My fiance does a lot of abdominal surgeries, including robotic. There are a handful that are "difficult" in the traditional sense - lots of complicated steps, i

My fiance does a lot of abdominal surgeries, including robotic. There are a handful that are "difficult" in the traditional sense - lots of complicated steps, indications and contraindications for different methods to complete the same task, etc - but by-and-large most of them are following a set of prescribed steps. For her, because the surgeries are abdominal, a lot of the difficulty comes in when dealing with patients of larger weight and/or who have had lots of previous procedures. A surgery that takes 45 minutes on a 110-pound 17 year old with no major medical history can easily take 4 hours or more for a 400-pound woman with multiple c-sections and multiple other surgeries. Scar tissue distorts the anatomy, it's just physically more difficult to move past outer layers, etc.