The Benefits of Robotic Surgery: Are They Technical or Molecular?

Excerpt

Training to be a commercial pilot for a major airline today requires inordinate hours of practice in a high-tech simulator and multiple hours of actual air flight in a high-tech commercial air plane. The formal and rigorous certification process and training, coupled with the many technological advances in airplane design and equipment, have made commercial air flight safer today than ever. Yet to specifically determine the influence of pilot technical competence on air flight complications, which in this example would be passenger injury or death, is problematic. The reason for this is uncoupling the pilot’s technical competence from the airplane’s advanced enabling technology, built in environmental redundancies (i.e., checklists, a co-pilot, communication to the tower, GPS, etc.) and is challenging, if not impossible. Short of an individual pilot safely landing a commercial jet with 100 passengers or more in the Hudson river with no casualties while disengaged from all enabling technology and communication, it is becoming increasingly challenging, if not impossible to single out the individual as the independent operational variable of a complex task that involves advanced instrumentation and team cooperation. Analogously, emerging technology in robotic surgery may be similarly challenged as the “captain of the ship” notion as being responsible for all outcomes fades as dependence on instrumentation and a functioning team becomes more integral to the outcome. From the patient’s viewpoint, in terms of safety and efficacy, one might consider this shared responsibility an advance. In this piece, we posit that when examining the processes, executions, and advantages of robotic surgery, one might consider that something else beyond the instrument itself is at play. Here we attempt to outline this notion by positing that beyond technique, there may be multiple positive elements that contribute to the improved outcomes being observed with robotic surgery inclusive of more stringent patient selection, mandated procedure rehearsal, a greater attention to operating bloodlessly, a smoother anastomotic construction beyond the technical aspects of the connection itself, and a higher demand on oneself to operate at peak performance. While invariably there will be multiple attempts to uncouple each element to better understand how the whole process of robotic surgery is an advance at multiple levels, here we assert that such an exercise is both unnecessary and impossible. …