Actualidad y tendencias de la cirugía gastrointestinal robótica / Current news and trends in gastrointestinal robotic surgery

Resumen La cirugía ha pasado de ser una ciencia rudimentaria caracterizada por el padecimiento de insufribles dolores por falta de anestésicos, de realizarse en lugares poco acondicionados y de utilizarse instrumental poco ortodoxo con consecuencias nefastas para el desenlace de los procedimientos debido principalmente a las infecciones, a ser un campo desarrollado donde la tecnología juega un rol trascendental para el objetivo final que es el bienestar del paciente. En las últimas décadas, la cirugía ha pasado del acceso abierto al laparoscópico, cirugía por orificios naturales (NOTES), cirugía laparoscópica de puerto único, hasta la cirugía robótica. Es un hecho que estamos en un momento de la historia de la humanidad en el cual el desarrollo de las tecnologías a cambiado nuestra vida cotidiana, así como también el de nuestra practica quirúrgica diaria y no podemos ser ajenos a esta. El propósito de esta revisión es mostrar la situación actual de la cirugía robótica gastrointestinal y sus perspectivas a futuro. Para esto se realizó una búsqueda en la base de datos medline con las palabras claves "review robotic surgery, robotic digestive surgery, robotic bariatric surgery, robotic esophagectomy, robotic gastrectomy, robotic hepatectomy, robotic pancreatectomy, robotic hernia repair". Además una búsqueda de datos en la web sobre "intutive investorpresentation, future of robotic surgery, digital surgery, new robotic system in surgery, trends in robotic surgery".

It is a fact that we are at a moment in the history of humanity in which the development of technologies has changed our daily lives, as well as that of our daily surgical practice. The fast evolution in technology has allowed surgery to evolve from a rudimentary science characterized by painful, highly invasive procedures, to a rapidly developing and precise field with ever improving patient outcomes. In recent decades, gastrointestinal surgery has gone from open access to laparoscopy, natural orifice transluminal endoscopic surgery (NOTES), single-port laparoscopic surgery, and more recently, robotic assisted surgery. The purpose of this review is to show the current situation of robotic gastrointestinal surgery and its future prospects. A literature review was conducted in the Medline database with the keywords "revision of robotic surgery, robotic digestive surgery, bariatric robotic surgery, robotic esophagectomy, robotic gastrectomy, robotic hepatectomy, robotic pancreatectomy, robotic hernia repair". In addition, online search engine data was conducted using the following key words "intutive investor presentation, future of robotic surgery, digital surgery, new robotic system in surgery, trends in robotic surgery"

Modelo intensivo de reabilitação na síndrome de Guillain-Barré: um relato de caso / Intensive rehabilitation model in Guillain-Barre syndrome: a case report

Existem poucas informações na literatura médica sobre a reabilitação de pacientes com a Síndrome de Guillain-Barré (SGB). Há estudos clínicos que demonstram a eficácia do programa de reabilitação por meio de uma equipe interdisciplinar, porém sem protocolos bem definidos e apenas realizados em regime ambulatorial. Este relato de caso tem como objetivo descrever a evolução de um paciente com SGB, durante o programa de reabilitação multiprofissional intensivo em regime de internação, discutindo as possibilidades terapêuticas para reabilitação da doença

There is little information in the medical literature on the rehabilitation of patients with GuillainBarre Syndrome (GBS). There are clinical studies that demonstrate the effectiveness of a rehabilitation program using an interdisciplinary team, but without well-defined protocols and only performed on an outpatient basis. This case report aims to describe the evolution of a patient with GBS during the intensive multidisciplinary inpatient rehabilitation program, discussing the therapeutic possibilities for rehabilitation of the disease

The First Experiences of Robotic Single-Site Cholecystectomy in Asia: A Potential Way to Expand Minimally-Invasive Single-Site Surgery?

