Losing open approach surgical skills and techniques to minimally invasive surgery in the era of artificial intelligence: A narrative review

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Despite advancements in technology, a substantial portion of the global population still resides in rural areas and low-income countries where access to these advanced technologies is limited or nonexistent, emphasizing the continued importance of open surgical approaches. The rapid integration of artificial intelligence (AI) and robotic technologies into surgical practice raises significant concerns regarding the erosion of essential open surgical skills. Integrated minimally invasive surgery (MIS) combined with AI may offer benefits such as enhanced precision and improved patient outcomes, but these should not come at the cost of the erosion of open surgical skills. This narrative review discusses the drawbacks of relying heavily on minimally invasive surgery and AI, particularly the potential degradation of traditional manual techniques that are crucial for effective surgical care. While robotic-assisted surgeries can lead to reduced recovery times and fewer complications, evidence indicates a decline in proficiency in open techniques among surgeons who predominantly utilize these systems. This skill degradation poses substantial risks, especially in situations where technology fails or is unavailable, such as in emergency settings or resource-limited environments. To address these challenges, the review discusses strategies such as hybrid training approaches that combine robotic and manual techniques, skills preservation programs aimed at maintaining traditional competencies, and modular curricula integrating both technological and conventional aspects of surgery. It also highlights the necessity for ongoing research to assess the effectiveness of these strategies, ensuring that surgeons remain proficient in both advanced technologies and fundamental manual skills. A balanced approach is vital for maintaining comprehensive surgical care in the era of AI, particularly for populations that still rely on open surgical methods.