Innovations in minimally invasive surgery have led to the development of advanced robotic technology where instruments follow the commands of the surgeon situated at some distance from the actual surgery. Currently, the only commercially available robotic-assisted surgery (RAS) platforms are produced by Intuitive Surgical, Inc. (Sunnyvale, CA) and are known as the da Vinci Surgical Systems (S, Si, and Xi models) [1]. The purported benefits over standard laparoscopy include three-dimensional high-definition visualization, ergonomic control of wristed surgical instruments, minimization of surgeon hand tremor, and a sitting operating posture. While there is suggestion that basic skills can be learned more quickly using the RAS platform compared to laparoscopy, there is still a learning curve to become proficient at using the RAS platform [2, 3].

Between January 1, 2000 to August 1, 2012, 245 adverse events were reported to the FDA (Food and Drug Administration) including 71 deaths and 174 nonfatal injuries. The surgical mortalities reported were gynecologic (31%; 22/71), urologic (21.1%; 15/71), cardiothoracic (16.9%; 12/71), otolaryngologic (14.1%; 10/71), colorectal (4.2%; 3/71), and general surgical (4.2%; 3/71). The most common cause of mortality was hemorrhage (29.6%; 21/71). Reports of nonfatal injury were most common with hysterectomy (43.1%; 75/174) and prostatectomy (17.2%; 30/174). Nearly half (46.6%) of nonfatal injuries resulted in permanent damage, and 17.2% and 15.5% resulted in conversion to open and a second operation, respectively [4]. While it is difficult to understand the root cause for these adverse events, the greater our understanding of RAS and dissemination of practical insights gained from experience will reduce any potential that the RAS contributes to any complications . Even if no injury occurs to the patient, the expenses related to repairing the RAS platform may prohibit its subsequent use.