms when trocars were misplaced&#46; Moreover&#44; the need to wear special glasses made it cumbersome to perform surgery without them&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">da Vinci Surgical System<span class="elsevierStyleSup">&#174;</span></span><p id="par0070" class="elsevierStylePara elsevierViewall">This is the most complete and evolved major robotic surgical system&#46; It consists of 3 components&#58; a vision cart that holds a dual light source and dual 3-chip cameras&#44; a master console where the operating surgeon sits&#44; and a moveable cart where 3 instrument arms and the camera arm are mounted&#46; The console is composed of two &#8220;masters&#8221; that control the robotic arms with seven degrees of freedom&#44; a computer and a 3D imaging system&#46; An infrared sensor detects when the surgeon&#39;s head is placed into the console and subsequently triggers activation of the two masters and&#44; thus&#44; the robotic arms &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The da Vinci<span class="elsevierStyleSup">&#174;</span> Robotic Surgical System also has limitations&#44; the main one is still size&#59; it limits the space in the operating room&#59; moreover&#44; it has a lot of delicate connections that are inside the operating room that may cause accidents or can be damaged if not used adequately&#46; Furthermore&#44; some procedures such as bowel resections that require access to one or more abdominal quadrants mean that the robotic arms need to be undocked and redocked&#44; thus&#44; increasing operative and anesthesia times&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Teaching impact</span><p id="par0080" class="elsevierStylePara elsevierViewall">Robotic surgery has not just changed the way to perform surgery&#46; It has reformed the way to teach and learn surgery&#46; It has also been included in surgery programs around the globe&#44; used to teach surgery and practice on 3D virtual models instead of practicing on patients&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Robotic surgery and surgical education</span><p id="par0085" class="elsevierStylePara elsevierViewall">Despite numerous technological advances&#44; surgical training has stayed more or less unchanged for more than a century&#46; Surgeons in training have always had to gain operative experience through &#8220;supervised trial and error&#8221; on real patients&#46; This approach makes surgical training completely dependent on the actual case load&#44; prolongs surgical training&#44; and compromises patients&#8217; safety&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;19</span></a> Robotic surgery will create a new medium for acquiring surgical skills through simulation of all operations that can be done via the robot&#46; Surgeons can use surgical robots to practice operations on 3-dimensional&#44; virtual-reality simulators and soft-tissue models that recreate the texture of human tissue through force feedback &#40;haptics refers to the sense of touch&#44; tactile sensation&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;20&#44;21</span></a> Image-guided simulations will allow surgeons to practice procedures on 3-dimensional reconstructions of a targeted anatomy scheduled for surgery the next day&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#8211;24</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Telepresence surgery &#40;surgery using virtual telepresence in another physical location by means of telecommunication technology&#41; has been successfully used in teaching basic surgical skills to third-year medical students guiding them through telementoring classes&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;25</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">These systems are expected to significantly enhance the learning curve&#44; allowing trainees to acquire surgical skills in a short period of time while improving patients&#8217; safety by reducing surgical errors&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Ultimately&#44; these applications will be integral to the training and licensing of surgeons and will provide objective means for assessment of surgical skills&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Robotic technology is expected to play an increasingly important role in the future of surgery&#46; However&#44; most residency programs in the United States have not placed adequate emphasis on training in robotic surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;19</span></a> A survey in 2002 showed that only 23&#37; of surgery program directors had plans to incorporate robotics into their programs&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> In 2003&#44; another survey by the same group showed that although 57&#37; of surgical residents demonstrated high interest in robotic surgery&#44; the majority &#40;80&#37;&#41; did not have a robotic training program at their institutions&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> Few academic centers have developed formal didactics to train teams in robotic surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Ensuring competency to perform robotic procedures is left to individual hospitals&#46; It is expected that as formal training in robotic surgery develops&#44; more standardized credentials will be required to obtain robotic surgical privileges&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;30</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Impact on urology and other specialties</span><p id="par0110" class="elsevierStylePara elsevierViewall">Although robotic surgery was developed initially for cardiovascular surgery&#44; the most dramatic impact has been in urology with enormous progression&#44; showing excellent results in several procedures such as radical prostatectomy&#44; partial nephrectomy&#44; live donor nephrectomy&#44; and pyeloplasty among many others&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In less than a decade&#44; robotic-assisted laparoscopic radical prostatectomy has rapidly become the most commonly performed surgical technique for prostate cancer&#46; By 2009&#44; the number of robotic prostatectomies performed was estimated to exceed 60&#44;000&#44; driven by physician enthusiasm&#44; patient interest&#44; and aggressive&#44; effective marketing&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Nowadays&#44; more than 85&#37; of all radical prostatectomies performed in the US are done with robotic assistance&#44;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> but there are still some skeptics of the technique that have emphasized that the robotic approach needs to show that it is