Surgical trends
General surgery and is set to expand to other specialisms, where it is hoped they will have a positive impact on patient care. However, there are some hurdles to overcome for widespread acceptance – there are high system costs, complex technology and a resource heavy training requirement needed to familiarise surgeons with robotic surgery. The expiry of key patents in the da Vinci robotic system, and others, has opened up the market to a new generation of more advanced surgical robots. It can be seen that the entire sector has been bottlenecked and has prevented innovation.4 It is expected that the newly freed market for
robots will generate a great deal of interest in surgery and adoption by many other specialties. The modern designed robots are likely to have AI integrated into them, which will revolutionise the area further, driving advances in precision, efficiency and patient care. Despite the potential for expansion, there is
a lack of clinical evidence and, at present, no robust regulatory framework to delineate the responsibilities between the technology and the surgeon. It is also noticeable that there is no national training programme to enhance the readiness of the workforce to meet the rapid expansion of the surgical approach.
Personalised medicine Personalised medicine is a field which aims to tailor surgical treatments on the basis of individual patient characteristics including genetic, environmental and lifestyle factors. Advances in genomics and bioinformatics have enabled the identification of genetic markers associated with disease risk and treatment response.5
This information can guide the
selection of surgical techniques, additional adjuvant therapies and the management of postoperative care. A study being undertaken at present by
Enhanced Recovery After Surgery (ERAS) The ERAS guidelines emphasise multimodal pain management, early mobilisation and
the North West Genomic Medicine Service Alliance is investigating how genetic insights can be incorporated into everyday prescribing practices in primary care. Pharmacogenomics uses genetic information to improve medication safety and effectiveness, reducing adverse drug reactions and enhancing patient outcomes. Genetic profiling can help identify patients who are at greater risk of complications or recurrence, enabling more personalised and proactive care. Advances in bioinformatics and machine learning will enable the analysis of large datasets, allowing the identification of therapeutic targets and novel biomarkers. It remains to be seen how surgery will be impacted.
nutritional support to accelerate recovery and reduce complications.5
Recent studies have
shown that ERAS leads to shorter hospital stays, reduced postoperative pain, and lower rates of complications. The guidelines identify the multidisciplinary nature of ERAS, which encompasses pre-operative counselling, carbohydrate loading, opioid sparing analgesia and early postoperative feeding and mobilisation - preferably in theatre recovery. There is nothing very new about the practice of ERAS but it can contribute a lot to patient comfort, confidence and recovery and can equally be added to by some of the available technology. Further developments are indicated by patient’s personal wearable technologies. The remote monitoring. which can be undertaken, may help to support the implementation of ERAS protocols. Initially, ERAS implementation was patchy and
slow but now there is demonstrable evidence that it can reduce the length of hospital stay, as well as decrease morbidity by as much as 50%. This has also been accompanied by significant cost cutting either through the reduction in complications following surgery or by more efficient use of resources including hospital beds. Successful implementation requires the training and education of staff members and good clinical leadership.
Telemedicine Advances in low latency, high speed internet connections may pave the way for remote surgery where surgeons can operate on patients located in different regions. This concept is at an early stage of development, although it holds promise for increasing access to specialised surgical expertise. COVID-19 enabled the
July 2025 I
www.clinicalservicesjournal.com 15
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