I am currently a senior surgical trainee at a major American academic medical center (1 year to go out of 7). Thought I can provide some insight on some of the primary questions I see in the comments:

Before addressing anything further, robotic surgery is probably a misnomer, a better classification would be robotic assisted laparoscopic surgery. Once in place and spatial / positional orientation is obtained, the robot remains a tool directly controlled by the surgeon, no automation of the actual surgery is involved.

1: Regarding the actual commentary in the article:

Surgical trainees have transiently suffered in the still (early) adoption of this technology as the Attending surgeons themselves are often recently trained in robotic assisted surgery and lack confidence in letting trainees take full control. In the hands of an experienced attending surgeon, the trainee experience is comparable with any other surgery. Most academic centers should have two consoles, one for the resident and one for the attending, and control is easily handed off.

As is appropriate, robotic training is being increasingly incorporated into surgical training, with some programs being more advanced than others. There are a few classes (I.e graduation years) of trainees that have / will be left out of this due to the relatively recent and ongoing adoption. Overall though this is a transient issue that is being actively resolved.

2) Is surgery hard?

While in many way surgery is similar to mechanical repair / construction, the human body is much less discrete and predictable than most mechanical objects. While some surgeries are straightforward and can be learned quickly (I.e with 30-100 cases), there is an enormous variation in complexity and risk even with a particular surgery. For example, laparoscopic appendectomy is a common surgery that is considered to be “easy”. However there is a lot of subtlety in that assessment. First appendicitis can range in severity, with severe cases lacking in identifiable anatomy and often requiring a procedure of fundamentally higher complexity. How would you replace a clutch if you can’t actually see the clutch, are not sure where it is, and it is surrounded but a wide range of other critical components that would be irreparably damaged if they are touched in the wrong way. In addition, a lot of the learning is determining how hard you can safely pull or push without inadvertently hurting something or causing substantial bleeding, which is a learned skill. Finally, surgery is an extension of medicine, so you also have to learn how to determine a diagnosis, whether or not a surgery is indicated, what specific surgery is indicated, and how to take care of your patient post operatively to minimize complications.

All of this usually takes many years of hands on experience. Reading about something (and there is a lot to read) doesn’t mean you know how to safely and appropriately manage an issue.

3) What benefits are there to robotic assisted laparoscopy compared to traditional laparoscopy

The robotic arms add a fully rotating “wrist” joint near the tip of the instrument which adds multiple degrees of freedom to the standard straight sticks of laparoscopy (which only has rotation of the instrument tip). This adds for much more flexibility in tight spaces, such as the pelvis, or in areas where rigidity limits mobility of the instruments (the chest). Related to this, it improves surgeon ergonomics in many cases. It’s use is also being explored to allow for much more complex cases than have been possible with traditional laparoscopy due to awkward working angles, such as massive ventral hernia repairs. In addition it has a larger dual camera (for stereoscopic 3d) and comes with a more complex co2 insufflation system which both insufflates and drains air, greatly improving visualization (though this can theoretically be used with standard laparoscopy).

In terms of outcomes, for most cases there probably won’t be a difference, but a lot of the benefit is likely in intangible things like surgeon ergonomics, improved visibility, and enabling some cases that are simply too difficult or awkward to do safely with traditional laparoscopy.