Pearls and pitfalls: lessons learned in endoscopic robotic surgery- the da Vinci experience

The da Vinci telemanipulation system (Intuitive Surgical, Mountain View, CA) is a computer-enhanced instrumentation system that has helped to overcome some of the limitations of traditional endoscopic instruments. As of May 2001, a total of 1,250 endoscopic cardiac procedures have been performed using the da Vinci system. With the use of wristed instruments and a new generation of endoscopic stabilizers, total endoscopic coronary artery bypass grafting on the beating heart has been achieved in 56 cases. Mitral valve repair and closure of atrial septal defects have been performed successfully through 1 cm incisions in 140 patients. The development of adjunct technologies as well as integration of image-based navigation systems may help to expand the use of computer-enhanced instrumentation systems in the near future.