PURPOSE: Herein, we firstly present the robotic single-site cholecystectomy (RSSC) as performed in Asia and evaluate whether it could overcome the limitations of conventional laparoscopic single-site cholecystectomy. MATERIALS AND METHODS: From October 2013 to November 2013, RSSC for benign gallbladder (GB) disease was firstly performed consecutively in five patients. We evaluated these early experiences of RSSC and compared factors including clinicopathologic factors and operative outcomes with our initial cases of single-fulcrum laparoscopic cholecystectomy (SFLC). RESULTS: Four female patients and one male patient underwent RSSC. Neither open conversion nor bile duct injury or bile spillage was noted during surgery. In comparisons with SFLC, patient-related factors in terms of age, sex, Body Mass Index, diagnosis, and American Society of Anesthesiologist score showed no significant differences between two groups. There were no significant differences in the operative outcomes regarding intraoperative blood loss, bile spillage during operation, postoperative pain scale values, postoperative complications, and hospital stay between the two groups (p<0.05). Actual dissection time (p=0.003) and total operation time (p=0.001) were significantly longer in RSSC than in SFLC. There were no drain insertion or open conversion cases in either group. CONCLUSION: RSSC provides a comfortable environment and improved ergonomics to laparoscopic single-site cholecystectomy; however, this technique needs to be modified to allow for more effective intracorporeal movement. As experience and technical innovations continue, RSSC will soon be alternative procedure for well-selected benign GB disease.

Cirurgia Torácica Robótica: Presente ou futuro? / Robotic Thoracic Surgery: Present or future?

A cirurgia robótica do tórax encontra-se ao final da sua primeira década de existência; apesar disso, os seus resultados iniciais são compatíveis com as técnicas videoassistidas das praticadas nos grandes centros acadêmicos nos últimos 20 anos. A evolução tecnológica constante dos instrumentos de imagem, miniaturização dos sistemas robóticos econsequente aprimoramento da relação homem-máquina com dispositivos interativos mais precisos apontam umcaminho promissor para a robótica em cirurgia. Neste artigo, revisamos alguns dos principais elementos da cirurgia robótica, as suas atuais vantagens edesvantagens comparadas a outras técnicas minimamenteinvasivas, trazendo perspectivas sobre o seu presente efuturo.

Benefícios da marcha com assistência robótica na lesão medular: uma revisão sistemática / Benefits of robotic-assisted gait in spinal cord injury: a systematic review

Objetivo: Avaliar a qualidade atual de evidências quanto à eficácia da marcha robótica com suspensão de peso corporal em indivíduos com lesão medular, com ênfase no desempenho da marcha. Método: O levantamento bibliográfico foi realizado nas bases de dados PubMed, LILACS e EMBASE referentes às publicações de ensaios clínicos dos últimos doze anos (2000-2012), utilizando-se a relação entre as palavras chave Spinal cord injury AND (gait OR walking OR deambulation) reahbilitation AND robotic AND (lokomat OR ReoAmbulator OR Formador Gait). Resultados: Dos oito estudos selecionados, apenas um não observou melhora no padrão de desempenho da marcha. Dos estudos que encontraram melhora, 6 encontraram melhora estatisticamente significativa e um não encontraram nenhuma diferença significativa, apesar de uma tendência de melhora ter sido observada. As conclusões destes estudos foram obtidas por meio de ferramentas de avaliação como o teste de caminhada de 6 minutos e de 10 metros, MIF (medida de independência funcional, WISCI II (Índice de caminhada de Lesão Medular), entre outros. Alguns estudos apontam uma diminuição na necessidade de órteses e dispositivos auxiliares nesse grupo. Quanto à qualidade metodológica, seis artigos apresentaram escores inferiores a 3 pontos e apenas um artigo teve a pontuação máxima de 5 na escala JADAD (baixa qualidade pontuação inferior a 3) Implicação/Impacto na reabilitação. Conclusão: Apesar da pequena quantidade de artigos encontrados, da baixa qualidade metodológica e o fato desta ser uma intervenção nova e de alto custo, os resultados são significativos quando comparados com a terapia física convencional e outras técnicas bem estabelecidas na fisioterapia.

Objective: To evaluate the quality of current evidence regarding effectiveness of body weight-supported, robot-assisted gait in subjects with spinal cord injury, with emphasis on gait performance. Method: A survey was conducted in PubMed, LILACS and EMBASE using the keywords "spinal cord injury" AND (gait OR walking OR deambulation) reahbilitation AND robotic AND (Lokomat OR ReoAmbulator OR Formador Gait). Clinical trials published between 2001-2012 which compared locomotor training with or without other intervention were included. Results: From the 8 selected studies, only one did not findimprovement in gait performance. From the studies which found improvement, 6 found statistically significant improvement and one found no significant difference, although a tendency to improvement was noticed. The findings of these studies were obtained through assessment tools like the six-minute and the ten-meter walk tests, FIM (Functional Independence Measure, WISCI II (Walking Index for Spinal Cord Injury), among others. Some studies pointed to a decrease in the need for orthotics and assistive devices in this group. Regarding methodological quality, 6 articles presented scores lower than 3 points and only one article got the maximum score 5 in JADAD scale (low quality less than 3). Implication/Impact on rehabilitation. Conclusion: In spite of the small quantity of articles found, of the low methodological quality noted and the fact that this is a costly and new modality of intervention, the results are significant when compared to conventional physical therapy and to other well-established techniques in physical therapy.

