Surgical innovation and regenerative medicine

Improvements and innovation in surgery

Over the past 20 years surgical innovation has significantly improved patient outcomes, rates of complications and length of stay (1,2,3). This improvement will continue as minimally invasive surgical techniques, robotic systems and virtual reality training enter mainstream use.

Worldwide, the number of robot-assisted procedures increased from 80,000 in 2007 to 205,000 in 2010 (4).

Robotic systems can enable surgeons to carry out complex procedures with a shorter inpatient stay (5). Although, robotic systems are expensive and use patented software, the next generation of systems will be smaller and more affordable. Surgeons will use the systems to assist with advanced precision surgery and to perform operations remotely (6,7,8,9,10,11).

Virtual simulation tools are already used to train medical students; their use is likely to become more widespread as procedures become more intricate (12,13).

Advanced surgical techniques could dramatically increase our capacity to treat many conditions, including cancer. However, robotic systems also require significant investment, which could impede innovation and implementation on a larger scale restricting them to specialist or teaching hospitals (14).

Developments in regenerative care

Regenerative medicine has enormous potential. This emerging field spans stem cell transplantation, cell reprogramming, synthetic organ creation through tissue engineering and nanotechnology. However, despite the progress of the past 10 years, it is still uncertain how regenerative medicine will develop in the future. Currently, effective and safe regenerative therapies beyond bone marrow transplants remain elusive and expensive.

Synthetic bladders and tracheas, grown in a lab (15,16), have already been used in operations. Early results are promising and this method has the potential to revolutionise the supply of organs for transplantation.

Xeno-transplantation (using organs from genetically engineered animals, particularly pigs) is in the initial research stage. Pig heart valves are already in routine use, but timescales for full organ transplantation are unclear (17,18). Portable artificial 'organs', such as the artificial pancreas, wearable haemodialysis units and artificial sight through retinal implants are possible in the near future (19,20,21,22,23).

Within stem cell research, regenerative transplants would enable clinicians to replace failing or dead cells with functioning reprogrammed adult cells (24). The ability to reprogramme heart cells could be achieved within 10 years, and other cell types, such as liver and pancreas, within 20 years (25). Early clinical studies transplanting embryonic stem cells into mice have been able to restore sight and treat heart failure; scientists are now working towards translating these developments to benefit humans (26,27,28).

The ability to maintain sustainable investment in research and ethical concerns could hamper the speed of progress.

