While we’re not there yet, we may be approaching a point where we’re facing a significant skills shortage among surgeons. A 2017 study by Meritt Hawkins found that 52 percent of orthopedic surgeons were 55 and older, as were 48 percent of general surgeons. As many surgeons approach retirement age, there is a pressing need to up-skill and up-level the next generation of surgeons, especially with demand for a range of surgical procedures for the Baby Boomers, from knee and hip replacements to abdominal procedures, rising quickly. Surgical robotics may be an important part of the solution for upskilling the tens of thousands of experienced and talented surgeons that will be needed in the coming decades.
Surgical robotics has advanced quickly with cutting-edge developments in robotic arm movements and range of motion, along with immersive reality, giving surgeons unparalleled visibility inside the human body. Imagine the benefits of a single incision robot that has full range of motion and mimics a surgeon’s hands, wrists, elbows, and shoulders, effectively shrinking the surgeon and putting her or him inside the human body. To make this a reality, a new generation of surgeons will need to continue to embrace their hunger for knowledge and lead the charge to move surgical robotics forward.
Training the next generation of surgeons
There has been tremendous progress in surgery, requiring surgeons today to constantly be learning and evolving. In the 1990s, with the advent of laparoscopic surgery, the cholecystectomy and hiatal hernia surgery moved from a lengthy recovery to outpatient surgery. In the last 20 years, complex gastric surgery has also moved to a laparoscopic approach. Now we are seeing the advantages of robotic surgery in hernia repair, colon, gynecologic and urologic surgery. Today’s emerging surgeons are constantly on the cusp of learning, and robotic surgery is no exception.
Robotics are already a significant part of surgery training, with technology such as virtual reality providing physicians with 3D views inside the body to study relationships at work. Sitting at a robot and feeling comfortable spending time with it is something most surgeons are already exposed to, and without preconceived notions about the way things should be done, new surgeons will have fewer constraints when it comes to being early adopters for robotic procedures.
Yet early exposure itself is not enough to ensure the makings of a great surgeon. The ideal physician learner is really someone who embraces all new knowledge. Science is constantly moving innovation forward, and as physicians, we must have enough humility to recognize that we don’t know the future. I would advise any skeptics to gain exposure to the technology and let it show you the potential for what it can do for both you and the patient.
Benefits of robotic surgery
In surgery, the constraints of operating within the abdomen make existing multi-port procedures challenging. For example, in laparoscopic surgery, surgeons need to put pressure on the instrument in the opposite direction they want it to move because of the fulcrum effect of the abdominal wall. This makes learning laparoscopic surgery challenging because it is a non-intuitive motor skill, requiring many hours of dedication to master. Enter the possibility of robotics – where technology can reverse the motion of the surgeon’s hands inside the abdomen to align with typical human motor functions, improving hand-eye coordination. This prevents miscalculations, such as making an incision in the wrong area or cutting too deeply, which have negative clinical implications and result in a longer recovery.
To take things one step further, inserting the robot into the abdomen itself is the next logical step in providing minimally invasive care. Robotics can be used to “transport” surgeons inside the abdomen and bypass typical restrictions from the abdominal wall with a 360-degree field of vision to examine and operate in every quadrant. A robotic solution with arms that can replicate human motion offers remarkable mobility. A robot can see, reach, and work anywhere inside the abdomen, which effectively shrinks the surgeon and puts her/him inside the human body, all through an incision as small as 1.5 centimeters. This provides surgeons with the technology they need for safer, more accurate, procedures with faster patient recoveries and better outcomes.
The future of robotic surgery
Technology continues to evolve every day. In the near-term future, portable and easily deployable robots will allow surgeons all over the world to perform minimally invasive surgery in an increasing number of procedure types and become even more effective surgeons. To achieve our goal of having a future surgeon workforce that meets the demands of an aging population and delivers good patient outcomes, we need training and knowledge-sharing at scale. Surgical robotics is poised to be an important part of the solution.
Barry Greene is a general and bariatric surgeon.
Image credit: Barry Greene
