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The Value Of Robotic Surgery: It All Comes Down To Training

Wed, 10/23/2013 - 12:02pm
Jeff Berkley, PhD, Founder and CEO, Mimic Technologies

This is a response to a blog that appeared in Wednesday's edition of Today In Surgery.

Robotic surgery is currently being debated as part of a larger discussion the nation is having on both cost and quality in healthcare. Right now, the da Vinci robot is being used by surgeons and hospitals throughout the world.  As we debate costs and value, which surgery we choose will continue to be a significant public health issue. Minimally invasive surgery (MIS) technologies clearly have been part of the trend in medicine to provide patients with the best surgery possible.

Techniques including conventional laparoscopic and robot-assisted surgery allow operations for everything from acid reflux to heart surgery with the potential benefit of fewer complications and much shorter recovery times.

But conventional laparoscopic surgery is limited. Unlike human hands, most of the rigid instruments used in MIS cannot bend at the wrist so that surgeons can change their approach to operating at any angle. This requires surgeons to learn new moves very different from those well-practiced in open surgery, which can result in additional operating room time for surgeons new to the technique.

Another problem when surgeons operate on a patient using traditional laparoscopic techniques: small cameras give only a flat 2D view, making it hard to judge distances and the location of sharp instruments. The resulting complexity of traditional MIS makes the approach difficult for many surgeons to learn. This is one of the reasons surgeons have been slow to adopt the technique over the last 30 years since its introduction. Instead, now 80 percent of surgeries that could be done minimally invasively are still done by opening up the patient, which can cause you to have a needlessly long and painful recovery period.

That is why robot-assisted laparoscopic surgery was invented for patients. Because it addresses many of the complex needs of minimally invasive surgery. Its instruments are inserted through small incisions, but offer a wider, more natural range of motion, including bending at the wrist. This is possible because they are robotically actuated by a surgeon seated at a control panel that provides a magnified 3D image of the surgical area.

There are other reasons.  Because the motion that exists in your surgery can be scaled and the hand tremors filtered out, your robot-assisted surgery is potentially more precise than manual surgery and easier to learn than the traditional laparoscopic approach that you are hearing about.  Your surgeon can reach expert levels of performance faster when using the robot.

Even when a surgery such as hysterectomy can be achieved through traditional laparoscopy, it is important to consider how much practice on patients is necessary to achieve the results that patients need. The robotic approach for most surgeries is typically associated with a shorter learning curve. Add simulation training into the mix, where surgeons practice first (as if they were in surgery) and the learning curve for robotics becomes even shorter.

As media coverage has accurately included as part of its reporting, when adequate training is provided, the robot is safe for patients.  As we have this debate on which technology and what techniques are better for the patient, it is essential that we discuss and consider the training aspect. But even more, we must look at the level of care a surgeon can provide patients after they reach expert levels of performance. Ultimately, surgeons will choose the approach that is easiest to learn.  This is what helps explain the recent proliferation of robotic surgery.

Jeff Berkley, PhD, is the founder and CEO of Mimic Technologies, which provides worldwide training and software for the da Vinci robot.

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