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Gumbs et al. Mini-invasive Surg 2020;4:90 I http://dx.doi.org/10.20517/2574-1225.2020.110 Page 5 of 9

Figure 5. The Versius complete surgical system with surgical console, robotic arms, and laparoscopic tower (Versius Robotics, CMR,
Cambridge, UK)

and one of the main reasons certain minimally invasive surgeons have not embraced this technology is
[7]
that they are waiting for a robot with haptics . Notably, the initial generation Versius will also not have
[8,9]
haptics . Medtronic, one of the largest surgical instrument companies, has even developed a complete
surgical system called Hugo (Hugo Robot, Medtronic Inc., Dublin, Ireland).

With the general surgeon’s current definition of robotic surgery, the robot is not autonomous and does
not perform any actions automatically. Instead, the instruments move either through the action of a
telemanipulator with motorized end-effectors or through computer control. In short, robotic surgery
[1]
seems to fall well short of the definition proposed by the American Institute of Robotics . On the contrary,
in spinal surgery (Mazor Robotics, Mazor Robotics, Inc., Caesarea, Israel), radiation therapy with the
Cyberknife (Cyberknife System, Sunnyvale, CA, USA), and head and neck surgery (Flex Robotics System,
MedRobotics, Raynham, MA), there are several robots that also have some degree of automation [2,10-12] .
Ultimately, it must be remembered that the logical conclusion of developing robotic surgery will probably
result in either partial or total automation of operations even in general surgery.

Another reason that the term robotic surgery is difficult to define is that several devices used in abdominal
surgery have automatic motorized components. There is a hand-held stapler called the iDrive (iDrive,
Medtronic Inc., Dublin, Ireland) with automatic motorized stapling that if used could technically define a
procedure as being robotically-assisted [Figure 6]. Theoretically, an open colectomy where a surgeon uses
the iDrive could be considered a robotically-assisted procedure. Furthermore, although some so-called
robotic cases use a complete “robotic” surgical system for the majority of the procedure, some procedures
use a hybrid approach. For instance, should a minimally invasive esophagectomy that had its abdominal
portion done laparoscopically, but the thoracic portion done with the da Vinci robot, be considered
robotic, robot-assisted, or is minimally invasive a better term? Is there a percentage of a case that needs to
be done with the robot before it should be considered laparoscopic, robotic, or robot-assisted? What about
robotically-assisted Whipple procedures where the pancreatic head resection is done laparoscopically,