Hope Notes:
The Technological Transformation of Surgery

By Scot Noel

A mere 180 years ago and surgery was a brutal reality. Practitioners lacked knowledge of both anesthesia and bacteria. In one famous incident, British surgeon Robert Liston achieved a 300% mortality rate when he cut off an assistant’s finger during surgery and then sliced into a bystander, who died of shock on the spot. Gangrene got the other two.

Advances in surgery have greatly improved modern life, making treatments for conditions ranging from appendicitis and cataracts to coronary bypasses and knee replacements far more effective, successful, and gangrene free.

While we don’t often think of surgery as a harbinger of the future, that’s about to change.

Robotic Surgery

Let’s face it, even the best human surgeons have limitations. Restricted vision. Wrists that turn only so many degrees. Hands that are often outsized tools for working in constricted spaces. Utilizing robotic systems, surgeons can perform complex surgeries with greater accuracy, flexibility, and control than ever before.

Robotic systems generally look like this: one or more robotic arms, a central console, and a high-resolution visual system. The surgeon operates from a console, manipulating robotic arms equipped with surgical instruments.

Advantages Over Traditional Methods

The immediate benefits of robotic surgery are enhanced visuals, improved dexterity, and precise control over robotic elements smaller than a human hand. Even the best human surgeon cannot hold a scalpel with the steadiness of a machine. All this means smaller incisions, reduced risk of infection, less blood loss, faster recovery times, and shorter hospital stays.

In fact, robotic surgery is generally used where precision is so important that even small variances can affect the outcome. Some examples include use in urology, gynecology, cardiothoracic work, orthopedics, colorectal, and head and neck surgery.

Improving the Machines

The next generation of surgical machines incorporate advanced materials and mechanical designs that improve the surgeon’s ability to operate in tight anatomical spaces with greater range of motion and improved delicacy of touch. New feedback systems tied to machine learning algorithms help these robots improve their performance over time as they learn from each procedure. (Now patients should ask “How many times has this machine done this surgery?”)

The global market for surgical robots is set to reach $275 billion in 2025. Over 60,000 surgeons have been trained on Intuitive Surgicals’ da Vinci system, which is on its third generation of devices. British CMR Surgical is coming on strong with their MAS Versius robotic surgeon, and specialty machines are being built for things like the fight against lung cancer, including Auris Health’s Monarch platform.

AI is the Next Addition

AI brings the power of data analytics and machine learning to the operating room.  Robotic systems can analyze data from past surgeries, review medical literature, and respond to real-time sensory inputs. That means AI-enhanced robots can assist surgeons in making the best decisions during procedures, based on the most successful outcomes from similar past surgeries. AI also has the potential to pick up on subtle cues that might be overlooked by human eyes.

Looking to the future, the integration of AI into robotic surgery could lead to semi-autonomous or fully autonomous surgical robots. These robots will free surgeons to focus on more complex aspects of the operation. Additionally, AI could facilitate remote surgery, where surgeons control robots from distant locations, bridging the gap between world-class surgical expertise and underserved areas.

Telepresence Surgery

Telepresence surgery has the potential to make the expertise of skilled surgeons accessible worldwide, including in rural and underserved areas. By controlling robotic surgical instruments from a distance, surgeons can operate across geographic barriers, bringing high-quality healthcare to regions that lack specialist services.

In February 2024, the Nicholson Center in Orlando, Florida achieved a landmark in medical technology. A pioneering live telesurgery was demonstrated, connecting a surgeon in Orlando to Dubai in the United Arab Emirates, over 10,000 kilometers away. This groundbreaking achievement was made possible by advanced robotic surgeons and cutting-edge 5G technology.

Cyber security is an important factor, as the systems must protect sensitive patient data and prevent unauthorized access that could lead to life-threatening interruptions or manipulations during surgery.

Nanotech Surgery

The next surgical frontier may be the use of nanotechnology in surgery. This includes nanomaterials for surgical implantation, targeted drugs that effect specific tissues, and even microscopic machines with specific programming as they flow through your body.

Today, nanomaterials are already being used to lower the implant failure rate. Nanostructured implant coatings provide thermal insulation, prevent wear, and shield implants from erosion. Coating materials used are metalloceramic, hydroxyapatite, and nanostructured diamond.

Within a decade or two, we could have AI integrations with nanobots, making them smarter and more autonomous, capable of performing complex surgical tasks entirely on their own. The potential for such technology to conduct preventive repairs at the first sign of disease could revolutionize health care.

I’m reminded of the scene in 1986’s Star Trek IV when Dr. Leonard McCoy encounters a woman in a hospital. When he asks, "What's the matter with you?", she replies, "Kidney, dialysis". McCoy reacts in horror and gives her a pill. “Here, dear, you swallow that, and if you have any problems just call me.”

Nanotechnology I presume.

On the Cutting Edge of the Future

180 years ago, surgery was fast, dirty, and often lethal. You could easily die in pain from the disease or from the cure.

Today, over 64 million skilled, safe, and clean surgical procedures are performed in the United States alone each year.

Tomorrow, advances in surgical procedures and technology may make daunting tasks like complex organ transplantation a routine procedure. On the horizon may be things like 3D bioprinting to replace large sections of the brain damaged by stroke or trauma, as well as reconstructing other complex tissues like the eye or the spinal cord, potentially restoring functions that were once thought permanently lost.

As has always been true, if you are sick and in need of surgical intervention, the future is the place you want to be.

Reference Links for Further Study:

The Future of Robotic Surgery:
https://blog.engineering.vanderbilt.edu/the-future-of-robotic-surgery-3-trends-to-look-for

National Library of Medicine:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10839429/

Robotic Surgical Machines:
https://www.medicaldevice-network.com/features/da-vinci-surgical-robot-competitors/