How Surgical Care is Changing in the Technological Era

Abstract

It is undoubted that in the last 20 years technology has changed surgical care, which is now evolving rapidly following the introduction and expansion of minimally invasive surgery and the utilization of tablets and smartphones to communicate between patients and doctors, or between doctors themselves (mobile healthcare). In this article, I try briefly to analyze how these two major changes may bring a new dimension to the future of worldwide healthcare, using the example of thoracic surgery. To begin, the introduction in 1998 of the ‘uniportal’ surgery today permits us to perform many operations in thoracic and abdominal surgery through a single small skin incision [1–6]. Uniportal video-assisted surgery is more and more often used worldwide, and is currently performed by a team formed by one or two surgeons. This is less than 20 years ago, and therefore it can be envisioned that in the future we could certainly need fewer surgeons [7]. Moreover, the fact that surgical skills needed to operate through a small incision must be prominent, it will be necessary for the surgeon to undergo specific training to acquire the necessary elevated surgical capability to operate on patients [2]. I envisage, for the benefit of our patients, that every complex operation could be watched by ‘expert surgeons’ who, in a supervisory room, act as live councilors for when an intraoperative doubt arises – this could decrease intraoperative risks and give better long-term results. Of note here is that use of smaller incisions to treat cancer should never place patients at risk, and the uniportal surgery would require approval by scientific societies following evidence of improvement of patient outcomes, or at least maintenance of the same outcomes, for benign and malignant diseases. I agree with the unpublished words of T Treasure that these techniques are not for every surgeon to explore, but if proven to be in a patient’s best interests, they should not be avoided but adopted. The big question is therefore how to test whether innovations are true improvements, using randomized trials. Another point of future discussion is how to train our next generation of surgeons, who must use both hands to operate through a small entry in the chest or abdomen; of course, this will be facilitated in the case of robotic surgery as the surgeon will operate via the console. Next, we will consider the use of mobile technology such as smartphones or tablets in medicine, which permit that images files (x-rays, CT-scan, angiography etc.) could be transferred through social media applications such as Whatsapp; the consultant can therefore see the images within a few seconds from home or wherever he\she is, and consequently medical opinions can be delivered to the resident without hesitation and without the need to reach the hospital, as was How surgical care is changing in the technological era