How close are we to the routine use of remote robot surgery? After all, one of the main reasons why big US brands like Mayo Clinic and Cleveland Clinic have struggled to set up abroad is the understandable reluctance of top American surgeons to fly around the world. Robots would enable them to operate from their home city.

So, as part of a larger feature on the big US chains, we asked the big, not-for-profit, US brand names what their plans were in this area. The response was overwhelmingly negative. Over a decade on, the international heads at Johns Hopkins, Mayo Clinic, Cleveland Clinic, MD Anderson and University of Pittsburgh Medical Centre, told us that they wouldn’t be mass-adopting the technology any time soon.

One of the main reason is professional resistance. Chuck Bogosta at UPMC says “The biggest barrier for us is the regulations that exist on a country-by-country basis. We’ve found that within Europe it’s easy to move around as a physician, but if you’re outside Europe it’s difficult to collaborate because of the law.” Mayo Clinic also cited tough laws as preventing remote surgery taking off in their clinics. “It’s definitely on the horizon for us, but the many issues surrounding the technology means we don’t know when it will become the norm,” says David Hayes, Medical Director of the Mayo Clinic Care Network. He predicts it will take years for until Mayo Clinic “will see robots in the operating room“.

Another factor is the cost of robotic surgery. The market is dominated by a single player, Intuitive Surgical, and this means that the cost of robot surgery is many times higher than traditional surgery.  That is why the only Da Vinci robots in the UK were all bought for research purposes. Interestingly, costs could plummet as many of Intuitive’s patents are due to end in 2016-2017.  As a result, we hear a lot of investors are pouring money into the field.

The verdict?  Even if prices plummet, we doubt that surgery across borders will take off soon thanks to professional resistance.

After all, the radiologist profession around the world was quick to react to the threat posed by tele-radiology by banning the interpretation of images taken within their country being interpreted elsewhere.  Germany, for instance, bans their export – although, interestingly, is happy to allow German radiologists to interpret foreign images!

But it is sad to see a profession standing in the way of technological improvements which are clearly in patient and tax-payer interests. A surgeon based in India who specialised in performing the same specialist operation over and over again by robot will have better outcomes at lower prices than far better paid surgeons in Western Europe who do the procedure only a few times a year.

Read your robotic surgery article

—