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Currently, da Vinci of Intuitive Surgical remains the only surgical system in performing robotic surgery. However, the Si system has evolved over the last ten years. Surgeons now control a high-definition three-dimensional camera system with a wristed instrument that has seven degrees of movement. This results in intuitive surgical movement, fewer tremors, improved stability and precision and reproducibility. Furthermore, the surgeon sits on a console to operate, which minimizes surgical fatigue and improves ergonomics. Improved tissue magnification allows the surgeon to visualize vital structures and avoid unnecessary trauma or injuries. As the surgeon controls three surgical instruments in addition to a camera, the surgeon can operate with very little assistance, thus not having to rely on the assistant’s expertise. The latest method Xi allows multiple quadrants surgery. This is enabled through the use of cameras in all ports which allows the visualization of operative fields from different vantage points (camera hopping), surgeon controlled surgical bed motion and reduction of port distance to 6cm. Complex procedure including pelvic and left infrarenal para-aortic node dissection, omentectomy, bowel resection, anterior and posterior exenteration and resection of recurrent tumour becomes technically possible. Robotic assisted reconstructive surgery such as ileal conduit and continent urinary reservoir becomes feasible. Complex surgery requiring a team of surgeons can be carried out efficiently without any change of patient position.

Simulation and procedure specific modules allow gynaecological surgeons to acquire and maintain their skills through their surgical career. Training and teaching can be standardised and allow progression of surgical skill development from registrars to specialist consultants.

Task performance and learning curve for acquisition of skills were found to be superior with the robotic system when compared with conventional laparoscopy in laboratory settings. When the viewing condition specifically between the two systems was evaluated, the three-dimensional features provided an advantage. In studies where both the novice and non-novice surgeons were tested, surgeons may not need previous exposure to laparoscopic surgery to adapt to the robotic system.