Robotic Surgery: Applications, Limitations, and Impact on Surgical Education

Bishoy Morris, MBBCH (Hons)

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Robotic Surgery and Surgical Education

Despite many technologic leaps, surgical training has stayed more or less unchanged for more than a century. Surgeons in training have always had to gain operative experience through "supervised trial and error" on real patients. This approach makes surgical training completely dependent on the actual case load, prolongs surgical training, and compromises patients' safety.[1] Robotic surgery will create a new medium for acquisition of surgical skills through simulation of all operations that can be done via the robot. Surgeons can use surgical robots to practice operations on 3-dimensional, virtual-reality visual simulations and soft-tissue models that recreate the textures of human tissues through force feedback (haptics).[60,61] Image-guided simulations will allow surgeons to practice procedures on 3-dimensional reconstructions of the anatomy of the actual patients who they plan to operate on the next day.[62,63,64] In all of these simulations, trainees can be guided through telementoring. Telepresence surgery has been also successfully used in teaching surgical skills to third-year medical students.[65]

These systems are expected to significantly enhance the learning curve, allowing trainees to acquire surgical skills in a short time while improving patient safety by reducing surgical errors.[1] Ultimately, these applications will be integral to the training and licensing of surgeons and will provide objective means for assessment of surgical skills.[66]

Robotic technology is expected to play an increasingly important role in the future of surgery. However, most residency programs in the United States have not placed adequate emphasis on training in robotic surgery.[1] A survey in 2002 showed that only 23% of surgery program directors have plans to incorporate robotics into their programs.[67] In 2003, another survey by the same group showed that although 57% of surgical residents demonstrated high interest in robotic surgery, the majority (80%) did not have a robotic training program in their institutions.[68] A few academic centers have developed formal didactics to train teams in robotic surgery.[69]

Ensuring competency to perform robotic procedures is left to individual hospitals. It is expected that as formal training in robotic surgery develops, more standardized credentials will be required to obtain robotic surgical privileges.[45,70]

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