Achieving a positive outcome and improving the quality of life for the patient is the goal of any surgical intervention. This objective has long driven advancements in the surgical field, including today’s digital solutions that are designed to help surgeons reduce variation in care and potentially improve patient outcomes.

These new digital technologies are addressing unmet needs for surgeons, such as providing virtual training and proficiency advancement and offering enhanced pre- and intra-operative visualization. From virtual operating rooms to tools for video assessment and data collection, digital tech, or MedTech, is becoming an integral part of the surgical environment.

Ongoing skills measurement and development is an important tool for potentially improving outcomes – and it’s a lifelong journey, increasingly fueled by the speed of technological advancement in the surgical field.

Expert in robotics, Dr. Prakash Gatta (Chair of Robotics and Division Head of Esophageal Surgery, Director of National Mentor Site Robotic Surgery, and Co-director of the Minimally Invasive Surgery Fellowship Program at MultiCare Health System in Tacoma, Washington), agrees that a mindset of continual improvement is essential to surgical advancement and innovation. “If you stop innovating,” he says, “if you stop putting yourself in a slightly uncomfortable position and being disruptive to yourself, you never grow.”[2]

Enhancing Surgical Planning and Skills Proficiency

Digital solutions encompass Machine Learning (ML) and Artificial Intelligence (AI)-assisted software designed for healthcare institutions. These can include applications for surgical skills measurement, SaaS-based platforms designed to improve surgical efficiency, and applications to aid in surgical planning and visualization.

Such software can fill voids in traditional models of feedback put under stress by time constraints and the reduced availability of mentors. In a poll of practicing surgeons[1], 45% of respondents reported that they rarely received feedback on their performance in the OR, and 45% said they only received it sometimes.

One digital tool empowering surgical proficiency advancement is the C-SATS™ product. Defined as Crowd-Sourced Assessment of Technical Skills, the C-SATS product facilitates surgical review from a global network of peers and specialty experts using video-based assessment. It also provides surgeons with crowd-sourced and AI-generated data analytics to aid in benchmarking and identifying key areas for improvement.

“C-SATS allows us to say, ‘This was a well performed procedure,’ or otherwise and specifically why,” says Dr. Gatta, who serves as one of C-SATS’s expert reviewers.

Digital solutions have the added benefit of measuring surgical skill to give data-driven insights into proficiency progression.[3] This ability to quantitatively and qualitatively measure performance will likely continue to offer better educational opportunities[4] as it develops.

In addition to tools for digital assessment and feedback, augmented reality and virtual reality (VR) platforms enable surgeons to perform simulated procedures without risk to patients.[4] VR can also be equipped to provide haptic feedback, giving trainees a realistic sense of the physical sensations experienced during surgery.[5] VR tools are now expanding to include simulations for multiple users, allowing surgical teams to train together and enabling coaches and mentors to participate.[6] As the use of robotics in surgery progresses, these types of VR tools will be indispensable for training on new equipment and procedures.

Then there are digital tools using technology to improve upon existing resources, such as 3D modeling software like ETHICON’s 3D Pre-operative Planning powered by Visible Patient, S.a.S. These technologies make three dimensional images accessible to surgeons by using CT and MRI scans to build interactive, color-coded anatomical models. These models can help overcome some of the challenges of traditional imaging – such as seeing only in grayscale, or not being able to navigate through the image – and give surgeons the ability to see patient-specific anatomical variations and estimate resection volumes before surgery.[7-10]

The Potential of Digital Tech in Surgical Advancement

Bringing AI-assisted platforms like the C-SATS platform and VP PLANNING™ solution as well as other AI-assisted technologies into the operating room also opens a door to advancing the use of machines and machine learning to provide intra-operative guidance for surgeons.[11]

Dr. Gatta sees platforms like these as a first step towards expanding intra-operative digital capabilities. “Advancing the digital surgery platform will improve proficiency in smaller ways such as improved articulation and also in bigger ways such as haptic feedback, image capture, predictive analytics, and automation,” he says. “By watching surgeon behavior, or the technical steps of the procedure…. [and] developing higher, superior quantitative metrics generated by an algorithmic machine learning platform, I predict that we could allow science to prove what will ultimately translate into better outcomes, therefore less complications.”

Adopting New Tools

A mindset of continual improvement powered by digital solutions can help bring new technology into clinical practice and pave the way for innovation. It isn’t always an easy transition, and one that surgical practice has been slow to take on, says Dr. Gatta.

“In our daily lives, people are oftentimes comfortable adopting a new, disruptive technology, i.e., your smart phone.  And while many things outside of the OR have changed, much in the OR has remained the same,” he says. “Why is that? Why is that acceptable?”

“People are finally understanding that the robotic platform is not only a physical tool, but a tool which creates a digital imprint. We can create a pathway where we can predict a surgeon’s proficiency based on qualitative and quantitative data, like what C-SATS allows us to do.”

With concrete, personalized data on surgical proficiency through surgical analytics and data management programs such as the C-SATS platform, surgeons can reflect on how and where to improve. Additionally, digital tools that enable 3D imaging, such as VP PLANNING, can aid in pre-operative modeling and resection simulation in effort to adopt more minimally invasive approaches.

Dr. Horgan advises that surgeons using these tools need to truly understand the data provided in order to evaluate their outcomes. “Are your outcomes where they should be and are you happy or is your operation taking four hours when it should take one?” he says. “Because that’s something that C-SATS gives you: feedback based on data.”[12]

Putting Insights Into Practice

A 2022 trial of medical students showed that learning through simulated operations using an AI tutoring system achieved significantly higher performance scores compared with more traditional expert instruction.[13] A 2019 trial showed that using 3D virtual reality models to plan surgeries reduced operative time, shortened length of patient stay in hospital, and reduced surgical complications.[14]

But while new advancements in healthcare using AI and machine learning remain a big focus for medical practitioners and the healthcare industry, there are numerous hurdles to overcome before the benefits can be fully realized – including buy-in from healthcare systems with many stakeholders. In 2021, a report from the UK’s Health Foundation recognized that healthcare systems must work together in order to make the most of new technology:

In the US, new tech has additional obstacles to overcome in the form of complex interrelated systems of insurers, healthcare providers, hospitals, pharmaceutical companies, and more.[16] Technological advancements can only achieve the end goal of helping patients when every party involved in the healthcare system is on board.[17]

Ultimately, the potential of MedTech and digital solutions to improve patient care is vast, with the benefits currently being seen in the pre-operative planning and surgical proficiency enhancement environments. But as with any tools, the success of these new technologies remains in the hands of the surgeons who use them.