While laparoscopy allows manipulation of instruments up, down and side-to-side, surgery with the da Vinci allows more natural wrist movement.

The robot's arms have wrists with eight degrees of freedom that allow the surgeon "to bend around corners and work in ways that are much more natural," said Boggess. This allows full range of motion and the ability to rotate instruments 360 degrees through tiny incisions. Direct and natural hand-eye instrument alignment is similar to open surgery, with "all-around" vision and the ability to zoom in and out.


Another advantage with da Vinci is the elimination of tremor. Surgeons can scale, or ratio, their finger movement to that of the robotic instrument. A movement of inches at the console can be scaled down to centimeters in the patient.

"This can re-introduce precision in an elderly surgeon, who has all those years of experience but has lost some dexterity," Boggess said.

Dr. Daniel von Allmen, chief of surgery at the N.C. Children's Hospital and associate professor of surgery at UNC, has performed several successful pediatric operations with the da Vinci robotic system and said the scalability was a major advantage.

"This is very important in pediatric surgery, given the smaller space to operate, and for performing refined interventions very precisely," he said, adding that "the ultimate potential for the system, if the instruments can be made small enough, would be its use in fetal surgery, in utero."

Since the arrival of the da Vinci robot at UNC Hospitals in early 2005, several successful "robotic-assisted laparoscopic radical prostatectomies," or RALRPs, have been completed.

The robot is a better tool and an improved instrument compared to what has been used previously, said Dr. Eric M. Wallen, assistant professor of urologic surgery, director of urologic laparoscopy at UNC Hospitals and a UNC Lineberger member.

"I expect that over the next decade, RALRP will become the most common surgery performed for patients with prostate cancer. The robot improves the view that the surgeon has, and its instruments have more flexibility to perform the delicate nerve sparing and sewing parts of the procedure," he said.

Patients, in turn, recover quickly and are able to resume their normal life within days of major surgery instead of months, Boggess said.

"The robot provides the laparoscopic surgeon with a degree of precision and safety not achievable with traditional surgery or laparoscopy and will redefine abdominal/pelvic surgery for the next generation of surgeons," he added.

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