Page 26 - Read Online

Gagner. Mini-invasive Surg 2021;5:12 I http://dx.doi.org/10.20517/2574-1225.2021.23 Page 3 of 5

industry has never been able to demonstrate a cost advantage to laparoscopic surgery, and it will get
worse. Why? Because the cost of doing laparoscopy is constantly decreasing, year after year, with cheaper
trocars and better staplers, and more solid reusables of increasing quality. While regarding robotic-assisted
surgery at the moment, costs are increasing year after year, with cost of research and development having
to be amortized in the costs of robotic systems, costs like disposables, added energy sources, stapling and
approximation technologies and perhaps in the near future, artificial intelligence and image processing.
Also, diameters are getting smaller, and more endoscopic tools are getting into play so that the combination
of laparoscopic and flexible endoscopy may give a hard time to robotic systems in the next 2 decades at a
lower cost again. If patients can be discharged the same day, it will be difficult to beat, as costs will be even
[29]
lower. It may also be a generation thing . The younger surgical generation has not known the struggles
and fights to move laparoscopy from open surgery. They have been raised with computer games, laptops,
and smartphones. They see robotic-assisted surgery as a similar platform and learn it faster than training
harder with discipline on laparoscopic instruments, even if it costs more at the end, I think. There is the
promise that true robotic surgery will emerge one day, so they might get involved now after all.

[30]
Then do you know what robotic-assisted surgery really is or should be ? It is autonomous surgery with
artificial intelligence. The presently called “robotic surgery” is not, which is a misnomer, a confused
terminology, as it is firstly laparoscopic-assisted, and the robot is not a robot. The early pioneers of so-
called robotic surgery, are today not doing any sort of routine or daily robotic surgery, who long ago saw no
real benefit of the technology. Ask Jacques Himpens and Guy-Bernard Cadiere from Belgium, the first users
of the DaVinci, and myself the first user of Zeus. We are not doing any sort of regular robotic surgeries. We
did not get fooled by these laparoscopic manipulators; we have been waiting for the real thing for 25 years
now. I did work on the clinical development of Surgibot (different from Senhance, Surgibot is a flexible
single port platform) from Trensenterix, a North Carolina based company, and provided animal expertise
and data for the FDA approval, but the robot did not demonstrate superiority to existing laparoscopy,
and the approval was denied in 2016. Transenterix sold the intellectual property to GBIL( Great Belief
International Limited) in December 2017 for 29 millions, with the hope to develop it in China. GBIL also
acquired Auto-Lap in 2019, reminiscent of AESOP reinvented, a laparoscope holder, as we are now closing
the circle 25 years later. How interesting! Now that the general robotic surgical patents have expired, and
there are a multitude of copycats like, competition is finally happening again, we may see emerging real
robotic surgery, and until then, it is not different from laparoscopic surgery.

DECLARATIONS
Authors’ contributions
The author contributed solely to the article.

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
The author declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.