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Robotic surgery, as a type of minimally invasive surgery, is applied in the medical care, and offers numerous benefits for patients. In this article, the development and changes in robotics, and the aim of robot manufacturing will be reviewed. Furthermore, by summarizing the history of the surgical field, we are going to describe the main paradigm shifts, which show the human acceptance and usage of novel ideas in Europe and in the USA. As a summary, the complex structure, place in surgery and the advantages of the surgical robots and some state-of-the-art research projects will be described, to let us forecast the surgical field of the future.

Competing Interests: Declaration of competing interest Francisco Schlottmann and Mario A. Masrur have no conflicts of interest, financial ties, or funding/support to disclose.

Harry Reich, MD, FACOG, FRCOG, FACS is known worldwide as a pioneer in the field of laparoscopic surgery. He performed the first laparoscopic hysterectomy, the first pelvic lymphadenectomy for cancer, and the first excision of cul-de-sac endometriosis that included rectal resection. This article explores his life and contributions. The author knew Dr. Reich from medical conferences over many years and visited Dr. Reich in Pennsylvania to observe him in the operating room. For this article, the author spoke with Dr. Reich on nearly a nightly basis over a 13-month period in 2022 and 2023. Dr. Reich's descriptions were cross-referenced with his publications and those of his peers. The author also interviewed physicians who worked closely with Dr. Reich and reviewed the trial transcript of the February 1980 Nesbitt Memorial Hospital special ad hoc investigatory committee. The result is a comprehensive review spanning from Dr. Reich's early life to his ultimate recognition as one of the most significant innovators of advanced laparoscopic surgery. The author concluded that Dr. Reich's accomplishments are rooted in his command of pelvic anatomy, his lifelong interest in surgery and his willingness to challenge existing surgical dogma. By attending medical school in Ireland, Dr. Reich benefitted from the deep study of anatomy offered there. He also had a unique background of being a Harvard-trained gynecologic surgeon practicing in Wilkes-Barre, a small Pennsylvania community that trusted him because both his parents practiced medicine there before him. Dr. Reich favored conservative surgery rather than hysterectomy for endometriosis and patiently excised deep disease, offering relief to countless women, at times without compensation. He exhibited astonishing bravery and perseverance in the face of scathing criticism. Dr. Harry Reich's empathy for his patients and willingness to challenge the status quo were pivotal in improving the lives of many thousands of women and revolutionizing gynecologic surgery.

Objective: Entry into the abdomen during operative laparoscopy is a source of some controversy regarding the safest and most useful method. The objective of this review is to describe, compare, and contrast the most popular entry techniques., Data Sources: Data were collected from the historical starting point until present day from English language journal articles and book chapters., Methods of Study Selection: Descriptive accounts dating back to the start of laparoscopy in the 1970s and spanning to present day well-designed randomized controlled trials and Cochrane reviews were compiled to evaluate the evidence for the effectiveness and safety of abdominal entry techniques., Tabulation, Integration, and Results: The most common sites of entry are the umbilicus and the left upper quadrant. Between the Veress needle, direct trocar insertion, and open entry there is no high-quality evidence to suggest that any of these offers a universal safety advantage. The Veress needle is still the most used among gynecologists and facilitates primary trocar placement. Direct trocar entry under laparoscopic visualization may be underused, is faster, and may result in fewer failed entries. Open (Hasson) entry can be more technically challenging, but may be best for patients with suspected intra-abdominal adhesions., Conclusion: Surgeon comfort is critical in choosing the entry site, method, and equipment. Surgeon familiarity with entry-failure troubleshooting, possible complications, and management is essential because major entry complications are rare in modern laparoscopy but critical because the essential steps of recognition and management can be lifesaving., (Copyright © 2020 AAGL. Published by Elsevier Inc. All rights reserved.)

This is the second of a three-part series that charts the history of minimal access surgery from antiquity to current times. Although rapid developments in laparoscopic and robotic surgery have transformed surgical care over the last 30 years, our predecessors made significant advances in their time which set the principles for modern practice. Part I of this series described how ancient medical practitioners developed simple instruments, from metal or wood, for viewing body cavities. Improvements in the use of metal, glass and lighting allowed for inspection of deeper parts of the body. This second part of the series will show how advances in electrical technology allowed the development of improved lighting for endoscopy and laparoscopy along with the use of electrocautery for a wide range of therapeutic procedures.

