Surgery set for a facelift

This vision of the future of surgery is the result of a workshop involving leaders in the surgical and interventional industries. The workshop report also details how technology will influence the ‘deskilling’ of surgery. As new markets emerge and developed markets mature, the global demand for skilled surgeons will only intensify. Over the next 10-20 years there is going to be an explosion of demand for specialist physicians to treat ‘the next billion’ and the only viable solution will be to reduce the burden on the highly skilled with devices that will simplify or automate complex tasks and remove unnecessary ones.

The report foresees a two-tier healthcare system that will drive device innovation to primarily focus on those technologies that can improve clinical benefit to patients while reducing the overall cost of care by increasing efficiency. In the primary tier, traditional models will persist but will only treat life-threatening conditions. A secondary tier will see patients paying out of their own pockets for non-life-threatening treatments and procedures.

“As the commercial shape of our industry shifts over the next two decades – from a task-based to an outcome-based value model – so our model for product innovation will need to change,” said Simon Karger, associate director, surgical & interventional products, at Cambridge Consultants. “In the majority of cases, this will lead to device manufacturers basing their development decisions on the value of the clinical benefit delivered by a device in the context of its impact on overall clinic operational benefit.”

The two-tier healthcare system will also mean patients taking more responsibility for their own medical decisions and, as a result, the medical industry is set to become more consumerised than ever before. While there will always be the balancing influence of the care-giving organisations and regulatory bodies, patients will demand choice and – above all – satisfactory outcomes. In response, medical device companies will need to learn how to ‘serve customers’, not just ‘treat patients’. In turn, hospitals will demand devices and technologies that draw more patients, while payers will seek to maintain a ‘value balance’.

“We are already seeing this shift to a customer-responsive two-tier system along with a deskilling of surgical specialties at hospitals around the world,” said Karger. “For example, the Cleveland Clinic in the US is already starting that process by organising its hospitals around patient needs instead of the traditional division between medicine and surgery, which increases efficiency and is more responsive to the patient. Looking toward 2030, we see this process accelerating, building on the current trend of moving minor – and even some major – surgical procedures out of the classic operating theatre setting. And, with the continued advances in surgical robotics and intelligent surgical devices, we see a future where surgeries will take place in more specialised settings such as clinics, an office or perhaps even the home.”

In a future with a deskilled two-tier system that is more and more consumerised, the report offers a glimpse into what types of technologies will dominate. For example, only those technologies and innovations that offer rounded value to the clinic will stick. Increasingly ‘interventional’ (catheter-based) devices will offer less traumatic surgery by requiring less anaesthesia and quicker recovery, which will reduce intra- and post-operative costs. In addition, active, intelligent and sensor-rich devices will guide and inform surgeons, reducing the demand for highly skilled specialists in all but the cases where their niche skills are most essential. Energy systems will increasingly replace blades, offering precise cutting with real-time coagulation.