First of all we should remeber how the research of evidence is very hard in surgery and few operations (open, laparoscopic or robotic) had reached a sufficient level of evidence according to the Oxford Standards. On the other hands, the reasearch and surgical innovations still continue to try improving the quality of life of patients, despite some methodological concerns. Recent publications reported excellent outcomes of robotics, but they are confined to single centers with high financial availability. I am strongly convinced that robotic surgery could overhelm many of the technical drawbacks of laparoscopy when dealing with pancreatic surgery, includind node dissection and anastomosis. In the future, the robotic surgery add reproducibility to many complex operations.

Robotics offer advantages over laparoscopy and these are due to 3D vision ,better depth perception & easy effortless suturing. The best example is Robotic Radical Prostatectomy. Less blood loss, lesser operative time and perfect suturing make Robotics very beneficial for the patient.

I am writing from the perspective of a pediatric urologist. All the above statements are true, however in the field of pediatrics, the main advantage of laparoscopic surgery (for example pyeloplasty)  is cosmetic when one uses a 5 mm camera in the umbilicus and 2 - 3 mm working ports, resulting in invisible scars. Another advantage is that laparoscopic pyeloplasty can be applied to children of all ages, including 4 or 5 kg babies. The disadvantage of laparoscopic surgery is the somewhat longer surgical time and the long learning curve.

With the DaVinci, the learning curve is short, but some of the cosmetic advantages are lost even using 5 mm working ports. In addition, most surgeons use a fourth port for suction, traction and to introduce sutures leaving quite visible scars.

In my opinion, with the current state of the art technology, it would be a waste of valuable resources for a children´s hospital to invest in a Da Vinci. Besides, from a teaching point of view, it is more useful in 2014 for young pediatric surgeons to be competent in laparoscopic surgery than in the use of the Da Vinci, available in only a handful of children´s hospitals, mostly in the USA. 

The future of the development of miniaturized technology similar to the DaVinci (which is not a robot but a movement translator) applicable to infants is rather questionable given the low priority that pediatric medicine holds with   reimbursements systems worldwide.

I haven't experience in robotic surgery

I totally agree with Héctor Romero Talamás. Differences or benefits are not clear yet. Maybe this is also due to a lack of better randomized multicenter studies? Scientifically, we are not as far as with laparoscopic procedures. But technology will improve, for sure. One step is the new Xi-System (smaller instruments, easier setup, stapling device...)

In the specialty of gynaecology, and I imagine many other surgical specialties, the indications for and the value of robotic surgery are as yet undefined. That being said, the driver for the adoption of this technology in the US system are unrelated to the benefits to patients but clearly related to the rush to use new and "sexy" technology to maintain market share and to appeal to many patient's misguided belief that more technology translates to better care. 

As a gynaecologist, the evidence to date for GYN procedures indicates that the only value in the technology is to the surgeon, reducing the skill set required for a minimally invasive surgical technique and improving the ergonomics of the procedure. The OR time is increased without improved length of stay or morbidity including blood loss. The cost was significantly higher in the robotic cases.

If this technology is to survive and become useful the costs need to come down significantly. The evolution of this technology should be continually subjected to rigorous scientific evaluation before universal adoption. Our profession has a very poor record for adopting new techniques and technology prior to appropriate scientific evaluation. We too often rely on industry pressure to determine the direction of new medical and surgical interventions.

(Good examples of this phenomenon in gynaecology include mesh for pelvic organ prolapse.)

I totally agree with Hector Romero Talamas. All the benefit from a robotic procedure goes to the surgeon and I would add also to the industry. For radical prostatectomy I use the perineal approach with the same benefits of the robotics with less operating time, better results regarding continence  and minimal costs. On the other hand we should pass through this step in order to develop new technologies, but my feeling is that the adoption of this new technique was done too fast without waiting for appropiate scientific evaluation.   

Hopefuly, for most surgical diseases , non invasive targeted therapies will be found. This is the general direction which medicine is going and I think that in the near future robots won't be needed for surgery anymore.   

I have to say that I completely disagree with Dr. Romero in the case of Colorectal Surgery. 

I am writing this comment from the experience of more than 250 colorectal robotic resections in the last four years in a public university hospital in Spain. 

First of all, I agree that there is no clear evidence yet of those benefits for the patient. This is an emergent technology that has not been widely adopted (mainly for economical reasons). This makes difficult to have that evidence yet. 

I am sure that the evidence will come in the near future for colorectal surgery. My point of view is that robotic instruments are not necessary for the easy cases, but that they add a value in the difficult cases both for the surgeon and for the patient. A high BMI male patient with a locally advanced low rectal tumor in a narrow pelvis an example of a difficult case. My point of view is that a lower conversion rate, less blood loss during the procedure, less circumferential affected margins in locally advanced tumors and less wound problems will be the main benefits for those patients.

Anyway, I am looking forward to the future that Dr. Shalev talks about. Hopefully surgery won't be needed in the future ;). Until that moment, robots will have more and more importance.

There are two questions: Laparoscopic surgery outcome is better tan open surgery for sure!.

Less postoperative pain in robotics than laparoscopy is a fact and nobody knows why! Other putcome are the same!

For gynecologic disease, there is no difference of surgical outcomes among three approaches.