Robotic Mechanical Localization of Prostate Cancer Correlates with Magnetic Resonance Imaging Scans

PURPOSE: To evaluate the concordance of cancer location of the tissue mapping from a mechanical pressure transducer with magnetic resonance imaging (MRI) scans. MATERIALS AND METHODS: A total of 60 indentations were performed on 5 prostate specimens obtained after radical prostatectomy utilizing a robotic indentation system. The mechanical elastic moduli of suspected malignant lesions were calculated and mapped, and their locations were compared with suspicious areas of malignancy on MRI scans. RESULTS: The concordance rate between the location mapping from the robotic indentation system and MRI scans results was 90.0% (54/60). The sensitivity and specificity of the robotic indentation system were 87.9% (29/33) and 92.6% (25/27), respectively. The positive predictive value and negative predictive value were 93.5% (29/31) and 93.1% (27/29), respectively. CONCLUSION: The locations of malignant lesions derived from our robotic indentation system correlated strongly with the locations of suspected areas of malignancy on MRI scans. Our robotic system may provide a more targeted biopsy of the prostate than conventional non-targeted systemic biopsy, possibly improving the diagnostic accuracy of prostatic biopsies for cancer.

Robótica, nanotecnología y singularidad / Robotics, nanotechnology and uniqueness

Los avances en la tecnología nos han llevado a descubrimientos científicos importantes, a descubrir causas y tratamientos de enfermedades que antiguamente solo eran mitos y suposiciones y en las últimas décadas hemos tenido en el campo de la otorrinolaringología nuevos elementos que nos llevan a mejores desempeños en el campo laboral, no es futurista hablar de robots, de cirugía de telepresencia, y cibernética es lo que actualmente estamos viviendo, es el hoy y el mañana de la medicina. Es por ello que en el presente artículo hemos querido plasmar un campo desconocido aun por muchos y por otros realmente exaltado es el campo de la robótica, la nanotecnología y la singularidad, su aplicaciones en la otorrinolaringología, algunas de sus ventajas y desventajas. Puede que para nosotros sea el comienzo pero para nuestros hijos y futuros colegas sea la base fundamental de su vida profesional...

Advances in technology have led to important scientific discoveries, to discover causes and treatments of diseases that formerly were only myths and assumptions and in recent decades we have had in the field of otolaryngology new elements that lead to better performances in the workforce, not to mention futuristic robots, telepresence surgery, and cybernetics is what we are currently experiencing, is the present and the future of medicine. That is why in this article we want to express an unknown field and even by many others really excited is the field of robotics, nanotechnology and the singularity, its applications in otolaryngology, some of the advantages and disadvantages. It may be the start for us but for our children and future colleagues is the foundation of his professional life...

Robot-assisted Resection of Paraspinal Schwannoma

Resection of retroperitoneal tumors is usually perfomed using the anterior retroperitoneal approach. Our report presents an innovative method utilizing a robotic surgical system. A 50-yr-old male patient visited our hospital due to a known paravertebral mass. Magnetic resonance imaging showed a well-encapsulated mass slightly abutting the abdominal aorta and left psoas muscle at the L4-L5 level. The tumor seemed to be originated from the prevertebral sympathetic plexus or lumbosacral trunk and contained traversing vessels around the tumor capsule. A full-time robotic transperitoneal tumor resection was performed. Three trocars were used for the robotic camera and working arms. The da Vinci Surgical System(R) provided delicate dissection in the small space and the tumor was completely removed without damage to the surrounding organs and great vessels. This case demonstrates the feasibility of robotic resection in retroperitoneal space. Robotic surgery offered less invasiveness in contrast to conventional open surgery.

