Increasing Acceptance and Adoption of Surgical Robotics

As new surgical robotics platforms are released, there is an increasing amount of training that needs to be done in order to bring surgeons up to speed. On Episode 3 of The Surgibots Podcast’s second season, I was joined by Dr. Caitlin Houghton, the Assistant Professor Of Surgery at the Keck Medicine of USC, to talk about how we can improve this learning curve as an industry. Here are her insights:  

How did you train to use surgical robotics? 

I considered myself a laparoscopic surgeon at the time. I had been on the robot and manipulated the console four or five times, I had done some of the training courses and I had a certificate for completing them. Back when I trained there wasn't a rigorous set of rules on how you can access the robots and how much training you had to do first, so my experience was limited, despite the certificate. When I had the opportunity, however, to teach the residents robotics, they wanted me to do inguinal and gall bladders. At the time I thought the robot was for more complex things, and my attitude was that it would be a waste of resources. But that quickly changed. I realised that by getting on the robot for three cases every week and consistently working on those fundamental skills, not only was I able to increase my skills along with it, but I was also able to teach some of those fundamentals to the residents at the same time. I was really going through my learning curve as I was starting to teach residents and fellows. 

How are you helping other surgeons become native to robotics? 

I love minimally invasive surgery. One of the advantages of robotics is that it's accessible, it's an enabling technology and its tools and  visualisation are better. It's an advancement from laparoscopy. If we can teach more surgeons how to do robotics, then patients get access to more minimally invasive surgery. Some of those open procedures, like transplants, that never took off minimally invasively because of the challenges of laparoscopy, we can now do with robotic technology. There’s a lot of potential in the hepatic biliary space, general surgery, abdominal wall reconstructions, and other major surgeries that were really exclusively open. Now we're adapting and are able to do them more easily with robotics.  

The great thing is that it's not confined to those surgeons that really dedicated themselves to learning minimally invasive surgery. You still have a learning curve, but the timeline can be shorter because it's easier to adopt. In the long run, more patients are going to be able to have access to minimally invasive surgery if we continue to promote robotics. My role is to speak about it and teach it, not just for the company but also when I'm speaking at societies. I often incorporate videos to highlight what the technology can do so that people can see the quality and then hopefully want to train it. 

What barriers have you come up against when you're trying to get people to embrace new technologies? 

I think whenever you're trying to change or disrupt a culture there's going to be a range of perspectives on it. There's going to be the people that are excited, because they see it and they want to be the early adopters. Then there's the surgeons who are like, ‘Well, I'm doing laparoscopy very well with my technique, my patients have good outcomes, so I don't need any other technologies to assist with that’. Then there's the ones that are just resistant to technology or change. I think most people are in the middle.  

Age comes into it too. Some of the trainees that are coming out now have been exposed to this technology the whole time, so their perspective is different and they are more adept at embracing technology because they are used to it. Surgeons who were trained minimally invasively or laparoscopically like me will also have a good perspective, because they've trained to do something well, and they're doing it consistently. It's important to most of them to embrace robotics, because we see how it's changing medicine for future generations.  

There is concern about how much we embrace technology versus teaching the basics of open techniques because of access. What if you're in a rural area, or you don't have access to the technology? For the most part, when people are challenging the technology, I try and highlight the things that it is enabling, like the complexity of surgeries. The more complex the procedure, the more technically difficult it is for the surgeon. With robotics however, it's a flatter curve. There's a broad area in the mid-range of complexity of surgical cases where the patients do well, the morbidity and mortality don't go up with the case complexity, and the difficulty for the surgeon stays even. That's a huge benefit of the robotic platforms, so enabling surgeons to adopt it will have better outcomes for patients.  

How can we flatten that learning curve out? 

There's a lot of companies that are working on that. One of the companies that I really like is Fundamental VR, who are working to make a virtual reality where you don't have to have access to a physical simulator or to the robot itself, but you can have a headset that simulates the robotics training in virtual reality. That's a really cool concept.  

Right now we do have simulators in a lot of the training. Most of the time, when a surgeon is going to start training, they start on a simulator -but again, access to that simulator is a bottleneck. There may only be one or two simulators in an institution, or some have none, so you have to travel to get on the simulator. We know that as you're adopting a new skill, the more practice you have, the more muscle memory builds so that it becomes more automated. We need to get surgeons through to that automated point where they're no longer thinking about the technology, but they're thinking about the surgery.  

What I like about the idea of a virtual reality setting is that you could go back to it. You could do a training session and then have that training accessible online. If someone does the training, then their first case isn't till three months from now, they can go back to that training in real time the day before or an hour before, and you don't have to travel off campus. You can brush up within your normal workflow, which I think would really change the game as far as the learning curve and access to simulation.  

To learn more about training for and adopting surgical robotics, tune into Season 2, Episode 3 of The Surgibots Podcast here.