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In 1977, Scheinman sold his invention to Unimation. On this basis, Unimation collaborated with General
Motors and developed the Programmable Universal Manipulation Arm (PUMA), which represented the
[7-9]
basis for the production of a series of successful industrial robots .
With the production of PUMA, the robotic technology entered the operating theatre. Indeed, the first use
[10]
of a robot in a surgical procedure was documented in 1985 by Kwoh et al. , who reported a CT-guided
stereotactic biopsy of a brain tumor performed in a 52-year-old male patient using a Unimate PUMA 200
robotic arm at the Memorial Medical Center, Long Beach, California.

Surgical robots spreading
Since the second half of the 1980s, several robotic surgical systems started to appear in the operating
theatres. In 1988, researchers from the Imperial College of London developed the PROBOT system to
perform prostatic resections. In 1992, Integrated Surgical Systems, in collaboration with IBM, released the
ROBODOC system, successfully used for milling the femur in hip replacement procedures [1,3,11-14] .

In the same period, a group of researchers of the National Aeronautics and Space Administration (NASA)
working on virtual reality started collaborating with researchers of the Stanford Research Institute (SRI)
working on accurate surgical telemanipulators for open microsurgery. After the presentation of Jacques
Perrisat’s laparoscopic cholecystectomy at the Society of American Gastrointestinal and Endoscopic
Surgeons in 1989, the SRI developers were urged to adapt their telepresence surgical system to the new
laparoscopic approach, which was immediately regarded as a perfect field of implementation for robotic
[14]
technology .
Meanwhile, the U.S. Defense Advanced Research Projects Agency (DARPA) started a research program to
develop a robotic surgical telemanipulator mounted on a mobile armored vehicle and remotely operated
by a surgeon at a rear facility area. The aim of this project was to allow surgeons to control life-threatening
injuries on the battlefield and stabilize injured soldiers before they were taken away. For this purpose,
DARPA funded SRI, which developed a robotic system proving successful in performing complex surgical
procedures in animal models. Finally, the project was not completed for human use, but it provided a solid
[14]
basis for the development of the robotic systems later used in surgery .

In 1993, Computer Motion, funded by NASA and DARPA, released the Automated Endoscopic System for
Optimal Positioning (AESOP), an intern replacement voice-controlled robotic arm allowing the automatic
[14]
control of a camera during laparoscopic surgery .

In 1996, the same company released ZEUS, a surgical system consisting of three robotic arms attached to
the operating table, one of which was an AESOP, with originally six degrees of freedom (later seven) and a
[15]
[14]
monitor provided console for remote control . In 2001, it was used by Pr. Marescaux et al. operating in
New York to perform the first transatlantic robotic cholecystectomy in a 68-year-old female patient laying
on the operating table in Strasbourg, the so-called “Lindbergh Operation” [15,16] .

In 1995, Drs. Fred Moll and John Freund, together with engineer Robert Younge, founded Intuitive Surgical
after negotiating for the intellectual properties of SRI robotic surgical systems. On this basis, Intuitive
Surgical developed the first prototype of the da Vinci surgical system in 1997. After being ameliorated, the
system received US Food and Drug Administration approval in 2000. After passing through several versions,
it currently represents the most widespread and used master-slave robotic surgical system in general
[14]
surgery .

It must be noted that several other robotic systems have been used in surgery thus far, but here we only
select the ones appearing to mark more deeply the evolution of robotic technology in operating rooms.