Watching the Robotic Surgical System Evolution in Real Time

Although surgical robotics have been available to the healthcare industry for almost a quarter century, we’re still in the technology’s infancy. With their newness comes an ongoing debate over their benefits. Depending on the study you read, differences between robotic surgery and laparoscopic procedures are negligible. If you look hard enough, you’ll find studies that report a small improvement with robotic systems, but most show no substantial difference between the techniques.

This will undoubtedly continue to be the case until more surgeons become experts with robotic systems or the technology advances further such that there are significant improvements with robotic procedures over more well-established techniques.

In the meantime, we’ll continue to see headlines regarding robotic surgical systems—for both positive and negative reasons. When a laparoscopic surgery goes wrong, it’s rare for it to make mainstream headlines. With a robot, however, regardless of the reason, the story will almost certainly make the evening news.

Unfortunately, such was the case with a 2021 procedure involving the da Vinci surgical system, which has resulted in a lawsuit being filed. The lawsuit alleges a stray electrical arc from the surgical robot burned a patient’s small intestine during a procedure, which resulted in her death.

In response to “recent media coverage,” Intuitive Surgical stated, “There have been more than 14 million procedures performed using da Vinci surgical systems, and more than 38,000 scientific articles published that support the safety, effectiveness, and positive clinical outcomes for patients.”

Regardless of who is to blame, hopefully, the incident will lead to resolutions that address a potential problem. Innovation will take place and a solution will be conceived. As horrible as it is for the family of the patient who died, this can be a driving force for medical technology advancement. The da Vinci will continue to be improved and, at the same time, competitors will also make revisions that will forward the technology’s progress.

On the other hand, not all robotic system news generates negative headlines as fantastic “firsts” are also highlighted. This was the case when a “surgical procedure” was performed in space. A team of surgeons took turns using Virtual Incision’s spaceMIRA (miniaturized in vivo robotic assistant) to cut through “human tissue” (i.e., rubber bands acting the part). The surgeons were located on Earth while the “patient” and surgical robot were aboard the international space station. While the successful test procedure required the surgeons to move slower than they were accustomed to (there was about a half-second delay in visual feedback), it demonstrated the feasibility of operating in space when a surgeon was not aboard. A small step for [a] man…well, you know the rest.

There’s still another factor in the evolution of robotic surgery—price. This topic is addressed briefly in this issue’s C-Suite Reflections column. Robotic surgical systems are quite expensive, typically only allowing large healthcare systems to invest in them. But again, necessity is the mother of invention. Companies are developing more affordable solutions that will enable these systems to penetrate more healthcare facilities and be brought to more regions than their pricey predecessors. This will enable the benefits of robotic surgery to extend to remote locations (not quite as remote as space) and leverage the experience of robotic surgical experts where they don’t exist.

There is one benefit of robotic surgery that’s already well established and seems to be making an impact. In addition, it’s significant considering how much has been said of the shortage of healthcare professionals, which is only likely to worsen. Performing robotic surgery is more comfortable (i.e., ergonomic) for a physician than when operating with a more traditional method.

A quote from a 2021 New York Times article surprised me. “There is this ergonomic advantage,” said Dr. Gerard M. Doherty, surgeon-in-chief at Brigham and Women’s Hospital in Boston. “We move the arms of the robot while sitting comfortably. I have one surgeon who told me it will extend his career by a decade.”

That’s significant when we’re hearing about concerns over physician shortages. Even if a decade is an exaggeration, extending surgeons’ abilities to remain in the OR for more years due to the use of a robotic system is an incredible benefit.

There will undoubtedly be more headlines written about robotic surgical systems, and they will continue to be both positive and negative. This is inevitable given where this technology is and how quickly it’s evolving. In the meantime, pay attention and see where your company can find opportunity to improve on the technology and/or techniques associated with these systems. 

Sean Fenske, Editor-in-Chief
[email protected]