Comparisons between aviation and robot-assisted surgery in gynaecology: lessons from safety practices in high-risk industries.

High-risk industries such as aviation have long since understood that technical competencies alone do not guarantee safety or success. Surgical disciplines including robot-assisted surgery (RAS) have achieved this understanding relatively recently, despite also being considered high-risk. Both disciplines face challenges from technical (TS) and non-technical skill (NTS) perspectives, requiring calm, controlled, and skilled management to overcome adversity. Whilst aviation demonstrates admirable safety records, RAS has been highlighted as a potential health technology hazard. Comparisons are increasingly being drawn between the technology, culture, safety practices, and training modalities of RAS and aviation. Aviation recognises NTS limitations and reflects this through its simulation-based training. Whilst the amended intraoperative dynamics of RAS constitute unique NTS challenges, the inclusion of NTS within formalised RAS training curricula is comparatively negligible. Virtual-reality (VR) simulation in aviation allows pilots to achieve and maintain their TS and NTS competencies. Simulation's role in the development and maintenance of RAS competencies is not treated with parity; however, RAS VR simulation has the potential to improve the feasibility of the integration of simulation with RAS training. The incorporation of aviation-based safety practices in RAS needs further consideration, given that surgery remains behind its high-risk counterparts. RAS stands to benefit from adopting key components of their practices, including work environment, culture, simulation, and the standardisation and regulatory oversight of its training programmes. Through implementing established safety practices utilised in other high-risk industries, RAS has the potential to reduce the frequency and severity of adverse events, with patients becoming the ultimate beneficiaries.