4.3. Multiarticulated kinase inhibitor Erlotinib Instruments EndoWrist instruments have 7 degrees of freedom, which improves dexterity, allowing maneuverability that approaches that of open surgery. 4.4. Fatigue Reduction During the robotic portion of the surgery the surgeon is sitting with his/her forearms resting comfortably on a pad and the head resting against the console, therefore improving ergonomics. This results in reduced body fatigue. With the surgeon sitting at a remote workstation, it eliminates the need to physically twist and turn in awkward positions to move instruments within the operative field while simultaneously visualizing a monitor. In addition, hand muscle fatigue is reduced, which when considered together with improved visualization, makes tasks such as suturing substantially easier.
Studies suggest (Berguer and Smith ) that robotic surgery is less stressful for the surgeon. 4.5. Restore Proper Hand-Eye Coordination The robotic system eliminates the ��fulcrum effect��  of endoscopic surgery and makes instrument and camera manipulation more intuitive, emulating another property of open surgery. 4.6. Telesurgery Since the inception of robotic surgery, the wish to overcome geographical constraints and the availability of specialists was an important goal. Marescaux and collaborators  described the feasibility and safety of a robot-assisted laparoscopic cholecystectomy at distance using high-speed connection between the surgical unit at Strasbourg, France, and the surgical console in New York. Telesurgery allows for these barriers to be overcome as well as offering new teaching and tutoring possibilities.
4.7. Training The robotic system provides some interesting tools and opportunities for teaching. An experienced surgeon can use another console next to the trainee, which can be activated to command the main arms or auxiliary arms. The Vinci Skills Simulator (Intuitive Surgical Inc.) can be attached to the console, allowing a virtual training environment to be creating while maintaining the same robotic interface . However, there are currently no standardized residency curriculums that formally support the teaching of robotic surgical skills . 5. Disadvantages of Robot-Assisted Surgery 5.1. Absence of Tactile and Haptic Sensation The surgeon is unable to feel tissue resistance or how tight a knot is being tied.
This can lead to ripping of the tissue or the suture. This can be a significant problem early on, although the improvement in visualization is such that the surgeon rapidly learns Dacomitinib visual clues to compensate for his lack of feedback. Despite this, RAS still requires careful handling of tissues by the surgeon. 5.2. Equipment Size and Weight Increased physical space requirements in the operating room are needed to accommodate the large and heavy equipment.