Fusion of medicine and technology in endoscopic surgery

Although endoscopic surgery has become widespread and is currently used in a wide range of general, thoracic, urologic, gynecologic, and orthopedic procedures, many major difficulties remain because sensorial information is restricted to a two-dimensional image, and effector instruments have limited maneuverability due to the rigid shaft axis fixed to the abdominal wall by the entry trocar. To overcome these problems, advanced engineering technology has been introduced in laparoscopic surgery which includes three-dimensional video imaging, robotic laparoscopic cameraholders, telemanipulated flexible effector instruments, and tactile feedback. A voice-controlled robotic laparoscopic holder (AESOP200, Computer Motion Inc. USA) provides stable support for the laparoscope during laparoscopic surgery performed by a single surgeon. A new computer-assisted telemanipulation robot (Intuitive Surgical Inc. USA) permits the performance of completely endoscopic coronary artery bypass and Nissen fundoplication. Furthermore, price reductions and technological advances in telecommunications have made telementoring in endoscopic surgery available for routine clinical use, and intercontinental surgical video teleconferences fruitful opportunities for discussing technical details. The fusion of medicine and technology in endoscopic surgery would overcome difficulties in the conventional endoscopic approach.