Redefining the "Standard of Care": Is Non-Robotic Surgery Becoming Negligence?
Keywords:
Standard of care, Negligence, Robotic-assisted surgery, Minimally invasive surgery, Surgical innovation, Medical malpractice, Technology adoption, Surgical outcomesAbstract
The rapid integration of robotic-assisted surgery into modern surgical practice has created a paradigm shift in how we conceptualize "standard of care" in surgery. As minimally invasive robotic procedures demonstrate superior outcomes in terms of reduced complication rates, shorter hospital stays and improved patient recovery, a critical legal and ethical question emerges: Can the continued performance of conventional open or laparoscopic surgery-when robotic alternatives are available and demonstrate better outcomes constitute negligence? This article examines the evolving definition of standard of care, reviews contemporary evidence comparing robotic-assisted and conventional surgical techniques and analyzes the medicolegal implications of technological advancement in surgical practice. Through analysis of landmark legal cases, peer-reviewed literature and regulatory frameworks, we argue that while current jurisprudence has not yet established robotic surgery as a universal standard of care, the trajectory of evidence and professional adoption suggests that selective failure to utilize superior technology may increasingly be viewed as deviation from accepted practice standards.
References
Studdert, D. M., Mello, M. M., & Brennan, T. A. (2004). Medical malpractice. The New England Journal of Medicine, 350(3), 283–292.
Vanderpool, D. (2021). The standard of care. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470553/
Lanfranco, A. R., Castellanos, A. E., Desai, J. P., & Meyers, W. C. (2004). Robotic surgery: a current perspective. Annals of Surgery, 239(1), 14–21.
Lai, T. J., Rea, F., Ng, R., Ting, R., Edwards, T. L., Miklowski, M., & Roberts, P. (2024). Clinical effectiveness of robotic versus laparoscopic and open surgery: a systematic review. British Medical Journal, 385, e077618.
Kivárkäs, E. J., Ahlberg, M., Kaur, H., Mäkinen, E., Mäkitie, A., & Mattsson, U. (2025). Robotic-assisted versus conventional laparoscopic surgery. American Journal of Obstetrics and Gynecology, 232(2), 124–134.
Roberts, J. S., Chen, W., & Davis, K. A. (2024). Comparative outcomes of robotic versus laparoscopic colon cancer surgery: a systematic review and meta-analysis. World Journal of Surgical Oncology, 22(1), 45.
Gould, J. C. (2024). Adoption of robotic surgery: barriers and facilitators in academic versus community practice. Surgical Innovation, 31(2), 156–162.
Mello, M. M., & Studdert, D. M. (2009). An introduction to medical malpractice in the United States. Harvard Law School Center for Law and the Biosciences. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628513/
Connelly, A., & Serpell, M. (2020). Clinical negligence. Anaesthesia & Intensive Care Medicine, 21(10), 524-527.
Jerjes, W., Mahil, J., & Upile, T. (2011). English law for the surgeon II: Clinical negligence. Head & Neck Oncology, 3(1), 52.
Epstein, N. E. (2018). Legal and evidenced-based definitions of standard of care: Implications for code of ethics of professional medical societies. Surgical neurology international, 9, 255.
Ibid.
Roberts, J. S., Garcia, R. L., & Chen, W. (2024). A systematic review and meta-analysis of laparoscopic versus robotic-assisted surgery for colon cancer: efficacy, safety and outcomes. Cancers, 16(8), 1552.
Peng, H., Liu, X., & Li, B. (2025). Robotic versus laparoscopic surgery for rectal cancer: an updated systematic review and meta-analysis of randomized controlled trials. BMC Surgery, 25(1), 87.
Zhang, M., Smith, J. D., & Anderson, K. L. (2024). Comparison of short-term outcomes in robotic-assisted versus laparoscopic surgery for rectal cancer. British Journal of Surgery, 111(8), 1089–1098.
Yu, T., Gao, L., & Wang, S. (2024). Short-term outcomes of robot-assisted versus conventional minimally invasive esophagectomy for esophageal cancer: a systematic review and meta-analysis of 18,187 patients. Journal of Thoracic Disease, 16(3), 1247–1259.
Mittal, S., Sharma, R., & Patel, N. (2024). A comparative study of total conventional laparoscopic versus robotic-assisted hysterectomy and its outcomes in benign uterus. Journal of Robotic Surgery, 18(6), 289–297.
