ENP108: AI and Robotics in Surgery

Summary

Podcast Summary: Endocrine News Podcast – ENP108: AI and Robotics in Surgery

Date: December 17, 2025
Host: Aaron Lohr (A)
Guest: Dr. Hassan Heshmati (B)

---

Episode Overview

This episode explores the transformative role of artificial intelligence (AI) and robotics in surgery, with an emphasis on endocrinology and adrenal tumors. Dr. Hassan Heshmati, a seasoned endocrinologist and researcher, discusses the evolution, advantages, challenges, and future of robotic surgeries. The conversation examines key trends, outcomes, cost factors, and the continued role of human professionals in a rapidly changing surgical landscape.

---

Key Discussion Points and Insights

1. The Rise of Robotic Surgery in Medicine

• Rapid Integration: AI and robotic technologies have shifted from science fiction to everyday medical realities, particularly in surgical procedures.
• Historical Context:
  • First robotic surgery: 1985
  • Exponential growth in the last 15 years, particularly in the USA, Germany, and South Korea
  • U.S. stats: about 2,000 hospitals offer robotic surgery (15% of all surgical procedures in 2020); 876,000 robotic procedures in 2020
  • Leading uses: General surgery and prostate operations
  • Market size: $7B in 2024, projected $16B by 2032
  • [01:52] Dr. Heshmati:

    "Robotic surgery has been around for almost 40 years...you have an increase in the number of these procedures over the last 15 years, an exponential increase."

2. Advantages Driving Adoption

• Minimally Invasive: Smaller incisions and scars
• Enhanced Visualization & Precision: Better access to surgical sites, no hand tremor, greater flexibility
• Patient Benefits: Lower complication rates, less blood loss, shorter hospital stays, and possible remote access to top surgeons
  • [03:24] Dr. Heshmati:

    "You can have access to a top surgeon remotely. The surgeon can be in Australia, the patient can be in Spain, for example."

3. Focus on Adrenal Tumors

• The featured research zeroed in on adrenal tumors due to space limitations in conference presentations, though robotic surgery is also applicable to pituitary, thyroid, parathyroid, and pancreatic procedures
  • [04:32] Dr. Heshmati:

    "You can have robotic surgery for the pituitary gland, for thyroid, for parathyroid, for the adrenals, for the pancreas..."

4. Types of Surgical Robots by Level of Autonomy

• Supervised Autonomy / Master-Slave: No preprogramming; fully controlled by surgeon
• Collaborative Autonomy: Semi-active; preprogrammed robots with surgeon complementing actions
• Full Autonomy: Active systems work autonomously under surgeon supervision, intervention possible
  • [05:15] Dr. Heshmati:

    "The first type is supervised autonomy or master slave system... The second type is collaborative autonomy... The third type is full autonomy..."

5. Safety, Outcomes, and Costs

• Safety & Outcomes: At least as safe as traditional surgeries; often better due to less invasiveness and shorter hospital stays
• Cost Considerations:
  • Currently more expensive—around $2,000 more for adrenal tumors, driven by initial equipment ($1–2M) and annual maintenance ($100–$150K)
  • Potential for cost reduction with increased procedure volume
  • [06:06] Dr. Heshmati:

    "The safety of robotic surgery is as good, if not better than the traditional surgery... The cost of materials is between 1 and 2 million dollars and then you have to maintain the whole system annually."

6. Factors Affecting Future Growth

• Budget and Investment: Availability of funds for equipment and training
• Technological Advancements: Expansion beyond the da Vinci system
• Data Drives Progress: Combining AI analytics with surgery enhances performance and safety
• Demographic and Political Factors: Growing populations and health policy leadership may steer adoption
  • [07:41] Dr. Heshmati:

    "There are many factors that can influence the growth... One is the availability of the budget... the evolution of technology... new data... the political situation..."

7. The Enduring Role of Humans

• AI Limitations: AI relies on past data; does not generate novel ideas or oversight
• Ongoing Human Necessity: Inputting and maintaining data, system support, strategic decision-making
• Workforce Impact: Likely reduction in active operating room personnel, but humans remain irreplaceable
  • [08:59] Dr. Heshmati:

    "Artificial intelligence is using the available experience and data. It cannot generate ideas from scratch. So there is always a need for humans..."

---

Notable Quotes & Memorable Moments

• Trend Marker (Aaron Lohr, [00:00]):

  "We used to ask, what is the role of AI in medicine? Are we getting closer to a time where we'll be asking, what is the role of humans?"

• Global Perspective & Data Surge (Dr. Heshmati, [01:52]):

  "Approximately 2,000 hospitals are performing robotic surgery, and this represents approximately 15% of all surgical procedures in 2020."

• Remote Surgery Possibilities (Dr. Heshmati, [03:24]):

  "The surgeon can be in Australia, the patient can be in Spain, for example."

• Defining Autonomy (Dr. Heshmati, [05:15]):

  "There is always a need for humans to incorporate the data to support the system and to maintain the system."

• Future & Human Relevance (Dr. Heshmati, [08:59]):

  "Artificial intelligence is using the available experience and data. It cannot generate ideas from scratch."

---

Timestamps for Important Segments

• 00:00 – Introduction and episode focus
• 01:52 – Global data and trends in robotic surgery
• 03:24 – Advantages of robotic surgery
• 04:32 – Why focus on adrenal tumors?
• 05:15 – Types of surgical robots
• 06:06 – Safety, outcomes, and costs
• 07:41 – What drives future growth?
• 08:59 – What is the future role of humans?

---

Conclusion

This episode provides an informed and balanced exploration of how AI and robotics are revolutionizing surgical practice within endocrinology and beyond. Dr. Heshmati presents a clear-eyed look at both the remarkable advances and ongoing challenges—particularly around cost, infrastructure, and the irreplaceable need for human judgment, creativity, and oversight even in a future increasingly shaped by automation.

---

To Contact or Suggest a Topic:
Email: [e-mail]
Find more episodes: www.endocrine.org/podcast

Transcript

[A]

Hello, I'm Aaron Lohr, and this is the Endocrine News podcast. It wasn't that long ago that artificial intelligence was a concept reserved for science fiction. That's certainly no longer the case. In the last five years, the field of AI and robotics has taken off and has become a part of our everyday life, and it continues to grow and evolve. How are AI and robotics shaping the field of medicine? How is it improving the lives of doctors and patients? We used to ask, what is the role of AI in medicine? Are we getting closer to a time where we'll be asking, what is the role of humans? To help us answer these questions, my guest today is Dr. Hassan Hashmati. Dr. Hashmati has been a physician for 49 years and an endocrinologist for 45 years. With experience in clinical research in academia and in the pharmaceutical biotech industry. He founded Endocrinology Metabolism Consulting, and recently presented an abstract at Endo 2025 entitled Update on the Use of Robotic Surgery and AI for Adrenal Tumors. Thank you for being here today, Dr. Hashmati.

[B]

Thank you very much for your kind invitation. The work that I presented was made in collaboration with my colleague, Dr. Nadia Zahmini, who is currently in Tehran, Iran.

[A]

Now everyone is talking about AI and robotics and how these advancements will impact the medical field. But of course, the reality is they already are. What do we know about how much robotic surgery is now being done compared to traditional surgery performed by humans?

[B]

Robotic surgery has been around for almost 40 years. The first robotic surgery was performed in 1985, and you have an increase in the number of these procedures over the last 15 years, an exponential increase. The leading countries performing robotic surgery are USA, Germany and South Korea. In US approximately 2000 hospitals are performing robotic surgery, and this represents approximately 15% of all surgical procedures in 2020. In US 876,000 procedures were performed using robotic surgery. Most of them were for prostate. The market size of robotic surgery in 2024 in US was around $7 billion, and this number is expected to reach $16 billion in 2032. And most of these procedures are performed for general surgery.

[A]

So clearly, robotic surgery is escalating in popularity. So what are the advantages to robotic surgery? Why do you think it's progressing so quickly and how much it's being used?

[B]

So there are several advantages with minor differences between the type of surgery. You have smaller incisions, which means at the end, smaller scars for the patient. It's less invasive. You have a better approach to the surgical site with a better Visibility, you have more flexibility with enhanced range of motion. There is no hand tremor. This is a human factor, very important, especially if the duration of the surgery is long. You have, in most cases, lower complications, such as blood loss. You have shorter hospital stay, you can save several days of hospitalization, and you can have access to a top surgeon remotely. The surgeon can be in Australia, the patient can be in Spain, for example. These are the main advantages.

[A]

And your study was looking specifically at robotic surgery regarding adrenal tumors. Why did you want to focus there?

[B]

As you know, when you submit an abstract, you have space limitations. So we couldn't present all endocrine glands, but you can have robotic surgery for the pituitary gland, for thyroid, for parathyroid, for the adrenals, for the pancreas, et cetera. At the endocrine meeting in Europe, we presented robotic surgery for pituitary tumors, and we presented robotic surgery for thyroid disorders at the American Thyroid Association.

[A]

Your study mentioned that surgical robots could be categorized into three types, depending on how autonomous they are. Can you walk us through those three types?

[B]

The first type is supervised autonomy or master slave system. There is no pre programming and the whole system depends on the surgeon activity. The second type is collaborative autonomy, semi active, and the surgeon is complementing the robot that is pre programmed. The third type is full autonomy is an active system that works autonomously but under the supervision of the surgeon and the surgeon can intervene as needed.

[A]

In your review, you were looking at robotic surgery and safety outcomes and cost. Can you walk us through what you found in each of those?

[B]

In all the studies, the safety of robotic surgery is as good, if not better than the traditional surgery. Regarding the outcome, an important advantage is a shorter hospital stay, which can save some money for everybody. Regarding the cost, the robotic surgery currently is more expensive than the traditional surgery. For example, for the adrenal tumors, the difference of cost between robotic surgery and traditional surgery is around $2,000. Why there is a difference in cost? Because if you want to perform robotic surgery, you need to have an initial investment for all the materials you need and train your personnel. The cost of materials is between 1 and 2 million dollars and then you have to maintain the whole system annually. And the cost is between 100 and $150,000 per year. However, this cost can decrease if the number of procedures with robotic surgery is increased in one center.

[A]

Clearly, the field of robotic surgery, as we mentioned, is rapidly advancing and will continue to advance, I imagine. How do you think this field will grow in the next five years?

[B]

So there are many factors that can influence the growth of robotic surgery. One is the availability of the budget in order to have the initial investment and perform the training. The other factor is the evolution of technology and the development of new systems for robotic surgery. Currently the main system is da Vinci system, but there are many more that are acting or in development. Also the availability of new data. Because the importance of having a combination of AI and robotic surgery is to use the experience, experience based on data. Another factor which is important is the expansion of the population in a country, in a city, in a community, and lastly, the political situation. We don't know who will be the next Secretary of Health, what type of idea the person will have and how it can impact this procedure.

[A]

Indeed, I may have been saving my hardest question for last. So let me ask it now. As robotic surgery advances, what do you see as the role of the human?

[B]

So, as you know, artificial intelligence is using the available experience and data. It cannot generate ideas from scratch. So there is always a need for humans to incorporate the data to support the system and to maintain the system. However, there will be a reduction of active personnel in the operating room.

[A]

Well, I think that's about all the time we have for today. I want to thank my guest, Dr. Heshmati. Thank you so much for being on the podcast today and walking us through your research and what you've been discovering about robotics and AI have been advancing healthcare. I really appreciate you taking the time today.

[B]

My pleasure. Thank you very much.

[C]

That's all for this episode. As always, thank you for listening to the Endocrine News podcast. If you'd like to hear more of these, check us out on endocrine.org podcast or Apple, Google or wherever you get your podcasts. And if you're enjoying these, please let us know by leaving a review on Apple. And if you'd like to get in touch with us, send us an [e-mail] thanks again. Endocrine News podcasts are a free service of the Endocrine Society. To learn more or to become a member, visit the society's website at www.endocrine.org.