The Learning Curve for Robotic Surgery: How Fast Do Surgeons Become Proficient?

Artemis has been very proactive with all sorts of expansion, and is very much into the international world — we're there to support it. With the new digital world, things like today's Zoom session can happen, and I'll be very happy to be part of any travel needed, taking time out every couple of months to be with the doctors and patients there. I'm a very proactive person when it comes to teaching and training, because the skills we've acquired are good to spread around so more people can gain the expertise.

Robotic surgery is a little more expensive than laparoscopic surgery — depending on the type of surgery, somewhere around $1,000 to $1,200 extra than any conventional laparoscopic surgery.

It depends on the age of the patient and her fertility desire. If it's a perimenopausal woman around 48 who has completed her family and has multiple fibroids, it's her choice whether she wants just the fibroids removed or the uterus removed too — sometimes women have very tiny peanut-sized fibroids we cannot take out at the time, and those can recur and regrow. So in many such women it's often better to think about getting the uterus removed rather than saving it. These are the kinds of discussions I'd have with the patient, taking them through the pros and cons of either, and then they can make a call.

People who train in robotic surgery are mostly already laparoscopic surgeons who've done many laparoscopic surgeries — very few robotic surgeons are 'de novo,' never having done laparoscopic surgery. If you've driven a manual car and now you're going to an automatic, proficiency comes sooner — you just need to learn to drive the robot. On conversion: I had one case in the last three to four years where I had to open a patient up, purely because during robotic surgery the patient's head is at a 30-degree angle, quite low down, and there was a lung compromise issue — the patient wasn't able to maintain oxygen saturation. We tried undocking the robot and raising her head, waited ten minutes and restarted, but her saturation kept dropping, so we had to open her up. That's the only case I can recall in three years, out of several hundred surgeries — patient selection is the most important thing.

With God's grace, none of my patients have ended up in the ICU or anything like that — they've all recovered beautifully. I've done more than 400 to 500 robotic surgeries so far, and I cannot recall any complications in terms of injury to the bladder, bowel, or ureter — essentially a 100% success rate at the post-operative stage.

Surgeons who are already experienced in laparoscopic surgery typically reach proficiency in robotic surgery after around 10 cases, since they are learning to operate a new interface rather than learning surgical decision-making from scratch.

The transition is compared to already knowing how to drive a manual car and then learning to drive an automatic. The underlying skill of operating and decision-making during surgery is already there, so proficiency with the robotic interface comes faster.

No. Clinical outcomes in robotic surgery remain closely tied to a surgeon's overall experience, and outcome data such as complication and conversion rates typically comes from steadily building experience after an already substantial background in laparoscopic gynaecological surgery.