One step forward, two steps back: preserving surgical skill in the age of robotics

Abstract: This perspective overview examines the tremendous increase in utilization of robotic-assisted surgery in general and minimally invasive surgical training, as well as the potential impact on trainee skill and competence in performing core surgical and subspecialty-specific minimally invasive procedures following the completion of training. We examine current evidence, explore how robotic surgery is often integrated into surgical training including an examination of minimum trainee case thresholds, and the transition of surgical technique development from delicate tissue handling reliant on haptic feedback to “feeling” tissue via only visual feedback. We highlight the importance of deliberate, intentional, and thoughtful incorporation of robotics in surgical training in such a way as to welcome and capitalize on technological advances and prepare the next generation of surgeons for an evolving practice environment while still safeguarding both surgical proficiency and patient safety.