For surgeons, there is a constant need to innovate, adapt to changes in the field, and improve patient outcomes. Advances in surgical technologies aim to enhance patient experiences and improve care through shortened recovery times and reduced complication rates. So how specifically are advancements in medical technology, or MedTech, being developed to help improve patient outcomes?

Some exciting technological developments coming onto the scene for surgery include 3D and virtual reality modeling of patient anatomy, gesture and voice controlled augmented-reality devices, and video review platforms. But how and where are they best deployed to support optimal patient care?

1. Pre-operative 3D Modeling

Gone are the days when surgeons were limited to planning operations based on 2D medical imaging and many shades of gray from CT and MRI scans. 3D modeling can now be used to help surgeons plan complex surgeries more safely and efficiently. Today, technologies are in market that can reconstruct 2D scans to create a 3D model of the patient’s anatomy. These models can then be manipulated, allowing the surgeon to view critical anatomical structures from multiple perspectives. This degree and method of pre-operative planning has been shown to improve surgical outcomes and reduce complication rates.[2]

These planning tools are helpful for large, multidisciplinary teams discussing optimal care for the patient, as well as for the surgeon about to perform the operation.[3] For complex surgeries such as lung segmentectomy, which require navigating vascular and bronchial structures and their variability in segmental levels, 3D modeling before and during surgery has been shown to enhance the safety of the operation, improve surgical accuracy, and provide a greater sense of security for the operating surgeons.[4]

Another benefit of pre-operative planning using 3D models is that it allows for simplified visualization of key organs with surrounding structures hidden or shown. This is a useful aid in discussions between colleagues during surgical planning and can be helpful in explaining key features of procedures to patients.

2. Intra-operative Imaging

Advancements in imaging aren’t limited to 3D modeling - they’re also making their way into operating rooms in the form of holographic technologies, including 3D display on hand-held device interfaces, as well as laptops, desktops, OR screens and simulators for surgeons and the OR team. Extended reality (XR) helps surgeons visualize organs, tumors, X-rays, and ultrasounds in real time and from multiple angles without diverting attention away from patients. XR includes virtual, augmented, and mixed reality: 

• Virtual reality (VR) offers a fully immersive experience that can support the need for lifelong training.  

• Augmented reality (AR), in laparoscopy, thoracoscopy or endoluminal surgery, highlights and overlays, with some transparency, existing anatomical structures helping guide surgeons in identifying critical nerves, vessels, ureters, etc. and protecting/avoiding them. [2][6] 

• Mixed reality (MR) is a fusion between the real field of vision and imported content, including 3D personalized models created from medical imaging digital data. More supporting technologies are making their way into the operating room. 

In the future integral imaging, also referred to as fly-eye vision, may remove the need for eyewear. Edge computing and cloud-based analytics from video feed and sensors data may trigger AR warnings and help surgeons prevent intra-operative events. 5G and soon 6G will allow for very low latency broadcast and control, enabling tele-mentoring and telesurgery opportunities.

3. Virtual Reality

Going a step beyond 3D imaging and holographic projections, training with virtual reality simulators has been shown to improve surgical technique in students and healthcare staff[13] ‑ a clear benefit given that better technical skill is associated with greater patient safety.[12]

AI trainers in virtual operations can be programmed to accurately grade the skill level of the trainee by observing their performance and commenting constructively using a human voice.[13][14] As the use of such AI trainers expands, they may be able to take on a greater role in student and graduate education.

4. Objective Feedback

Ongoing training for surgeons is an essential part of continuing the pursuit of surgical excellence, but is often challenging due to busy schedules and lack of available mentors. New technologies are helping to surmount these hurdles by giving surgeons remote access to objective peer review.

The C-SATS™ product is a clinical insights and data management platform where surgeons can upload videos of operations and obtain constructive feedback from peers and expert reviewers on how they can improve their technique. The performing surgeon remains anonymous, so the feedback is objective. With the accelerated pace of MedTech industry innovations, this objective video assessment can be beneficial for trainees and practicing surgeons alike.

Dr. Gianluca Torregrossa, Director of Robotic Coronary Revascularization at Lankenau Heart Institute, part of Main Line Health in Philadelphia, PA routinely leverages the C-SATS product. “By reviewing the videos, by offering suggestions, by looking at how other people deal with the same problems, you learn and you enhance your own activities,” says Torregrossa.

Surgical video feedback has been shown to help surgeons improve.[15][16] In one study, a group of 3rd and 4th year medical students using a virtual patient simulator received feedback from senior colleagues on their uploaded videos. The response to the feedback was overwhelmingly positive and participants noted that it motivated them to do better.[15] In another study, students and junior residents who received virtual training and feedback from senior experts about critical skills showed significant improvements in their knowledge acquisition and confidence.[16]  The assessment and measurement of such technical skills is important, as higher technical skills are associated with fewer post-operative complications and lower rates of re-operation, re-admission, and visits to the emergency department.[12]

5. Robotic Surgery

One of the most exciting emerging technologies for surgery is the continued advancement of robotic surgery.[17]

The advantages of robotic surgery are well documented: it can shorten hospital stays, decrease complication rates, and allow surgeons to perform more detailed operations using techniques not available with traditional open and laparoscopic approaches.[15][18] Despite the increased costs and training times involved with these technologies, the benefits are so significant that robotic techniques are being widely adopted in many hospitals across multiple specialities.[17][18][19]

The expansion of robotic units is likely to grow significantly in the future[19] - perhaps even expanding into fully automated procedures. “The holy grail is surgical automation,” says Dr. Gatta, “where the robot learns through machine learning and increasingly could perform certain segments of the procedure steps. It will be an incremental process where parts of the operation can be automated and at some point, the robot will learn the entire procedure.”[1]

Summary

Can surgeons embrace tomorrow’s world, today? Yes!

3D modeling, virtual reality imaging modalities, video-based assessment, and robotic surgery are emerging technologies that have the potential to disrupt and revolutionize modern surgical practice.

Early research has shown that the use of these technologies can lead to fewer complications and better patient outcomes.[2][18] They also create more opportunities for training and pre-operative surgical preparation. Further research will help us understand how they can be introduced to a wider group of surgeons and to learn how to manage the difficulties inherent with introducing changes to conventional surgical practices.