Surgical innovation and regenerative medicine

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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


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