In the transition from open to laparoscopic surgery, tactile sense was compromised. However, with experience and better instrumentation these challenges are gradually being overcome. Robotic surgery offers even less haptic feedback and therefore the surgeon must “learn” appropriate grasping pressures so as to avoid damage to the bowel and other structures. Much of that feedback relies on the lines of tissue tension upon which the extent of retraction and force applied on the tissues must be based. The three-dimensional imaging does go a long way in recognizing these visual cues (5). Initially developed as a platform for cardiac surgery, the robotic system is limited in the range of available instruments for surgery on the bowel. New instruments for the robotic arms are slowly evolving as the utilization of robotic assistance increases across different surgical specialties. Figure 5.1 depicts the tissue graspers currently available for colorectal surgery.

There is much debate over the costs of robot-assisted surgery. In a study by Delaney et al. (3), a direct comparison of robot-assisted with laparoscopic colectomy was performed using case matched controls. The authors concluded that although a robot-assisted colectomy was safe and feasible, the additional cost was a matter of concern. A similar study by Rawlings et al. (6) confirmed the safety and efficacy of robotic colectomy but reported similar findings of a longer operative time and a higher cost. We recently conducted a cost analysis in a series of 40 consecutive robotic right hemicolectomies and compared it to the cost associated with a laparoscopic right colon resection (7). The initial investment to procure the robot as well as the maintenance and ongoing costs for the robot was also considered. Costs associated with a robotic procedure were higher in every cost category.