a safe and effective procedure supported by evidenced-based outcomes which go beyond mere speculation&#44; promise&#44; or marketing&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">However&#44; a rapidly growing body of evidence is showing that the robotic approach measures up to the past and present standards for radical prostatectomy and&#44; with certain benefits of decreased blood loss and lower morbidity&#46; Robotic surgery may soon represent a new surgical standard of care for the treatment of localized prostate cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Urology is just one surgical specialty that has been highly impacted by robotics&#44; but in fact&#44; it has reached many other fields such as general surgery&#44; cardiac surgery&#44; thoracic surgery&#44; neurosurgery&#44; gynecology&#44; ENT&#44; orthopedic and ophthalmologic surgery&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Virtual training in robotic surgery</span><p id="par0135" class="elsevierStylePara elsevierViewall">Another aspect to consider is that robotics is being used for virtual training&#46; There are a few simulators and software that allow surgeons to practice surgical procedures as many times as they need before actually performing it on a real patient&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Mimic Technologies&#44; Inc&#46; is one of the companies that is working on robotic virtual training and has developed systems such as&#58; Mimic&#39;s dV-Trainer&#8482;&#44; a &#8220;flight simulator&#8221; for robotic surgery designed to allow efficient on-demand training for surgeons learning to use the da Vinci<span class="elsevierStyleSup">&#174;</span> Surgical System<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Mimic&#39;s Mantis Duo&#8482; is a truly unique two-handed haptic system that can be used for a wide range of simulation applications&#44; including open surgery and robotics with a high quality force feedback and little computational overhead to your host PC&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">RoSS&#8482; is another robotic surgical simulator from Simulated Surgical Systems LLC&#44; which uses virtual reality to introduce the user to the operation and feel of a robotic surgical console&#44; providing close-to-life experience of working on the master console of da Vinci<span class="elsevierStyleSup">&#174;</span> Surgical System&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">There are also publications about using laparoscopic simulation programs adapting virtual reality trainers improving their capability to develop surgical skills&#46; Feifer et al&#46;&#44; 2010&#44; present a randomized controlled trial using LapSim<span class="elsevierStyleSup">&#174;</span> &#91;LSM&#93;&#44; and the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills<span class="elsevierStyleSup">&#174;</span> &#40;MISTELS&#41; utilizing a hybrid augmented reality trainer&#44; ProMIS<span class="elsevierStyleSup">&#174;</span> &#91;PM&#93;&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> Additionally&#44; the use of MISTELS tasks can be adapted for the da Vinci<span class="elsevierStyleSup">&#174;</span> platform&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Robotics for laparoendoscopic single-site surgery &#40;LESS&#41;</span><p id="par0155" class="elsevierStylePara elsevierViewall">Laparoendoscopic single-site surgery &#40;LESS&#41; is a new vision of surgery that provides the ability to perform major surgery with minimal incisions and nearly scar-free results&#44; it can be regarded as the latest progression in laparoscopic surgery and has garnered much enthusiasm with &#62;400 cases reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">36&#44;37</span></a> The use of a single incision within the umbilicus conceals much&#44; if not all&#44; of the wound while allowing for access to the abdomen during transabdominal procedures&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">36&#44;37</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">The two greatest challenges include clashing of the laparoscope with instruments and the loss of triangulation with limitation of instrument maneuverability&#46; The primary advantage of the da Vinci<span class="elsevierStyleSup">&#174;</span> Surgical System for LESS includes easier articulation using EndoWrist instruments&#46; Other benefits include three-dimensional visualization&#44; motion scaling&#44; and tremor filtration<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">36&#44;37</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">LESS is evolving&#44; and robotic assistance and other technical developments may well lead to its further enhancement&#46; LESS Urology has been used to carry out nephrectomy&#44; partial nephrectomy&#44; donor nephrectomy&#44; adrenalectomy&#44; renal cryoablation&#44; pyeloplasty&#44; ileal interposition&#44; ureteroneocystostomy&#44; varicocelectomy&#44; radical prostatectomy&#44; simple prostatectomy&#44; and radical cystoprostatectomy&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">What is next&#63; Future directions</span><p id="par0170" class="elsevierStylePara elsevierViewall">Although future means uncertain things in many aspects of life&#44; in robotic surgery it does not seem to be that way&#46; Every day&#44; there appear new aspects and robot models that actually improve current robotic systems&#46;</p><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Future robots</span><p id="par0175" class="elsevierStylePara elsevierViewall">Robotic surgery has developed over the past 10 years into a proven and growing method of treatment&#46; Titan Medical Inc&#46; is a Canadian company&#44; &#40;TSX VENTURE&#58;TMD&#41; focused on robotic surgical technologies&#44; that is currently developing Amadeus&#8482;&#44; a 4-armed robotic surgical system&#44; with some particular characteristics such as&#58; multi-articulating arms&#44; communications&#44; enhanced vision systems&#44; and force feedback&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">37&#44;38</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">Force feedback is an outstanding and unique characteristic of this robotic surgical system&#46; It enables the elimination and correction of one of the biggest challenges that still remains in current robotic systems&#58; the absence of haptics&#44; which means that the surgeon is unable to know and feel the amount of force needed to pull or grasp tissue without breaking or damaging it&#46; Linda van den Bedem&#44; TU&#47;e researcher in Science Daily report&#44; developed a much more compact surgical robot called Sophie&#44; which uses &#8216;force