Calling on the Next Generation of Surgeons

Eleven A.M. on Tuesday 22nd of February 2050, at the university medical centre, an autonomous robot for ophthalmic surgery, has already performed thirty cataract surgeries. This new generation of robot treats up to ten patients at a time. Meanwhile, in the orthopaedic operating room (OR), autonomous surgical robots are implanting knee and shoulder prostheses, which were manufactured overnight using 3D metal printers based on each patient's imaging data. ¹ In the transplant room, an autologous kidney graft printed using the patient’s cells is being transplanted. ² In the following OR, a snake-like autonomous robot performs an endoscopic sleeve gastroplasty. ³ Next to it, a surgeon is performing a prosthetic hernia repair guided by an augmented reality solution. ⁴ The prosthesis was manufactured locally from a 3D printer. Another digestive surgeon is supervising three different autonomous robots performing a left colectomy, in the “control room”, ready to respond to anomalies. He intervenes for the dissection of the inferior mesenteric vessels. Following this step, he re-engages the autopilot and so the robot can finish the procedure.

When laparoscopic surgery began in the ‘90s, it was unthinkable that just a few decades later, surgeons would be using robotic platforms to operate, ⁵ AR to review the localization of the tumor, ⁴ or AI enforced software to plan customized prostheses. Technological advances are rapidly progressing and surgeons are still at the forefront of research and development (R&D). As Claude Bernard famously described in 1865, physicians were halfway between hospitals and labs. Likewise, labs of yesteryear are becoming robotic engineering start-ups. However, these novel technologies were so far additional tools and it is only now that we perceive a potential replacement of human skills.

From evolution to revolution, this transition is likely to happen in two phases: first, the surgeon’s abilities will be increased by assistive surgical systems relying on AI and AR; later, autonomous surgical robots guided by AI will perform parts of surgeries on their own supervised by surgeons. The role of surgeons will adapt over time. They will participate in the design of emerging technology with engineers, test prototypes, file patents, supervise the machines and intervene in case of malfunctions. In fact, they will become familiar with engineering sciences and might be known as “Surgineers”. His education will undoubtedly become longer and more difficult, making him unique and more valuable, highly sought-after by both hospitals and industries.

This change will affect many other fields. The surgical floor will be enhanced by artificial intelligence algorithms that will optimize the sequencing of patients, triggering a series of actions: calling the next patient, informing the recovery room, notifying the cleaning team, and automatically issuing operating reports. Surgical procedures will have audio and video recording, eventually becoming mandatory. ⁶ Recordings will become an element of medical records in the same way as any other medical data, improving patient safety. Moreover, the recordings will provide a large dataset useful for machine learning, ⁷ with algorithms capable of differentiating a normal to an abnormal phase instantly, anticipating adverse events and alerting the supervising surgeon. ⁸ Surgical training will also encounter drastic modifications: engineering classes will be integrated into medical school programs, full 3D human-scale virtual environment will offer countless training sessions before the first on-patient experience, ⁹ analytical programs will document trainees on their practical skills. ¹⁰

However, this disruption won’t happen without a fierce struggle between hospitals and industries at first, although the considerable technological impact that companies will offer might tip the scale to one side. Acceptance from patients and surgeons might be gradual and ethical debate will be essential to discuss the balance between preserving human surgical expertise and complete reliance on machines. Inequalities between states or countries will only be aggravated and the design of healthcare systems might be re-thought.

Overall, the future of surgical innovation is bright even so unstoppable. New technologies are going to shape the way surgical care is delivered whether surgeons will comply or not. It is critical for young surgeons to be aware of the impending innovations and to incorporate them into their curriculum. So young surgeons, the train is leaving the station, will you be on it ?