The Surgeon Of The Future

Technology has become a major driver of the future direction of healthcare and surgery. Likewise, the speed of change has accelerated beyond comprehension, with a number of revolutions occurring during a surgeon's career. Being an agent of change or rapidly adapting to change has become the hallmark of the gifted surgeon. The fundamental challenges to a future surgeon are addressed from a technological viewpoint, with emphasis on the impact upon the practice of surgery.

Richard M. Satava

Department of Surgery, University of Washington Medical Center,

Seattle, Washington and Advanced Biomedical Technologies, Defense Advanced Research

Projects Agency (DARPA), Arlington, Virginia, U.S.A.

Technology has become a major driver of the future direction of healthcare and surgery. Likewise, the speed of change has accelerated beyond comprehension, with a number of revolutions occurring during a surgeon's career. Being an agent of change or rapidly adapting to change has become the hallmark of the gifted surgeon. The fundamental challenges to a future surgeon are addressed from a technological viewpoint, with emphasis on the impact upon the practice of surgery.

Everything occurs in cycles: revolution, change, adaptation to change, acceptance of the new standard, codifying the new establishment, resistance to further change, revolution, and the cycle begins again. In healthcare and surgery, this cycle had been occurring about every 100 years, but recently there has been a perceptible acceleration of this cycle. The first revolution for surgery came during the Industrial Age in the mid-1800s simultaneously with the introduction of anesthesia, asepsis, pathology, new instrumentation, and so on. Nearly a 100 years later, in the mid-20th century, as the Information Age was about to begin, surgery was advancing with antibiotics, intravenous fluid and hyperalimentation, radical surgery resections, and chemotherapy to name but a few. By the 1990s, laparoscopic (or minimally invasive) surgery emerged and became the standard for many procedures. Information Age technologies, such as video cameras and monitors, continued the evolution. But technology is accelerating faster than ever, and we are on the threshold of yet another revolution. This is referred to as the Biointelligence Age (1), an age of multidisciplinary medicine that can achieve much more than a single researcher or clinician can. The complexities of nature are yielding to interdisciplinary teams performing multidisciplinary research—genomics as a combination of biology and information sciences or robotics as a combination for physical (engineering) and information sciences. Much as previous revolutions, this current transformation is occurring because many different technologies are converging to fundamentally change surgery. There is a veritable explosion of new discoveries, such as genomics, micro-electro-mechanical systems, robotics, intelligent systems, molecular biology, etc. The entire surgical environment and culture is changing at an unprecedented rate of innovation that challenges the practicing surgeon every day. The change is occurring because of "disruptive technologies" that seemingly overnight completely reverse the fundamental approaches that have been standard for decades. In addition to technology, the surgical environment includes clinical practice, reimbursement, regulatory (such as Health Information Portability and Privacy Act), education and training, certification, research, and clinical trials. Because it is not possible to do justice to all those competing forces, the focus shall be upon the impact of technology, while fully admitting that at any one time, any of the factors play a dominant role in the life of a surgeon.

The opinions or assertions contained herein are the private views of the author and are not to be construed as official, or as reflecting the views of the Department of the Army, the Department of the Navy, the Defense Advanced Research Projects Agency, or the Department of Defense.

■ INTRODUCTION

■ CLINICAL PRACTICE

■ EMERGING TECHNOLOGIES

■ EDUCATION AND TRAINING

■ RESEARCH FOR CLINICAL TRIALS

■ MORAL AND ETHICAL CHALLENGES

■ CONCLUSION

■ REFERENCES

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