Surgeons and their patients recognise that one of the major advances in surgical technique over the last 20 years has been the growth of minimal access surgery by means of laparoscopic and robotic approaches. Partnerships with industry have facilitated the development of advanced technical instruments, light sources, recording devices and optics which are almost out of date by the time they are introduced to surgical practice. However, lest we think that technological innovation is entirely a modern concept, we should remember that our predecessors were masters of their craft and able to apply new technologies to surgical practice. The history of minimal access surgery can be traced back to approximately 5000 years ago and this review aims to remind us of the achievements of historical doctors and engineers, as well as bring more modern developments to wider attention.This review will comprise a three-part series:Part I 3000BC to 1850 Early instruments for viewing body cavitiesPart II 1850 to 1990 Technological developmentsPart III 1990 to present Organisational issues and the rise of the robots.

Total mesorectal excision (TME) was first described 40 years ago by Richard Heald. The purpose of this article is to point out importance of this surgical procedure. Starting from first attempts to surgically cure rectal carcinoma in the nineteenth century through Miles' operation at the beginning of the twentieth century results were not satisfactory due to high number of local recurrences after resections for rectal cancer. Progress in surgical technique and knowledge of anatomy and embryology of the rectum led to development of TME. Principle of TME is surprisingly simple: removal of the rectum with complete embryonic space containing lymph nodes which are site of primary dissemination of the disease. Main advantages and drawbacks of TME as well as focus on newer procedures developed from the concept of TME are presented in the form of a review.

Study Objective: To investigate the surgical trends among different types of hysterectomy (abdominal, vaginal, laparoscopic, and subtotal) over a 15-year period in Taiwan., Design: A retrospective cohort study., Setting: A population-based National Health Insurance Research Database., Patients: Women undergoing various types of hysterectomy for noncancerous lesions., Interventions: Data for this study were extracted from the inpatient expenditures by admissions files of Taiwan's National Health Insurance Research Database from 1998 through 2012 and divided into three 5-year time frames: first (1998-2002), second (2003-2007), and third (2008-2012). The variables included types of hysterectomy, patient age, gynecologist age and sex, hospital accreditation level, and surgical volume. Chi-square and trend tests were used to examine the association between the variables., Measurements and Main Results: A total of 329 438 patients who underwent various types of hysterectomy were identified; 306 257 were included in the study. During the 15-year period, 45% underwent total abdominal hysterectomy, 41% underwent laparoscopic hysterectomy (LH), 9.8% underwent vaginal hysterectomy, and 4.2% underwent subtotal abdominal hysterectomy. The frequency of LHs increased from 35.9% in the first period to 43.9% in the second period and remained at 44.2% in the third period. During the same time period, there was a decrease in the frequency of total abdominal hysterectomies. Typically, younger patients underwent LHs by gynecologists with large volume surgical practices and medical centers., Conclusion: This 15-year study describes an increase of LHs and subtotal abdominal hysterectomies over time and provides evidence of surgical trends and a paradigm shift of hysterectomies. Surgical skills and performance extended from high- to low-surgical volume gynecologists and from medical centers to regional and local hospitals. This shift may have a great influence on patient and health care provider choice of treatment., (Copyright © 2019. Published by Elsevier Inc.)

