Role of Innovation in Surgery:
Historical perspective and A
way forward
Muhammad Saleem
Professor of Pediatric Surgery, Professor Emeritus, University of Child Health
Sciences, Lahore, Pakistan
Introduction
Innovation is the lifeline of surgical advancement. Discipline of surgery, has always
stood at the crossroads of skill, science, and technology. Throughout history, the
innovation has played a critical role in evolution of surgical instruments and
techniques, refining them from crude instruments and procedures/techniques of the
past to highly advanced technology like robotic systems today, continuously driven by
innovation. From basic open procedures to complex minimally invasive and robotic
techniques, innovation has shaped every aspect of surgical care. This editorial
enlighten the historical milestones, recent advancements, and future prospects of
innovation in surgery, emphasizing its very important role in improving patient
outcomes, surgical safety, and the scope of operative procedures especially in low
recourse settings.
Past: The Foundation of Modern Surgery
Although history of surgery dates back to before Christianity, but in early days,
surgery was very limited due to lack of understanding of anatomy, infection control,
and anesthesia. Hippocrates and Zaharwi were well known surgeons of the past and
they invented many surgical instrument and techniques. Then there is an era of
darkness. Afterward Landmark innovations such as antisepsis by Joseph Lister,
ether anesthesia by William Morton, and the discovery of antibiotics by Fleming
revolutionized surgical safety and feasibility ⁽1⁾. John Hunter is recognized as father
of new era of surgery. The introduction of surgical sutures, sterilization techniques,
and blood transfusion further expanded the boundaries of surgery. Open surgery
dominated the early 20th century, with procedures becoming more sophisticated as
knowledge of human physiology and surgical anatomy improved.
Present: The Era of Minimally Invasive
and Digital Surgery
In the late 20th century, the introduction of minimally invasive techniques, such as
laparoscopic and thoracoscopic surgery, resulted in a paradigm shift in context of
patient trauma, recovery time, safety and cost effectiveness, ⁽2 ⁾. It markedly improved
cosmetic outcomes too.
The present surgical landscape is also characterized by the widespread adoption of
robotic systems (e.g., da Vinci), computer navigation, and image-guided
interventions, enhancing precision and dexterity ⁽3⁾. Artificial Intelligence (AI),
augmented reality (AR), and 3D printing are now integrated into preoperative
planning, intraoperative assistance, and postoperative care, particularly in complex
fields like pediatric surgery ⁽4⁾. Moreover, telemedicine and remote surgical
training using virtual platforms are addressing disparities in access to specialized
care, especially in low-resource settings.
Future: The Promise of Personalized and
Autonomous Surgery
Looking in to the future, innovation in surgery is poised to enter an era of
personalized, data-driven, and autonomous procedures. AI-powered platforms are
expected to enhance decision-making, predict surgical risks, and guide real-time
intraoperative actions with minimal human intervention ⁽5⁾.
Regenerative medicine, bioprinting of tissues and organs, and nanotechnology
may soon enable the repair or replacement of complex structures previously
considered inoperable. Fully autonomous robotic systems performing intricate
surgical tasks remain a long-term possibility, though ethical, legal, and regulatory
frameworks are yet to be developed.
Future challenges: A very important challenges is keeping in the human
element in patient care, ensuring equitable access to new technologies, and training
future surgeons to balance innovation with judgment and empathy.
Pathway to Safe and Effective Innovation
Innovation’s true success lies in mindful adoption. The IDEAL framework (Idea,
Development, Exploration, Assessment, Long-term study) provides a structured road-
map for introducing and evaluating surgical innovations responsibly ⁽7⁾. Surgeons
must also receive proper training through simulation and mentorship before
transitioning to new tools and techniques ⁽8⁾.
In low-resource settings, innovation assumes a different but equally important role.
Cost-effective surgical kits, simplified procedures, and telemedicine platforms have
democratized access to safe surgery where it was previously limited or unavailable.
Ethical, Economic, and Global Implications
High cost and infrastructure requirements can limit access, especially in low-resource
regions. However, innovative “frugal” technology solutions and remote robotic
systems (e.g., telesurgery) offer hope for broadening surgical equity ⁽9⁾. Ethical
considerations—such as data privacy, device regulation, and patient consent—must
also shape implementation strategies ⁽10⁾.
Conclusion
Surgical innovation has transformed the field from rudimentary manual interventions
to sophisticated, technology-driven procedures. Its continued evolution promises
safer, more effective, and personalized surgical care. However, this progress must
remain anchored in ethical practice, surgical expertise, and a commitment to
improving global surgical equity. The journey of innovation in surgery is far from
over; indeed, its most exciting chapters may yet lie ahead.
References (Vancouver Style)
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Saleem M, Talat N, Hashim I, et al. COVID-19 Pandemic: Advisory and Consensus
Statement from APSP. J Pediatr Adolesc Surg. 2020;1(1):5-12.
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