Future of endoscopic gynecologic surgery

Augmented reality, a surgical black box, and tissue engineering are three technologies that bode well for the future of endoscopic gynecologic surgery, according to a panel presentation at the American Association of Gynecologic Laparoscopists’ (AAGL) 2020 Virtual Global Congress.

“Improved vision, laparoscopy and endoscopic surgery were made possible by an image revolution,” said Michel Canis, MD, PhD, an ob/gyn from Clermont-Ferrand, France, who chaired the panel. “But new revolutions are coming using augmented reality and fluorescence, which will allow us to see structures which are not now visible. We will also be able to understand and to visualize intraoperative physiology -- an essential tool when deciding intraoperative management. Computer vision will be a major step forward.”

Dr. Canis told Contemporary OB/GYN that although the concept of

augmented reality is well known, few surgeons understand its exact meaning. “Moreover, very few surgeons are aware that augmented reality may become a surgical tool within the next few months or years,” he said.

Improved vision has always been the main catalyst of endoscopic approaches. “Together with fluorescence, augmented reality will revolutionize the world of surgery,” Dr. Canis said.

On the other hand, a surgical black box will benefit the complex environment of an operating room (OR). “Analyzing this airline technology is something new for the medical field,” Dr. Canis said. “Studies clearly demonstrate that many events which can cause complications in the OR are not noticed by OR personnal, so the ability to analyze these at-risk events by using computers and artifical intelligence (AI) technology will improve our knowledge of what happens in the OR and our ability to improve outcomes, particularly when it comes to safety.”

Tissue engineering is also expected to play a major role in the future, due to an aging population, for which reconstructive surgery such as prolapse surgery will become increasingly important. “The complications related to meshes clearly indicate the risks of foreign materials,” he said. “However, few surgeons are aware that by using three-dimensional (3D) bioprinting and stem cell technology, we will be able to design meshes without any non-organic components, thus likely leading to much fewer complications.”

The ability to produce meshes with biologic components is of major signifance for prolapse surgery because after surgery without meshes, “the risk of recurrence is close to 40%,” Dr. Canis said.

Tissue-engineered technologies will also be used for adhesion prevention and for treating uterine synechia.

Some of these innovations will be easier than others to incorporate into practice. For instance, virtual reality tools will be software that is not very expensive, although preoperative magnetic resonance imaging (MRI) will be required.

A surgical black box is somewhat uncomfortable for surgeons at the beginning, but education will help them to accept the technology, even though most surgeons are afraid of litigation, according to Dr. Canis. “This fear is unwarranted, however, because the data are stored for 6 weeks only,” he said. “Afterward, the data are destroyed, so they are not available for judges and lawyers.”

Lastly, Dr. Canis believes tissue-engineered meshes will be readily embraced by surgeons because they will be happy to implant a mesh without long-term risks.

Dr. Canis takes inspiration from a quote from former First Lady of the United States, Eleonore Roosevelt: “The future belongs to those who believe in the beauty of their dreams.”

Dr. Canis was joined by three experts who have published extensively about the future of surgery: Nicolas Bourdel, MD, PhD, from France; Teodor Grantcharov, MD, PhD, from Canada; and Caroline Gargett, MD, PhD, from Australia.

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Dr. Canis is co-founder of SurgAR, a French virtual-reality startup.