The anterior approach to lumbar spine fusion, termed anterior lumbar interbody fusion (ALIF), is becoming increasingly popular, with numerous recognized indications, well-defined advantages, and potential complications. From its first theoretical description in 1932 and the first operation published in 1933 to the more recently reported less invasive procedures, an anterior approach to the lumbar spine has many technical variations. Here we describe the evolution of the anterior approach to the lumbar spine, from a hugely invasive transperitoneal route to the current minimally invasive retroperitoneal approach. Many advantages have been advocated for the ALIF approach, and some issues about intraoperative and postoperative complications need to be evaluated in a more specific and homogeneous manner., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Pediatric laparoscopic surgery has developed rapidly in the past 20 years in mainland China with the help of international collaborative training programs. High-volume laparoscopic workload has enabled Chinese pediatric surgeons to innovate and gain experience within a short span of time. We feel that outcomes are comparable or even in some cases superior to that of open surgery. In this article, based on the Storz Lecture to the 65th BAPS Congress in Liverpool, we share our experience of this rapid development of pediatric laparoscopy. EVIDENCE LEVEL: V., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Robotic-assisted kidney transplantation (RAKT) represents the most recent innovation in the evolution of kidney transplantation surgery. Vascular techniques enabling kidney transplantation have existed since the early 20th century and contributed to the first successful open kidney transplant procedure in 1954. Technical advances have since facilitated minimally invasive laparoscopic and robotic techniques in live-donor surgery, and subsequently for the recipient procedure. This review follows the development of surgical techniques for kidney transplantation, with a special focus on the advent of robotic-assisted transplantation because of its potential to facilitate transplantation of those deemed previously too obese to transplant by standard means. The different techniques, indications, advantages, disadvantages, and future directions of this approach will be explored in detail. Robot-assisted kidney transplantation may become the preferred means of transplanting morbidly obese recipients, although its availability to such recipients remains extremely limited and strategies targeting weight loss pretransplantation should never be abandoned in favor of a "RAKT-first" approach.

Minimal-invasive gastrectomy has been established as commonly used method for the early gastric cancer in Korea and Japan. From the first laparoscopic cancer gastrectomy in 1992 in Japan, numerous prospective randomized trials from these two countries have gained the evidence for non-inferiority or even specific benefits compared to open surgery. In Korea, the "Korean Laparoscopic Gastrointestinal Surgical Study Group" (KLASS group) founded, in 2004, successfully gained evidence not only in regards of oncological safety of laparoscopic gastrectomy, but also for the impact of different reconstruction methods and alternative extents of luminal resection on postoperative outcome and quality of life. Awaited results of latest studies from Korea, Japan, and China may suggest laparoscopic approaches as an option even in advanced gastric cancers. These studies could potentially be the starting point to find the role of laparoscopic gastrectomy in the west, where the incidence of gastric cancer is rather lower; the cancers are mostly diagnosed in advanced stages, and often, a perioperative chemotherapy is applied. Robotic (-assisted) gastrectomy was not shown to be superior to laparoscopic resection in Korea, but new technological developments should continuously be evaluated in clinical trials regarding a potentially favorable learning curve, which might play a key role in regards of the limited case load per center of gastric cancer in the west. This review summarizes the history of laparoscopic cancer gastrectomy in Asia and points out the important steps of establishing a nation-wide scientific network to support the surgical routine by the necessary evidence with a focus on Korea.

Introduction: Bariatric surgical practice changes in the community setting may be under-reported. We present the developments in a Spanish bariatric surgical practice in the community setting of Alcoy from its origin in 1977 through the present., Methods: Bariatric surgical techniques employed in a country community setting over the course of nearly four decades were reviewed retrospectively and qualitatively., Results: Surgeons and medical professionals from Alcoy, Spain were involved in the evolution of bariatric surgery patient management and surgical technique from 1977s through 2017. During the last 40 years, 1,475 patients were treated in our clinics. Spanish bariatric surgeons contributed to advances in gastric bypass in the 1970s, vertical banded gastroplasty in the 1980s, bilio-pancreatic diversion/duodenal switch in the 1990s, and innovations associated with laparoscopy from the 1990s onward. Outcomes and approaches to prevention and treatment of bariatric surgical complications are reviewed from a community perspective. Contributions to the bariatric surgical nomenclature and weight-loss reporting are noted., Conclusions: The practice of bariatric surgery in the community setting must be updated continuously, as in any human and surgical endeavor. Medical professionals in community bariatric practices should contribute their experiences to the field through all avenues of scientific interaction and publication.

