Robotics in endoscopic surgery: can mechanical manipulators provide a more simple solution for the problem of limited degrees of freedom?

Robotic manipulators for endoscopic surgery have been developed on an experimental basis from the early 1990s and are now in clinical use. The main motivation to apply robotics technology to endoscopic surgery is to re-establish six degrees of freedom (DoF) of motion at the tip of the instrument. The cost–benefit ratio of these devices is still unclear. Although the products offered today are based on excellent technology and show a high functionality, most hospitals still hesitate to invest in robotic manipulators for fiscal reasons. For a significant number of procedures, especially in non-microsurgical disciplines, the functionality offered by robotic manipulators is not required, although the procedures would profit from instrumentation with 6 DoF. Mechanical manipulators with 6 DoF, but without computerised control, may be the right solution for these procedures. We have developed a workplace solution for endoscopic surgery that involves mechanical instrument-guiding systems and manipulators that offer 6 DoF, but use a significantly simplified technology at low cost. Further studies will need to show whether these mechanical manipulators answer the needs of the surgeon and offer an affordable alternative to robotic manipulators in surgical areas where microsurgical manipulations are not dominant.