Clinical Challenges in Minimally Invasive Surgery: Emerging Robotics and Adapting Laparoscopy – An Interview with Dr. Jim Porter

Robotic surgery has moved from novelty to norm, and in this episode of Behind the Knife, Drs. James Jung and Joey Lew sit down with urologic pioneer and Medtronic CMO Dr. Jim Porter to dissect how we got here, what the data really say about “the death of laparoscopy,” and where competing robotic platforms like Hugo may take the field next. From ergonomics and education to economics and global access, they tackle both the hype and the hard questions around robotics as the future of minimally invasive surgery.

Hosts: 
·      James Jung, MD, PhD, Assistant Professor of Surgery, Duke University
·      Joey Lew, MD, MFA, Surgical resident PGY-3, Duke University, @lew__actually

Learning Goals: 
By the end of this episode, listeners will be able to:
·      Describe key clinical, ergonomic, and educational drivers behind the rapid adoption of robotic surgery in the United States and globally.
·      Summarize current evidence comparing robotic and laparoscopic approaches for common procedures, including where outcomes are equivalent, inferior, or clearly superior.
·      Explain how surgeon ergonomics, trainee experience, and video-based learning influence practice patterns and learning curves in minimally invasive surgery.
·      Discuss the role of cost, reimbursement structures, and market competition (e.g., Medtronic Hugo vs da Vinci) in shaping robotic adoption across different health systems.
·      Anticipate how next-generation, task- or organ-specific robotic platforms may further change standards of care in minimally invasive surgery.

References:
·      Violante T, Ferrari D, Novelli M, Larson DW. The Death of Laparoscopy - Volume 2: A Revised Prognosis. A retrospective study. Ann Surg. 2025 Jun 16. doi: 10.1097/SLA.0000000000006792. Epub ahead of print. PMID: 40518997. https://pubmed.ncbi.nlm.nih.gov/40518997/
·      Yu Yoshida, Yoshiro Itatani, Takehito Yamamoto, Ryosuke Okamura, Koya Hida, Kazutaka Obama, Single-incision plus one robot-assisted surgery (SIPORS) using the Hugo robotic-assisted surgery (RAS) system for rectal cancer, Annals of Coloproctology, 10.3393/ac.2025.00787.0112, 41, 6, (586-591), (2025). https://pubmed.ncbi.nlm.nih.gov/41486916/

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