The History of Laparoscopic Surgery and Its Later Developments

History

The history of surgery spans more than 2,000 years, beginning with the earliest surgical procedures of Sushruta in ancient times, followed by the surgical practices of the Middle Ages associated with figures such as Andreas Vesalius and Ambroise Paré. Later, John Hunter, a Scottish surgeon, laid the early foundations for modern surgery.

Through many historical changes and alongside the development of science and technology, the French surgeon Philippe Mouret performed the world’s first laparoscopic surgery: a gallbladder removal on a middle-aged woman on March 17, 1987. This was a true revolution in the field of surgery, creating the foundation for the development of many advanced surgical techniques based on laparoscopy. It also marked the beginning of the era of minimally invasive surgery.

In traditional open surgery, patients often had to endure a long incision, accompanied by pain and prolonged recovery. In contrast, laparoscopic surgery uses only small incisions of about 5–10 mm to insert surgical instruments of similar diameter into the body. Water or CO₂ gas is then introduced into the surgical area to create a working space for the surgeon.

As science continued to advance, robotic surgery emerged alongside the development of modern medicine. Medical literature records the first case of robot-assisted surgery in 1985, involving a brain tumor biopsy. Three years later, a prostatectomy using the PROBOT robotic surgical system was successfully performed at Imperial College London.

After developing through early robotic systems such as PUMA, AESOP, and ZEUS, today the Da Vinci robotic surgical system is considered one of the most advanced systems, with four robotic arms that closely simulate the movements of the human hand.

In principle, robotic surgery is still based on laparoscopic surgery. Surgeons create small incisions of about 5–10 mm on the patient’s body to insert endoscopic instruments. In traditional laparoscopic surgery, the surgeon directly controls the instruments. In robotic surgery, however, the robotic arms function like the surgeon’s hands, manipulating surgical instruments inside the body.

From a control console located away from the operating table, surgeons can control robotic arms that rotate up to 540 degrees, move freely within narrow spaces, and perform highly delicate surgical maneuvers.

Thanks to these characteristics, robotic surgery helps overcome many limitations of the human hand, such as fatigue during long procedures, limited wrist and hand rotation in complex surgical movements, difficulty accessing deep anatomical areas, and restricted visualization. Robotic systems also enhance vision through 3D imaging with high magnification.

Compared with traditional open surgery, both laparoscopic and robotic surgery have been shown to help patients recover more quickly because of smaller incisions, more aesthetic scars, less pain, less bleeding, and fewer infectious complications.

Present

In terms of disease treatment, almost all conditions that were previously suitable for laparoscopic surgery can now be treated with robotic surgery. These include procedures in ear, nose, and throat surgery; neurosurgery; gynecology; gastrointestinal surgery; hepatobiliary surgery; and others, in both adults and children.

In 2000, the University of Ohio applied robotic surgery to esophageal and pancreatic surgery, two challenging procedures in gastrointestinal and hepatobiliary surgery. In 2008, a research team from the University of Illinois performed the first robotic living-donor liver resection, with very promising outcomes.

In thoracic and vascular surgery, procedures such as coronary artery bypass surgery, mitral valve replacement, esophagectomy, and lung resection, which were previously performed through open surgery or laparoscopy, can now be carried out using robotic systems.

In neurosurgery, robotic surgery clearly demonstrates its advantages by overcoming the limitations of human dexterity and enabling precise manipulation within microscopic fields of vision. One study reported that the five-year survival rate after radical resection of glioma was 40%, compared with 22% in cases where only 95% of the tumor was removed. This highlights the importance of robotic surgery in overcoming human limitations and improving treatment quality for patients.

Ophthalmology also recorded its first robotic surgery in September 2016 at John Radcliffe Hospital, University of Oxford. Professor MacLaren controlled a robotic system to operate on a structure in the retina of a 70-year-old patient that was smaller than one-hundredth of a millimeter. The delay in applying robotic surgery to ophthalmology was mainly due to the challenge of miniaturizing robotic components to suit the very narrow environment of the eye.

Future

Robotic surgery is becoming increasingly widespread and is developing rapidly in many directions. Previously, robotic surgery focused mainly on diseases of the chest, abdomen, and limbs. More recently, researchers at the University of Illinois in the United States have developed robotic surgical systems for treating head and neck cancers through a transoral approach.

Scientists are also working to develop remote robotic surgery, in which surgeons may be located anywhere in the world and operate robotic systems from a distance. In addition, the concept of miniaturizing robotic systems is being explored for the treatment of blood-related diseases. Microscopic nanorobots could be introduced into blood vessels to identify and destroy abnormal blood cells.

Alongside development, researchers are also seeking to overcome the current limitations of robotic surgery. Because the robotic arms and surgical instruments come into direct contact with the patient’s tissues and organs, while the surgeon interacts with them indirectly, the surgeon’s ability to directly sense temperature, pressure, tension, and tissue softness or hardness remains limited.

For this reason, new generations of robotic systems are being developed to transmit these parameters to surgeons through real-time sensory feedback systems, improving interaction between the surgeon and the patient’s body.

Conclusion

Modern medicine continues to advance through humanity’s constant creativity and innovation, and robotic surgery is one of its many bright achievements. The emergence, development, and refinement of robotic surgery have helped the field of surgery overcome barriers and limitations that existed for hundreds of years.

We have every reason to hope that, in the near future, humanity will be better able to conquer disease, so that physical and emotional suffering may one day no longer exist on Earth.