As a BBC article explores what one surgeon believes is a growing dexterity problem with trainee surgeons, Yorkshire Knee Clinic’s Jon Smith considers whether robots are likely to help or compound the problem.
It’s really not the trainee surgeons’ fault. In an NHS creaking at the seams, with growing patient numbers and the constraints of the European Working Time Directive to contend with, it’s hardly surprising that new surgeons are struggling to put ‘surgical hours in the bank’. You might assume every surgeon has mastered the ‘craftsmanship’ side of our business – the cutting and stitching and so on – but that takes time and practice and you can’t magic either out of thin air.
Yet the professor of surgical education at Imperial College, London believes there’s another factor hampering student surgeons’ practical abilities: smartphones.
The wonderfully named Professor Roger Kneebone told the BBC that “A lot of things are reduced to swiping on a two-dimensional flat screen,” rendering, he says, students less competent and confident in using their hands.
Director of the Victoria and Albert Museum Tristram Hunt agreed, adding that creative skills are the ones “which will enable young people to navigate the changing workplace of the future and stay ahead of the robots.”
Letting the robot take the strain?
You might think that ‘staying ahead of the robots’ rather misses the point. As technology improves, does surgeon dexterity not become an outmoded skill? Does it really matter if our knee surgeons are less adept at stitching and sewing when, increasingly, there will be a robot that can handle that for them?
As The Telegraph noted, exploring the tragic case of Stephen Pettitt who died following botched heart surgery (which I’ll come to in a moment), “Lancashire Teaching Hospitals, which has been using a Da Vinci robot for a year, said it noticed a ‘significant reduction in patient recovery times and complications’.”
I would challenge much of this evidence – and you’ll find lots of similar studies lauding the success rates of robots used in surgery. The problem is that many of these trials are not ‘blinded’, which means the researcher, the patient or both know whether there has been robotic intervention in a procedure. Subconsciously or otherwise, bias inevitably creeps in.
What’s required is a randomised, clinically controlled, blinded trial to create the evidence we need.
And if we really are going to accept that robots will, over time, compensate for a lack of surgeon dexterity, then we need better training to use the robots too.
An absence of benchmarks
At the inquest into the death of Stephen Pettitt, reported by the BBC, the coroner found that the surgeon involved had “no one-to-one training on the… device and had been ‘running before he could walk’.
The coroner also said there was an “absence of any benchmark” for training on new intervention treatments.”
Crucially, the coroner also said it was “more likely than not” that Mr Pettitt would have survived had conventional open heart surgery been used, with only a 1%-2% chance of him dying.
This is the real issue: robots can’t mask a lack of skill, ability or dexterity if you don’t a) have the surgical experience to know how to resolve problems and b) have the technological skills on hand to correct a robot that is heading in the wrong direction (in this case the proctors, whose role was to offer expert technical support, left midway through the procedure).
So I agree with Professor Kneebone. We need to place greater emphasis on practical, manual skills, so that in the future, whether surgery is routinely handled by robots or not, we’ll retain the abilities required to intervene where necessary and keep patients safe.
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