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Acute appendicitis is one of the most common abdominal emergencies. There has been an increasing use of robotic abdominal surgery. However, it remains underutilised in emergency settings. This study aimed to systematically review robotic appendicectomy (RA) feasibility. A 20-year systematic review was performed, along with quality assessment. The research protocol was registered with PROSPERO. The search yielded 1,242 citations, including 9 articles. The mean quality score was 10.72 ± 2.56. The endpoints across the studies were rate of conversion to open surgery, length of hospital stay, blood loss and operative time. RA is a safe, feasible technique that can be performed in elective and emergency settings with minimal blood loss. The operative time and hospital stay were within acceptable limits. Robotic surgery's major drawback is its high cost and limited availability. Future studies evaluating RA with a focus on its application during emergencies and its cost-effectiveness are recommended.

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Robotic surgery (RS) is an evolution of minimally invasive surgery that combines medical science, robotics, and engineering. The first robots approved by the Food and Drug Administration (FDA) were the Da Vinci Surgical System and the ZEUS Robotic Surgical System, which have been improving over time. Through the decades, the equipment applied to RS had undergone a wide transformation as a response to the development of new techniques and facilities for the assembly and implementation of the own. RS has revolutionized the field of urology, enabling surgeons to perform complex procedures with greater precision and accuracy, and many other surgical specialties such as gynecology, general surgery, otolaryngology, cardiothoracic surgery, and neurosurgery. Several benefits, such as a better approach to the surgical site, a three-dimensional image that improves depth perception, and smaller scars, enhance range of motion, allowing the surgeon to conduct more complicated surgical operations, and reduced postoperative complications have made robotic-assisted surgery an increasingly popular approach. However, some points like the cost of surgical procedures, equipment-instrument, and maintenance are important aspects to consider. Machine learning will likely have a role to play in surgical training shortly through "automated performance metrics," where algorithms observe and "learn" individual surgeons' techniques, assess performance, and anticipate surgical outcomes with the potential to individualize surgical training and aid decision-making in real time.

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El trasplante renal de donante vivo suponela mejor opción terapéutica en un paciente con insuficiencia renal terminal, por su excelente funcionalidad ysupervivencia del injerto. La nefrectomía laparoscópica de donante vivo es la técnica de elección para laobtención del injerto. En manos expertas, distintas variantes mínimamente invasivas pueden ofrecerse con laprincipal ventaja de mejorar los resultados estéticos deldonante. Aunque pueda existir controversia en relacióna los dispositivos laparoscópicos para la ligadura vascular durante la nefrectomía de donante vivo, tanto lasendograpadoras como los clips con cierre tipo Hem-olok han demostrado ser seguros siempre que se respetela técnica adecuada en su empleo. La nefrectomía dedonante vivo no está exenta de una mínima morbi-mortalidad. La edad y el filtrado glomerular del candidato a donante son orientativas del riesgo de enfermedad renala largo plazo. En relación a la cirugía del implante, eltrasplante renal robótico se encuentra en los albores desu desarrollo. Las series publicadas no permiten aún establecer claramente su papel frente a la cirugía abiertaconvencional.(AU)

Living donor kidney transplantation is thebest therapeutic option in a patient with end-stage renalfailure, because it provides excellent functionality andgraft survival. Laparoscopic living donor nephrectomyis the gold-standard for obtaining the graft. In experthands, different minimally invasive surgeries can be offered with the main advantage of improving the aesthetic results. Although there may be controversy regardinglaparoscopic devices for vascular ligation during livingdonor nephrectomy, both endostaplers and locking clipshave proven to be safe as long as the proper techniqueis performed. Living donor nephrectomy has minimalmorbidity and mortality. Age and glomerular filtrationrate of the donor candidate are prognostic factor oflong-term renal failure. In relation to the implant surgery,robotic kidney transplantation is now probably at thebeginning of its development. Published series still donot allow to clearly establish its role compared to conventional open surgery.(AU)

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Living donor kidney transplantation is the best therapeutic option in a patient with end-stage renal failure, because it provides excellent functionality and graft survival. Laparoscopic living donor nephrectomyis the gold-standard for obtaining the graft. In exper thands, different minimally invasive surgeries can be offered with the main advantage of improving the a esthetic results. Although there may be controversy regarding laparoscopic devices for vascular ligation during living donor nephrectomy, both endostaplers and locking clips have proven to be safe as long as the proper techniqueis performed. Living donor nephrectomy has minimal morbidity and mortality. Age and glomerular filtration rate of the donor candidate are prognostic factor of long-term renal failure. In relation to the implant surgery,robotic kidney transplantation is now probably at the beginning of its development. Published series still do not allow to clearly establish its role compared to conventional open surgery.

El trasplante renal de donante vivo suponela mejor opción terapéutica en un paciente con insuficiencia renal terminal, por su excelente funcionalidad y supervivencia del injerto. La nefrectomía laparoscópica de donante vivo es la técnica de elección para la obtención del injerto. En manos expertas, distintas variantes mínimamente invasivas pueden ofrecerse con la principal ventaja de mejorar los resultados estéticos del donante. Aunque pueda existir controversia en relación a los dispositivos laparoscópicos para la ligadura vascular durante la nefrectomía de donante vivo, tanto las endograpadoras como los clips con cierre tipo Hem-olokhan demostrado ser seguros siempre que se respete la técnica adecuada en su empleo. La nefrectomía de donante vivo no está exenta de una mínima morbi-mortalidad.La edad y el filtrado glomerular del candidato a donante son orientativas del riesgo de enfermedad renal a largo plazo. En relación a la cirugía del implante, el trasplante renal robótico se encuentra en los albores de su desarrollo. Las series publicadas no permiten aún establecer claramente su papel frente a la cirugía abierta convencional.

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Background@#Robotic surgery is a form of minimally invasive surgery wherein the surgeon controls the camera and instruments in a console, remote from the operating room table. Currently, the system in place is the da Vinci Surgical System which was approved by the United States Food and Drug Administration in 2000 for laparoscopic surgery. Since its approval in 2005 for Gynecologic procedures, the da Vinci Surgical System has been used for hysterectomies, lymph node dissections, sacrocolpopexies, myomectomies, and cerclage.@*Objective@#This paper presents the initial seven cases of benign gynecologic diseases operated on utilizing the da Vinci Surgical System in our institution – six hysterectomies and one myomectomy.@*Methodology@#Seven gynecologic surgeries that utilized the da Vinci Surgical System in 2019 until the first quarter of the year 2020 were done. Medical records of the seven patients were reviewed.@*Results@#The average docking time was 38 minutes (range: 25 – 65 minutes) and the average console time was 227 minutes (range: 175 – 345 minutes). The average blood loss was 576 cc (range: 80 – 1200 cc). No cases converted to an abdominal laparotomy and no morbidities were reported. While two cases underwent blood transfusion intraoperatively, all cases were stable post-operatively and were for discharge after two days. On follow-up, all patients were stable with an unremarkable clinical course.@*Conclusion@#Our initial experience demonstrates that robotic surgery appears as a viable alternative to traditional approaches. As more cases are to be done in the future, fine-tuning of the logistical set-up and surgical skills are expected, as well as venturing into other gynecologic diseases such as malignancies. Further research must be conducted on various aspects of robotic surgery, such as but not limited to outcome comparison with traditional and other laparoscopic approaches, long term outcomes, patient safety, and patient experience and preference, among others.

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