Clinical applications of handheld robotic devices in general surgery: A mini-review

Laparoscopy has evolved the surgical field around the world. Although this has defined minimally invasive surgery, there are limitations. Lack of articulating instrument tips restricts their use in difficult cases. Ergonomic challenges risk occupational injury. Although there is now an increasing use of robotics, these platforms have significant costs. Articulating laparoscopic instruments, termed handheld robotic devices, pose a potential solution to this problem. We aimed to perform a mini-review the clinical applications of handheld robotic devices in general surgery. A limited literature search of the MEDLINE, EMBASE, and Cochrane databases were performed to identify handheld robotic devices with clinical trial data. Primary outcomes were operative time, complication rate, and conversion to laparoscopy or open surgery. Three devices were identified. Noninferiority was demonstrated with respect to laparoscopic instruments in terms of operative time and postoperative complications. This is despite the devices being in their relative infancy with learning curves. Subgroup analysis in a comparative trial with robotics for inguinal hernia repair revealed no significant difference in operative duration during unilateral flap closure. There were no cases requiring conversion. The need for cost-effective robotic devices is clear. Handheld robotic devices have been engineered to provide articulating instrument tips while using existing laparoscopic equipment. They have been demonstrated to be safe and effective. The amalgamation of precision-enhancing robotic instruments with the fiscal advantages of laparoscopic tools has the potential to fundamentally alter the field of minimally invasive surgery.