WHICH TECHNOLOGIES WILL MAKE THE GREATEST IMPACT?
Surgery will be transformed over the next two decades. Four groups of technological developments are likely to make the greatest impact.
Minimally Invasive Surgery
Surgery has moved towards ever less invasive interventions, with fewer but more-precise cuts and incisions to reduce the impact on patients. Surgery is shifting from seeing, feeling and manipulating organs and tissues through the surgeon’s own eyes and hands, to using an intelligent robotic medium to see and intervene inside the body.
Developments in laparoscopic and endoscopic surgery will enable less invasive diagnostic and therapeutic procedures. A new generation of surgical robots – planned to hit the market in 2019 – will be more slender, versatile and affordable. These attributes will improve the take-up of robot-assisted surgery, with the potential to reduce variation in outcomes.
Developments in robotics and machine learning suggest that surgical tasks will increasingly be automated, with more guidance, support and information available to the surgical team. However, fully autonomous robot-surgeons remain unlikely to populate operating theatres in the next few decades.
The human touch of the clinician and their relationship with the patient will remain central to the delivery of excellent care. The ethical and regulatory framework must keep up with advances in technology to ensure patient safety.
Imaging, VR and AR
Imaging technology is key to the delivery of less invasive interventions, allowing the visualisation of internal structures and organs with reduced impact on the patient. In the next few years, advances in imaging technology will deliver better guidance during a surgical procedure and improve accuracy.
Better imaging is also likely to improve the speed and accuracy of diagnosis. If the direction of travel is one where imaging becomes better able to capture increasingly smaller structures and their functioning inside the body, surgery might move towards interventions at the micro level, such as the cellular level.
Simulation tools, such as augmented reality and virtual reality platforms, are already used by some surgeons to train and rehearse surgical procedures. The use of these technologies can improve surgical training and outcomes, while standardising procedures and democratising access to training.
Big Data and Genomics
The role of data collection and analysis will increase in future years. The potential for this resource to enable better prediction of disease and more personalised and effective treatments is huge. However, patients and the public must remain informed partners in every stage of this journey and standards on the use of their data must be enforced. Investment and leadership are also necessary to bring the healthcare system and its organisations into the future.
More patients will have access to a genomic medicine service. Genomic testing will improve our understanding of disease profiles, both at a patient-specific and population-based level. In the long-term, genomics will help the development of precision medicine. The choice of treatment will be based on their predicted success for each individual patient.
In the long-term, there will be more complex and specialised interventions. The delivery of cell-based therapies, bio-printed tissues and organs, ‘intelligent’ prosthetics or animal to human transplants will require specialised teams working together in multidisciplinary centres.
In ten to twenty years, organ bioengineering and 3D bio-printing might provide organs to patients waiting on the transplant list, and restore form and function in patients who have sustained trauma or burns.
3D printing and planning technologies are already widely used in surgery to prepare interventions and produce personalised implants. Further developments in 3D printing are likely to make surgery more precise, or open avenues for surgical procedures currently too complex or with outcomes that are too poor.
The use of robotic prosthetics has increased in recent years, with electrodes placed on muscles to control movement. For example, on the digits in a robotic hand. Research is ongoing on the development of ‘intelligent’ prosthetics, as the future of organically controlled prosthetic limbs is quite far away and is not likely to have an impact on surgery immediately in the NHS.
Over the next five years, it is likely that we will see more applications of stem cells across different conditions, such as chronic inflammatory conditions or neurodegenerative diseases.
Although developments in all these technologies hint at an exciting future for medicine and patient care, the complexity, cost, uncertainty and ethical implications of some of these interventions mean that their translation into routine medical practice might take a long time.