The Impact of Technology on Surgery: The Future Is Unwritten

Mario Morino, MD


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

In This Article

New Millennium: The First Decade

The most disruptive technological achievement in the era of MIS was the so called Lindbergh procedure, a transatlantic laparoscopic cholecystectomy performed by Jacques Marescaux and his team from New York on a patient in Strasbourg. The paper reporting this extraordinary procedure was published in Nature few weeks after the performance.[5] Although in his article Marescaux discussed the advantages of this technique and its role in the future of surgery, the concept of remote surgery was abandoned. Nevertheless, this project, financed by Telecom France, improved significantly the speed of telecommunication and radically changed the quality of long distance phone calls. But it had no impact on surgery.

The advent of laparoscopy represented also a huge opportunity for the surgical companies. In the 1990s, the companies producing laparoscopic equipment and instruments had a huge commercial success.

Companies like Ethicon Endosurgery and Autosuture were among the main driving forces behind the diffusion of MIS: they organized courses, created facilities for dry and wet lab surgery, financed research projects, and influenced surgical careers.

All of a sudden, the relationship between companies, surgeons, medical associations, and institutions became more complex. Till then, general surgeons were not used to deal with the concept of conflict of interest, while this issue was well known in the pharmaceutical industry.

In the 1990s, the growth of many companies acting in the field of MIS was very consistent. To keep up with these financial results they needed new technologies, new "revolutions." Companies and surgeons were looking forward to reproducing a new laparoscopic revolution: Single Incision Laparoscopic Surgery (SILS)? Natural Orifices Transluminal Endoscopic Surgery (NOTES)? Robotic surgery?