Da Vinci robotic surgical technology and ethical status: A comparison between global and China_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHENG Ming , XU Wei , DING Renquan , HU Boxiao ,  WANG Shumin

Department of Thoracic Surgery, General Hospital of Northern Theater Command, Shenyang, 110016, P. R. China;

Corresponding?author：

WANG Shumin, Email: sureman2003congo@163.com

Keywords：

Da Vinci robot; medical ethics; health policy; telesurgery; Chinese medical technology; artificial intelligence

DOI：

10.7507/1007-4848.202603009

Video：

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The da Vinci robotic surgical system, as the world's leading surgical platform, has achieved remarkable accomplishments in technological evolution and clinical practice, while also provoking profound ethical considerations. This paper systematically reviews the core technologies, global application landscape, multidisciplinary clinical evidence, and the ethical challenges accompanying the development of the da Vinci surgical system, with a particular focus on comparing the similarities and differences between global and Chinese contexts in terms of technology adoption pathways, ethical response strategies, and governance models. In the future, the technology will evolve towards deep integration with artificial intelligence and single-port miniaturization, while ethical governance requires the construction of a global collaborative framework, centered on patient safety and equitable access, to guide the technology towards beneficial outcomes. This paper aims to provide an evidence-based reference for surgical clinical practice, medical technology policy, and ethical governance.