Iliac Vein Injury Due to a Damaged Hot Shearstrade mark Tip Cover During Robot Assisted Radical Prostatectomy

We report a rare case of vascular injury secondary to a damaged Hot Shearstrade mark tip cover. Two 1 mm holes in the tip cover resulted in perforations in the obturator and external iliac veins during pelvic node dissection. Bleeding was controlled with bipolar coagulation and a 5 mm metal clip in the obturator and iliac vein, respectively. The rest of the procedure was completed uneventfully. Frequent integrity assessment of this accessory is necessary. Its function is important in order to carry out safe dissection in proximity to delicate structures. When injuries arise from areas not directly involved in the dissection, immediate inspection of the instruments should be mandatory.

Development of a computer assisted gantry system for gaining rapid and accurate calyceal access during percutaneous nephrolithotomy

PURPOSE: To design a simple, cost-effective system for gaining rapid and accurate calyceal access during percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: The design consists of a low-cost, light-weight, portable mechanical gantry with a needle guiding device. Using C-arm fluoroscopy, two images of the contrast-filled renal collecting system are obtained: at 0-degrees (perpendicular to the kidney) and 20-degrees. These images are relayed to a laptop computer containing the software and graphic user interface for selecting the targeted calyx. The software provides numerical settings for the 3 axes of the gantry, which are used to position the needle guiding device. The needle is advanced through the guide to the depth calculated by the software, thus puncturing the targeted calyx. Testing of the system was performed on 2 target types: 1) radiolucent plastic tubes the approximate size of a renal calyx (5 or 10 mm in diameter, 30 mm in length); and 2) foam-occluded, contrast-filled porcine kidneys. RESULTS: Tests using target type 1 with 10 mm diameter (n = 14) and 5 mm diameter (n = 7) tubes resulted in a 100 percent targeting success rate, with a mean procedure duration of 10 minutes. Tests using target type 2 (n = 2) were both successful, with accurate puncturing of the selected renal calyx, and a mean procedure duration of 15 minutes. CONCLUSIONS: The mechanical gantry system described in this paper is low-cost, portable, light-weight, and simple to set up and operate. C-arm fluoroscopy is limited to two images, thus reducing radiation exposure significantly. Testing of the system showed an extremely high degree of accuracy in gaining precise access to a targeted renal calyx.

A Unique Instrumental Malfunction during Robotic Prostatectomy

Over the past decade, the introduction of robotics in the field of medicine has provided a new approach to patients requiring surgery, and both its advantages and disadvantages are currently under study by many groups worldwide. The use of robotics has especially been considered by the urological community as a treatment option in radical prostatectomy. The current case report is one in which the da Vinci Surgical Systemtrade mark, with fourth arm use was employed in radical prostatectomy. This case presents a unique occurrence in which a bolt of the Prograsper forcep became loose during an operation, leading to diminished device functionality and later impedance of its removal. A circumstance such as this has not previously been reported, so we introduce for other robotic surgeons our unique instrumental malfunction case during a robotic prostatectomy.

Cirugía robótica en el tratamiento quirúrgico de la acalasia: primera experiencia en el Hospital Universitario de Caracas / Robotic surgery in the treatment of achalasia: first experience at the Hospital Universitario of Caracas

Reportar la experiencia inicial en el tratamiento quirúrgico de la acalasia asistido por robot en el Hospital Universitario de Caracas. Paciente masculino de 62 años de edad quien consultó por presentar disfagia de 6 meses de evolución, la endoscopia digestiva superior no mostró hallazgos patológicos, se realizó manometria donde se observó alteración del periltastismo y falta de relajación del esfínter esofágico inferior confirmándose el diagnóstico de acalasia. Se decide realizar tratamiento quirúrgico dentro del marco del programa de Cirugía Robótica del Hospital Universitario de Caracas. El paciente es llevado a mesa operatoria, donde se realizó miotomia de Heller y funduplicatura tipo Dor por vía laparoscópica asistida por robot, en un tiempo operatorio de165 minutos, sin complicaciones asociadas al procedimiento. El paciente es egresado satisfactoriamente a las 24 horas. El tratamiento quirúrgico mínimamente invasivo de la acalasia asistido por robot, es un procedimiento seguro y factible, que parece aportar ciertas ventajas sobre la cirugía laparoscópica convencional.

