**6. Future of robotic surgery**

Since the introduction of robotic-assisted surgery, surgeons and medical engineers have continuously searched for new technologies and advancements across all surgical fields. Since its introduction approximately 20 years ago, the da Vinci robotic surgery system (Intuitive Surgical Inc., Sunnyvale, CA, USA) has been involved in over 5 million operations, making Intuitive Surgical the largest player in the surgical robotic market [81]. However, with the original da Vinci patents now expiring, many medical 'tech' companies are now setting their sights on joining this lucrative, growing market. New systems in the near future will likely aim to improve on the current robotic models by incorporating new technologies such as single-port instrumental arms, haptic feedback, eye-movement tracking, and virtual reality (VR) [82]. In addition to the technological aspects of the current robotic systems, there are also some important practical limitations that can be improved upon, such as the high operational costs, the size of the robotic systems, and its accessibility in lower-income countries. Several "large" robotic systems have become available in the last few years. Some examples are the Senhance console (TransEnterix, Morrisville, NC, USA), BITRACK system (Rob Surgical, Barcelona, Spain), and the Revo-i surgical robot (Meere Company, Seoul, South Korea). These systems each have some advantages over the da Vinci system, such as haptic feedback or eye-tracking, but are generally limited by their price and large size [81].

**69**

**Author details**

**Conflict of interest**

**7. Conclusion**

Antwerp, Belgium

and Jeroen M.H. Hendriks\*

Lawek Berzenji, Krishan Yogeswaran, Patrick Lauwers, Paul Van Schil

the benefits of robotic-assisted approaches outweigh its costs.

The authors declare no conflict of interest.

\*Address all correspondence to: jeroen.hendriks@uza.be

provided the original work is properly cited.

Department of Thoracic and Vascular Surgery, Antwerp University Hospital,

© 2021 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

*Robotic Surgery for the Thoracic and Vascular Surgeon DOI: http://dx.doi.org/10.5772/intechopen.97598*

In addition to these large systems, many companies have started to create smaller, more portable systems that allow more flexibility in hospitals that do not have robot-dedicated operating rooms. Perhaps the most daring and revolutionary concept that is entering the field of surgery is the surgical microrobot. Microrobot surgery is fundamentally different to the current robotic systems as it is not physically tethered to a console. These microbots can be propelled externally via electromagnetic fields or ultrasonographic energy, or internally using chemical reactions. Recent proof-of-concepts have shown that these microbots are able to perform various surgical manoeuvres such as dissecting, grasping, and ablation at a microscale [83–85]. Undoubtedly, the future of robotic surgery looks exciting as many new technologies are emerging at an exponential pace. The COVID-19 pandemic has shown an unprecedented demand of surgical robotic systems as well, mainly due to their ability of providing an additional shielding layer between the healthcare worker and the patient [86]. It is likely that this demand will outlast the pandemic

itself and propel the development of surgical robotic technology.

It is without a doubt that robotic surgery has changed the surgical world over the last decade. An increasingly large group of surgeons are incorporating robotic approaches in their daily practice as more and more data has shown the benefits of these approaches. In thoracic surgery, RATS has proven to be a valuable tool for many oncological and non-oncological indications, resulting in it being considered one of the standard treatment approaches in many centres. Similar, although less prominent, trends are being noted in the field of vascular surgery as well. However, despite these promising future perspectives, there is still a lack of well-powered, multi-centre randomised trials comparing robotic approaches to open surgery or conventional laparoscopy/thoracoscopy. Furthermore, more data regarding the cost and cost efficiency of robotic surgery are necessary in order to determine whether

*Robotic Surgery for the Thoracic and Vascular Surgeon DOI: http://dx.doi.org/10.5772/intechopen.97598*

In addition to these large systems, many companies have started to create smaller, more portable systems that allow more flexibility in hospitals that do not have robot-dedicated operating rooms. Perhaps the most daring and revolutionary concept that is entering the field of surgery is the surgical microrobot. Microrobot surgery is fundamentally different to the current robotic systems as it is not physically tethered to a console. These microbots can be propelled externally via electromagnetic fields or ultrasonographic energy, or internally using chemical reactions. Recent proof-of-concepts have shown that these microbots are able to perform various surgical manoeuvres such as dissecting, grasping, and ablation at a microscale [83–85]. Undoubtedly, the future of robotic surgery looks exciting as many new technologies are emerging at an exponential pace. The COVID-19 pandemic has shown an unprecedented demand of surgical robotic systems as well, mainly due to their ability of providing an additional shielding layer between the healthcare worker and the patient [86]. It is likely that this demand will outlast the pandemic itself and propel the development of surgical robotic technology.