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2.	Sheetz KH, Claffin J, Dimick JB. Trends in the adoption of robotic surgery for common surgical procedures. JAMA Netw Open, 2020, 3(1): e1918911.
3.	Nahas WC, Rodrigues GJ, Rodrigues Gon?alves FA, et al. Perioperative, oncological, and functional outcomes between robot-assisted laparoscopic prostatectomy and open radical retropubic prostatectomy: a randomized clinical trial. J Urol, 2024, 212(1): 32-40.
4.	Yaxley JW, Coughlin GD, Chambers SK, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet, 2016, 388(10049): 1057-1066.
5.	李曦哲, 高陽, 程遠大, 等. 機器人胸外科日間手術的現狀與展望. 機器人外科學雜志(中英文), 2022, 3(2): 79-84.Li XZ, Gao Y, Cheng YD, et al. Current status and prospect of robot-assisted thoracic day surgery. Chin J Robot Surg, 2022, 3(2): 79-84.
6.	郭成旺, 張銘澤, 郭璽, 等. "雙中心" 背景下5G遠程機器人外科的發展機遇與挑戰. 機器人外科學雜志(中英文), 2025, 6(1): 6-11.Guo CW, Zhang MZ, Guo X, et al. Development opportunities and challenges of 5G remote robot-assisted surgery in the context of double-center construction. Chin J Robot Surg, 2025, 6(1): 6-11.
7.	Yang HX, Woo KM, Sima CS, et al. Long-term survival based on the surgical approach to lobectomy for clinical stage Ⅰ non-small cell lung cancer: comparison of robotic, video-assisted thoracic surgery, and thoracotomy lobectomy. Ann Surg, 2017, 265(2): 431-437.
8.	邢進, 趙曌. 開展國內首例經臍單孔達芬奇機器人宮頸癌根治術. 老年健康, 2018, 12: 7.Xing J, Zhao Z. The first domestic transumbilical single-port Da Vinci robot-assisted radical hysterectomy for cervical cancer. Geriatr Health, 2018, 12: 7.
9.	Soga S, Watanabe G, Ishikawa N, et al. How does the surgeon's experience of abdominal operations influence the learning curves for robot-assisted vascular anastomosis? Innovations (Phila), 2013, 8(6):427-432.
10.	Saracino A, Deguet A, Staderini F, et al. Haptic feedback in the da Vinci Research Kit (dVRK): a user study based on grasping, palpation, and incision tasks. Int J Med Robot, 2019, 15(4): e1999.
11.	Bistre-Varon J, Elhadi M, Alcocer-Barrios J, et al. Cost analysis of robot NICE procedure versus open, laparoscopic, and robotic colorectal surgery: is there an economic benefit to natural orifice resection? Surg Endosc, 2025, 39(11): 7252-7261.
12.	陳文龍, 羊基用, 劉亞玲, 等. 5G遠程機器人輔助外科手術的臨床結局、當前挑戰與未來展望. 中國胸心血管外科臨床雜志, 2026, 33(5): 698-709.Chen WL, Yang JY, Liu YL, et al. 5G-enabled remote robot-assisted thoracic surgery: clinical outcomes, current challenges, and future perspectives. Chin J Clin Thorac Cardiovasc Surg, 2026, 33(5): 698-709.
13.	Ramsay C, Pickard R, Robertson C, et al. Systematic review and economic modelling of the relative clinical benefit and cost-effectiveness of laparoscopic surgery and robotic surgery for removal of the prostate in men with localised prostate cancer. Health Technol Assess, 2012, 16(41): 1-313.
14.	Carbonara U, Srinath M, Crocerossa F, et al. Robot-assisted radical prostatectomy versus standard laparoscopic radical prostatectomy: an evidence-based analysis of comparative outcomes. World J Urol, 2021, 39(10): 3721-3732.
15.	Jayne D, Pigazzi A, Marshall H, et al. Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. JAMA, 2017, 318(16): 1569-1580.
16.	Jayne D, Pigazzi A, Marshall H, et al. Robotic-assisted surgery compared with laparoscopic resection surgery for rectal cancer: the ROLARR RCT. Effic Mech Eval, 2019, 6(10): eme06100.
17.	Arnold BN, Thomas DC, Narayan R, et al. Robotic-assisted lobectomies in the National Cancer Database. J Am Coll Surg, 2018, 226(6): 1052-1062.
18.	Hu D, Wang Z, Tantai J, et al. Robotic-assisted thoracoscopic resection and reconstruction of the carina. Interact Cardiovasc Thorac Surg, 2020, 31(6): 912-914.
19.	Husen TF, Kohar K, Angelica R, et al. Robotic vs other surgery techniques for mitral valve repair and/or replacement: a systematic review and meta-analysis. Hellenic J Cardiol, 2023, 71: 16-25.
