Robotic surgery has been around for about 40 years. The first robot-assisted surgical procedure took place in 1985, when a robotic arm originally designed for industrial use was repurposed to perform a brain biopsy. What started as a single experimental operation has since grown into a global field, with robotic systems now used across dozens of surgical specialties.
The First Robotic Procedure: 1985
The PUMA 560, an industrial robotic arm, was used in 1985 to assist with a neurosurgical biopsy. This was not an autonomous robot performing surgery on its own. A surgeon controlled the arm, using its precision to guide a needle into the brain for a tissue sample. The procedure demonstrated something that would define the next four decades of development: a robot could hold instruments steadier and position them more accurately than a human hand alone.
At that point, no one was building robots specifically for surgery. The PUMA 560 was borrowed from manufacturing. It would take several more years before engineers began designing systems with the operating room in mind.
Purpose-Built Surgical Robots Arrive in the 1990s
The late 1980s and early 1990s brought the first robots designed specifically for medical use. In 1992, a system called ROBODOC became the first robotic platform used in orthopedic surgery, assisting with hip replacements. It helped surgeons precisely shape the bone cavity where the implant would sit, a task that required a level of consistency difficult to achieve by hand. In 1994, a camera-holding robot called AESOP received FDA approval, giving surgeons a steady, voice-controlled view during minimally invasive procedures.
These early systems were limited in scope. Each one did a single job: hold a camera, drill a bone, position a needle. The idea of a multipurpose robotic platform that could handle entire operations was still years away, though the groundwork was being laid in an unexpected place.
Military Research That Shaped the Field
Much of the technology behind modern surgical robots traces back to military-funded research. In the late 1980s, engineers at SRI International (formerly Stanford Research Institute) began building a “telepresence surgery system” with funding from DARPA, the Pentagon’s research agency. The original goal was ambitious: allow a surgeon to operate on wounded soldiers from a safe distance using robotic arms and a 3D video feed.
The first prototype had two main parts. A workstation where the surgeon sat, wearing a head-mounted display and controlling instruments with gloves, and a remote surgical unit that translated those hand movements into precise actions. By June 1993, the system was demonstrated during military field exercises at Fort Gordon in Georgia. The surgeon manipulators used in this system were patented in 1995.
The telepresence concept never saw battlefield use, but it produced something arguably more valuable. The core technology, where a surgeon sits at a console and controls robotic arms across the room, became the foundation for the commercial systems that followed.
The da Vinci System Changes Everything
In 1998, a company called Intuitive Surgical brought the first version of the da Vinci system into human use. Its initial commercial sale went to the Leipzig Heart Center in Germany, where surgeons used it to perform a cardiac valve repair and coronary artery bypass that were far less invasive than traditional open-chest surgery. The system gave surgeons a magnified 3D view of the surgical site and translated their hand movements into smaller, more precise motions inside the patient’s body.
In 2000, the da Vinci received FDA approval for general laparoscopic procedures, making it the first operative surgical robot cleared for use in the United States. That initial version had three arms: one holding a camera and two holding instruments. By 2002, a four-arm version was approved, giving surgeons an extra instrument to work with during complex procedures.
The approvals expanded quickly from there. In 2001, the da Vinci was cleared for robot-assisted prostatectomy, a procedure that had previously been done almost entirely through open surgery. That same year, a competing system called Zeus received limited FDA approval. Intuitive Surgical eventually acquired Zeus’s manufacturer, effectively consolidating the market. The da Vinci became, and remains, the dominant robotic surgery platform worldwide.
The First Transatlantic Surgery: 2001
One of the most dramatic demonstrations of robotic surgery’s potential happened in September 2001. Surgeon Jacques Marescaux, sitting in New York City, removed the gallbladder of a 68-year-old patient lying in a hospital in Strasbourg, France. The operation, nicknamed the “Lindbergh Operation,” used the Zeus robotic system and a dedicated high-speed fiber optic connection running at 10 megabits per second. The delay between the surgeon’s hand movements in New York and the robot’s actions in Strasbourg was less than 200 milliseconds.
The operation cost over one million euros, mostly due to the telecommunications infrastructure required. It proved telesurgery was technically feasible but also highlighted the enormous cost barrier. Two decades later, routine telesurgery across continents remains rare, though shorter-distance remote procedures have become more practical.
Expansion Into Orthopedics and Beyond
While the da Vinci system dominated soft-tissue surgery, orthopedics followed its own robotic path. After ROBODOC’s introduction for hip replacements in 1992, the next major leap came in 2006 when the Mako system performed its first robotic-arm-assisted partial knee replacement. By 2017, Mako expanded to total knee replacements. These systems work differently from the da Vinci. Rather than the surgeon controlling arms remotely from a console, orthopedic robots typically create a virtual boundary based on preoperative imaging, guiding the surgeon’s hand and preventing cuts outside the planned area.
How Robotic Surgery Compares Today
After four decades of development, the practical advantages of robotic surgery over conventional minimally invasive (laparoscopic) techniques are measurable but nuanced. Large analyses comparing the two approaches show that robotic procedures tend to result in shorter hospital stays and lower readmission rates within 90 days. In studies of robotic hysterectomy, patients lost about 50 milliliters less blood on average compared to laparoscopic surgery and were less likely to stay in the hospital beyond two days. For prostate removal, robotic patients had shorter hospital stays and recovered faster from catheter use.
The tradeoff is time. Robotic procedures consistently take longer to perform than their laparoscopic equivalents, partly because of the setup required for the robotic system. For the patient, the longer operating time is generally offset by the smoother recovery afterward.
Where Robotic Surgery Stands Now
Despite nearly 40 years of development, robotic surgery still represents a small fraction of all procedures performed globally. In the United States, robotic-assisted operations account for about 5% of surgeries. In Europe, that figure drops to 2%, and in the rest of the world it sits below 1%. These numbers closely track how much each region spends on healthcare, reflecting the high cost of purchasing and maintaining robotic systems.
The trajectory, though, has been consistently upward. What began with a repurposed industrial arm performing a single brain biopsy in 1985 has become a multibillion-dollar industry spanning urology, gynecology, cardiac surgery, orthopedics, and general surgery. Each generation of systems has gotten smaller, more capable, and more widely available, even if the price tag remains the biggest barrier to adoption.