Surgery is going to look like sci-fi, and it will happen sooner than you think
From 3d printing to robots, from faster wound healing to AI, surgery is going to get smarter, more precise, and safer
By Adrian Baker
Read time: 6 mins
Image credit: Pixabay
When people think of surgery, they often think of the blue scrubs, anaesthesia, and blood. Ask people to think back to the first ‘surgery’, and they might think back to the medieval times where procedures often resembled barbaric torture rituals. But surgery dates much further back – to about 5000bc – when holes would be drilled into a victim’s person’s head to relieve everything from abnormal behaviours to migraines. And the ancient Egyptians also used surgical techniques, with evidence of antiseptics, immobilisation, and sutures being used. From those crude times to anaesthesia, laproscopic surgery, modern operating rooms and high-tech surgical instruments, surgery has come a long way. Now, thanks to the convergence of different breakthrough technologies, surgery might just experience its most significant improvements.
The prep work
Surgery isn’t only about the time spent in the operating theatre. It’s about before, during, and after the surgical process. Advances that focus on the steps before the actual surgery are important in order to prepare surgeons for the exact individual characteristics of the person undergoing the operation.
Recent breakthroughs in 3d printing will help reduce uncertainties and surprises, and will therefore be increasingly used as fundamental tools of preparation. Currently, surgeons prepare by looking at a patient’s medical history, scans such as MRI and CT, and findings from lab tests and physical exams. However, none of those truly help with practicing for the operation beforehand.
A partnership between the University of California San Diego and Rady Children’s Hospital demonstrated that practicing operations on 3d printed models of patients with a hip disorder dramatically reduced operating times (thereby reducing risk) and cut costs. Whilst 3d printing is nothing new and 3d prints of CT scans can be achieved using existing computer software, the breakthrough here is in the material used for the 3d printed models. The models themselves required advances in materials science so that they could mimic the bones undergoing surgery and withstand the surgical tools that would be used in practicing for the operation.
Though 3d printed models would unlikely be needed for every operation, using these new materials for 3d printed models is particularly useful for conditions such as slipped capital femoral epiphysis. For this condition, surgeons have traditionally been unable to visualise the bone deformity in 3d, and have required X-rays before and even during the operation. The new materials allow surgeons to use 3d printed models instead of X-rays. This not only means reducing exposure to radiation, but also reducing operating times by not having to wait for X-rays during surgery. Even better, 3d printed models also help surgeons educate patients as to the procedure that will occur, helping patients ask more informed questions and to feel more involved with their own treatment.
Robots will give surgeons a helping hand
There are already robotic surgery companies on the market. Surgical robots like Intuitive Surgical’s da Vinci robot are said to improve the precision of surgeons by removing hand tremors that even the most stable of surgeons might have. However, whilst Intuitive Surgical is the leading surgical robotics company, new players are starting to creep into the space.
Verb Surgical – a joint venture by Johnson & Johnson and Verily Life Sciences (owned by Google’s parent company Alphabet) – argues that the da Vinci robot is more like an extension of a surgeon’s eyes and hands, rather than a robot that can automatically and autonomously assist the surgeon. Verb Surgical wants to use big data and AI imaging to assist surgeons. Their vision is that through robotic surgical assistance, the average surgeons will be able to produce the same surgical outcomes as the best surgeons in the world. No one surgeon can have the entire world’s knowledge of surgery at any given time. But imagine that with AI assisted robotic surgery, your local surgeon would have the same outcomes as the best surgeon on the planet.
As Catherine Mohr, vice president of strategy for Intuitive Surgical sees it, a ‘second wave’ of surgical robotics is occurring thanks to the digitisation of surgery. That’s because anything that can be digitised beings with it the benefits of big data and AI. Data will be collected and analysed from surgery in real time, using advances in chemical profiling. This on-the-spot diagnosis will allow the robotic surgeon to assist the human surgeon in making the best decisions based on a database of similar surgeries and genetic types. In that sense, it is less like today’s typical robot arm, and more like an integrated system of robotic machinery, high tech imaging, real time diagnosis, data matching, and AI computer systems.
Robotic surgeons will come in all shapes and sizes
Whilst it’s easy to think of surgical robots as big machines with long telescopic arms, the trend in the future will be to have a mix of robotic sizes in the surgical arsenal. For example, a team at Harvard John A. Paulson School of Engineering and Applied Sciences and the Wyss Institute for Biologically Inspired Engineering at Harvard University developed a robotic arm that fits inside endoscopes and only pops out to assist the surgeon when it arrives at the desired destination. Importantly, this tiny robot integrates sensing, multiple degrees of freedom, and soft-robotics.
Advances in soft robotics are particularly important for surgery because it allows surgeons to use robots to perform operations without the risk of creating internal injuries. And smaller still, robots will be put into pills and perform basic tasks such as removing swallowed objects from the stomach and healing internal wounds without even the need for surgery.
Whilst robots will be increasingly used to assist surgeons in the near future, in the longer-term robots will be used to conduct less-complex operations autonomously. A team at the Sheikh Zayed Institute for Paediatric Surgical Innovation at the USA’s Children’s National Health System in Washington, DC have already carried out a fully autonomous surgery on a live animal using their Smart Tissue Autonomous Robot (STAR). And whilst STAR at present takes longer than a human surgeon, it does cut cleaner. Future breakthroughs will likely reduce that time to be more in-line with that of a human’s.
Healing wounds, faster and safer
Whilst surgical AI robots, miniature origami robots, and 3d printed organs are the most obvious signs of new advancements in surgery, more modest yet equally important breakthroughs are occurring. How surgeons heal, stitch, or glue together wounds from operations can be just as important as the surgery itself. Wounds not cared for properly can lead to complications, infections, repeated hospital visits, further operations, and even life-threatening internal bleeding. Recent advances in nanotechnology and materials science have meant that traditional sutures and surgical glues will be greatly improved. At present, some sutures or surgical glues can be expensive, can lead to the body’s immune system attacking the surgical site, or can result in unwanted side effects. But trials have shown that nanofiber sutures laced with Vitamin D could promote the body’s own healing mechanisms, reducing the need to use current surgical sutures. Similarly, new glues are being developed that are easier to apply and heal wounds more quickly. Such breakthroughs will give surgeons a much wider and more effective arsenal in wound healing.
From sticks and stones to sci-fi
Surgery can be a scary thing. Thousands of years ago, it would have meant almost certain death, but as technologies have advanced and scientific breakthroughs have broadened our understanding of the human body, surgeons can now perform operations that only a few decades ago would have been more common in sci-fi novels. As technologies are converging from 3d printing, imaging, AI, robotics, nanotechnology and materials science, they’re all making their way into surgery. And this will transform surgery in profound ways.
About the author
I look at emerging technologies from a social science and policy perspective. I completed my PhD on the diffusion of innovations at University College London, looking at how innovation gets implemented in healthcare organisations. My main interests are on policies that encourage innovation and the diffusion of emerging technologies, and understanding their social implications so that everybody wins.