Vijay Singh, MD: The Robotic Surgery Debate

FEBRUARY 04, 2018
Matt Hoffman
Vijay Singh, MD, a cardiothoracic surgeon with Northwell Health, sat with MD Magazine to discuss the ongoing debate surrounding the use of robotics in surgery, and where the two sides stand. Singh also discusses the topics robotic surgeons will get into post-operation, and how they're constantly seeking to improve the tools they utilize.

Vijay Singh, MD, a cardiothoracic surgeon with Northwell Health:
After an operation, especially if you're operating with another robotic surgeon, we usually discuss what were the anatomical difficulties with the robot. 

Even though the robot has been out for, probably about a decade and there is a lot of experience [with it], there are still some things that you are learning as you go along. I think the most, or the main issue, that comes up is: Was the robot used optimally? Was there anything else we could have done—could we have moved the camera, etc. It's just basically technical issues with the robot, and [the question of] did we maximize its potential.

There is always a discussion in terms of the validity of robotic surgery in general. Is it useful, is it worth the cost, is it better than a thoracoscopic or laparoscopic operation, does the cost justify its use? Basically, a robotic surgeon who is committed to it will say yes, and [point to] the fact that they feel they can replicate an open operation the best with this application. 

That ongoing controversy is still there, and it's in evolution, and it is going to be—until there is firm literature showing one or the other—a hot debate.

The forces that are pushing against robotic surgery are really the costs. I think things that will mitigate that will be when there is competition with other robots coming out. That cost will decrease markedly, I believe, just like anything else when the market has competition, prices should go down. 

That, and the fact that if you can actually completely replicate an open operation. In terms of, if you're doing a cancer operation [for example, you would be] replicating the exact same operation with a minimally invasive platform. That will drive robotics. 

So, really, the cost is the issue and if you can show no major increase in cost with a benefit, then it will be here for a long time to come—which I believe it will be. 

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