The available robotic instrumentation is appropriate for gynecological surgery, but there is no vessel sealing cutting device or suction-irrigation device. An assistant is necessary, at the surgical site away from the surgeon, and therefore, all orders or corrections are verbal.
Although the grasping pressure of the robotic instruments is high and can damage tissue, tissue traction is not as efficient as with conventional laparoscopic instruments. Because there is no tactile feedback when grasping a tissue, there is only visual control of the traction exerted upon any structure. The lack of tactile feedback is an advantage in obese patients (see above technology), but can be a disadvantage when the instruments are not in the visual field.
Cost is a common reason why many institutions have delayed the initiation of robotic programs. The initial purchase of the robotic system is high, about $1.5 million, with an additional annual maintenance fee, and all robotic instruments become functionless after ten uses, so they are disposed.
The robotic column and its arms are bulky, with a total weight of 1,200 lb. An operating room must have adequate space, preferably about 600 square feet. There must be a dedicated team for robotic surgery and preferably a specific team for each surgical specialty. The surgical assistant must be versed in robotic technology and be able to provide the required maneuvers without direct interaction because the surgeon is away at a console and not in a surgical sterile condition.
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