Time to Evolve Plastic Surgery Education? Integrating Robotic Techniques and Artificial Intelligence into Training Curricula

Abstract

We, as plastic and reconstructive surgeons, have long prided ourselves on our intricate skill, precision, and manual dexterity. Using simple magnification with microscopes, we have successfully performed delicate procedures such as anastomosing lymphatic vessels as minuscule as 0.2 mm, using hand-held microsurgical instruments. However, as technology continues to advance, we are faced with the question of how far we can push the boundaries of surgical innovation, relying solely on traditional magnification and manual instruments. Other surgical specialties stand further in their uptake of new-age technology, such as robotic surgical techniques in urology and general surgery,1 artificial intelligence (AI) in orthopedics and neurosurgery,2,3 and virtual reality across various disciplines. Although some may argue that plastic surgery, dealing primarily with the external surface of the human body, does not necessitate such technological adjuncts, the rapid adoption of these innovations by other specialties raises important questions about the future of our field. Purists may argue that the essence of plastic surgery lies in the artistic finesse and subjective judgment of the surgeon, rather than the precise calculations of machine-driven precision. Indeed, much of our craft is based on aesthetic principles and the surgeon’s intuitive sense of form and proportion. However, dismissing robotic and AI development outright overlooks the potential benefits they may offer in enhancing surgical outcomes, efficiency, and patient care. It may further put us at a disadvantage compared with other specialties, which enjoy a higher integration of robotic technology and AI. It is our opinion that true change and uptake can only come from training and increased exposure during the surgeon’s formative years. Exposure, in turn, can lead to new innovations and indications for robotic surgery and AI. The earlier this happens in our career, the more scope and motivation there is for innovation, research, and development. This forms the basis of the argument to consider integrating robotics and AI in our training curricula. Nonetheless, to effectuate any form of change, it is wise to determine whether as a specialty we are ready for this, and whether our young colleagues even want to learn about robotic surgery and AI, especially as indications currently seem limited. As the landscape of surgical innovation continues to evolve, the question arises: should plastic surgery residency programs incorporate training in robotic surgery skills and AI? To this aim, a national survey was done to gauge awareness, interest, and future perspectives of Belgian residents on robotic plastic surgery. A 30-point questionnaire was designed by the national resident organization in cooperation with the Organization of Robotics and Surgical Innovation Young Professionals Board. Questions were designed as Likert scales from 1 to 5 (low to high). This was sent to all Belgian residents by e-mail in February 2022, followed by a reminder 1 and 2 weeks later. Of the 60 residents, 40 (67%) with an average age of 29 years replied to the questionnaire. Responses were received across all training years and from all training programs. Only one in five residents had witnessed robotic procedures during their plastic surgery residency, most of which were for robotic DIEP flap harvest, with none having used AI. The average rating (out of 5 on Likert scales) for current utility in robotic surgery was 2.4, and for cost effectiveness, 1.6. When asked about future utility, this rose to 3.3 (P = 0.007 when compared with current utility), and for future cost-efficiency, to 3 (P < 0.0001 when compared with current cost-efficiency). Robotic training as an added value for residency was rated highly (4 or above) by 66% of residents with an average rating of 3.6. Residents rated their current knowledge on robotic surgery as 2.2. Interest in learning more about robotics in plastic surgery was rated 4