Back to the Future: Which Robotic System to Choose for Our Department? A Narrative Review of the Evolution, Current Landscape, and Future Directions in Robotic Surgical Systems

Abstract

Robotic-assisted surgery has transformed modern surgical practice, particularly in urology, where it has become the gold standard for procedures such as radical prostatectomy and partial nephrectomy. For nearly two decades, the da Vinci system (Intuitive Surgical) held an effective monopoly, becoming synonymous with robotic surgery itself. However, the landscape has changed dramatically. Since the expiration of key patents, numerous competitors have entered the market — from the modular Versius (CMR Surgical) and haptic-enabled Senhance (Asensus Surgical) to a wave of emerging “game-changer” systems from China (MicroPort Toumai, Edge Medical, Kangduo) and India (Mantra). This narrative review traces the history of robotic surgery from its conceptual origins in military medicine to the first transatlantic telesurgery (Operation Lindbergh in 2001) and the subsequent rise and diversification of the market. We provide a comparative analysis of available systems, discussing technical specifications (open vs. closed consoles, instrument articulation, force feedback), clinical applications, regulatory status (CE mark (European Conformity), FDA (Food and Drug Administration), NMPA (National Medical Products Administration)), and economic considerations (acquisition cost, maintenance, instrument life). Special attention is paid to the resurgence of telesurgery enabled by 5G networks and the potential of new Chinese systems to democratise robotic surgery in developing regions in robotic landscape, including the Baltics. Drawing an analogy with the Back to the Future film series, we reflect on how the surgical community has “returned” to the original vision of remote telepresence after decades of technological refinement. Furthermore, this review evaluates system selection through the unique lens of small-population nations, such as the Baltic states, where demographic and budgetary constraints demand highly versatile, multi-specialty systems. Incorporating the core principles of the Latvian National Strategic Plan (2025–2035), we argue that established platforms like the da Vinci Xi offer crucial advantages over modular competitors in terms of comprehensive cross-speciality regulatory approvals, technical reliability, and standardised proctoring infrastructure. Finally, we offer a practical framework to help department heads choose the most appropriate system based on institutional volume, budget, clinical specialties, and strategic goals.