To report the initial experience in robot assisted laparoscopic treatment of achalasia in the University Hospital of Caracas. Sixty two years old male patients who presented a 6 months history of dysphagia. The superior endoscopic study was normal and the esophageal manometry showed alteration in peristaltism with absent inferior esophageal sphincter relaxation, confirming the diagnosis of achalasia. The patient is referred to the robotic surgery program of the Hospital Universitario of Caracas. A robot assisted laparoscopic treatment of achalasia was performed. The operative time was 165 minutes, with no procedure associated complication reported. The patient was dischange 24 hours after intervention. The robot assited minimally invasive surgical treatment of the achalasia is a safe and effective procedure which apparently show some advantanges over traditional laparoscopy.

Robotic-assisted partial nephrectomy: surgical technique using a 3-arm approach and sliding-clip renorrhaphy

INTRODUCTION: For the treatment of renal tumors, minimally invasive nephron-sparing surgery has become increasingly performed due to proven efficiency and excellent functional and oncological outcomes. The introduction of robotics into urologic laparoscopic surgery has allowed surgeons to perform challenging procedures in a reliable and reproducible manner. We present our surgical technique for robotic assisted partial nephrectomy (RPN) using a 3-arm approach, including a sliding-clip renorrhaphy. MATERIAL AND METHODS: Our RPN technique is presented which describes the trocar positioning, hilar dissection, tumor identification using intraoperative ultrasound for margin determination, selective vascular clamping, tumor resection, and reconstruction using a sliding-clip technique. CONCLUSION: RPN using a sliding-clip renorrhaphy is a valid and reproducible surgical technique that reduces the challenge of the procedure by taking advantage of the enhanced visualization and control afforded by the robot. The renorrhaphy described is performed under complete control of the console surgeon, and has demonstrated a reduction in the warm ischemia times in our series.

Nanomedicine: promising tiny machine for the healthcare in future-a review

One of the 21 st century's most promising technologies is nanotechnology. Nanomedicine, an offshoot of nanotechnology, refers to highly specific medical intervention at the molecular scale for curing disease or repairing damaged tissues, such as bone, muscle, or nerve. Nanotechnology is a collective term referring to technological developments on the nanometer scale, usually 0.1- 100n.m. A nanometer is one-billionth of a meter, too small to be seen with a conventional laboratory microscope. It is at this size scale - about 100 nanometers or less- that biological molecules and structures inside living cells operate. Therefore, nanotechnology is engineering and manufacturing at the molecular scale. Utilities of nanotechnology to biomedical sciences imply creation of materials and devices designed to interact with the body at sub-cellular scales with a high degree of specificity. This could be potentially translated into targeted cellular and tissue-specific clinical applications aimed at maximal therapeutic effects with very limited adverse-effects. Nanomedicine can offer impressive resolutions for various life threatening diseases. Disease areas which can be expected to benefit most from nanotechnology within the next few years are cancer, diseases of the cardiovascular system, the lungs, blood, neurological [especially neurodegenerative] diseases, diabetes, inflammatory/infectious diseases, Parkinson's or Alzheimer's disease and orthopaedic problems. In the fist half of the 21 st century, nanomedicine should eliminate virtually all medical pain. This article presents an overview of some of the applications of nanotechnology in nanomedicine

Early experience of robotic assisted laparoscopic radical prostatectomy.

INTRODUCTION: Quality of life after laparoscopic radical prostatectomy has been a discussed issue among patients. Robotic Assisted Laparoscopic Radical Prostatectomy (RALRP) has been shown to provide the best surgical outcomes in terms of potency and continence. The program of robotic prostatectomy was started at Siriraj Hospital. Early result of the author's experience was evaluated. OBJECTIVE: To evaluate the feasibility of Robotic Assisted Laparoscopic Radical Prostatectomy done at Siriraj Hospital. MATERIAL AND METHOD: From March 2007 to November 2007, 34 patients (Group 1) with localized prostate cancer underwent Robotic Assisted Laparoscopic Radical Prostatectomy (RALRP). Perioperative data was evaluated and compared to those of 34 patients (group 2) who underwent Laparoscopic Radical Prostatectomy (LRP) during the same period by the same surgeon. RESULTS: There were no demographic differences between the two groups. Catheterization time was significantly shortened in the RALRP group (p < 0.05). There was no major complication in the RALRP group, one LRP patient suffered bilateral ureteric injuries and required bilateral reimplantation. In pathological T2 patients of the last 17 consecutive cases, positive surgical margin rate was similar (14%) in both groups. CONCLUSION: The author early experience has shown that RALRP is feasible and safe. Oncological outcome can be improved with more experience and long term follow up is needed to evaluate functional outcome including potency rate and incontinence rate.