20.	李劍濤, 黃佳, 林皓, 等. 單中心連續333例機器人輔助胸腔鏡肺葉切除術治療Ⅰ期非小細胞肺癌. 中國胸心血管外科臨床雜志, 2017, 24(11): 825-829.Li JT, Huang J, Lin H, et al. Perioperative outcome of robot-assisted pulmonary lobectomy in treating 333 patients with pathological stageⅠnon-small cell lung cancer: a single center report. Chin J Clin Thorac Cardiovasc Surg, 2017, 24(11): 825-829.
21.	李紀文, 瞿冀琛, 張文天, 等. 國內首例機器人輔助雙孔胸腔鏡下全隆突重建術. 機器人外科學雜志(中英文), 2023, 4(2): 167-170.Li JW, Qu JC, Zhang WT, et al. First domestic case of robot-assisted double-port thoracoscopic total carinal reconstruction. Chin J Robot Surg, 2023, 4(2): 167-170.
22.	蒲寶紅, 崔佳明, 馬世勛, 等. 遠程機器人輔助手術適應證的研究與展望. 機器人外科學雜志(中英文), 2026, 7(3): 383-389.Pu BH, Cui JM, Ma SX, et al. Research and prospects of indications for remote robotic-assisted surgery. Chin J Robot Surg, 2026, 7(3): 383-389.
23.	王楠, 孟元光. 5G遠程機器人手術的發展與應用現狀. 機器人外科學雜志(中英文), 2025, 6(3): 503-507.Wang N, Meng YG. Current development and application status of 5G remote robotic surgery. Chin J Robot Surg, 2025, 6(3): 503-507.
24.	張超, 王正, 張宗勤, 等. 國產單孔蛇形臂機器人手術系統在零缺血腎部分切除術中的初步應用. 中華泌尿外科雜志, 2022, 43(2): 6.Zhang C, Wang Z, Zhang ZQ, et al. Study on the feasibility and safety of a novel single-port robotic surgical system in zero ischemic partial nephrectomy. Chin J Urol, 2022, 43(2): 6.
25.	李津喬, 蘇衍宇, 袁櫻, 等. 國產機器人與達芬奇Xi機器人輔助腎部分切除術圍手術期指標及學習曲線的比較研究. 中華外科雜志, 2026, 64(5): 531-537.Li JQ, Su YY, Yuan Y, et al. A comparative study on perioperative outcomes and learning curves of domestic robot-assisted versus Da Vinci Xi robot-assisted partial nephrectomy. Chin J Surg, 2026, 64(5): 531-537.
26.	Chen D, Kang P, Tao S, et al. Cost-effectiveness evaluation of robotic-assisted thoracoscopic surgery versus open thoracotomy and video-assisted thoracoscopic surgery for operable non-small cell lung cancer. Lung Cancer, 2021, 153: 99-107.
27.	Kneuertz PJ, Singer E, D'Souza DM, et al. Hospital cost and clinical effectiveness of robotic-assisted versus video-assisted thoracoscopic and open lobectomy: a propensity score-weighted comparison. J Thorac Cardiovasc Surg, 2019, 157(5): 2018-2026.e2.
28.	Mavroforou A, Michalodimitrakis E, Hatzitheo-Filou C, et al. Legal and ethical issues in robotic surgery. Int Angiol, 2010, 29(1): 75-79.
29.	Shentu X. A review on legal issues of medical robots. Medicine (Baltimore), 2024, 103(21): e38330.
30.	景武堂, 萬浩浩, 苗長豐, 等. 5G遠程機器人手術的應用現狀及展望. 機器人外科學雜志(中英文), 2025, 6(1): 1-5.Jing WT, Wan HH, Miao CF, et al. Current status and prospects of 5G remote robot-assisted surgery. Chin J Robot Surg, 2025, 6(1): 1-5.
31.	聶睿婕, 張恭, 劉榮. 超越距離: 遠程機器人手術對現代戰爭醫療的影響. 國防科技, 2025, 46(6): 134-140.Nie RJ, Zhang G, Liu R. Beyond distance: the impact of remote robotic surgery on modern warfare medicine. Natl Def Sci Technol, 2025, 46(6): 134-140.
32.	唐唯珂. 收費有了 "國家標準" 手術機器人加速商業化. 21世紀經濟報道, 2026-01-23(003).Tang WK. There is now a "national standard" for charging. Surgical robots are accelerating their commercialization. 21st Century Business Herald, 2026-01-23(003).
33.	國家衛生健康委, 教育部, 科技部, 等. 關于印發涉及人的生命科學和醫學研究倫理審查辦法的通知 (國衛科教發[2023]第4號). 中華人民共和國國家衛生健康委員會公報, 2023, 2:24-31.National Health Commission of the People's Republic China, Ministry of Education of the People's Republic China, Ministry of Science and Technology of the People's Republic China, et al. Notice on issuing measures for ethical review of life sciences and medical research involving human subjects (No. 4 [2023]). Bull Natl Health Comm People's Republic China, 2023, 2:24-31.
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1. 成名, 許世廣, 徐惟, 等. 機器人輔助與電視輔助胸腔鏡手術治療非小細胞肺癌近遠期生存差異的回顧性隊列研究. 中國胸心血管外科臨床雜志, 2022, 29(9): 1133-1139.Cheng M, Xu SG, Xu W, et al. Short- and long-term survival between robot-assisted thoracic surgery and video-assisted thoracoscopic surgery for non-small cell lung cancer: a retrospective cohort study. Chin J Clin Thorac Cardiovasc Surg, 2022, 29(9): 1133-1139.
2. Sheetz KH, Claffin J, Dimick JB. Trends in the adoption of robotic surgery for common surgical procedures. JAMA Netw Open, 2020, 3(1): e1918911.