feedback&#8217; to allow the surgeon to feel what he or she is doing&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> Another issue that has been studied is the possibility to have robotic surgical systems controlled by artificial intelligence&#46; In 2010&#44; Duke University bioengineers demonstrated that a robot &#8211; without human assistance &#8211; can locate a man-made or phantom lesion in simulated human organs&#44; guide a device to the lesion&#44; and take multiple samples during a single session &#40;Duke Robot Biopsy Guided by 3-D Ultrasound&#41;&#46; The researchers believe that as technology is developed&#44; autonomous robots could someday perform many more simple surgical tasks&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">However&#44; this is not the end of this futuristic race&#59; there are new challenges to come and the next step to reach could be the use of nanorobots&#46; These are cell sized and can be introduced into the bloodstream being able to destroy cancer cells&#44; repair tissues&#44; or pick up toxic radicals&#44; all guided by remote control&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusions</span><p id="par0190" class="elsevierStylePara elsevierViewall">The history of robotics has shown a rapid evolution in the last decade&#46; This technology has been responsible for establishing new concepts such as telesurgery&#44; imaging symbiosis&#44; and virtual training&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Robotic surgery has developed and enhanced several surgical techniques in specialties such as urology&#44; general surgery&#44; and gynecology&#44; to mention a few&#46; Moreover&#44; robotics has shown results that are changing the way of performing and teaching surgery&#44; establishing new standards of treatment and demonstrating that it is here to stay and evolve&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">It has also been able to facilitate and increase the uses of minimally invasive surgery allowing surgeons to use technology like LESS in many procedures&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">There is still much in the horizon to study and develop in robotic surgery but the results obtained are encouraging and it seems to be just a matter of time until robotic surgery becomes the new standard of treatment in a significant amount of surgical procedures&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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              "titulo" => "Teaching impact"
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              "identificador" => "sec0040"
              "titulo" => "Robotic surgery and surgical education"
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            6 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Impact on urology and other specialties"
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              "identificador" => "sec0050"
              "titulo" => "Virtual training in robotic surgery"
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          "identificador" => "sec0055"
          "titulo" => "Robotics for laparoendoscopic single-site surgery &#40;LESS&#41;"
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          "titulo" => "What is next&#63; Future directions"
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              "titulo" => "Future robots"
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          "titulo" => "Conclusions"
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          "titulo" => "References"
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    "fechaAceptado" => "2011-04-09"
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          "clase" => "keyword"
          "titulo" => "Keywords"
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            0 => "Robotics"
            1 => "Surgery"
            2 => "History"
            3 => "Surgical systems"
            4 => "AESOP"
            5 => "ZEUS"
            6 => "Teaching"
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            0 => "Rob&#243;tica"
            1 => "Cirug&#237;a"
            2 => "Historia"
            3 => "Sistemas quir&#250;rgicos"
            4 => "AESOP"
            5 => "ZEUS"
            6 => "Ense&#241;anza"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Context</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The purpose of this article is to review the history of robotic surgery&#44; its impact on teaching as well as a description of historical and current robots used in the medical arena&#46;</p> <span class="elsevierStyleSectionTitle">Summary of evidence</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Although the history of robots dates back to 2000 years or more&#44; the last two decades have seen an outstanding revolution in medicine&#44; due to all the changes that robotic surgery has made in the way of performing&#44; teaching and practicing surgery&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Robotic surgery has evolved into a complete and self-contained field&#44; with enormous potential for future development&#46; The results to date have shown that this technology is capable of providing good outcomes and quality care for patients&#46;</p>"
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      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Contexto</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este art&#237;culo es hacer una revisi&#243;n de la Historia de la cirug&#237;a rob&#243;tica&#44; su impacto en la ense&#241;anza&#44; as&#237; como una descripci&#243;n de los robots antiguos y actuales usados en el campo m&#233;dico&#46;</p> <span class="elsevierStyleSectionTitle">Resumen de evidencia</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Aunque la historia de la rob&#243;tica tiene 2&#46;000 a&#241;os o m&#225;s&#44; las &#250;ltimas dos d&#233;cadas han mostrado una marcada revoluci&#243;n en Medicina&#44; debido a todos los cambios que la cirug&#237;a rob&#243;tica ha provocado en la manera de hacer&#44; ense&#241;ar y practicar cirug&#237;a&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La cirug&#237;a rob&#243;tica ha evolucionado hasta ser un campo aparte&#44; con un enorme potencial para su futuro desarrollo&#46; Los resultados muestran hasta ahora que esta tecnolog&#237;a es capaz de ofrecer buenos resultados y un adecuado tratamiento a los pacientes&#46;</p>"
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Article information
ISSN: 21735786
Original language: English
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es en pt

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