Nadeem Niyaz Jan
The future of surgery offers an amazing cooperation between humans and technology, which could elevate the level of precision and efficiency of surgeries so high we have never seen before.
Will we have Matrix-like small surgical robots? Will they pull in and out organs from patients’ bodies?
The scene is not impossible. It looks like we have come a long way from ancient Egypt, where doctors performed invasive surgeries as far back as 3,500 years ago. Only two years ago, Nasa teamed up with American medical company Virtual Incision to develop a robot that can be placed inside a patient’s body and then controlled remotely by a surgeon.
That’s the reason why I strongly believe surgeons have to reconsider their stance towards technology and the future of their profession. Surgeons have to rethink their profession as they are at the top of the medical food chain. At least that’s the impression the general audience gets from popular medical drama series and their own experiences. No surprise there. Surgeons bear huge responsibilities: they might cause irreparable damages and medical miracles with one incision on the patient’s body. No wonder that with the rise of digital technologies, the Operating Rooms and surgeons are inundated with new devices aiming at making the least cuts possible.
We need to deal with these new surgical technologies in order to make everyone understand that they extend the capabilities of surgeons instead of replacing them.
Surgeons also tend to alienate themselves from patients. The human touch is not necessarily the quintessence of their work. However, as technological solutions find their way into their practice taking over part of their repetitive tasks, I would advise them to rethink their stance. Treating patients with empathy before and after surgery would ensure their services are irreplaceable also in the age of robotics and artificial intelligence.
As a first step, though, the society of surgeons has to familiarize with the current state of technology affecting the OR and their job.
So, I collected the technologies that will have a huge impact on the future of surgery.
Virtual reality
For the first time in the history of medicine, in April 2016 Dr Shafi Ahmed, Onco surgeon performed an operation using a virtual reality camera at the Royal London hospital. It is a mind-blowingly huge step for surgery. Everyone could participate in the operation in real time through the Medical Realities website and the VR in OR app, and I was lucky enough to be a part of the observing team. No matter whether a promising medical student from Cape Town, an interested journalist from Seattle or a worried relative, everyone could follow through two 360 degree cameras how the surgeon removed a cancerous tissue from the bowel of the patient.
This opens new horizons for medical education as well as for the training of surgeons. Today, only a few students can peek over the shoulder of the surgeon during an operation. This way, it is challenging to learn the tricks of the trade. By using VR, surgeons can stream operations globally and allow medical students to actually be there in the OR using their VR goggles.
Augmented reality
As there is a lot of confusion around VR and AR, let me make it clear: AR differs in two very important features from VR. The users of AR do not lose touch with reality, while AR puts information into eyesight as fast as possible. With these distinctive features, it has a huge potential in helping surgeons become more efficient at surgeries. Promising startup, Atheer developed the Android-compatible wearable and complementary AiR cloudbased application to boost productivity, collaboration and output. The Medsights Tech company developed a software to test the feasibility of using augmented reality to create accurate 3-dimensional reconstructions of tumors. The complex image reconstructing technology basically empowers surgeons with X-ray views – without any radiation exposure, in real time. The True 3D medical visualization system of EchoPixel allows doctors to interact with patient-specific organs and tissue in an open 3D space. It enables doctors to immediately identify, evaluate, and dissect clinically significant structures.
Surgical robotics
The most commonly known surgical robot is the da Vinci Surgical System; and believe it or not, it was introduced 15 years ago! It features a magnified 3D high-definition vision system and tiny wristed instruments that bend and rotate far greater than the human hand. With the da Vinci Surgical System, surgeons operate through just a few small incisions. The surgeon is 100% in control of the robotic system at all times; and he or she is able to carry out more precise operations than previously thought possible.
Minimally Invasive Surgery
Thro ughout the history of surgery, the ultimate goal of medical professionals was to peak into the workings of the human body and to improve it with as small incisions and excisions as possible. By the end of the 18th century, after Edison produced his lightbulb, a Glasgow physician built a tiny bulb into a tube to be able to look around inside the body.
But it wasn’t until the second half of the 20th century when fiber-optic threads brought brighter light into the caverns of the body. And later, tiny computer chip cameras started sending images back out. At last, doctors could not only clearly see inside a person’s body without making a long incision, but could use tiny tools to perform surgery inside.
One of the techniques revolutionizing surgery was the introduction of laparoscopes. The medical device start-up, Levita aims to refine such procedures with its Magnetic Surgical System. It is an innovative technological platform utilizing magnetic retraction designed to grasp and retract the gallbladder during a laparoscopic surgery.
Live diagnostics
The intelligent surgical knife (iKnife) was developed by Zoltan Takats of Imperial College London. It works by using an old technology where an electrical current heats tissue to make incisions with minimal blood loss. With the iKnife, a mass spectrometer analyzes the vaporized smoke to detect the chemicals in the biological sample. This means it can identify whether the tissue is malignant real-time.
The technology is especially useful in detecting cancer in its early stages and thus shifting cancer treatment towards prevention.
Artificial Intelligence
I believe surgery will take to the next level with the combination of surgical robotics and artificial intelligence.
In my view, AI such as the deep learning system, Enlitic, will soon be able to diagnose diseases and abnormalities. It will also give surgeons guidance over their – sometimes extremely – difficult surgical decisions.
I truly believe the future of surgery, just as the future of medicine means a close cooperation between humans and medical technology. I also cannot stress enough times that robots and other products of the rapid technological development will not replace humans. The two will complement each other’s work in such a successful way that we had never seen nor dreamed about before. But only if we learn how.
(The author is a Vascular Surgeon)
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