The ability to create a device that simplifies work is one of the unique qualities of the human species. Over the ages, mankind has produced innumerable simple tools to assist in specific tasks. With the advent of the industrial revolution, complex devices were developed and widely used to increase productivity and facilitate work. These early machines required direct human operation and could not replace human labor that required decision making. Joseph Jacquard, in 1801, was one of the first to circumvent this problem and empower machines with “intelligence.” He developed a loom that utilized a punch-card system to weave tapestries. By using different cards in series, various weaving needles in a predetermined sequence passed different color threads to weave intricate patterns. This rudimentary punch-card system, the precursor of modern computers, allowed the loom to “make decisions” and replace a human worker. This marked the advent of what we today refer to as a robot: an automated, reprogramable mechanical device.

The term robot is derived from the Czechoslovakian word “robota,” which means “worker.” In 1921, the Czech author Karel Capek wrote a popular play entitled Rossums Universal Robots in which the protagonist played God and created mechanical beings (robota) to serve human society. Unfortunately, the robota revolted making humans subservient and initiating the common misperception in many novels and films that robots are independent, unpredictable villains. Many individuals, however, have realized that rather than evil beings, robots could be used as important tools and improve the results of a variety of manual tasks.

Robots are essentially mechanical systems controlled by microprocessors and equipped with sensors and motors.<sup>5 Cadeddu J.A., Stoianovici D., Kavoussi L.R. Robotics in urologic surgery Urology 1997 ;  49 : 501  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Computer algorithms utilize the environmental information provided by the sensors to determine appropriate motor commands for the mechanical system to perform the desired task. Robots have been used extensively in industrial manufacturing, space exploration, and undersea applications over the past several decades. More recently, because of the economic advantages and improved quality demonstrated by manufacturing robots, medicine has begun exploring the use of robots for health care delivery.

There are three main categories in which robots have been studied and applied in medicine: (1) supportive, (2) rehabilitative, and (3) surgical. Supportive robots have been developed as patient and hospital staff assistants. An example is the Help-Mate (Transitions Research Corporation, Milford, CT), which is commercially available and serves as a courier inside hospitals delivering patient meals, medications, and radiographs.<sup>13 Engelberger J.F. Health-care robotics goes commercial: The “HelpMate” experience Robotica 1993 ;  11 : 517  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> It is programmed with a hallway blueprint, including elevator location, allowing it to navigate the hospital and make deliveries. Motion sensors prevent inadvertent collisions.

In rehabilitative medicine, robotic applications have been intensely investigated to assist people with manipulative disabilities. Typical devices involve robotic arms attached to a wheelchair or furniture. These enable the person to control artificial limbs for the purpose of eating or assisting with item manipulation in an office setting. Robotic devices are also available to help with automated locomotion. Though demonstration systems exist for many rehabilitative applications, commercial availability and clinical use are limited because of expense.<sup>3 Buckingham R.A., Buckingham R.O. Robots in operating theatres BMJ 1995 ;  311 : 1479

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The utilization of robots in the surgical theater has been the most challenging application investigated in the health care field. Beginning in the 1980s, the concept that robots may be more precise than humans was first investigated in the fields of neurosurgery and orthopedic surgery.<sup>3 Buckingham R.A., Buckingham R.O. Robots in operating theatres BMJ 1995 ;  311 : 1479

Cliccare qui per andare alla sezione Riferimenti</sup> These specialties, which perform surgical procedures on organs that provide fixed landmarks as reference points, simplify the task of robot registration and remain at the forefront of surgical robot development. In neurosurgery, three broad types of devices have been developed to improve spatial accuracy and surgical precision<sup>3 Buckingham R.A., Buckingham R.O. Robots in operating theatres BMJ 1995 ;  311 : 1479

Cliccare qui per andare alla sezione Riferimenti, 16 Glauser D., Flury P., Burckhardt C.W. Mechanical concept of the neurosurgical robot “Minerva.” Robotica 1993 ;  11 : 567  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 21 Kall B, Kelly P, Stirling S, et al: Computer assisted stereotactic neurosurgery, functional design, and clinical applications. In Proceedings of the Int. Conf. IEE EMBS. Paris, France, 1992

Cliccare qui per andare alla sezione Riferimenti</sup>: (1) neuronavigators, (2) stereotactic localizers, and (3) robotic assistants. In orthopedic surgery, robots that cut or ream bone provide similar advantages.<sup>3 Buckingham R.A., Buckingham R.O. Robots in operating theatres BMJ 1995 ;  311 : 1479

Cliccare qui per andare alla sezione Riferimenti</sup> The RoboDoc system (Integrated Surgical Systems, Sacramento, CA) prepares the proximal femur to accept an uncemented total hip prosthesis.<sup>32 Paul H.A., Bargar W.L., Mittelstadt B. , e al. Development of a surgical robot for cementless total hip replacement Clin Orthop 1992 ;  285 : 57

Cliccare qui per andare alla sezione Riferimenti</sup> The cavity it creates is accurate to 0.4 mm (10 times more accurate than manual reaming) and permits 90% surface contact with the prosthesis allowing uncemented hip replacement.

The success of robots in neurosurgery and orthopedic surgery has encouraged the investigation of robots in other surgical specialties including urology. This article introduces robotic terminology and reviews current clinical research and applications of robots in urologic surgery. Finally, their critical role in telesurgery and future developments is reviewed.