SOS Physician Blog | July 2018 | Dr. John Parker

July 10th, 2018

By: Dr. John Parker

Dr. John ParkerI called my best cycling buddy early on a Saturday morning and suggested a bike ride. “Can’t,” he replied. “I’m going over to Home Depot. I’m putting in a new sink in the kitchen.”

I was impressed. He sounded so confident. Wow.

The next morning, Sunday, I called him back, and again suggested a bike ride.

“Can’t,” he said. “I have to wait for the plumber.”

Ah. Plan B.

We all know that things don’t always go according to plan, and that sometimes the only reason to have a plan is to change it. Sometimes you have to think on your feet, flip the script, and make a whole new plan on a moment’s notice. And that in itself is a skillset, one you can practice and get better at.

And the system works. With practice, and experience, you become more and more adept at recognizing when a plan is about to fail, and at abandoning that failing plan and making a new plan on the spot, and then executing that plan instead. You call the plumber.

In the field of orthopedic surgery, this occurs all the time. Pre-operatively, we look at x-rays, examine the patient, and make a plan, only to find, once the incision is made, that our plan may not work as we had hoped. So we adjust, we recalibrate and reposition, and we create a new plan on the fly. We go to Plan B.

Today, in 2018, our industry is sometimes using robotics in surgery, and the technology is truly remarkable. The robot makes things look so easy. Bone cuts are exactly the right depth, prostheses are in exactly the right position, and the post-op x-rays are out of a textbook. Usually.

But there’s one thing the robot can’t do - at least, not yet. It can’t get the sense that things are going ever so slightly wrong, that something subtle has changed intraoperatively. That a new plan needs to be made, and immediately.

Robotic surgery is amazing. But it’s still surgery, which means cutting someone open and moving body parts around. Even the best, most precise robot can only be as precise as the surgeon who’s operating it. So you still want that surgeon to be very skilled, very experienced, and very ready to go to Plan B when that’s suddenly what’s needed.

The role of robotics will continue to expand in the surgical setting, and rightly so - it offers distinct advantages and skills that are difficult to replicate manually.

But when it comes to the actual surgical care of patients, the best robot is still between the surgeon’s ears.

And the system works.