Building the intelligent operating room: The rise of digital surgery

How do you define “digital surgery,” and why is it becoming such an important focus area in healthcare today?

To me, digital surgery is the surgical experience of receiving real-time data-driven insights from a diverse set of digital devices to improve efficiency, enhance decision support, and lower cognitive burden for surgeons and their staff. It involves the convergence of different technologies like robotics, advanced imaging devices, and data science to produce an intelligent ecosystem in the OR by which teams can leverage not just their personal experience when operating, but the collective practice of surgeons globally for the same procedure.

The concept of digital surgery, even if not coined that way until fairly recently, has been something in the making for decades. When I was at Intuitive and we first launched the DaVinci robot in the early 2000s, most practitioners, hospital executives, and other device companies saw it merely as another tool, but they lacked the foresight to see that it was so much more than that. At the core, robotics, advanced optics, navigation systems, and sensorised tools are a means to digitise all human movement in the operating room while simultaneously registering the tissue response of the patient. Fast forward to today, and this technology is reaching a level of maturity that is enabling practitioners to move beyond the limits of their own hands. What’s more, this technology is driving a psychological readiness that these platforms are not meant to replace but rather to augment their training and decision-making in the surgical theatre.

All of this had to occur in a gradual stepwise fashion. Thirty years ago, most people would have never stepped into a self-driving car. First, you needed to build trust that the navigation system could get you efficiently from Point A to Point B. Then you needed to learn that lane departure, blind spot warning sensors, and automatic braking were going to make you a better driver and, in some cases, prevent an accident. And finally, it was about putting all this together with someone still in the driver’s seat to be there just in case. Technological readiness has driven adoption, but psychological acceptance is driving growth. Digital surgery is finally at a point where we are ready to drive with someone in the seat – with the proper guardrails in place to ensure we brake even when we aren’t ready to.

From your work at PA Consulting, what are the biggest technologies currently reshaping the operating room?

At PA Consulting, we are fortunate to be at the leading edge of our clients’ biggest aspirations. From large strategics continually looking to carve out portfolio enhancements to start-ups looking for the next breakthrough, we are entrusted by our clients to make them all a reality and, in doing so, get a chance to peek behind the curtain at what is five years ahead.

This is going to sound odd coming from someone who has lived and breathed robotics for 21 years, but the clinical opportunity being unlocked through advanced optics and AI-driven platforms is revolutionising what surgeons can see and how they formulate decisions. For over 25 years, robotics has been driving the precision, accuracy, and reproducibility of surgeon movement. The addition of new optical systems that have moved beyond white light and are using hyperspectral imaging, Raman spectroscopy, and AI-enhanced imaging to overcome the limitations of the human eye and allow practitioners to see what was previously thought impossible. These technologies can light up vasculature and nerve bundles and identify what is healthy versus cancerous tissue, allowing the healthcare industry to take a giant leap forward and drive certainty to inform a better level of surgical care.

In that same vein, AI-driven platforms in the diagnostics imaging space are helping practitioners get down to the pixel level to see what any human eye would have previously missed. AI is finding lesions years before they would have previously been caught, allowing for earlier interventions and better prognoses for patients. It is calling attention to areas of interest in procedures that might have been overlooked, either due to anatomic abnormalities or large scan volumes. Again, augmenting the surgeon – not replacing them – to arrive at better care for the patients undergoing these exams or procedures.

The future of these platforms will be to employ Edge AI and real-time decision-making intraoperatively. This will allow for procedure learnings in real-time and call out opportunities for practitioners to enhance the clinical outcome of the intervention. 

How do you see AI improving surgical decision-making before, during, and after procedures?

Before a surgeon even steps into the operating room for a procedure, the outcome is starting to be determined. What city we live in, what hospital and specialist we go to, who executed the diagnostic tests and imaging that will inform the surgical plan, all come down to who is involved in this cascade of data, where they trained, what their experience is, and frankly, how they are feeling on that day.

What if we could remove that variability and minimise the what-ifs to have platforms aggregating data not just across a health system or a region, but across borders and continents around the world? That opportunity is in our near future. Algorithms generating insights based on global data sets could inform what practitioners decide to do before and during a procedure, and certainly how they care for their patients during the recovery period.

When I was at Mazor, spine surgeons who immersed themselves in the planning software for the first time often remarked that their old way of one-size-fits-all for certain vertebrae based on sex, BMI, and age was wrong. They determined that the software was showing them a customised approach for each patient at every level they were operating on. When AI was introduced into the software in future generations, the next epiphany for these surgeons was reached as they started to look at how small tweaks to their existing decisions could mean monumental improvements for their patients post-operatively.

This is just one procedure completed by two specialties, so think about what is possible as these platforms roll out globally across all specialties and procedures. Regardless of the city or hospital, the power of global insights can fuel a better pre-op, intra-op, and post-op course of action.

What role will robotics play in the next phase of digital surgery, and how close are we to more automated surgical systems?

I have seen first-hand in procedures the unbelievable power that robotics provides, enabling surgeons and interventionalists to do what they previously could not without these platforms. As these devices get smaller and smarter, the path towards a new standard of surgical care is accelerated.

But humans are still fallible, and mistakes can happen. The power of the robot is what happens when the intelligence built into them places and enforces guardrails with the sole purpose of enhancing patient outcomes. These changes will be small at first; the “lane departure warnings and automatic braking” like we currently see in orthopaedics – but as trust in the technology grows, as does access to the significant data pulled from each procedure, the surgical landscape gets that much closer to automation.

The full interview was published on pages 18-24 of Medtech Opinion Leader.