What you also sacrifice is sense of touch. The farther away you get
from the patient the less sense of touch you have. With open surgery,
you have your hands right on the organs. Then there are laparoscopic
tools where your sense of touch is already deadened. The robot itself
does not relay any force signals. So you do miss out on that.
SP: What holds surgeons back from embracing
robotic technology and robotic surgery?
Berkley: To me, it is access to training. This is something that’s much
more challenging for robotics. If you are trying to learn just basic laparoscopic skills, you can start practicing right away. The instruments you
need aren’t terribly cost-prohibitive. But when it comes to working on
the robot, there’s no alternative to training on the robot itself.
Simulation can change this. We have two versions of our simulator.
One is a less costly offline trainer that isn’t going to tie up the robot for
training purposes and isn’t risking wear and tear on the robot.
Then there are advantages of simulation, when you are trying to
emulate a $1.8 million robot for less than $100,000, it is not going to
be exact. But there are validation studies that show working on the
simulator of the robot is just as effective for assessing the surgeon’s skills
and getting somebody up the learning curve as using the robot itself.
However, you can still use a surgeon’s console for simulation training as
There’s real OR costs with training with the robot. You need a staff.
You have to set up the robot. Also, typically people who are going to
train on the robot have to come in nights and weekends.
What we find is a lot of our customers do have the skill simulator for
use in the OR. It works well for something like warming up before surgery while the robot is being set up for the patient.
The importance of access to training and access to training for the
purposes of skills retention we think is crucial, and this is something
SP: Given some of the uncertainty regarding robot-
ics right now, how do you expect the technology and
adoption of it to develop over the course of the next
Berkley: The adoption of robotics has been fast, but there are challenges. There is the ability to get trained, and then there’s the cost. But
part of the cost is there is just one robot manufacturer right now. But I
fully expect within the next decade we are going to see the cost of robotics go down, and it will no longer be cost-prohibitive to do robotics.
This means you are going to have much more ability to do precise, complex cases in a minimally-invasive fashion.