Compared to trauma surgeons of today, the trauma surgeon of 2050 will probably know a great deal more about their patient and what’s going on inside them as they paint their torso with betadine. Injury mechanism and the specific location of bleeding vessels or damaged tissues may be more clearly defined, consigning the ‘exploratory’ element of the laparotomy to the history books. The risk of coagulopathy and multi-organ dysfunction will be known allowing for expedited or prolonged surgical procedures as deemed appropriate. The printing of organs known to be damaged beyond salvage may already be in progress in the lab adjacent the OR. The surgeon may have even been able to use augmented reality to rehearse their approach on that exact patient with their reconstructed images having been fed directly from scanner to surgical VR headset. Senior or specialist advice could be remotely sought from elsewhere with the images being securely transferred to an attending or consultant surgeon outside of trauma centre also utilising VR hardware.
Even today, after a decade of advances in damage-control resuscitation we’ve seen the implications of patients who previously would have died at the roadside surviving to get to the OR and succumbing to multi-organ failure on the ICU in the days that follow. By that same reasoning, further advances in prehospital and ED resuscitation may enable even more patients with significant injury burdens to find their way alive (just about) onto the operating table. This calls for advanced surgical techniques that avoid adding to the physiological stress of the initial injury. Nanotechnology will most likely play a significant role in achieving haemostasis. The use of nanobots as an imaging adjunct in locating bleeding cerebral aneurysms, delivering targeted thrombolysis in atherosclerotic disease and delivering targeted chemotherapy has garnered much interest in recent years. Even at the turn of the 21st century in-depth discussions were taking place about the potential for artificial mechanical platelets (clottocytes) inundated with haemostasis promoting proteins to control haemorrhage. Circulating ‘respirocytes’ may be able to maximise oxygen tissue delivery even in low-flow states. With regard to nerve injuries, advancements in technology have led to the development of devices on the nanoscale which allow manipulation of individual axons.
The greater use of nanotechnology to target hard-to-reach bleeding could facilitate a minimally invasive approach to trauma surgery. Furthermore, the knowledge that these nanobots could be left to quietly go about their business inside the patient could mean shorter times on the operating table, minimising the additional physiological insult of prolonged large-incision surgery. Patients could go to ICU with surgery ongoing inside them. The patient’s ICU journey could become more predictable and manageable with greater knowledge of the expected inflammation response owing to genomic analysis and artificial intelligence.
Patients will have greater control of their long-term rehabilitation with individually customised recovery plans and specialist support, building on existing services such as MyRecovery.AI and AfterTrauma.
There is no doubt that the surgeon of the future will need to be ‘multilingual’ in a number of biomedical and allied disciplines, be it genetics, bioengineering, computing or data science. They will need to employ quick thinking and common sense to piece all the various bits of information together. Greater flexibility and multi-disciplinary collaboration throughout medical training will be crucial to this. Technology, however, can never replace the ‘human touch’, especially in a specialty where both patients and relatives will potentially be having the worst day of their entire lives. An in-depth technical and scientific must be coupled the timeless qualities of empathy and compassion.
Obi Nnajiuba is a British surgical resident and current PhD student with a specialist interest in trauma, acute care, prehospital care, triage, mass casualty events and trauma systems. His postgraduate qualifications include an MSc in Trauma Sciences and membership of the Royal College of Surgeons of England. He is also a registered Motorsport UK physician, providing trackside advanced trauma care to competitors at world famous motor-racing circuits such as Brands Hatch, Goodwood and Silverstone.