Next trend: Information technologies >

References

  1. Maeso S, Reza M, Mayol JA, Blasco JA, Guerra M, Andradas E, Plana MN (2010). Journal article. ‘Efficacy of the Da Vinci surgical system in abdominal surgery compared with that of laparoscopy: a systematic review and meta-analysis’. Annals of Surgery, vol 252, no 2, pp 254–62.
  2. Reza M, Maeso S, Blasco JA, Andradas E (2010). Journal article. ‘Meta-analysis of observational studies on the safety and effectiveness of robotic gynaecological surgery’. British Journal of Surgery, vol 97, no 12, pp 1772–83.
  3. Weinberg L, Rao S, Escobar PF (2011). Article. ‘Robotic surgery in gynecology: an updated systematic review’. Obstetrics and Gynecology International.
  4. Barbash G, Glied SA (2010). Journal article. ‘New technology and health care costs: the case of robot-assisted surgery’. New England Journal of Medicine, vol 363, no 8, pp 701–4.
  5. Health Services Journal. News article. Torbay Hospital robot in worldwide first. 20 July 2012
  6. Boggi U, Vistoli F, Signori S, D’Imporzano S, Amorese G, Consani G, Guarracino F, Melfi F, Mussi A, Mosca F (2011). Article. ‘Robotic renal transplantation: first European case’. Transplant International, vol 24, no 2, pp 213–18.
  7. Ahmed HU, Hindley RG, Dickinson L, Freeman A, Kirkham AP, Sahu M, Scott R, Allen C, Van der Meulen J, Emberton Ml (2012). Journal article. ‘Focal therapy for localised unifocal and multifocal prostate cancer: a prospective development study’. Lancet Oncology, vol 13, no 6, pp 622–32.
  8. Dieterich S, Gibbs IC (2011). Article. ‘The CyberKnife in clinical use: current roles, future expectations’. Frontiers of Radiation Therapy and Oncology, vol 43, pp 181–94.
  9. Dolghi O, Strabala KW, Wortman TD, Goede MR, Farritor SM, Oleynikov D (2011). Article. ‘Miniature in vivo robot for laparoendoscopic single-site surgery’. Surgical Endoscopy, vol 25, no 10, pp 3453–8.
  10. Shah BC, Buettner SL, Lehman AC, Farritor SM, Oleynikov D (2009). Article. ‘Miniature in vivo robotics and novel robotic surgical platforms’. Urologic Clincs of North America, vol 36, no 2, pp 251–63.
  11. Economist. Article. Surgical robots: The kindness of strangers 
  12. Patel HR, Patel BP (2012). Article. ‘Virtual reality surgical simulation in training’. Expert Review of Anticancer Therapy, vol 12, no 4, pp 417–20.
  13. Tan SS, Sarker SK (2011). Journal article. ‘Simulation in surgery: a review’. Scottish Medical Journal, vol 56, no 2, pp 104–9.
  14. Hottenrott C (2012). Article. ‘Robotic surgery and limitations’. Surgical Endoscopy, vol 26, no 2, pp 580–1.
  15. Jungebluth P, Alici E, Baiguera S, Le Blanc K, Blomberg P, Bozóky B, Crowley C, Einarsson O, Grinnemo K-H, Gudbjartsson T, Le Guyader S, Henriksson G,  Hermanson O, Juto JE, Leidner B, Lilja T, Liska J, Luedde T, Lundin V, Moll G, Nilsson B, Roderburg C, Strömblad S, Sutlu T, Teixeira AI, Watz E, Seifalian A, Macchiarini P (2011). ‘Tracheobronchial transplantation with a stem-cell-seeded bioartificial nanocomposite: a proof-of-concept study’. Lancet, vol 378, no 9808, pp 1997–2004.
  16. Nature news blog. Nature magazine. What's new about new synthetic organs? 
  17. Cooper DK, Ayares D (2011). Journal article. ‘The immense potential of xenotransplantation in surgery’. International Journal of Surgery, vol 9, no 2, pp 122–9.
  18. Ekser B, Ezzelarab M, Hara H, van der Windt DJ, Wijkstrom M, Bottino R, Trucco M, Cooper DK (2012). Journal article. ‘Clinical xenotransplantation: the next medical revolution?’. Lancet, vol 379, no 9816, pp 672–83.
  19. Jacobs PG, El Youssef J, Castle JR, Engle JM, Branigan DL, Johnson P, Massoud R, Kamath A, Ward WK (2011). Article. ‘Development of a fully automated closed loop artificial pancreas control system with dual pump delivery of insulin and glucagon’. Conf Proc IEEE Eng Med Biol Soc, pp 397–400.
  20. Feasibility Study of a Portable Artificial Pancreas System in Type 1 Diabetes Mellitus 
  21. Wall Street Journal. Article. Awak to Give Dialysis Patients Freedom
  22. Zrenner E, Bartz-Schmidt KU, Benav H, Besch D, Bruckmann A, Gabel V-P, Gekeler F, Greppmaier U, Harscher A, Kibbel S, Kock J, Kusnyerik A, Peters T, Stingl K, Sachs H, Stett A, Szurman P, Wilhelm B, Wilke R (2011). ‘Subretinal electronic chips allow blind patients to read letters and combine them to words’. Proceedings of the Royal Society B: Biological Sciences, vol 278,no 1711, pp 1489–97.
  23. Scientific American. Article. Electric Eye: Retina Implant Research Expands in Europe, Seeks FDA Approval in U.S
  24. Ilic D, Polak J (2012). Journal article. ‘Stem cell based therapy – where are we going?’. Lancet, vol  379, no 9819, pp 877–8.
  25. Foresight Healthcare Panel (2000). Healthcare 2020. UK Department of Trade and Industry.
  26. Wu KH, Han ZC, Mo XM, Zhou B (2012). Article. ‘Cell delivery in cardiac regenerative therapy’. Ageing Research Reviews, vol 11, no 1, pp 32–40.
  27. Makkar RR, Smith RR, Cheng K, Malliaras K, Thomson LE, Berman D, Czer LS, Marbán L, Mendizabal A, Johnston PV, Russell SD, Schuleri KH, Lardo AC, Gerstenblith G, Marbán E (2012). Article. ‘Intracoronary cardiosphere-derived cells for heart regeneration after myocardial infarction (CADUCEUS): a prospective, randomised phase 1 trial’. Lancet, vol 379, no 9819, pp 895–904
  28. Pearson RA, Barber AC, Rizzi M, Hippert C, Xue T, West EL, Duran Y, Smith AJ, Chuang JZ, Azam SA, Luhmann UF, Benucci A, Sung CH, Bainbridge JW, Carandini M, Yau KW, Sowden JC, Ali RR (2012). Article. ‘Restoration of vision after transplantation of photoreceptors’. Nature, 18 April.