The Future and Challenges of Surgical Technology Implementation and Patient Safety

  • Chandler D. Wilfong
  • Steven D. Schwaitzberg


Surgical practice is currently advancing at a rapid pace, driven by new advances in technology. Minimally invasive techniques, assisted by technologies such as the da Vinci robotic platform, per oral endoscopic myotomy, natural orifice transluminal endoscopic surgery (NOTES), as well as modern operating suite technologies are now becoming a part of the practice of surgery as well as the training of resident surgeons. Telementoring is enabling the continued education of practicing surgeons in new techniques across previously insurmountable geographic barriers. Newly discovered immune-modulating therapies are changing the way malignancies are approached by the surgical community and redefining the role of the surgeon in modern cancer therapy. These technological advances are leading a new era of surgery which will continue to change and grow in the coming years.


Surgery Future of surgery Robotics Laparoscopy NOTES 


  1. 1.
    Schwaitzberg SD. Financial modeling of current surgical robotic system in outpatient laparoscopic cholecystectomy: how should we think about the expense? Surg Endosc. 2016;30(5):2082–5.PubMedGoogle Scholar
  2. 2.
    Jensen PF, Barach P. The role of human factors in the intensive care unit. Qual Saf Health Care. 2003;12(2):147–8.PubMedCentralGoogle Scholar
  3. 3.
    Chellali A, Schwaitberg SD, Jones DB, Romanelli J, Miller A, Rattner D, Roberts KE, Cao CGL. Towards scar-free surgery: an analysis of the increasing complexity from laparoscopic surgery to NOTES. Surg Endosc. 2014;28(11):3119–33.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Arkenbout EA, Henselmans PW, Jelinek F, Breedveld P. A state of the art review and categorization of multi-branched instruments for NOTES and SILS. Sure Endosc. 2015;29(6):1281–96.Google Scholar
  5. 5.
    Karamichalis J, Barach P, Henaine R, del Nido P, Bacha E. Assessment of surgical competency in pediatric cardiac surgery. Prog Pediatr Cardiol. 2012;33(1):15–20. doi: 10.1016/j.ppedcard.2011.12.003.Google Scholar
  6. 6.
    Ponsky TA, Bobanga ID, Schwacter M, Stathos TH, Rosen M, Parry R, Nalugo M, Rothenberg SS. Transcontinental telementoring with pediatric surgeons: proof of concept and technical considerations. J Laparoendosc Adv Surg Tech A. 2014;24(12):892–6.PubMedGoogle Scholar
  7. 7.
    O’leary J, Barach P, Shorten G. Improving clinical performance using rehearsal and warm up. A systematic review of randomized trial and observational studies. Acad Med. 2014;89(10):1416–22.PubMedGoogle Scholar
  8. 8.
    Barach P, Cosman P. Teams, team training, and the role of simulation. In: Barach P, Jacobs J, Laussen P, Lipshultz S, editors. Outcomes analysis, quality improvement, and patient safety for pediatric and congenital cardiac disease. New York, NY: Springer Books; 2014. ISBN 978-1-4471-4618-6.Google Scholar
  9. 9.
    Causer J, Barach P, Williams M. Expertise in medicine: using the expert performance approach to improve simulation training. Med Educ. 2014;48:115–23. doi: 10.1111/medu.12306.PubMedGoogle Scholar
  10. 10.
    Rostenberg B, Barach P. Design of cardiovascular operating rooms for tomorrow’s technology and clinical practice. Part 1: Progress in pediatric cardio.Google Scholar
  11. 11.
    Rostenberg B, Barach P. Design of cardiovascular operating rooms for tomorrow’s technology and clinical practice. Part 2: Progress in pediatric cardio.Google Scholar
  12. 12.
    Rostenberg B, Barach P. Design of cardiac surgery operating rooms and the impact of the built environment. In: Barach P, Jacobs J, Laussen P, Lipshultz S, editors. Outcomes analysis, quality improvement, and patient safety for pediatric and congenital cardiac disease. New York, NY: Springer Books; 2014. ISBN 978-1-4471-4618-6.Google Scholar
  13. 13.
    Kirkpatrick AW, Vis C, Dube M, Biesbroek S, Ball CG, Laberge J, Shultz J, Rea K, Sadler D, Holcomb JB, Kortbeek J. The evolution of a purpose designed hybrid trauma operating room from the service perspective: The RAPTOR (resuscitation with angiography percutaneous treatments and operative resuscitations). Injury. 2014;45:1413–21.PubMedGoogle Scholar
  14. 14.
    Barach P, Weinger M. Trauma team performance. In: Wilson WC, Grande CM, Hoyt DB, editors. Trauma: emergency resuscitation and perioperative anesthesia management, vol. 1. New York, NY: Marcel Dekker, Inc.; 2007. p. 101–13. ISBN 100-8247-2916-6.Google Scholar
  15. 15.
