The Impact of Technology on Surgery: The Future Is Unwritten

Mario Morino, MD


Annals of Surgery. 2018;268(5):709-711. 

In This Article

Technology and Surgery in the Last Century

For decades, general surgery was performed with a limited use of technology. General surgeons till the 1980s were reluctant to embrace new technologies, such as flexible endoscopy or laparoscopy, and underestimated their potential.

The first laparoscopic appendectomy performed by a German gynecologist, Kurt Semm, on May 30, 1980 was considered an attempt to the holiness of abdominal surgery at such a point that the surgeon was suspended by the German board of surgeons.[1] A few years later, when Eric Muhe performed the first laparoscopic cholecystectomy, times were not yet sufficiently mature to accept and develop the concept of minimal invasive surgery (MIS): when the first postoperative complications occurred the technique was abandoned.[2]

However, the advent of Charge-Coupled Devices (CCD) cameras added to the laparoscope, radically changed the perception of laparoscopic surgery. In a few years, between 1987 and 1992, surgery changed forever. In 1987, Philippe Mouret performed a cholecystectomy by videolaparoscopy and, together with Jacques Perissat and François Dubois, standardized the technique.[3] The first presentation of a video showing a laparoscopic cholecystectomy in the US by Jacques Perissat in April 1989 during the Louisville Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Meeting was defined by Ken Forde, the SAGES president, as "…a singular event that changed the course of SAGES and surgery, perhaps for all time." The so called laparoscopic "second French revolution" had started and had its epitome during the 1992 world congress of the International Federation of Societies of Endoscopic Surgeons (IFSES) in Bordeaux. In the 5 years after the first videolaparoscopic cholecystectomy by Mouret, the vast majority of procedures in general surgery have been performed using the laparoscope: from colectomies to gastrectomies, from adrenalectomies to pancreatic resections, from bariatric to oncologic surgery.[4]

The possibility of making completely visible the act of surgery changed everything: the era of video-assisted surgery had just begun. This revolution in surgery was essentially driven by a few pioneers in laparoscopy and by the growing patients' demand for small scars and a better cosmesis. Industries have been taken by surprise. In fact in the early nineties laparoscopic instruments were sold out and manufacturers were unable to keep pace with the requests for new equipments.

All of a sudden, after decades of low technological profile, surgeons started to believe that technology per se was going to revolutionize surgery, leading to the equation "more technology = better surgery."

Is this true nowadays? Has this been true for the last decades?