Futuresurgery- The Coming Radical Transformation of Surgery

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What is the future of surgery in the next decade?  This will be a series of posts I will write on my vision for the future of surgery 10 years from now.  The concepts are based upon the plenary session lecture I gave at the 35th Annual AAGL Global Congress of Gyn Endoscopy 2006 in Las Vegas.  The session’s title was “Future Vision”.  The core concept is that surgery has undergone a series of advancements over the past 100 years but yet remains essentially the same.  That is until the development of laparoscopy which is the key development leading to a paradigm shift.  Why?  Because for the first time the surgeon’s hands and eyes are not directly linked to the patient.  There is a technological interface between doctor and patient- the surgeon operates with remote instruments and views the entire procedure on a video monitor.  This sets the stage for radical transformations in the next decade as the full gamut of digital technology steps into that interface.  This is not supposition or wild fantasy- I will share with you the real-life examples that exist today or are currently in development that will radically change how all surgery is performed.  As I told the audience of surgeons- most of what you do is destined to become obsolete in the next decade.  Let’s paint a picture of a future that does not yet exist but for which the signposts are clearly written…

Observation #1: Endoscopic technology is maxed out.   Endoscopy transformed medicine by allowing surgery to become less invasive with quicker recovery and lowered costs.  Almost 100% of the surgery I perform is laparoscopic or hysteroscopic.  For the layperson this is surgery performed with little telescopes passed into a body opening or through a tiny incision in the abdomen.  As someone closely involved in instrument and procedure development I have seen that the technology is now mature (after only 20 or so real years of intense use)  and little major progress can likely be made with current configurations. Back in 2000 I performed the world’s first HDTV laparoscopy– this pushed image quality to the resolution of the human eye.  These systems are commonplace now.  Any further increase in electronic resolution is meaningless since it would be beyond what the eye can see.  I also worked on developing tinier and tinier microlaparoscopes (down to 0.5 mm) but these cannot get any significantly smaller or they will become so flimsy as to be useless. 

Prediction 1: Alternative Visualization: This will be the first radical transformation of surgery.  I predict a major revolution in endoscopic surgery will be what I call alternate visualization systems.  The concept is to develop scopes that can see beyond what our native eyes can see.  When this is achieved the scope becomes not just an extension of our human abilities and senses but augments our native abilities — enabling new and unimagined procedures.   One example of this is the autofluorescent laparoscope I used for my recently reported research on endometriosis.  Previously used in the lung, I figured out a way to use this system in the pelvis where it allowed the visualization of otherwise invisible endometriosis disease.  Until now the scopes just gave us ordinary vision through a tiny incision.  For the first time the scope technology now sees more than what the human eye can see by itself.  Today surgeons are so excited by the introduction of robots into the OR but these are simply extensions of human hands.  Alternative visualization is the first step along the path that will lead to technology and robots with non-human or superhuman abilities.  For examples of the augmented visualization see the following posts on:

infrared imaging – available now to see veins through your skin- check out this video of it in action on my arm

near IR imagingcameras that can see through tissue to locate potentially any hidden organ or disease.

As this series continues I will share with you examples of military and NASA technology for robotic rovers going inside the body, x-ray machines that can provide virtual imaging, and remote controlled surgery without touching a patient, virtual reality gesture control systems and more.  Surgery will change from a doctor directly operating on a patient to a doctor coordinating a technologic system that executes the procedure.  It’s all becoming real now.  More than anything this is an exciting time of unparalled development.  Do not fear the technology – be excited about what it will enable.

Update: My podcast from AAGL global congress on this theme now up

Related Posts:  Why so much of this med development comes from military research.

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