    Tsuda S, Oleynikov D, Gould J, Azagury D, Sandler B, Hutter M, Ross S, Haas E, Brody F, Satava R. SAGES TAVAC safety and effectiveness analysis—DaVinci surgical system. Sunnyvale: Intuitive Surgical; 2015. Scholar
  16. 16.
    Collinson F, Jayne D, Pigazzi A, Tsang C, Barrie J, et al. An International, multicentre, prospective, randomized, controlled, unblinded, parallel-group trial of robotic-assisted versus standard laparoscopic surgery for the curative treatment of rectal cancer. Int J Colorectal Dis. 2012;27:233–41.PubMedGoogle Scholar
  17. 17.
    Bianchi PP, Ceriani C, Locateli A, Spinoglio G, Zampino MG, Sonzogni A, Crosta C, Andreoni B. Robotic versus laparoscopic total mesorectal excision for rectal cancer: a comparative analysis of oncological safety and short-term outcomes. Surg Endosc. 2010;24(11):2888–94.PubMedGoogle Scholar
  18. 18.
    Baik SH, Lim DR, Hur H, Min BS, Lee KY. Oncologic outcomes and perioperative clinicopathologic results after robot-assisted tumor-specific mesorectal excision for rectal cancer. Ann Surg Oncol. 2013;20(8):2625–32.PubMedGoogle Scholar
  19. 19.
    Luca F, Valvo M, Ghezzi T, Zuccaro M, Cenciarelli S, Trovato C, et al. Impact of robotic surgery on sexual and urinary functions after fully robotic nerve-sparing total mesorectal excision for rectal cancer. Ann Surg. 2013;257(4):672–8.PubMedGoogle Scholar
  20. 20.
    Vennix S, Pelzers L, Bouvy N, Beets GL, Pierie JP, Wiggers T, Breukink S. Laparoscopic versus open total mesorectal excision for rectal cancer (review). Cochrane Database Syst Rev. 2014;(4):CD005200.Google Scholar
  21. 21.
    Dario P. Scuola Superiore di Studi Universitari e di Perfezionamento Sant’Anna. Assembling reconfigurable endoluminal surgical system. The final report. 2009.
  22. 22.
    Moris DN, Bramis KJ, Mantonakis EI, Papalampros EL, Petrou AS, Paplampros AE. Surgery via natural orifices in human beings: yesterday, today, tomorrow. Am J Surg. 2012;204:93–102.PubMedGoogle Scholar
  23. 23.
    Sharata AM, Dunst CM, Pescarus R, Shlomovitz E, Willie AJ, Reavis KM, Swanstrom LL. Peroral Endoscopic Myotomy (POEM) for esophageal primary motility disorders: Analysis of 100 consecutive patients. J Gastrointest Surg. 2015;19:161–70.PubMedGoogle Scholar
  24. 24.
    Inoue H, Sato H, Ikeda H, Onimaru M, Sato C, Minami H, Yokomichi H, Kobayashi Y, Grimes KL, Kudo S. Per-Oral endoscopic myotomy: a series of 500 patients. J Am Coll Surg. 2015;221(2):256–64.PubMedGoogle Scholar
  25. 25.
    Teitelbaum EN, Soper NJ, Satnos BF, Arafat FO, Pandolfino JE, Kahrilas PJ, Hirano I, Hungess ES. Symptomatic and physiologic outcomes one year after peroral esophageal myotomy (POEM) for treatment of achalasia. Surg Endosc. 2014;28:3359–65.PubMedGoogle Scholar
  26. 26.
    Antoniou SA, Antoniou GA, Franzen J, Bollmann S, Koch OO, Pointer R, Granderath FA. A comprehensive review of telementoring applications in laparoscopic general surgery. Surg Endosc. 2012;26:2111–6.PubMedGoogle Scholar
  27. 27.
    Kopelman Y, Lanzafame RJ, Kopelman D. Trend in evolving technologies in the operating room of the future. JSLS. 2013;17(2):171–3.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Wong VW, Wan DC, Gurtner GC, Longaker MT. Regenerative surgery: tissue engineering in general surgical practice. World J Surg. 2012;36:2288–99.PubMedGoogle Scholar
  29. 29.
    Huang SP, Hsu CC, Chang SC, Wang CH, Deng SC, Dai NT, Chen TM, Chan JY, Chen SG, Huang SM. Adipose-derived stem cells seeded on acellular dermal matrix grafts enhance wound healing in a murine model of a full thickness defect. Ann Plastic Surg. 2012;69:656–62.Google Scholar
  30. 30.
    Iyyanki TS, Dunne LW, Zhang Q, Hubenak J, Turza KC, Butler BE. Adipose-derived stem-cell-seeded non-cross-linked porcine acellular dermal matrix increases cellular infiltration, vascular infiltration, and mechanical strength of ventral hernia repairs. Tissue Eng Part A. 2015;21(3–4):475–85.PubMedGoogle Scholar
  31. 31.
    Rosenberg SA. Cell transfer immunotherapy for metastatic solid cancer—what clinicians need to know. Nat Rev Clin Onc. 2011;8(10):577–85.Google Scholar
  32. 32.
    Saied A, Pillarisetty VG, Katz SC. Immunotherapy for solid tumors—a review for surgeons. J Surg Res. 2014;187(2):525–35.PubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Department of SurgerySUNY University at Buffalo, Buffalo General Medical CenterBuffaloUSA
  2. 2.Department of SurgeryUniversity at Buffalo School of MedicineBuffaloUSA

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