"Microsurgery" is a set of principles developed to improve fertility surgery outcomes. These principles were developed progressively based on common sense and available evidence, under control of clinical feedback obtained with the use of second-look laparoscopy. Fertility outcome was the end point; significant improvement in fertility rates validated the concept clinically. Postoperative adhesion formation being a major cause of failure in fertility surgery, the concept of microsurgery predominantly addresses prevention of postoperative adhesions. In this concept, magnification with a microscope or laparoscope plays a minor role as technical facilitator. Not surprisingly, the principles to prevent adhesion formation are strikingly similar to our actual understanding: gentle tissue handling, avoiding desiccation, irrigation at room temperature, shielding abdominal contents from ambient air, meticulous hemostasis and lavage, avoiding foreign body contamination and infection, administration of dexamethasone postoperatively, and even the concept of keeping denuded areas separated by temporary adnexal or ovarian suspension. The actual concepts of peritoneal conditioning during surgery and use of dexamethasone and a barrier at the end of surgery thus confirm without exception the tenets of microsurgery. Although recent research helped to clarify the pathophysiology of adhesion formation, refined its prevention and the relative importance of each factor, the clinical end point of improvement of fertility rates remains demonstrated for only the microsurgical tenets as a whole. In conclusion, the principles of microsurgery remain fully valid as the cornerstones of reproductive microsurgery, whether performed by means of open access or laparoscopy., (Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Morbid obesity and obesity-related comorbidities are major public health problems around the world, including in East Asia. Although Asian populations have been shown to have an elevated risk of type 2 diabetes mellitus, hypertension, and hyperlipidemia at a relatively lower BMI than Western populations, the Asian perspective on bariatric and metabolic surgeries has not been actively discussed until recently. Bariatric surgery in East Asia has undergone a paradigm shift since the first laparoscopic vertical bariatric surgery was performed in Taiwan in 1998, which was subsequently followed by the introduction of laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass, and mini-gastric bypass. Since 2006, use of laparoscopic sleeve gastrectomy has remarkably increased because of its ease, speed, and safety. With regard to metabolic surgery, a randomized controlled trial in Taiwan demonstrated that laparoscopic Roux-en-Y gastric bypass is more effective than laparoscopic sleeve gastrectomy for surgical treatment of poorly controlled type 2 diabetes mellitus and metabolic syndrome. In this article, we describe the history of bariatric procedures, revision surgeries, weight-loss effect, and metabolic surgeries in Asian populations, and we also discuss minimally invasive bariatric surgery with some important citations., (© 2015 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.)

In the 50 years since the first edition of this journal, operative paediatric surgery has undergone radical change. Many of the most common instruments are unchanged, both as a testament to their utility and in recognition of past surgeons remembered eponymously. Surrounding that basic core of instruments, theatre has changed radically as new tools and techniques have arisen. Surgeons have come down from their pedestals, recognising surgery as a team sport rather than a solo performance. More than half of the current paediatric surgical trainees are women, a higher proportion than in any other craft group of the Royal Australasian College of Surgeons. The appearance, and rapid development, of laparoscopy is to many observers the most notable change in surgery over the last 50 years. Placed in its context though, it is simply the most prominent example of a frameshift in surgical thinking. The patient as a whole is now the focus, rather than just the disease. Recent developments are as much about minimising harm to normal tissues as they are about extirpating pathology. As a surgical maxim, 'Primum non nocere' is even more in evidence in 2015 than it was in 1965., (© 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).)

Single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) have rapidly gained pace worldwide, potentially replacing conventional laparoscopic surgery (CLS) as the preferred colorectal surgery technique. Currently available data mainly consist of retrospective series analyzed in four meta-analyses. Despite conflicting results and lack of an objective comparison, SILS appears to offer cosmetic advantages over CLS. However, due to conflicting results and marked heterogeneity, present data fail to show significant differences in terms of operative time, postoperative morbidity profiles, port-site complications rates, oncological appropriateness, duration of hospitalization or cost when comparing SILS with conventional laparoscopy for colorectal procedures. The application of "pure" NOTES in humans remains limited to case reports because of unresolved issues concerning the ideal access site, distant organ reach, spatial orientation and viscera closure. Alternatively, minilaparoscopy-assisted natural orifice surgery techniques are being developed. The transanal "down-to-up" total mesorectum excision has been derived for transanal endoscopic microsurgery (TEM) and represents the most encouraging NOTES-derived technique. Preliminary experiences demonstrate good oncological and functional short-term outcomes. Large-scale randomized controlled trials are now mandatory to confirm the long-term SILS results and validate transanal TEM for the application of NOTES in humans.

