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Table 1. History of surgical robotics
Year Event
1985 Puma 200 was used for neurosurgical biopsy
1986 ROBODOC was used for artificial joint replacement
1994 AESOP (Computer Motion Inc.) released and approved by the FDA
1998 ZEUS (Computer Motion Inc.) released
1999 da Vinci Surgical System (Intuitive Surgical Inc.) released
2000 da Vinci Surgical System approved by the FDA
2001 First case of intercontinental telesurgery (US-France)
2002 Hashizume performed robot-assisted distal gastrectomy
2003 Merger of Intuitive Surgical Inc. and Computer Motion Inc.
FDA: food and drug administration

[7-9]
hospital stays . Nevertheless, this procedure has several drawbacks such as two-dimensional surgical
view and the motion restriction using linear forceps. Surgical robotics has introduced in 1990s having the
potential to overcome those limitations and is spreading rapidly in the world.

In this review, we provide an historical outline of the development of surgical robotics, and describe the
advantages and disadvantages of robot gastrectomy for gastric cancer compared to LG.

HISTORY OF SURGICAL ROBOTICS
The history and development of surgical robotics [Table 1] goes back to the 1950s, with the development
of so-called “telepresence robotic arms”, although these were not intended for surgical applications, but
rather for remotely controlled systems to handle hazardous substances or to perform tasks underwater or
in space. In the 1980s, robotic arm development progressed rapidly with advances in computer technology,
[10]
and in 1985, surgical robotics was first used in a clinical setting to perform a neurological biopsy . A year
later, researchers at the IBM Thomas J. Watson Research Center and University of California completed the
development of ROBODOC, which became the first surgical robot approved by the USA Food and Drug
[11]
Administration (FDA) for clinical use in humans . In 1994, Computer Motion Inc. developed Automated
Endoscopic System for Optimal Positioning (AESOP; Computer Motion Inc., USA) with the aim of solo-
[12]
surgery using voice recognition to control the endoscope .
The US army also developed medical robotics for the use of telesurgery in the late 1980s with a master-
slave manipulator system that was originally designed for battlefield surgery. This system was subsequently
introduced into the clinical market as the da Vinci Surgical System (DVSS) by Intuitive Surgical Inc, and
in 2000, DVSS became the first robot-assisted surgical system approved by the FDA for use in general
laparoscopic surgery [13,14] . Computer Motion Inc. also developed ZEUS in 1998, adding a remote-control
[15]
function to AESOP . In the beginning, both systems were used only for cardiovascular surgery; however,
they were gradually expanded to digestive surgery, urology, and gynecology. In 2001, ZEUS was used for
[16]
the first case of telesurgery between New York and France to perform cholecystectomy . This operation
was called “Lindbergh operation” after the American aviator Charles Lindbergh who was the first person
to fly solo across the Atlantic Ocean. The first RG [robotic distal gastrectomy (RDG)] for gastric cancer was
[17]
reported in 2002 by Hashizume et al. using DVSS.

In 2003, Computer Motion Inc merged with Intuitive Surgical Inc., and since then DVSS has been the only
FDA-approved surgery-assisting robot, building a near-monopoly. In September 2018, there were 4,814 installed
[18]
DVSS units worldwide, including 3,110 in the United States, 821 in Europe, and 629 in Asia [Figure 1].

CURRENT STATUS OF RG FOR GASTRIC CANCER
The most apparent advantage of RG over LG is that articulated devices are available in RG. In addition, the
motion scaling and tremor suppression functions in RG enable more precise movement, which is believed