The revolution of computer-aided surgery - the dawn of robotic surgery.

Endoscopic surgery has rapidly changed the performance of surgical procedures in a wide range of surgical specialities, but difficulties with endoscopic manipulation remain. The next step in the revolution initiated by the introduction of endoscopic surgery will be achieved by the introduction of robotics, tele-mentoring systems and telepresence surgery. Primary capabilities brought to surgery by robotic manipulators can be summarised as surgical assistance, image-guided therapy and dexterity enhancement. Using computer-aided systems, such as robotics and image-guided surgery, the next generation of surgical systems will be more sophisticated, and will permit surgeons to perform surgical procedures beyond the current limitation of human performance — on the microscale, or on moving organs. Industry is focusing currently on developing manipulators for endoscopic microsurgery, and several devices have already entered clinical use. Taking advantage of one such robotic system, we have developed a new method of endoscopic cholecystectomy, which is performed without leaving foreign bodies and using a procedure that prevents adhesions after surgery. Some new endoscopic procedures have also become feasible, although these are currently performed only by open surgery, without this system. It seems to be highly probable that master–slave manipulators will soon be in routine surgical use for selected indications.