How Modern Surgery has
Outgrown the Operating Room

The presence of these robots makes Cheshire an outlier among rural hospitals, particularly at a time when surgical care—much less cutting-edge, robotics-assisted surgery—is increasingly hard to access across rural America.

Today, there are 18% fewer surgeons in the U.S. than there were at the turn of the century. In rural areas, the number of practicing surgeons is down by nearly a third. Furthermore, while a fifth of Americans live in rural areas, only a tenth of all U.S. surgeons work there. And those surgeons aren’t young—more than half of surgeons in rural America are over the age of 50, with many nearing retirement. This shortage combined with aging infrastructure and growing elderly populations, who have the greatest surgical needs, means some rural hospitals are struggling to serve their populaces.

Against these odds, Dartmouth Health member hospitals, which serve 1.9 million people across northern New England, are working to improve their surgery departments with strategic investments in new technologies, like surgical robots, and infrastructure, as well as developing improved techniques and approaches to surgery.

“These robots and other surgery improvements are giving our patients the best possible care for some pretty complex problems, from general surgeries to gynecological procedures,” says Ashley Copeland, MS, RN, CNL, CNOR, Cheshire director of surgical services. “We’re proud to offer these services in a time when many rural hospitals are struggling.”

“There’s a real top-notch surgical team here,” says Cheshire patient and local Keene business owner Mary Jane Doody. Doody has undergone multiple surgeries at Cheshire in the past four years for breast cancer and rotator cuff injuries. “Surgeons are really important and good ones can be hard to come by, so we’re lucky here.”

Growing Demand

The American population today is older than ever. Maine and New Hampshire are some of the oldest states, with median ages of 44.8 and 43.6 years, respectively. This is leading to a rapid rise in joint replacement surgeries for northern New Englanders. In the next decade, according to an analysis of Census Bureau data, total knee and hip replacements are predicted to double.

Cheshire’s investments in robotics, which are increasingly used in hip and knee surgeries, will help them keep up with the demand for these operations. But better technology isn’t the only solution. Cheshire staff have noticed that giving patients physiotherapy right after joint surgery and sending them home that same day improved recovery outcomes, as opposed to keeping the patient overnight. This new approach not only allows Cheshire to see more patients, but also gives those patients improved recovery timelines.

“It’s more comfortable recovering at home than in a hospital bed,” Doody says.

Cheshire patient Elaine Dall also experienced a quick turnaround after she was diagnosed with breast cancer in 2016. Within two weeks of her diagnosis, she underwent a lumpectomy at Cheshire to remove the cancerous tumor in her breast and was back home the next day.

“The truth is, baby boomers like me are putting a burden on the medical system because there’s so many of us,” Dall says. “Yet at Cheshire Medical Center I always feel that I’m getting excellent care.”

Small Incisions, Large Tools

Cheshire launched a public fundraising campaign in November 2025 to further improve and modernize their spaces. The hospital currently has five operating rooms. Cheshire plans to add a new operating space and double the size of their existing operating rooms, which are much smaller than modern ones. The extra square footage is needed to make room for the new robotic technologies, which take up a lot of space.

Unlike times past, when surgeons had to make long incisions to access areas of the body that need treatment, many surgeries today are done with the help of robots that can access the body through tiny openings. The robots at Cheshire represent the next generation in laparoscopic or minimally invasive surgeries. While early laparoscopic robots have tools with tiny claws that can grab and open in one direction, the newer robots have more three-dimensional mobility and integrated sensors that can help surgeons reduce tissue damage.

The downside to these technologies is that they consist of multiple units that can take up a lot of valuable space in an operating room. When Cheshire’s Da Vinci Xi robot was installed in 2024, it barely fit in the room. But already the squeeze is worth it—there were nearly 5,300 total surgeries at the hospital in 2025, up from 3,400 total in 2023, in part thanks to the robots’ help.

“Right now, we’re in a transition period where we’re expanding our surgical department and incorporating a lot of new technology,” Copeland says. “It’s been our goal here at Cheshire to widen our surgical specialties and try to provide as much surgical care here as we can.”

Investing in Surgeries and Beyond

Investments in rural surgeries can bring an economic windfall as well as a health boon. An estimate from the American College of Surgeons found that a busy rural surgeon can bring in 40% of a hospital’s revenue, produce $4.4 million in payroll, and create an average of 26 jobs. But transformational improvements don’t come easy. Cheshire’s expansion plans— the subject of their capital campaign that launched in November of 2025—are estimated to cost more than $60 million. The campaign is already making huge strides toward that goal, thanks in large part to the largest single gift in the history of the Dartmouth Health system, a $25 million donation from an anonymous local Keene family.

Other Dartmouth Health member hospitals are also raising money to improve their technologies, such as in New London, an hour north of Keene. There, community fundraising and a matching gift from The Burkehaven Family Foundation in 2024 allowed New London Hospital to acquire two types of biopsy devices to improve breast cancer screening and diagnosis, and provide cutting-edge surgical intervention closer to home. In 2025, Southwestern Vermont Medical Center also added a Da Vinci 5 surgical robot to support minimally invasive general surgeries, like gallbladder removal, hernia and colon surgery, and more. It is the first surgical robot of its kind in Vermont.