Contemporary robotic surgical systems: A preliminary review

Robot-assisted surgery has emerged as the most transformative technological advancement in this field of medicine over the past two decades. Since the U.S. Food and Drug Administration (FDA) approved the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, California, USA) in 2000, it has revolutionized minimally invasive surgery by shortening the learning curve and facilitating reconstructive steps in many procedures compared to conventional laparoscopy. Today, the da Vinci system accounts for approximately 80% of the global surgical robotics market. However, its high acquisition and maintenance costs remain a significant barrier for many hospitals, including those in the United States. As many of the original patents filed by Intuitive Surgical have reached their 20-year expiration, opportunities have arisen for the development of alternative systems. In addition to cost, common criticisms of the da Vinci system include limited communication between the surgeon and the operating team due to the closed-console design, lack of haptic feedback, rigid arm positioning, and the large physical footprint of the platform. Over the past decade, several new robotic systems have been introduced, some of which have been approved for clinical use. Each of these platforms incorporates key innovations aimed at addressing the technical and economic limitations of the da Vinci system. The entry of these systems into the market has effectively ended Intuitive Surgical’s monopoly. Although none of them is currently available worldwide, platforms such as Senhance, Versius, and Hugo RAS have gained traction primarily in Europe, whereas others—such as the KangDuo surgical robot, Toumai, Revo-I, and Hinotori—are used in China, South Korea, and Japan. Comparative evaluation of these systems against the da Vinci must account for several factors. Since its initial launch in 2000, five generations of the system have been developed: the original 2000 model, S, Si, Xi, and the fifth-generation model. Most of the systems reviewed here are still in their first generation and are expected to undergo further improvements and refinement. This review provides an overview of both well-established and emerging robotic surgical platforms, their distinct design features, clinical applications, and surgical outcomes. It covers widely used systems such as da Vinci, Senhance, Versius, and Hugo RAS, as well as less extensively reported platforms including Revo-I, Avatera, KangDuo, Hinotori, Dexter, and Chinese alternatives to the da Vinci system, notably the first domestically developed Chinese surgical robot, Toumai.