Hybrid robotic systems

Standard laparoscopic instruments have limited dexterity because of their few degrees of freedom, making some surgical tasks extremely challenging. Robotic surgery was developed to overcome these issues, but the da Vinci system is associated with high costs. During recent years, many companies developed new robotic systems to improve dexterity and ergonomics with less impact on cost-effectiveness. This work describes the main commercially available modular robotic platforms, focusing on the technology, architecture and features, and advantages and disadvantages of each system. One of the main advantages of modular systems is the possibility of performing the whole procedure robotically or performing part of the procedure laparoscopically and part robotically as a hybrid approach. Next-generation robotic systems mainly include a modular design, open or semiopen consoles, smaller instruments, decreased cost, and augmented reality. To date, there are still few data in the literature comparing the systems, as many of them are awaiting regulatory approval. Thus, future studies are necessary to answer these questions. Many other robotic platforms are currently under development and will be available on the market, with a potential to alter surgical practice.