With the developments in medical technology and increased surgical experience, advanced laparoscopic surgical procedures are performed successfully. Laparoscopic abdominal surgery is one of the best examples of advanced laparoscopic surgery (LS). Today, laparoscopic abdominal surgery in general surgery clinics is the basis of all abdominal surgical interventions. Laparoscopic abdominal surgery is associated with systemic and splanchnic hemodynamic alterations. Inadequate splanchnic perfusion in critically ill patients is associated with increased morbidity and mortality. The underlying pathophysiological mechanisms are still not well understood. With experience and with an increase in the number and diversity of the resulting data, the pathophysiology of laparoscopic abdominal surgery is now better understood. The normal physiology and pathophysiology of local and systemic effects of laparoscopic abdominal surgery is extremely important for safe and effective LS. Future research projects should focus on the interplay between the physiological regulatory mechanisms in the splanchnic circulation (SC), organs, and diseases. In this review, we discuss the effects of laparoscopic abdominal surgery on the SC.

Central pancreatectomy (CP) is a parenchyma-sparing surgical procedure. The aims are to clarify the history and the development of CP and to give credits to those from whom it came. Ehrhardt, in 1908, described segmental neck resection (SNR) followed, in 1910, by Finney without reconstructive part. In 1950 Honjyo described two cases of SNR combined with gastrectomy for gastric cancer infiltrating the neck of the pancreas. Guillemin and Bessot (1957) and Letton and Wilson (1959) dealt only with the reconstructive aspect of CP. Dagradi and Serio, in 1982, performed the first CP including the resective and reconstructive aspects. Subsequently Iacono has validated it with functional endocrine and exocrine tests and popularized it worldwide. In 2003, Baca and Bokan performed laparoscopic CP and, In 2004, Giulianotti et al performed a robotic assisted CP. CP is performed worldwide either by open surgery or by using minimally-invasive or robotic approaches. This confirms that the operation does not belong to whom introduced it but to everyone who carries out it; however credit must be given to those from whom it came.

Single-port laparoscopic surgery (SPLS) is implemented through a tailored minimal single incision through which a number of laparoscopic instruments access. Introduction of operation-customized port system, utilization of a camera without a separate external light, and instruments with different lengths has brought the favorable environment for SPLS. However, performing SPLS still creates several hardships compared to multiport laparoscopic surgery; a single-port system inevitably leads to clashing of surgical instruments due to crowding. To overcome such difficulties, investigators has developed novel concepts and maneuvers, including the concept of inverse triangulation and the maneuvers of pivoting, spreading out dissection, hanging suture, and transluminal traction. The final destination of SPLS is expected to be a completely seamless operation, maximizing the minimal invasiveness. Specimen extraction through the umbilicus can undermine cosmesis by inducing a larger incision. Therefore, hybrid laparoscopic technique, which combined laparoscopic surgical technique with natural orifice specimen extraction (NOSE)--i.e., transvaginal or transanal route-, has been developed. SPLS and NOSE seemed to be the best combination in pursuit of minimal invasiveness. In the near future, robotic SPLS with natural orifice transluminal endoscopic surgery's way of specimen extraction seems to be pursued. It is expected to provide a completely or nearly complete seamless operation regardless of location of the lesion in the abdomen.

Dimitrij Oscarovic Ott (1855-1929) can undoubtedly be called the true pioneer of laparoscopy, especially of natural orifice transluminal endoscopic surgery. In 1901 already he performed abdominal examinations via a transvaginal access calling this procedure 'ventroscopy'. In 1902 the publication of his first results, as well as a description of the method and the equipment used, were released. In addition to Georg Kelling (1866-1945) and Hans Christian Jacobaeus (1879-1937), he therefore was one of the pioneers of present-day laparoscopy. Whereas Kelling published and presented his first results of merely animal trials in 1901 and Jacobaeus performed his first interventions on humans only in 1910, Ott had already used his new method in clinical practice since 1901. By only one incision in the cul-de-sac and utilizing a head lamp system similar to reflector lamps used by otolaryngologists, he inspected the abdominal cavity making use of a gynecological speculum. The patient was positioned in an extreme head-down position; for better lighting he used an additional light source which was connected to the speculum. Nowadays in Russia Prof. Ott still is a legend, especially in St. Petersburg. He was the director of the National Institute of Obstetrics and the personal physician to Empress Aleksandra Fedorovna (1872-1918). He is regarded as the father of the Russian school of obstetrics and gynecology as well as the founder of endoscopic surgery and laparoscopy in Russia., (© 2014 S. Karger AG, Basel.)

