Digital Surgery : Seeds in Fertile Soil

Reflections from the inaugural Digital Surgery Summit by Jean Nehme, co-founder at Digital Surgery

Just over one year ago, in my blog post, “The Dawn of Digital Surgery”, I reflected on the digital technologies that have transformed our day-to-day lives and outlined our company’s ambitions to continue to digitize surgery and extend into the operating room (OR).

One year later, we’ve been fortunate to cohost our inaugural Digital Surgery Summit, which gathered top-tier investors, leading surgeons, and key industry members to discuss all things  digital surgery.



Industry 4.0 and Surgery 4.0

The same forces are at work in surgery, defining the boundaries of ‘Surgery 4.0’ or ‘Digital Surgery’. Like the shifts that came before it – from laparoscopic to robotic surgery – change is being driven by the need for better outcomes, and the need for more supply at lower costs.

What’s distinct about the digital surgery revolution is that it’s not a single technological shift – for example, better visualization or improved cavity access – but rather, a system-level shift. It’s a shift that affects the link between what happens in the OR and what happens outside of it. Without a doubt, surgical tools will continue to evolve. Far beyond the type or form of advancement, however, the thesis for digital surgery coalesced around a core fundamental: culture change. Digital must become THE standard for surgery and we must support a “collective surgical knowledge base” by adopting a “one-to-many” learning model.

Of course, we must also be clear about the fundamental goals of digital surgery. Aside from improved quality and reduced costs, my personal view is that we need to get better at scaling surgery, in a manner that ensures equality. Today, access to surgical care is limited to just under half of the world’s population. We must get better at democratizing surgery.



Figure 2. Carla Pugh, Professor of General Surgery, Stanford School of Medicine speaking about objective quantification of operative skills in surgery.


“Ground Truth” through Data and Transparency

Actionable and validated data will fuel the transition to digital surgery – the ability to process greater volumes of data at faster speeds and the capability to derive structured data from unstructured data.

Although we’ve gotten a lot better at collecting and using data in surgery, war stories from audience members revealed just how hard it (still) is to understand the “ground truth.” Administrative data, sitting in EHR’s, remain shallow and erroneous. Some health systems are beginning to employ dedicated staff to cleanse administrative data. The rationale behind it is simple: it’s too expensive to have bad data.

The arrival of accurate and actionable data can facilitate the realization of value-based care in surgery, allowing for a better understanding of the patterns of care delivery against the patterns of costs and outcomes. Parallels can be drawn between our personal experiences with digital entities, e.g. Uber and Amazon, which have vastly improved the consumer experience and reduced the price of goods and services. If executed well, data and digital services in surgery are expected to have a similarly welcomed impact on cost and the consumer experience.

In my personal reflections after the event, I am reminded of the impact of clinical registries on the joint reconstruction business. Prior to mandatory reporting, joint replacement treatment choices were highly complex, due to the vast array of implantable devices available, and often resulted in suboptimal outcomes. Data availability has increased significantly since the establishment of the first joint registry four decades ago, and this has fundamentally changed the orthopedic clinical and product landscape. Once again, I return to my conviction in the necessity of culture change: the willingness by all stakeholders to embrace data and transparency, as part of the journey to make high-quality, cost-sustainable and scalable surgical care the global standard.



Figure 3. Panellists discussing ‘digital surgery in the context of value-based care’. Featured from left to right: Dinesh Vyas, Chair, Department of Surgery, College of Medicine, California Northstate University; Heather Lyu, General Surgery Resident, Brigham and Women’s Hospital; Sarah Neville, Global Pharmaceuticals Editor, Financial Times; Jean Nehme, CEO and Co-founder, Digital Surgery Ltd. Not featured above: Ozanan Meireles, Assistant Professor of Surgery, Massachusetts General Hospital and Harvard Medical School.



Continued Improvement of Robotic Intelligence

Robots will become smaller and more compact in their construction. Without a doubt, these advancements will make robotic surgery relevant to a wider range of procedures. However, it is only at the intersection of AI and data that robotic surgery can truly address the elephant in the room: surgical variation. Surgery, although a technically-demanding profession, is largely dependent on the decision-making capabilities of the surgeon. Variability in surgical education and other factors mean that the same procedure, performed by two different surgeons, can result in very different outcomes. What if we can leverage data and a surgical robot that is powered by AI, allowing it to independently interpret the surgical scene, annotating anatomical parts (e.g. the edge of the tumor) and guiding the surgeon, in real-time? This is the full promise of digital surgery.


Final Thoughts

One of my favourite talks of the day outlined what the surgical department of one health system is doing to prepare itself for the future of surgery. The presentation outlined investments into building data infrastructures, and curating reliable data to explore disease mechanisms, process optimization, and surgical decision-support. What was inspiring about this particular talk was the underlying vision for surgery: moving from the realm of opinion-based surgery to data-based surgery.

From the point of view of a co-organizer, it was fantastic to see so many individuals from all backgrounds gathered in the same room, congregating around the same denominator: a vision for a safer, more evidence-based future for surgery. Thank you to all the attendees and speakers who joined us in San Francisco.

From the point of view of a student, it was an incredible learning opportunity to engage with those who are leading the charge on realizing the vision of digital surgery. For everyone else who would like to join us next year, please don’t hesitate to get in touch.