1996-2016. 20 Years of Robotic Surgery in Mexico. the Experience at Our Hospital

Harry S Miller, MD¹, Jonathan M Sackier, MD². ¹H.G.R. 20 Instituto Mexicano del Seguro Social, ²Oxford University Nuffield Department of Surgical Sciences

INTRODUCTION: In August 1993, in San Diego, Ca., the first robotic arm system for holding the laparoscope was used by Sackier,M.D. called  Automated Endoscopic System  for Optimal Positioning  (AESOP ) . In our Hospital in Tijuana, Mexico,on June 26, 1996 the first two cases of robotically assisted cholecystectomies with AESOP 1000 where performed. On November 1999 the tele robotic system Zeus was at our Hospital and dry lab was set, and porcine lap cholecystectomies where performed. From 1999 to 2015, 09 robotic courses have taken place, one of them endorsed by SAGES, the last eight with AESOP 3000 voice activated.

METHODS: 173  robotically assisted cases have been performed with AESOP (Automated Endoscopic System for Optimal Positioning) the first 20 with AESOP 1000 (pedal and hand controlled) and 6 degrees of freedom,  with AESOP 3000 with  voice activation and 7 degrees of freedom 153 cases have been performed.. During the 9 courses all surgeons have demonstrated to be competent after 2 weeks of training.. All cases had informed consent and full explanation of the procedure by the surgical team.

RESULTS: In 1996 20 cases performed with AESOP 1000, 14 cholecystectomies, 03 TEP Hernia repairs, 01 tubal ligation and 2 Nissen fundoplication’s. From 1999 to 2015  a total of 153 cases have been performed during 9 courses each one two weeks in length  01 liver biopsy,  01 TAPP Hernia repair, 12 Nissen fundoplication’s, 01 diagnostics for gunshot wound and bullet extraction, 01 gastro- plicate  01 gastric sleeve  this to for obesity control, and 136 laparoscopic  cholecystectomies several of them including cholangiography. No serious complications have been present in all cases, surgical times similar to hand laparoscope control. Quality of image and stillness better with Robot enhancement.

CONCLUSIONS: Using a Robotic Scope Holder with voice activation facilitates several basic laparoscopic procedures even some with higher technical dificulty like intracorporial knotting and dissections. In the 09 courses or Minifellows, the best area for training is the cholecystectomy because it is the most frequent procedure performed. The system even out dated is a great area for training skills and it is cost-efficient. Not mentioned in this abstract, Mexico is participating in the robotic era with new and more robust systems with magnified enhancement and dexterity.