Is technology in the surgical suite really helping patients or is it time for surgeons to go back to the basics?

A scalpel and surgical thread used to be the primary tools of surgeons. Now the surgical suite looks more like a sci-fi movie complete with HD monitors, robots and computer equipment galore. Surgeons continue to expand their use of minimally invasive procedures to avoid large incisions and associated tissue damage in an effort to reduce complications and time to patient discharge. But are these technological advancements really all good? New data suggests that all options from invasive surgery to laparoscopic and robotic procedures must be carefully considered as not all patients seem to benefit from advanced procedures. Surgeons may require additional education to be able to fully consider their options and to incorporate recent clinical evidence into their practice.


Why do surgeons use minimally invasive procedures?
Minimally invasive procedures can reduce the size of the incision that is required to gain access to the tissue of concern. Since tissue damage caused by the surgery itself can be significantly reduced, many patients experience a reduction in postoperative pain and a shorter time to discharge. Another benefit is that some patients who might not be able to tolerate a typical surgical procedure due to age, advanced disease or poor health status, can be considered as candidates for minimally invasive procedures.


Both laparoscopic and robotic surgeries are minimally invasive procedures but robotic technology may expand the view of the surgical site, provide greater accuracy, and control compared to laparoscopic instruments. Improved accuracy is thought to reduce surgeon-induced damage, blood loss and scarring.


Although the new techniques have been touted as a revolution, new data suggests that surgeons must carefully consider the actual vs. perceived patient benefit. Patients with endometriosis, for example, did not benefit from the use of robotic surgery and their clinical outcomes were comparable to non-robotic procedures. The actual time in the surgical suite was increased as was fatigue reported by the surgeons.


Don’t blame the robots
While it may be true that the use of advanced technology is on the rise and it is an attractive option for surgeons, new technology is not the only answer. Many studies have demonstrated that experience matters; the more familiar a surgeon is with a technique the better they perform. Experienced surgeons armed only with a scalpel can have clinical outcomes similar to or better than their colleagues using robots. The question is, can experienced surgeons armed with robots improve clinical outcomes?


The take home message
Technology is here to stay and its use in the surgical suite will continue to increase over time. However, it is not technology alone that will improve patient outcomes, it is technology coupled with experienced, trained surgeons. Advanced hands-on training using human tissue is one way for surgeons to both gain experience and fully incorporate technological advances into their practice.


Every patient is unique—patients with advanced disease may benefit from technology in ways that patients in early stages may not.  The decision for each patient should be left to the trained surgeon.