3. Nahas WC, Rodrigues GJ, Rodrigues Gon?alves FA, et al. Perioperative, oncological, and functional outcomes between robot-assisted laparoscopic prostatectomy and open radical retropubic prostatectomy: a randomized clinical trial. J Urol, 2024, 212(1): 32-40.
4. Yaxley JW, Coughlin GD, Chambers SK, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet, 2016, 388(10049): 1057-1066.
5. 李曦哲, 高陽, 程遠大, 等. 機器人胸外科日間手術的現狀與展望. 機器人外科學雜志(中英文), 2022, 3(2): 79-84.Li XZ, Gao Y, Cheng YD, et al. Current status and prospect of robot-assisted thoracic day surgery. Chin J Robot Surg, 2022, 3(2): 79-84.
6. 郭成旺, 張銘澤, 郭璽, 等. "雙中心" 背景下5G遠程機器人外科的發展機遇與挑戰. 機器人外科學雜志(中英文), 2025, 6(1): 6-11.Guo CW, Zhang MZ, Guo X, et al. Development opportunities and challenges of 5G remote robot-assisted surgery in the context of double-center construction. Chin J Robot Surg, 2025, 6(1): 6-11.
7. Yang HX, Woo KM, Sima CS, et al. Long-term survival based on the surgical approach to lobectomy for clinical stage Ⅰ non-small cell lung cancer: comparison of robotic, video-assisted thoracic surgery, and thoracotomy lobectomy. Ann Surg, 2017, 265(2): 431-437.
8. 邢進, 趙曌. 開展國內首例經臍單孔達芬奇機器人宮頸癌根治術. 老年健康, 2018, 12: 7.Xing J, Zhao Z. The first domestic transumbilical single-port Da Vinci robot-assisted radical hysterectomy for cervical cancer. Geriatr Health, 2018, 12: 7.
9. Soga S, Watanabe G, Ishikawa N, et al. How does the surgeon's experience of abdominal operations influence the learning curves for robot-assisted vascular anastomosis? Innovations (Phila), 2013, 8(6):427-432.
10. Saracino A, Deguet A, Staderini F, et al. Haptic feedback in the da Vinci Research Kit (dVRK): a user study based on grasping, palpation, and incision tasks. Int J Med Robot, 2019, 15(4): e1999.
11. Bistre-Varon J, Elhadi M, Alcocer-Barrios J, et al. Cost analysis of robot NICE procedure versus open, laparoscopic, and robotic colorectal surgery: is there an economic benefit to natural orifice resection? Surg Endosc, 2025, 39(11): 7252-7261.
12. 陳文龍, 羊基用, 劉亞玲, 等. 5G遠程機器人輔助外科手術的臨床結局、當前挑戰與未來展望. 中國胸心血管外科臨床雜志, 2026, 33(5): 698-709.Chen WL, Yang JY, Liu YL, et al. 5G-enabled remote robot-assisted thoracic surgery: clinical outcomes, current challenges, and future perspectives. Chin J Clin Thorac Cardiovasc Surg, 2026, 33(5): 698-709.
13. Ramsay C, Pickard R, Robertson C, et al. Systematic review and economic modelling of the relative clinical benefit and cost-effectiveness of laparoscopic surgery and robotic surgery for removal of the prostate in men with localised prostate cancer. Health Technol Assess, 2012, 16(41): 1-313.
14. Carbonara U, Srinath M, Crocerossa F, et al. Robot-assisted radical prostatectomy versus standard laparoscopic radical prostatectomy: an evidence-based analysis of comparative outcomes. World J Urol, 2021, 39(10): 3721-3732.
15. Jayne D, Pigazzi A, Marshall H, et al. Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. JAMA, 2017, 318(16): 1569-1580.
16. Jayne D, Pigazzi A, Marshall H, et al. Robotic-assisted surgery compared with laparoscopic resection surgery for rectal cancer: the ROLARR RCT. Effic Mech Eval, 2019, 6(10): eme06100.
17. Arnold BN, Thomas DC, Narayan R, et al. Robotic-assisted lobectomies in the National Cancer Database. J Am Coll Surg, 2018, 226(6): 1052-1062.
18. Hu D, Wang Z, Tantai J, et al. Robotic-assisted thoracoscopic resection and reconstruction of the carina. Interact Cardiovasc Thorac Surg, 2020, 31(6): 912-914.
19. Husen TF, Kohar K, Angelica R, et al. Robotic vs other surgery techniques for mitral valve repair and/or replacement: a systematic review and meta-analysis. Hellenic J Cardiol, 2023, 71: 16-25.
20. 李劍濤, 黃佳, 林皓, 等. 單中心連續333例機器人輔助胸腔鏡肺葉切除術治療Ⅰ期非小細胞肺癌. 中國胸心血管外科臨床雜志, 2017, 24(11): 825-829.Li JT, Huang J, Lin H, et al. Perioperative outcome of robot-assisted pulmonary lobectomy in treating 333 patients with pathological stageⅠnon-small cell lung cancer: a single center report. Chin J Clin Thorac Cardiovasc Surg, 2017, 24(11): 825-829.
