Media outlets (Wall Street Journal, Gizmodo) are again reporting that automation is degrading pilots’ skills, although this has been known for over 2 years. I blogged about the subject back then as part of a comparison of pilots to surgeons. My point was that surgeons did not have autopilots to rely on in the operating room.

These new reports have prompted some to wonder whether robotic surgery will lead to the deterioration of surgeons’ skills.

In my opinion, that is not likely at this time because the robot is not really doing the surgery by itself. It is simply a tool that helps the surgeon and is under the surgeon’s complete control at all times (except when it runs amok).

However, ever since the advent of laparoscopic surgery over 20 years ago and its popularity for many of the common procedures surgeons do, there has been concern that surgeons may eventually lose proficiency for open procedures. And a number of other open operations have been done less frequently due to alternate ways of treating patients such as non-operative or interventional radiologic techniques.

Here are some examples from the ACGME resident log data for the academic years 1999-2000 and 2011-2012.

We are approaching the critical lower limit for open gallbladder surgery expertise, especially when you consider that only the most difficult cholecystectomies will be done as open cases from now on.

What will happen in 20 years when few surgeons will have sufficient skill to remove a very inflamed open gallbladder?

Does anyone really believe that a surgeon can confidently take out an enlarged spleen having done fewer than two such cases during training?

This is a bigger problem and far more pressing than the possibility that automation will render human surgeons obsolete.

There’s another issue too, which is the predicted shortage of general surgeons in the near future. How are more surgeons going to be trained if there are not enough open cases to train the current number of graduating residents?

Has anyone else asked these questions? Who has the answers?

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last three years, he has been blogging at and tweeting as @SkepticScalpel. His blog averages over 1200 page views per day, and he has over 7500 followers on Twitter.