How reliable and effective are robot-assisted surgeries compared to human surgeons?

Author: Lily Bayley

Surgery has always been shaped by innovation, whether this is new techniques or scientific discoveries; all with the purpose of medical advancement. The latest milestone in the evolution of modern surgery is the introduction of robotic assistance. Over the past two decades, the operating room has developed to something unrecognisable from the traditional: robotic arms, 3D imaging equipment, and AI guided tools now assist tasks that were only previously possible with human hands. However, this rapid shift creates a dilemma, with some questioning the reliability and effectiveness of these surgeries compared to conventional procedures. 

Robotics are undeniably useful when assisting surgeries because they allow for lower risk outcomes and reduce stress on surgeons. Nonetheless, there is still possibility for machine error and some worry for what the future of surgery will bring. This essay argues that robot-assisted surgery represents a significant advancement in surgical practice, but its use must be evaluated in relation to restraints of technology and the necessity for human expertise in complex, often unpredictable procedures.

The main benefit of robot-assisted surgery is that it facilitates the work of human surgeons, meaning that they are under less pressure. For example, robotic arms are used to hold instruments that a surgeon can control using a joystick console. These arms have a greater range of motion than if the instruments were used by humans, which allows for procedures that would have been much more difficult before the integration of robotics in surgery. It also means that instead of standing for hours in awkward positions, the surgeon can sit at a console. This reduces fatigue and pain, often translating to better focus during long surgeries. Furthermore, high-definition cameras can now be used so that greater detail of the area can be viewed. This ensures that surgeons can work more accurately on smaller areas and means some procedures that previously required major surgery can now be done on a much smaller scale. 

One example of this is the use of technology in mitral valve repairs. Traditionally, this required a full sternotomy- or the splitting of the breastbone. With modern use of 3D cameras and small robotic instruments, this procedure can be exercised through a few small ports between the ribs. Robotic motion scaling and tremor filtering further enhances the delicate manoeuvres required for the surgery, opposed to the previous use of rigid laparoscopic instruments. Whilst the treatment still carries significant risk, the smaller incisions mean that patients suffer less pain in recovery and leave with minimal scarring. Furthermore, the surgeon doesn’t need to open the chest widely so there is a heavily reduced risk of infection after surgery. There is also much less possibility for human error during the surgery, carrying less stress for the surgeon.

On the other hand, the growing reliance on robots in surgery means that professionals have to complete additional training for procedures that would traditionally be done by hand. On top of standard surgical residency, surgeons are required to undergo initial platform training, followed by assessments in both simulated and real surgeries before gaining the credentials to use these new technologies. As well as this, hospitals often require surgeons to be re-trained annually. This doesn’t even take into account the continuous updates to software or new robotic instrument types. Some may argue that in this way, use of robotics in surgery actually makes the experience more difficult for healthcare professionals. However, this amount of training is heavily overshadowed by the vast amount of training already required for practicing surgeons and is almost a menial task in comparison. Furthermore, this is unavoidable whilst robot assisted surgery is still a novel concept, and once it has been completely phased in it is possible that technology training could be included in standard training.

Another advantage of the use of robotics in surgery is that it provides more consistent techniques, lowering variability between surgeons. This leads to more reproducible procedures across institutions, as specific manoeuvres can be refined and trainees can be taught using identical views and movements. This is important as it prevents the small but important inconsistencies that occur with manual tools that can lead to issues. For example, in non-robotic minimally invasive surgery, different assistants frame the operative field differently, but with robotics the camera positioning is so that image stability never varies and depth perception remains constant. This standardises how anatomy is viewed and approached in every case, meaning that the same course of action is taken by each surgeon. It could be argued that this sort of consistency is impossible, and that it is important to teach students with examples of different approaches to similar cases. However, the greatest concern is ultimately patient care, and the consistency of surgeries means that all patients can be well informed about their surgery beforehand and receive the same level of effective care after.

Another disadvantage of robot-assisted surgery is the increased risk that comes with the possibility of machine failure. This can be in the form of imaging problems, software issues or instrument malfunction. In this sense, robot assisted surgeries could pose a wide range of difficulties to both the patient and the healthcare professionals. Usually, a technology problem leads to the surgery being performed manually, which may require larger incisions or procedures that the patient was not informed of. This can lead to extended recovery times or hospital stays that are longer than expected. However, it is important to note that only a small fraction of all surgeries completed with robotic assistance face any issues at all, and even those that do are often resolved without resorting to human led surgery. It is also significant that the machinery cannot move by itself, and when it encounters a problem the default behaviour is to stop motion safely. Furthermore, there are significant built-in safety features to protect patients, such as fail-safe stop mechanisms and backup circuits. The main risk with machine failure is ultimately inconvenience, rather than patient injury, and robotic surgery is always performed with a fully trained surgical team who can ensure safety in the few cases where technology fails.

Overall, while robot-assisted surgery brings new challenges through added technical demands and the possibility of machine error, the evidence strongly suggests that this is overshadowed by the meaningful advancement it provides to the precision and consistency of surgery. Robotics do not replace the necessity for human expertise in procedures, but they certainly enhance the capabilities of modern medicine, allowing surgeons to operate with greater accuracy and focus. As these technologies continue to advance and become more seamlessly integrated in medical education, many of the current stumbling blocks like extra training and unpredictable outcomes will cease to exist. After all, all new methods used in healthcare treatment require refinements and practice before they reach their peak effectiveness. Therefore, technological assistance in the operating theatre shouldn’t be viewed as a threat to traditional methods but instead as a transformative tool that creates a pathway to the highest level of patient care, with minimal risk.