Vol.:(0123456789) 1 3 Journal of Robotic Surgery https://doi.org/10.1007/s11701-018-00901-2 BRIEF COMMUNICATION Evolution of robot-assisted general surgery in Greece and Cyprus Argyrios Ioannidis 1  · Nikolaos Machairas 2  · Christos Koutserimpas 1  · Eleftherios Spartalis 3  · Michael Konstantinidis 1  · Konstantinos Konstantinidis 1 Received: 3 April 2018 / Accepted: 2 December 2018 © Springer-Verlag London Ltd., part of Springer Nature 2018 Abstract Robot-assisted general surgery in Greece and Cyprus coincided with a devastating fnancial crisis. We hereby present the evolution of the technology in this unwelcoming environment, using data provided to us by the ofcial distributor of the Da Vinci platform in these countries. Keywords Robotic surgery · Robot-assisted surgery · Financial crisis · Robotic general surgery Robot-assisted surgery (RAS) was frst described in 1985 and has signifcantly evolved to its current state in the form of the da Vinci ® surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Da Vinci ® is currently the only com- mercially available robotic platform in the market, manufac- tured solely by Intuitive Surgical Inc., after United States Food and Drug Administration’s approval back in 2000 [1]. RAS was developed to increase the dexterity and facility with which complex surgical dissections are performed, to enhance visualization by providing three-dimensional sta- ble view to the surgeon and to overcome limitations of the standard laparoscopic approach such as ergonomics [2, 3]. Another critical advantage of RAS is the shorter learning curve when compared to laparoscopy, while intra-operative blood loss and operative time are believed to decrease as a surgeon’s experience grows [4]. On the other hand, disad- vantages of the technology are the high-to-acquire cost and the size of the device, making it almost impossible to ft into small operating rooms [5]. Since its launch, RAS has gained massive support in two specifc specialties: urology and gynecology. Indicative of this enthusiasm is the fact that, in 2012, out of almost 500,000 robotic operations worldwide, 350,000 of them have been performed for urological and gynecological indications [6]. This can be credited to the efcacy of the intracorporeal suturing that the robotic platform provides during urological or gynecological operations [7]. Apart from these two spe- cialties, the robotic technology is also used in general, pedi- atric, thoracic, and cardiac surgery among others [6]. In the case of general surgery, there have been numerous reports of a variety of abdominal operations, including: cholecystec- tomies, anti-refux operations, adrenalectomies, colorectal procedures, small bowel resections, pancreas and liver sur- gery, as well as bariatric operations [3]. Albeit the fact that robotics have been applied to almost all procedures of the general surgery spectrum, the precise role of the technology in this feld remains a subject that needs further research no matter the obvious advantages. Until now, limited clinical evidence exists that could establish the use of robotics as the gold standard for the procedures of general surgery. While RAS is still in its infancy with multiple novel systems cur- rently under development and clinical trials in progress, the opportunities for this technology are promising, and robotics should have a lasting impact in the feld of general surgery [8]. RAS gradually also gained its position in the Greek healthcare industry. Early after the arrival of the frst Da Vinci ® platform in the country, a series of robotic radical prostatectomies was published where the authors reported their encouraging results and described the technology as * Argyrios Ioannidis agis.ioannidis@gmail.com 1 Department of General, Bariatric, Laparoscopic and Robotic Surgery, Athens Medical Center, Distomou Str. 5-7, 15126 Athens, Greece 2 3rd Department of Surgery, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece 3 Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece