Speed Is a Poor Measure of Ability
It’s true that efficiency improves as we gain experience and develop muscle memory. But speed is only one factor among many. In my experience, and in that of clients and colleagues, surgical culture often overvalues speed.
Most of us have been there: you’ve just made your incision when the OR door swings open and the nurse manager asks, “Doctor, how much longer do you think you’ll be? I’m trying to find a place to put some add-ons.” By 3 p.m., the scrub and circulator start glancing at the clock.
We also hear the anecdotes—surgeons who are “fast” but have poor outcomes, or others who seem fast because they’re doing simpler cases.
Efficiency matters, of course. And the learning curve slows everyone down; that’s a normal human process. Surgeons who operate with robotics are acutely aware of their efficiency compared to peers. Some estimate the learning curve to be around 50 robotic cases. With that in mind, it’s not especially useful to compare data on speed until we’re past that point. Instead of competing with others, we might focus on becoming more efficient than we were last time. Even after case 50, we should ask: does a faster robotic operation truly mean better outcomes?
A 2013 study, Does speed matter? The impact of operative time on outcome in laparoscopic surgery, examined 77,000 laparoscopic cases from the ACS-NSQIP database between 2005 and 2008. Longer operative times for laparoscopic colectomy, cholecystectomy, Nissen fundoplication, and gastric bypass were statistically associated with higher odds of complications. Yet the study did not adjust for patient factors or case complexity.
Any general surgeon can tell you there’s a vast difference between a straightforward cholecystectomy and one involving a gangrenous gallbladder. The first is like driving on a sunny day; the second, like navigating through a snowstorm at night. Naturally, the simpler case will be faster. So while the study linked longer operative times with complications, the true cause may have been disease severity rather than surgeon skill. The data don’t tell us whether faster surgeons have better outcomes.
I often tell my kids, “Slow is smooth; smooth is efficient.” I remind them of this when they’re rushing to grab backpacks and folders before school. The same applies in surgery. When we’re in a state of urgency, we waste movements. Our surgical intuition tells us when we can move quickly and when we need to slow down.
The complexity of disease plays a major role in how often we find ourselves in those slower moments. Sometimes we can predict this from imaging or preoperative assessment. Other times, we discover it only after making the incision.
There’s also a medicolegal dimension. A colleague once said, “No surgeon has ever been sued for going slow.” When intuition tells us to slow down—even as the OR manager calls in, the scrub glances at the clock, and the CRNA peers over the drapes—we must have the presence of mind and courage to follow that instinct.
That intuition is often a quiet whisper amid the noise of urgency. Our job is to tune out the pressure, ground ourselves in our bodies, focus on the step in front of us, and take as much time as we need to operate safely and skillfully.
If you’re fresh out of residency or fellowship, you will be slower at first. That’s normal. Over time, as you learn to trust your intuition, efficiency will follow.
The goal isn’t speed for its own sake. It’s steady improvement, guided by judgment and self-awareness.
Because true mastery lies not in how fast we operate, but in how wisely we do.
