287 287 288 288 The tidal wave of enthusiasm for robotic surgery came when most minimally invasive urologists declared robotic prostatectomy to be preferable to laparoscopic and open prostatectomy.75 The great advantage—it would appear—of robotic prostatectomy is the ability to visualize and spare the pelvic nerves responsible for erectile function. In addition, the cre-ation of the neocystourethroctomy, following prostatectomy, was greatly facilitated by needle holders and graspers with a wrist in them. Female pelvic surgery with the da Vinci robot is also reaching wide appeal. The magnified imaging provided makes this approach ideal for microsurgical tasks such as reanastomosis of the Fallopian tubes. In general surgery, there is emerging 289 289 290 290 291 291 ![A surgical team operates a robotic system in a modern operating room with blue lighting and monitors.](https://cdn.orris.care/cdss_images/9550321a02d6fbcc204ae7ff979142289696b368ca8d5869c5e314a46ee89d4e.png) 292 292 293 293 *Figure 14-21. Room setup and position of surgeon and assistant for robotic surgery. (© 2013 Intuitive Surgical, Inc. Reprinted with permission.)* 294 294 295 295 296 296 297 297 popularity for the use of the robotic platform for revisional bar-iatric surgery and complex abdominal wall reconstruction. The ability to close the defect before placement of mesh in ventral hernia repairs or to perform complex transversus abdominus release herniorrhaphy is revolutionizing MIS hernia repair. 298 298 299 299 The final frontier for computer-enhanced surgery is the promise of telesurgery, in which the surgeon is a great distance from the patient (e.g., combat or space). This application has rarely been used, as the safety provided by having the surgeon at bedside cannot be sacrificed to prove the concept. However, remote laparoscopic cholecystectomy has been performed when a team of surgeons located in New York performed a cholecystectomy on a patient located in France.76 300 300 301 301 302 302 ## Endoluminal and Endovascular Surgery 303 303 304 304 The fields of vascular surgery, interventional radiology, neu- roadiology, gastroenterology, general surgery, pulmonology, and urology all encounter clinical scenarios that require the urgent restoration of luminal patency. Based on this need, fun- damental techniques have been pioneered that are applicable to all specialties and virtually every organ system. As a result, all minimally invasive surgical procedures, from coronary artery angioplasty to palliation of pancreatic malignancy, involve the use of access devices, catheters, guidewires, balloon dilators, stents, and other devices (e.g., lasers, atherectomy catheters) that are capable of opening up the occluded biologic cylinder77 (Table 14-2). Endoluminal balloon dilators may be inserted through an endoscope, or they may be fluoroscopically guided. Balloon dilators all have low compliance—that is, the balloons do not stretch as the pressure within the balloon is increased. The high pressures achievable in the balloon create radial expansion of the narrowed vessel or orifice, usually disrupting the atherosclerotic plaque, the fibrotic stricture, or the muscular band (e.g., esophageal achalasia).78 305 305 306 306 Once the dilation has been attained, it is frequently beneficial to hold the lumen open with a stent.79 Stenting is particularly valuable in treating malignant lesions and atherosclerotic 307 307 308 308 309 309 ## Table 14-2 310 310 311 311 Modalities and techniques of restoring luminal patency 312 312 313 313 314 314 < [... Output truncated due to length. 111 tokens/304 characters removed ...]

MODALITY	TECHNIQUE
Core out	Photodynamic therapy Laser Coagulation Endoscopic biopsy forceps Chemical Ultrasound
Fracture	Ultrasound Endoscopic biopsy Balloon