Background: Laparoscopic surgery is beneficial to the patient but challenging for the surgeon. The visual axis is not the same as the operative axis. The surgeon must manipulate long, sharp instruments through a fixed opening under the control of a two-dimensional monitor and without the help of any tactile sensation. The body cavity is penetrated by cannulas, which cannot be interchanged, so that the surgeon is obliged to move around the patient in order to reach the best position for every step of the procedure. Methods: A computer interface in command of a mechanical system (robot) makes it possible: 1) To regain several lost degrees of freedom through intra-abdominal articulations; 2) to obtain better visual control of instrument manipulation thanks to three-dimensional vision; 3) to modulate amplitude of surgical motions by downscaling and stabilization; 4) to operate at distance from the patient. These possibilities lead to improved surgical performance. In addition, the surgeon operates in an ergonomically correct position. The robot (da Vinci™ System, Intuitive Surgical, Mountain View, CA, USA) consists of a console and a surgical cart, which supports three articulated robotic arms. The surgeon sits at the console where he or she manipulates joystick-like handles while observing the operating field through binoculars that provide a three-dimensional image. This computer is capable of modulating data by eliminating physiologic tremor and by downscaling the amplitude of motions by a factor of 5 or 3 to 1. Results: The first robot-assisted procedure in a human was performed in March 1997 by our team. Since then, we have used robot-assisted laparoscopic surgery for 147 procedures, including 39 anti-reflux operations. Our study demonstrates the feasibility of telesurgery on humans in a variety of procedures including robotic Nissen fundoplication, with no morbidity specifically related to the use of robotics, and with acceptable operative times. Conclusions: In its present embodiment, the system seems most efficient when involved in microsuturing within the abdomen or in very confined spaces. Improved ergonomic conditions and improved instrument mobility at the level of distal articulation seem beneficial in routine abdominal procedures. More research is necessary for further improvement in tool configuration and visualization. The robotic approach implies new operative strategies, including specific trocar placement.