Last week the Royal College of Surgeons of England held the Future Surgery show, providing an insight into the views of the surgeon and perioperative care community into current issues and future changes. For those of us working in surgical medtech R&D I’ve distilled this into 3 hot topics.

The backdrop to these views contains some immediate challenges and an exciting future.

The NHS in England, alongside many healthcare systems around the world, faces a perfect storm of fiscal tightening, staffing challenges and a backlog of patients waiting for elective care – the NHS waiting list recently reported to have risen to 7 million patients.

Despite these challenges, there was tremendous positivity about the changing surgical environment, resulting from an increasingly diverse workforce and the adoption of new technology. As England’s Chief Medical Officer, Chris Whitty, explained – surgery has resulted in an incremental improvement in patient outcomes for many decades and we can expect that to continue.

The 3 hot topics

Digital & robotics

• Digital and robotics is the focus of much of the work that Sagentia Innovation performs for its surgical medtech clients and so it was pleasing to see a firm belief that these technologies are bringing benefits to both patients and healthcare providers, and will be adopted more and more by the latest generation of surgeons. The clinical evidence for the benefits of robotic assisted surgery is still being collected but it was plain to see the procedural advances being enabled by robotics – allowing the most challenging laparoscopy procedures to be transitioned to a wider population of surgeons, meaning more patients have the benefits of minimally invasive versus open surgery. As more surgeons use robotics, surgical techniques are being adapted to suit the advances provided in dexterity, ergonomics, and visualisation. It’s these new procedures and the wider adoption of MIS that will lead to the evidence on the benefits of robotic assisted surgery.
• Surgeons are looking to analyse their performance during training (more on this below) and their effectiveness as part of surgical teams (see below for more on human factors) using data analytics. There is interest in using sabermetric techniques deployed routinely and successfully in other highly skilled environments such as elite sport, to improve performance in operating theatres.
• Some of the remote care enforced by the covid-19 pandemic is sticking, and patients are reporting an improved experience in their care with the use of digital technologies. We heard one patient talk movingly of their decreased anxiety and uncertainty through app-based communication with their surgeon during their post operative recovery.

Human factors

• It’s a topic we in the medtech industry are very familiar with – focused on the minimisation of user error when using our products. The surgical community is adopting the same term to refer to reducing the chances of surgical error through surgical team performance, surgical system design, and interaction with medtech products. It’s the application of the same principle of human factors, with a wider lens. It borrows learning from other high reliability environments such as aviation, where much effort has been spent in reducing errors through a focus on team dynamics and behaviours, for example junior team members speaking out when they see a mistake being made. These learnings are being rolled out to surgeons in England through Royal College of Surgeons training. The takeaway for the medtech community is we can expect more interest from end users in the human factors testing we’ve performed and should facilitate more involvement in the ways we can assist their own application of human factors.

Training 

• There is a training backlog issue to match the elective patient waiting list backlog. The cancellation of elective surgeries during the pandemic has resulted in a loss of experience amongst trainee surgeons unable to gain experience through observation and participation in those surgeries.
• The training backlog is coupled with a desire amongst surgeons to only operate when they’ve reached a proficient level of expertise along the learning curve and to be trained by the very best experts, moving well away from the ‘see one, do one, train one’ paradigm.
• To compound these issues, surgeons are faced with new OR technologies, such as robotics, which necessitate training in basic robotic technique and in the new procedures enabled by robotics. England is less advanced in its robotics training than the US, such that training has been focused on consultant surgeons, leaving trainee surgeons searching around for how they can obtain robotic assisted surgery skills.
• The expectation amongst surgeons is that technology will be used to address these problems, through adoption of simulation training e.g. using virtual reality, and through adoption of video based telepresence systems which allow trainees to observe surgeries remotely, expert trainers to proctor trainees in their surgeries remotely, and video based analytics to drive feedback based improvement.

It was great to take part in the Future Surgery show, if you would like to discuss any of the topics outlined above, please get in touch with me, Rob Morgan, I’d be happy to have a call. To arrange a chat email [email protected]