Robotic Surgical Innovation Requires Developing Technology and the Surgeons Who Will Use It

This Clinician’s View is written by AdventHealth Foregut and Hepatopancreaticobiliary (HPB) Surgeon Sharona Ross, MD, FACS.

While robotic platforms have already revolutionized our approach to many surgical procedures, we continue to explore new frontiers in our quest to continually improve patient experience and outcomes.

As a Foregut and hepatopancreaticobiliary (HPB) surgeon, I am excited to help shape the future of the field through groundbreaking research that advances surgical technology while prioritizing patient safety and ethical leadership. I am also passionate about mentoring the next generation of surgeons and encouraging more women to pursue this challenging but highly rewarding work.

Driven by Curiosity and Inspired by Mentorship

For as long as I can remember, I’ve had a strong desire to investigate. As a 12-year-old girl growing up in Israel, I became captivated by the TV show Quincy, a mystery medical drama about a forensic pathologist. I quickly became determined to learn more about this field of medicine. Fortunately, a woman cleaning my mom’s office overheard my mom say she was trying to find a mentor to help nurture my newfound interest. That woman happened to know someone at the local hospital who connected us with a pathologist who became my very first mentor. What began as simply shadowing her led to us working together on a research project exploring breast cancer outcomes of Ashkenazi and Sephardic women in Israel. The experience boosted my confidence and clarified that I wanted more than a career spent evaluating slides and lab specimens. What I really wanted was to help people by fixing their problems in the operating room.

Thanks to that early mentoring and many more years of exploration, hard work and education, a passionate surgeon was born.

Evolving Robotic Surgery -- An IDE Pilot Study for Single Port da Vinci Foregut and HPB Procedures

I’ve specialized in Foregut and HPB surgery for over two decades now, with 80% of my practice focused on patients with cancers. The field has continually progressed from large incisions to more minimally invasive approaches with the introduction of robotic surgery bringing the greatest transformation. From robotic Whipple (pancreaticoduodenectomy) procedures to robotic esophagectomies, we are now seeing faster recoveries, less pain and fewer complications.

My latest foray into advancing our use of robotic technology is an investigation device exemption (IDE) pilot study I am leading at AdventHealth Tampa on use of the da Vinci SP (single port) system for Foregut and HPB operations. A 4th-generation robotic platform already approved by the U.S. Food and Drug Administration (FDA) for urologic and head and neck procedures, it is designed to enable minimally invasive surgery through one small incision or a natural orifice. The da Vinci SP employs a single robotic arm that delivers three-wristed instruments and a 3DHD camera for 360-degree anatomical access, which is ideal for deep, narrow surgical spaces, allowing us to reach anatomy in all four quadrants of the abdomen without redocking.

Our multi-phase IDE study began in the summer of 2024 and encompasses the following:

• Phase 1: Gallbladder and hiatal hernia procedures, including cystectomies
• Phase 2: Gastrectomies and distal pancreatectomies
• Phase 3: Esophagectomies and Whipples
• Phase 4: Liver surgeries, including hepatectomy

We have already successfully completed the first phase and are currently wrapping up work on the second. Our goal is to not only prove that these procedures are possible, but also safe and effective while identifying and refining the best surgical techniques for each. Overall, we believe the single-port approach will enhance preservation of healthy tissue due to less thoracic trauma while also improving patient quality of life through fewer incisions, less pain, reduced infection risk and quicker recovery. This is especially beneficial for our cancer patients who often must undergo additional therapies after their surgery.

Once our initial IDE study is complete, we hope to make it into a multi-institutional study, shortening the learning curve for surgeons on this paradigm-shifting technology.

Ensuring Responsible Adaptation of New Technologies

In addition to the introduction of a single-port robot, the incorporation of artificial intelligence (AI) into robotic surgical systems and the operating room in general holds the potential to further reshape surgery by enhancing surgical planning, strengthening real-time decision-making, revealing patterns and predicting risks with greater accuracy. The introduction of telementoring and telesurgery represent additional new frontiers that carry the potential to enhance access to surgical expertise and specialized care.

As we continue to push the boundaries of what is possible in surgery, it is critical that we view all these innovations as tools to improve our work as surgeons and not replacements for the human element of what we do. The patient must always come first. This means prioritizing safety, transparency and trust. That is why through the work of organizations like the Society of Robotic Surgery (SRS) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), we are reviewing research and evaluating evidence to identify best practices, define standards and create guidelines to ensure ethical, responsible integration of innovation.

Training and Mentoring the Next Generation of Surgeons

I know I am where I am today in large part because of my mentors along the way, including that pathologist when I was just a young teenager. However, it took me nearly a year and a half to find her, and she wasn’t a surgeon. Today, more than 50% of medical students are women, but most aren’t choosing careers in surgery because they believe it is a male-dominated field. I want these young women to find mentors so they, too, can make more informed decisions regarding their careers. I also believe that when you reach a leadership position as a woman, you should send the elevator down and help bring another woman up because there is room enough for all of us.

This led me to start the Women in Surgery Career Symposium in 2009. Held annually, it is a professional and academic event that promotes personal and professional growth and is designed to foster mentorship as well as a supportive peer network that champions women at every stage of their surgical journey -- from pre-med and medical students who have an interest in surgery to residents and fellows in the thick of their surgical education to attending surgeons in the throes of their careers. It is about women empowering women, forging new connections and building a community that helps the younger generation find the research, education and job opportunities to succeed.

In addition to the Symposium, I also enjoy leading the Complex Gastrointestinal Surgery/Foregut/HPB Fellowship Program at AdventHealth Tampa, where we train new surgeons to master a broad range of surgical techniques, including minimally invasive and robotic procedures. Coming full circle for me, I’m excited to share that this is the first year that both of our surgical fellows are women.

Remaining Patient-Centered in a Technology-Driven World

We’re at an exciting juncture in surgery, especially with complex Foregut and HPB procedures, and it is a privilege to be part of this transformative work. Through advancements, we are reducing surgical trauma, accelerating patient recovery and improving survival in complex abdominal cancers. As we continue to explore innovative technologies, our commitment should remain unwavering -- to always act in the patient’s best interest and place them at the center of every decision. Throughout my career, this principle has guided me and remains the most important lesson I pass on to the young physicians I train and mentor. If we all follow it, I believe great things lie ahead.