Surgeon-anatomist to robotic technician? The evolving role of the surgeon over three centuries

Abstract

In the 18th century, anatomy was the principal science underlying surgical practice. Over the next three centuries, the scientific basis of surgery changed dramatically. Morbid anatomy led to the understanding of organ-based pathologies that allowed surgeons to remove, reconstruct and in some cases replace internal organs. In the 19th century, the new science of microbiology facilitated antisepsis, then asepsis as surgery progressed from a craft to a scientific discipline. Yet many surgeons believed that surgery was not merely a science but also an art, in which the creativity of the doctor was necessary for progress. Surgical advancement depended on creative individuals with innovative flair, prepared to pioneer often risky procedures in the face of mainstream opposition. The 20th century saw a series of changes that made such individualism more difficult. ‘Scientific Management’ when applied to surgery decreed that procedures be performed according to predetermined schedules, a drive to uniformity producing better outcomes and diminishing individual variation. Yet inventive individuals continued to produce surgical advances. In the 21st century, moves toward standardisation developed further. The escalating safety culture in surgery moderates the introduction of novel, potentially riskier procedures, while more and more regulation increasingly requires surgeons to adhere to guidelines and protocols, further restricting surgical individualism. Moreover, the role of the individual is further diminished, as surgical care is delivered by teams, both in deciding management in major cases and in the operating theatre. The introduction of robotics into surgery has led to the suggestion that the role of the surgeon may become that of a technician. Will these constraints, and greater patient involvement in decisions, allow tomorrow’s surgeons the freedom to innovate? We believe that the pioneering spirit, imagination and flair will not be lost. Tomorrow’s surgeons must remain doctors, showing the compassion and empathy that robots cannot provide.

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“…The foundation for this individualism was based on the study of anatomy, predominantly inspired by the first Edinburgh Professor of Anatomy, Alexander Munro (1697-1767) and the surgeon anatomist brothers, William Hunter (1718-1783) and John Hunter (1728-1793) [2]. John Hunter is generally regarded as the father of scientific surgery; he proposed that surgery should be based on the principles of reasoning, observation and experimentation.…”

“…A recent excellent review by Hughes and Macintyre entitled ‘Surgeon‐anatomist to robotic technicians? The evolving role of the surgeon over three centuries’ outlines the history of surgery over the last three centuries from surgical scalpel to current robot assisted technology [2]. Hughes and Macintyre proposed that surgical advancement in the 18th and 19th centuries depended on creative individuals with innovative flair who were prepared to pioneer often risky procedures in the face of mainstream opposition [2].…”

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“…A recent excellent review by Hughes and Macintyre entitled 'Surgeon-anatomist to robotic technicians? The evolving role of the surgeon over three centuries' outlines the history of surgery over the last three decades from surgical scalpel to current robot assisted technology [7]. Hughes and Macintyre [7] proposed that surgical advancement in the 18th and 19th centuries depended on creative individuals with innovative flair prepared to pioneer often risky procedures in the face of mainstream opposition.…”

Surgeon robots and safe anaesthesia

“…In their interesting article on the future of surgery, 1 the authors state: ‘With increasing knowledge of internal organs, from the mid-19th century, surgeons were able to consider entering body cavities … yet little surgery was performed within the abdominal cavity because of the risk of introducing infection …’…”