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Main types of robots implemented in surgery
Some authors have distinguished the different robotic systems thus far used in surgery into three main
[12]
types :
1. “Precise path systems” include robots previously programmed to perform predefined and repetitive tasks,
such as several types of devices used for prostatic transurethral resections and to puncture the renal calyces.
2. “Intern replacement systems” include robotic devices intended to replace surgical assistants in tasks
requiring dexterity and stability, such as the AESOP system.
3. “Master-slave systems” have several robotic arms remotely controlled by a surgeon through a computer
console, mimicking precisely on the patient laying on the operating table the movements carried out by
the surgeon at the console, and never moving without the surgeon’s guidance. In this context, the da Vinci
surgical system has become paradigmatic.

Clearly, this is not a complete summary, but it is useful to set out some important phases in the implementation
of robotic technology in surgery.

MILESTONES IN ROBOTIC COLORECTAL SURGERY
The first publications available in the literature concerning robotic colorectal surgery are reported here. A
brief state of the art about the robotic surgery of colon and rectum is also provided.

Robotic surgery of the colon
[17]
[18]
The first cases of robot-assisted colectomies were published in 2002 . In particular, Weber et al. reported
one case of sigmoid colectomy for diverticular disease in a 50-year-old female patient, and one case of
right hemicolectomy for cecal diverticulitis in a 43-year-old male patient. In both procedures, a da Vinci
surgical system was used for large bowel mobilization, whereas colonic section and vascular ligations were
accomplished with a laparoscopic-assisted technique, and anastomoses were performed extracorporeally.
Moreover, the same surgical team published in the same year a comparative study reporting 15 laparoscopic
colectomies performed using an AESOP 3000 robotic camera holder and 11 not robot-assisted laparoscopic
[19]
colectomies .

The first cases of patients with colon cancer undergoing robot-assisted surgery with a master-slave robotic
[20]
system were reported by Hashizume et al. in 2002, and they consisted in one ileocecal resection, one left
hemicolectomy, and one sigmoidectomy performed by means of da Vinci technology for cecal, descending
[17]
colon, and sigmoid colon cancer, respectively .
Since then, many studies concerning robot-assisted surgery of the colon have been published, marking a
progressive amelioration of technical practices and a wide spread of competences. Among these studies, a
[21]
certain attention should be paid to a case series of right and left colectomies published by Rawlings et al.
in 2007, where the authors reported the first cases of robot-assisted side-to-side intracorporeal anastomosis
after right colectomy.

The advantages provided by robotic systems, such as stable, immersive, and three-dimensional view; better
dexterity due to seven degrees of freedom; and ambidextrous capabilities, seem to offer the potential to
overcome the limitations of conventional laparoscopy, mostly due to less favorable ergonomic features.
Therefore, over time, many studies were carried out to compare the outcomes of robotic and laparoscopic
surgery of the colon, but their results are contrasting and clear conclusions are not possible.

[22]
In particular, a recent systematic review with meta-analysis published by Ng et al. in 2009 tried to state
whether robot-assisted laparoscopic surgery had better outcomes compared to conventional laparoscopy in
colorectal cancer treatment. The authors included six randomized clinical trials (RCTs) and 67 prospective/
retrospective cohort studies and case-controlled studies, demonstrating that robotic surgery was superior to