One of the biggest problems confronting robotic surgery remains the persistent lack of understanding regarding the basic, fundamental tenant of robotics.
First and foremost: robotic surgery is a reproduction of open surgery, not laparoscopic surgery.
Laparoscopic surgery is a series of “shortcuts” like tacking instead of suturing, stapling or energy ligation instead of “clamp, cut, and tie,” and balloon dissection instead of manual dissection. Shortcuts are necessary because a surgeon is limited in manual dexterity with laparoscopy and, therefore, instruments such as tackers were created to replace normal “open” tasks.
The problem with these “shortcuts” is that they are much more expensive and less reliable than their open counterparts.
One of the best examples is examining how a surgeon deals with ligating a large cystic duct. The common laparoscopic approach is to use a laparoscopic stapler across the cystic duct, and often taking another step to “endoloop” the stump because of the concern of leakage through clips. This laparoscopic solution costs $400, while the integrity of the closure may provide postoperative concerns for the surgeon. The traditional open solution, however, involves just a single silk tie ligation. It costs pennies and the surgeon does not worry about the integrity of the closure. By reproducing open surgery in robotics, the benefits of minimally invasive surgery can be delivered in a financially and clinically advantageous compared to laparoscopy. This is Robotics 101 in action.
Please note, however, that I’m not suggesting that laparoscopic instruments do not have a place in robotic surgery. They do, especially in the learning curve of a surgeon transitioning from laparoscopy to robotics. During a learning curve, for example, a surgeon should worry only about getting through an operation safely and at a comfortable pace. Concerns of the financial implications and the need to speed up to save on indirect time costs or select disposables based on reduced cost should not burden the “apprentice” surgeon. During this period, disposables such as the V-loc suture or tackers can provide the “apprentice” surgeon with comfort or reassurance and provide a positive experience to a learning curve case in the form of time efficiency and convenience.