What’s the next big thing in surgery?

Technology is evolving rapidly with many new surgical innovations, but we have to continually ask ourselves–why this specific technology? How is it going to benefit the end user?  What’s important is that technology enables us as surgeons to do things better for our patients. 

One of the ways I see technology potentially helping patients is through remote surgery.  We learned recently that a pandemic can severely restrict travel, especially for people with serious existing disease, and as people age travel becomes more difficult. At the same time, many rural areas and developing countries lack highly-experienced surgeons in various specialties. In the future perhaps these patients could be treated remotely.

So what would it take to make remote surgery a reality? 

During the Covid shutdown period we learned that you don't always have to see patients in person. Prior to Covid, in India, online consultations were taboo. Now, general practitioners or family physicians have more than 50% of their consults online. It seemed to change overnight.

“New technologies are going to enable us to do the same in the OR. In fact, much of the technology already exists in separate arenas. What needs to happen is to put these various technologies such as robotics, virtual and augmented reality and super high speed data transfer, together.” 

–Dr. Venkatesh Munikrishnan

We also have to think about how we build an ecosystem to support remote surgery.  How do we provide the teaching, the training, the backup networks, and the technology that work together? These are questions that will have to be answered.

Virtual touch technology

One exciting enabling technology is virtual tactile feedback. If a patient has their CT, MRI or other imaging loaded and the doctor needs to do a physical examination the patient could wear a glove, palpate their own abdomen and the tactile feedback gets transmitted to the surgeon. This type of virtual touch technology is already happening in labs around the world. 

One barrier is simply getting past the assumption that patients always have to see their doctor physically. But once that hurdle is crossed, physician assistants could take the history, the doctor could chat with the patient and using augmented or virtual reality examine the patient– then operate to remove, for example, a rectal cancer of someone 3,000 kilometers away. 

Expanding access to remote communities

If we think even more broadly, there’s the possibility of surgery using a robotic platform operated by a surgeon in another location. Of course, we need to train local bedside teams to interact remotely with the surgeon so they could augment certain parts of the operation, as needed

One situation could be that there is a local surgeon who is very good, but the surgery requires someone with more specialized expertise and experience. Or there is a very remote hospital in, for example, the Himalayas where there is a local surgical team, but not a procedural specialist in areas such as urology, gynecology, or colorectal surgery.  Remote surgery opens up a huge new vista for these situations. 

There could be a set of procedures that are simple and safe that could easily be done remotely and if a patient needs a more complex procedure they would travel to a hospital in a larger city. This methodology could reduce costs for the patient and for the healthcare system, overall. 

Democratizing surgery 

It’s impossible to expect that every surgeon is going to have the same level of education, training, and specialization. In addition, there are pockets where access to advanced technology means some surgeons have performed five hundred or a thousand of a specific type of robotic case. In 20 years, that is who patients are going to ask for regardless of where they are located. It is truly democratizing to be able to offer a highly skilled surgeon's expertise to the most remote patients.

"Every patient deserves to have that level of quality of care, their location should not be a barrier.  If technology can enable that, it would be a game changing achievement for mankind."

–Dr. Venkatesh Munikrishnan

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