History can play tricks on our mind. At times we think something revolutionary happened in front of our eyes. But the truth is it’s the output of a series of small events and steps that gradually evolve over a number of years. There’s really no such thing as an overnight success. 

You might disagree and point to 1989–1990 which marked the end of traditional open surgery. With really no scientific evidence to support or substantiate the change from open to laparoscopic cholecystectomy, the change did indeed occur almost overnight. Patients were demanding this less invasive surgical option, medical device companies were sending surgeons to training workshops, and procedures that were previously performed with ease and speed were suddenly very difficult and lengthy. 

But the reality is that a switch wasn’t flipped. No revolution occurred. The path to that new era of surgery dates back to the 19th Century. Ever heard of Swedish surgeon Hans Christian Jacobaeus who is credited with coining the term “laparoscopy” and began his animal experiments in 1901? Does Heinz Kalk ring a bell? He was the German gastroenterologist who developed a superior laparoscope with improved lenses and the first forward-viewing scope, earning him the title “Father of Modern Laparoscopy” in 1929. Did you know that laparoscopy was even banned in certain countries during the mid-1950s and early 1960s? (Sidenote: If you love medical history like I do, check out this excellent historical documentation of surgery.) 

The slow evolution was in large part related to limitations in technology. The other part was the belief that “large problems require large incisions” which was deeply ingrained among surgeons. To create change, both technical and emotional barriers must be overcome. Back in the 1970s, the German gynecologist Kurt Karl Stephan Semm began using laparoscopy to diagnose and perform gynecological procedures, such as ovariectomies, and advanced to the first laparoscopic appendectomy in 1980. His methods were severely criticized initially, but by 1984, another German surgeon, Erich Mühe, had created his own surgical laparoscope and eventually performed the first laparoscopic cholecystectomy in 1985. 

In 1988, the laparoscopic cholecystectomy was adopted by a small number of American surgeons, and those surgeons started training others interested in the procedure. By the early 1990s, the demand for laparoscopes had skyrocketed and new instruments were being developed as minimally invasive surgeries became more popular and widespread. Remarkably, in September 1992, a JAMA article declared laparoscopic cholecystectomy the “gold standard” for managing cholelithiasis. After nearly a century, laparoscopy had finally been legitimized by the surgical community.

Two decades after laparoscopy went mainstream, robotic surgery emerged and introduced new technology like robotic control and 3D visualization that enabled traditional open surgeries in urology and gynecology to be performed in a minimally invasive manner. Today, robotic surgery is performed in less than 5% of all surgeries. It took almost another two decades before any new material technology advances were introduced with Digital Laparoscopy. By shifting the technology focus to digitizing the interface between the surgeon and patient, surgeons had increased levels of control, security, and comfort during laparoscopic procedures. 

However, if you ask most surgeons today what their number one frustration is, they’ll say that there’s more power and intelligence in their iPhone than in the OR. Surgeons are still missing technology and real-time clinical data to improve decision-making, which is critical in the high-pressure, highly variable situations which happen repeatedly during any surgery. This is what really drives surgical outcomes.

You might be surprised to know that today one in five patients undergoing surgery has one or more complications. That can translate to increased length of stay, repeat surgery, additional medical treatment, legal issues, and increased costs. Surgery is also being performed by many different people with different levels of skill, experience, and training. As such, consistent outcomes are challenging to achieve.

Former President of the Society of Laparoscopic Surgery, Dr. Mike Kelly Jr. said, “Successful change requires timing and a force more powerful than the status quo. The strongest force for sustainable change is a worthy goal.”

It’s clear that the evolution of surgery is still underway. But to what end? Surgeons and hospitals are committed to delivering the best patient outcomes possible—every time. That’s the worthy goal: to deliver consistently superior patient outcomes regardless of surgeon skill or training or location. 

So how can we bring the vision of consistently superior outcomes to reality? Based upon history, we know many things have to fall into place to make change happen. Often technology is the missing link, but we are actively developing those missing puzzle pieces. We are building upon the foundation of digital laparoscopy and adding machine vision, augmented intelligence, and deep learning capabilities to help guide improved decision making, enriched collaboration, and enhanced predictability for all surgeons to shift the promise of consistently superior surgery into practice. We call this performance-guided surgery. 

There are additional factors plaguing the healthcare industry that amplify the urgency to pursue the worthy goal of performance-guided surgery: 

• Value-based care is shifting a greater responsibility for poor quality and inefficiency to hospitals and physicians. 
• Covid-19 exposed the shocking financial frailty of the hospital system as well as capacity and resource constraints, which must be bolstered and requires an acceleration of innovation. 
• Patients are presenting with more complex conditions and treating them becomes more complicated. The absolute number of patients seeking care is increasing, and many more patients have multiple chronic conditions than they did even a decade ago.

One thing that’s for certain: Surgery will not stay the same. As was the case in the 1900s, technology will catch up with imagination and the evolution of surgery will continue. Ultimately, it’s up to the surgical community to decide what will help them perform better, more consistent surgery in the future. 

We are entering an exciting new season of surgical evolution and look forward to working with people who share our curiosity and capacity to invent a better way of surgery.

About the Author:

As Asensus President and CEO, Anthony Fernando sets the company’s overall strategic vision and oversees its organic growth. Prior to his current role, he was the COO and Chief Technology Officer at Asensus, where he led the company’s technology strategy and global business operations.

Prior to Asensus, he was Vice President of Innovation and Technology within the International Group at Stryker Corporation, across Stryker’s medical device portfolio. Before joining Stryker, Anthony held positions at Becton Dickinson & Company as Director, R&D Devices & Global Health, Greater Asia; PerkinElmer Inc. as Director, R&D and CoE Leader in Asia; and Varian, Inc. as Director of Operations/General Manager of the Pharmaceutical Products business unit.

Anthony earned an MBA from the Kenan-Flagler Business School at the University of North Carolina, Chapel Hill, and MS and BS in Mechanical Engineering with concentrations in Robotics and Automation from the University of Nevada-Las Vegas.

Photo: Motortion, Getty Images