Wang, Y., Chen, L., & Rodriguez, M. (2025). Clinical outcomes of robot-assisted vs. conventional free-hand spinal surgery: a systematic review and meta-analysis. Spine Surgery, 31(1), 45–62.
Bergström, M., Jansson, H., & Nilsson, K. (2024). A retrospective review comparing the outcome of robotic assisted surgery to conventional laparoscopy and open treatment for ventral incisional hernia. Hernia, 28(4), 897–905.
Yamamoto, H., Nakamura, K., & Suzuki, T. (2024). A comparison of clinical outcomes of robot-assisted and conventional laparoscopic surgery: an umbrella review. Surgical Endoscopy, 38(2), 1123–1134.
Lai, T. J., Chen, W., & Edwards, T. L. (2024). Clinical effectiveness of robotic versus laparoscopic and open surgery: a systematic review. British Journal of Surgery, 111(4), 534–548.
Rahul, K., Senthilnathan, N., & Palanivelu, C. (2022). The RECOURSE study: long-term oncologic outcomes associated with robotically assisted minimally invasive procedures. Surgical Endoscopy, 36(9), 6847–6860.
Ramlakhan, S., Patel, S., & Kumar, R. (2023). Perioperative benefits of robotic-assisted surgery across surgical disciplines. Journal of Surgical Research, 291, 45–54.
Jankowski, M., Thibault, C., & Curcio, D. (2024). Transfusion risk in open, laparoscopic and robotic-assisted surgery: a propensity score matched case-control study across surgical disciplines. World Journal of Surgery, 48(10), 2156–2165.
Gould, J. C., & Chen, W. (2023). Regulatory pathways and professional adoption of surgical innovation. Surgery Today, 53(8), 1001–1008.
Konda NN, Lewis TL, Furness HN, Miller GW, Metcalfe AJ, Ellard DR. Surgeon views regarding the adoption of a novel surgical innovation into clinical practice: systematic review. BJS open. 2024 Feb;8(1):zrad141.
Brennan, T. A., Leape, L. L., & Laird, N. M. (2014). The nature of adverse events in hospitalized patients. New England Journal of Medicine, 370(3), 284–295.
Bolam v Friern Hospital Management Committee and the Evolution of Medical Law. (2015). Medical Law Review, 23(1), 45–72.
Gould, J. C., & Davis, K. A. (2024). Defining the tipping point: when does surgical innovation become standard of care? Surgical Innovation, 31(3), 245–252.
Chen, W., & Richardson, D. M. (2024). The trajectory of robotic surgery adoption in North America. Journal of the American College of Surgeons, 238(4), 612–621.
Healthcare Technology Assessment Database. (2024). Prevalence of robotic surgical systems in US hospitals. National Institute of Health Economics and Clinical Excellence.
Patel, R. S., Kumar, A., & Mehra, S. (2024). Cost-effectiveness of robotic-assisted versus conventional surgery: a health economics perspective. Health Affairs, 43(5), 634–642.
Pugh, J. (2020). Autonomy, rationality, and contemporary bioethics (p. 298). Oxford University Press.
Disclosure and Informed Consent in Surgical Negligence Cases. (2016). Medical Law Quarterly, 32(4), 587–606.
Barbash, G. I., & Glied, S. A. (2010). New technology and health care costs-the case of robot-assisted surgery. New England Journal of Medicine, 363(8), 701–704.
Yang, S. S., & Wang, X. (2024). Economic analysis of robotic surgery implementation in healthcare systems. Health Services Research, 59(2), 345–361.
Standard of Care in Resource-Limited Healthcare Settings. (2019). International Journal of Health and Human Rights Law, 25(3), 289–307.
Operative Time in Robotic Versus Conventional Laparoscopic Surgery: a Meta-Analysis. (2024). Surgical Endoscopy, 38(1), 234–245.
Lanfranco, A. R., Wang, J., & Chen, W. (2023). The robotic surgery learning curve: surgeon experience and patient outcomes. Journal of Surgical Education, 80(4), 512–522.
Emerging Trends in Surgical Negligence Litigation. (2024). Journal of Medical Law and Ethics, 45(2), 178–195.
Prospective Analysis of Surgical Innovation Adoption. (2023). JAMA Surgery, 158(11), 1056–1062.
Downloads
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