21. 李紀文, 瞿冀琛, 張文天, 等. 國內首例機器人輔助雙孔胸腔鏡下全隆突重建術. 機器人外科學雜志(中英文), 2023, 4(2): 167-170.Li JW, Qu JC, Zhang WT, et al. First domestic case of robot-assisted double-port thoracoscopic total carinal reconstruction. Chin J Robot Surg, 2023, 4(2): 167-170.
22. 蒲寶紅, 崔佳明, 馬世勛, 等. 遠程機器人輔助手術適應證的研究與展望. 機器人外科學雜志(中英文), 2026, 7(3): 383-389.Pu BH, Cui JM, Ma SX, et al. Research and prospects of indications for remote robotic-assisted surgery. Chin J Robot Surg, 2026, 7(3): 383-389.
23. 王楠, 孟元光. 5G遠程機器人手術的發展與應用現狀. 機器人外科學雜志(中英文), 2025, 6(3): 503-507.Wang N, Meng YG. Current development and application status of 5G remote robotic surgery. Chin J Robot Surg, 2025, 6(3): 503-507.
24. 張超, 王正, 張宗勤, 等. 國產單孔蛇形臂機器人手術系統在零缺血腎部分切除術中的初步應用. 中華泌尿外科雜志, 2022, 43(2): 6.Zhang C, Wang Z, Zhang ZQ, et al. Study on the feasibility and safety of a novel single-port robotic surgical system in zero ischemic partial nephrectomy. Chin J Urol, 2022, 43(2): 6.
25. 李津喬, 蘇衍宇, 袁櫻, 等. 國產機器人與達芬奇Xi機器人輔助腎部分切除術圍手術期指標及學習曲線的比較研究. 中華外科雜志, 2026, 64(5): 531-537.Li JQ, Su YY, Yuan Y, et al. A comparative study on perioperative outcomes and learning curves of domestic robot-assisted versus Da Vinci Xi robot-assisted partial nephrectomy. Chin J Surg, 2026, 64(5): 531-537.
26. Chen D, Kang P, Tao S, et al. Cost-effectiveness evaluation of robotic-assisted thoracoscopic surgery versus open thoracotomy and video-assisted thoracoscopic surgery for operable non-small cell lung cancer. Lung Cancer, 2021, 153: 99-107.
27. Kneuertz PJ, Singer E, D'Souza DM, et al. Hospital cost and clinical effectiveness of robotic-assisted versus video-assisted thoracoscopic and open lobectomy: a propensity score-weighted comparison. J Thorac Cardiovasc Surg, 2019, 157(5): 2018-2026.e2.
28. Mavroforou A, Michalodimitrakis E, Hatzitheo-Filou C, et al. Legal and ethical issues in robotic surgery. Int Angiol, 2010, 29(1): 75-79.
29. Shentu X. A review on legal issues of medical robots. Medicine (Baltimore), 2024, 103(21): e38330.
30. 景武堂, 萬浩浩, 苗長豐, 等. 5G遠程機器人手術的應用現狀及展望. 機器人外科學雜志(中英文), 2025, 6(1): 1-5.Jing WT, Wan HH, Miao CF, et al. Current status and prospects of 5G remote robot-assisted surgery. Chin J Robot Surg, 2025, 6(1): 1-5.
31. 聶睿婕, 張恭, 劉榮. 超越距離: 遠程機器人手術對現代戰爭醫療的影響. 國防科技, 2025, 46(6): 134-140.Nie RJ, Zhang G, Liu R. Beyond distance: the impact of remote robotic surgery on modern warfare medicine. Natl Def Sci Technol, 2025, 46(6): 134-140.
32. 唐唯珂. 收費有了 "國家標準" 手術機器人加速商業化. 21世紀經濟報道, 2026-01-23(003).Tang WK. There is now a "national standard" for charging. Surgical robots are accelerating their commercialization. 21st Century Business Herald, 2026-01-23(003).
33. 國家衛生健康委, 教育部, 科技部, 等. 關于印發涉及人的生命科學和醫學研究倫理審查辦法的通知 (國衛科教發[2023]第4號). 中華人民共和國國家衛生健康委員會公報, 2023, 2:24-31.National Health Commission of the People's Republic China, Ministry of Education of the People's Republic China, Ministry of Science and Technology of the People's Republic China, et al. Notice on issuing measures for ethical review of life sciences and medical research involving human subjects (No. 4 [2023]). Bull Natl Health Comm People's Republic China, 2023, 2:24-31.
34. 國家衛生健康委, 國家中醫藥局, 國家疾控局. 關于印發醫療衛生機構網絡安全管理辦法的通知 (國衛規劃發[2022]第29號). 中華人民共和國國家衛生健康委員會公報, 2022, 8: 42-46.National Health Commission of the People's Republic China, National Administration of Traditional Chinese Medicine, National Disease Control and Prevention Administration. Notice on issuing measures for network security management of medical and health institutions (No. 29 [2022]). Bull Natl Health Comm People's Republic China, 2022, 8: 42-46.
35. 何達, 張培茗, 顧一純, 等. 腔鏡手術機器人操作培訓中國專家共識(2024版). 機器人外科學雜志(中英文), 2024, 5(5): 1001-1007.He D, Zhang PM, Gu YC, et al. Chinese expert consensus on endoscopic robot-assisted surgical operation training (2024). Chin J Robot Surg, 2024, 5(5): 1001-1007.
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