Dimitri Oscarovic Ott (1855-1929) can be justified in calling himself one of the true pioneers of laparoscopy and especially of natural orifices transluminal endoscopic surgery (NOTES). As early as 1901 he performed abdominal examinations via a transvaginal access and called this procedure ventroscopy. The publication of his first results and a description of the method and equipment were released in 1902. He was one of the pioneers of present day laparoscopy in addition to Georg Kelling (1866-1945) and Hans Christian Jacobaeus (1879-1937).While Kelling published and presented his first results of animal trials in 1901 and 9 years later in 1910 Jacobaeus performed his first interventions on human beings, Ott had already used the new method developed by him in clinical practice since 1901. Through a single incision in the cul-de-sac and using a head lamp system similar to reflector lamps used by otolaryngologists, he inspected the abdominal cavity with the aid of a gynecological speculum. The patient was positioned in an extreme head-down position and for better lighting he used an additional light source which was connected to the speculum. Even today Prof. Ott is a legend in Russia and especially in St. Petersburg. He was director of the National Institute of Obstetrics and personal physician to Tsarina Aleksandra Fedorovna (1874-1918). He is regarded as the father of the Russian school of obstetrics and gynecology as well as founder of endoscopic surgery and laparoscopy in Russia.

Objective: Robotic-assisted radical cystectomy (RARC) is a less invasive means of performing the radical cystectomy operation, which holds promise for improved patient morbidity. We review the history, technique and current literature pertaining to RARC and place the current results in context with the open procedure., Methods: All articles regarding RARC found in PubMed after January 2000 were examined. We selected articles that appeared in high-impact journals, had large patient population size (>80 patients), or were novel in technique or findings. We chose key laparoscopic articles to give reference to the history in transition to robotic radical cystectomy. In addition, we chose classic articles from open radical cystectomy to give reference regarding the newer robotic perioperative outcomes., Results: Studies suggest that a 20-patient learning curve is needed to reach an operative time of 6.5 h, with 30 surgeries performed to reach lymph node counts in excess of 20 (International Robotic Cystectomy Consortium). The only randomized surgical trial comparing open and robotic techniques showed equivalent lymph node yield, which may be surgeon and volume dependent. Literature demonstrates lower estimated blood loss, transfusion rates, early return of bowel function and decreased complications in early small series., Conclusion: RARC and urinary diversion are still early in development and limited to centers with extensive robotic experience and volume, although adoption of the robotic approach is becoming more common. Early studies have shown promise to reduce complications with equivalent oncologic results.

The history of energy sources used in surgery is inextricably linked to the history of electricity. Milestones include identification of safe electrical waveforms that can be used in the human body, patient isolation to prevent alternate-site burns, bipolar energy sources to negate capacitance injuries, laser energy, and the combination vessel sealing devices commonly used today. Engineering efforts to eliminate many of the hazards of electrosurgery are critical to how we practice modern gynecologic surgery. The introduction of bipolar instruments, increasing the safety of monopolar electrosurgery by not using hybrid trocars, and introduction of active shielding of the instruments from stray radiofrequency energy using intelligent secondary conductors have led to the re-emergence of electrosurgery as the universal surgical energy source. The low ongoing costs and the presence of electrosurgical generators in all hospitals readily enables electrosurgery to be the mainstay. Expensive lasers are confined to specialized centers, where they continue to be used, but for a long while filled a gap created by complications of electrosurgery. Sophisticated power sources continue to be introduced and include the ultrasonic scalpel, plasma surgery, and various devices for sealing vessels, all of which have advantages and disadvantages that are recognized as they begin to be subjected to scientific validation in randomized trials., (Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.)