Robotic Surgery in Gynecologic Field

Operative laparoscopy was initially developed in the field of gynecology earlier on and the advent of laparoscopic surgery led to advances in general surgery as well. In the last few years, a number of articles have been published on the performance of surgical procedures using the robot-assisted laparoscopy. The shortcomings of conventional laparoscopy have led to the development of robotic surgical system and future of telerobotic surgery is not far away, enabling a surgeon to operate at a distance from the operating table. The complete loss of tactile sensation is often quoted as a big disadvantage of working with robotic systems. Although the first generation da Vinci robotic surgical system provides improved imaging and instrumentation, the absence of tactile feedback and the high cost of the technology remain as limitations. New generations of the robotic surgical systems have been developed, allowing visualization of preoperative imaging during the operation. Though the introduction of robotics is very recent, the potential for robotics in several specialties is significant. However, the benefit to patients must be carefully evaluated and proven before this technology can become widely accepted in the gynecologic surgery.

Yonsei Experience in Robotic Urologic Surgery-Application in Various Urological Procedures

PURPOSE: The da Vinci(R) robot system has been used to perform complex reconstructive procedures in a minimally invasive fashion. Robot-assisted laparoscopic radical prostatectomy has recently established as one of the standard cares. Based on experience with the robotic prostatectomy, its use is naturally expanding into other urologic surgeries. We examine our practical pattern and application of da Vinci(R) robot system in urologic field. PATIENTS AND METHODS: Robotic urologic surgery has been performed during a period from July 2005 to August 2008 in a total of 708 cases. Surgery was performed by 7 operators. In our series, radical prostatectomy was performed in 623 cases, partial nephrectomy in 43 cases, radical cystectomy in 11 cases, nephroureterectomy in 18 cases and other surgeries in 15 cases. RESULTS: In the first year, robotic urologic surgery was performed in 43 cases. However, in the second year, it was performed in 164 cases, and it was performed in 407 cases in the third year. In the first year, only prostatectomy was performed. In the second year, partial nephrectomy (2 cases), nephroureterectomy (3 cases) and cystectomy (1 case) were performed. In the third year, other urologic surgeries than prostatectomy were performed in 64 cases. The first robotic surgery was performed with long operative time. For instance, the operative time of prostatectomy, partial nephrectomy, cystectomy and nephroureterectomy was 418, 222, 340 and 320 minutes, respectively. Overall, the mean operative time of prostatectomy, partial nephrectomy, cystectomy and nephrourectectomy was 179, 173, 309, and 206 minutes, respectively. CONCLUSION: Based on our experience at a single-institution, robot system can be used both safely and efficiently in many areas of urologic surgeries including prostatectomy. Once this system is familiar to surgeons, it will be used in a wide range of urologic surgery.

Robotic assisted radical prostatectomy: surgical techniques and outcomes

Robotic assisted radical prostatectomy (RARP) is gaining acceptance and popularity among urologists all over the world. Early oncologic and functional results are encouraging. In this manuscript, we describe in detail both approaches for RARP and show the results of the robotic surgery program with over 300 RARP performed at our institution.

Cirugía coronaria miniinvasiva asistida por computadora (robótica) / Computer-aided minimally invasive coronary surgery (robotics)

El principio básico de los robots utilizados corrientemente es el de brazos manipuladores con una arquitectura serial de articulaciones y conexiones. La movilidad de las articulaciones está provista por actores mecánicos que se manejan eléctrica o hidráulicamente. Los robots usados hoy en cirugía cardíaca son los llamados on line, porque el operador está en control permanente del sistema por vía de una interfase hombre-máquina. El concepto es combinar las habilidades humanas, como el juicio y la percepción, con la mecánica precisa del robot mediante tecnología mejorada por computadora. A causa de que los movimientos manuales del cirujano son convertidos en señales electrónicas por el input device de la consola, el paciente no necesita estar en la misma sala de operaciones ni ciudad que el cirujano para ser operado. El concepto de inmovilización virtual para eliminar los efectos del movimiento cardíaco también es atrayente. Moviendo la cámara y los instrumentos sincrónicamente con las excursiones del corazón, se puede crear una imagen de inmovilidad virtual, de modo de trabajar con la imagen detenida.