Credentialing for Robotic Surgery

Introduction: Why Is Robotic Privileging So Highly Charged? The emergence of robotic surgery has perhaps had a more polarizing effect on surgeons and patients than any other new surgical technology in recent memory. While some surgeons feel that robotic surgery is the new frontier of minimally invasive surgery, others feel its value is more as a marketing tool, with little or no concrete data to support its use. Proponents of robotic surgery claim that it is an enabling technology that improves surgical precision, speed, and outcomes while providing a more ergonomic operating environment for the surgeon. Critics emphasize the great financial cost associated with the use of robot and the dearth of controlled studies demonstrating any superiority of the technique over standard laparoscopic or thoracoscopic surgery. This controversy is enhanced by the fact that, as of 2016, there is only one brand of surgical robot approved for clinical use, the Intuitive daVinci system. The lack of technological alternatives gives Intuitive a monopoly on surgical robotics, allowing the company to unilaterally set prices for the robot, its associated disposables, service contracts, and mandatory training programs. Intuitive has taken a very aggressive approach to marketing their devices, implying that hospitals and surgeons who do not adopt the robotic technology will become surgical dinosaurs, tantamount to the general surgeons of the 1990s who failed to adopt new laparoscopic procedures into their practice. Many surgeons have used robotic surgery as a means of differentiating themselves from their competition, suggesting rightly or wrongly to patients that their practice is superior to others that do not offer robotic procedures. Vast amounts of such marketing materials become immediately evident upon performing an Internet search using the terms “robotic surgery” and the specialty or procedure of interest. This perceived value of robotic surgery as a marketing force, coupled with most surgeons' natural interest in trying out new technology, has the potential to encourage surgeons to initiate a robotic practice for reasons other than documented clinical benefit. This eagerness for robotic surgery is often met with pushback from hospitals that may wish to limit the number of robotic procedures in order to limit costs. Additionally, there may be resistance to new robotic surgeons from existing robotic practices that have invested heavily in training and marketing to differentiate themselves.