Current and future developments in surgery

Surgical techniques and instrumentation have experienced a spectacular development in the last decades. The development of microsurgery, bioengineering, imaging techniques and endoscopy, as well as the development of robotics have allowed progress of surgical procedures unimaginable only a few years ago. Advances in fields such as minimally invasive surgery, tissue engineering, robotic surgery, bariatric/metabolic surgery and transplantation, are clear examples of the rapid development of surgery.

Some of the most interesting and innovative techniques that have been developed over the past few years in different areas of surgery are explained below. Most of them are already in use, but in further development at the same time.

Minimally Invasive Surgery can be defined as the set of diagnostic and therapeutic techniques using natural orifices or minimal approaches to introduce surgical tools and perform surgery inside the human body. Today, more than 65% of surgeries performed in the USA use Minimally Invasive Surgery techniques. Examples include theSILS (Single Incision Laparoscopic Surgery):

or SPL (Single Port Laparoscopy) also known as SPA (Single Port Access Surgery):

Natural Orifice Translumenal Endoscopic Surgery (NOTES) is another minimally invasive surgical technique which consists in entering into the peritoneal cavity through natural orifices (mouth, vagina, anus or urethra) and then through an internal incision in the stomach, vagina, bladder or colon to enter the peritoneum avoiding any external incisions.

Actually there are some innovative transplants that were inconceivable some years ago. For example, the face transplant which is not a skin graft transplant, but where the graft of a whole donor's face is placed onto the patient's disfigured face, attaching nerves, blood vessels and muscles. It allows the patient to have facial expressions whilst skin grafts do not. It is important to note that the patient will not adopt the donor's facial likeness, since the bone structure, and the nerves that move the muscles are different. Examples of recently performed face transplants are shown in the following picture:

  

Recent developments in intrauterine surgery allow surgeons to act on the fetus as if it was a patient, not only administrating medication, but practicing open surgery without interrupting the pregnancy. It can be used as a palliative measure or as a permanent solution. It is normally used to deal with spina bifida and diaphragmatic hernia.

Some of these procedures could not have reached reality without the development of robotic surgery systems. The most extended one is the Da Vinci Surgical System, a sophisticated platform designed to expand the surgeon's capabilities to perform complicated surgical procedures with minimal invasion. It is mainly used for prostatic surgeries, reparation of cardiac valves, and gynecologic procedures:

One of the most recent advances in technology with applications in surgery as well as in telesurgery is Google Glass, a wearable computer with an optical head-mounted display (OHMD):

Google glass was used for the first time in 2013 by the Spanish Dr. Pedro Guillén (Clínica CEMTRO, Madrid) to broadcast a surgery (chondrocyte implantation in the knee) while interacting with other doctors and students in Stanford University (California):

Familiarize yourself with the main innovative surgical techniques explained in class:

• Minimally invasive surgery
• Innovative transplants
• Robotic surgery
• Intrauterine surgery