A brand-new performance

The operating theatre was named owing to its thespian-like origin. The ratio of actors to spectators was once analogous with patients to doctors. Patients drew centre stage for surgeons and professionals to practice, learn, and teach. In reflection of how much was yet to be understood, procedures in the operating theatre were, theatrical.

The heart, the liver, the spleen, oh my! Medical professionals took to the theatre to adorn on the spectacle of the human body.

Of more recent time, digital advances and the introduction of video recording has allowed for operations to be captured and stored; learning no longer had to take place in the theatre. Dispersion of recordings meant that the operating theatre could travel between office rooms of multi-disciplinary meetings to large-scale Congress conferences. The attendance in an operating theatre was no longer restricted to the number of seats. The theatre was bigger than ever before: Global.

Somewhere down the line the theatre streamlined to a much more intimate affair. What was once uncharted, nameless, and undiscovered, is now documented, named (usually after someone) and, discovered. So many minds have influenced the ‘performance’ within the operating theatre.

What can we expect from the performance of future theatres? Are we looking at ‘more’ sterility, ‘improved ‘protocol, or ‘better’ equipment? The introduction of robotics and ever evolving technologies suggests that the operating theatre can have it all.

The intricacy of robotics is arguably becoming more refined. Performances of robotic systems are constantly being fine-tuned to represent less cabaret and more… ballet. Surgically simulated environments are proving popular to enhance performance of surgeons and improve patient outcomes. Technology that cultivates patient anatomic environments are being refined to provide ‘dress rehearsals’ of surgical procedures, before the patient is even on the table. Though, the efficacy of the simulation lies with the uniformity of the surgical environment. This is where the artificial intelligence (AI) is coming in.

The advancement of AI has progressed exponentially since its inauguration, and to the most extent within the last ten years. Operative robots are now being conceptualised into cyborg-like humanoids, controlled by surgeons through holographic technology. AI systems are even advancing large language models (LLMs) capable of interpreting medical imaging and answering exam style questions.

Not only do these advancements change the dynamic of the operating theatre but they suggest the opportunity to remodel the whole stage. The development of the next AI generation is suggested to provide superior systems to best practice protocols, surpassing human intervention. It is indicated that by 2050, the need for surgeon control could be surplus.

Is this a curtain call for the ‘operating theatre’ as we know it? In 2050, could it be that there are no surgeons at all? That the performance of surgical staff is replaced and conducted by programmed patterns and responses of artificially generated systems?

The truth of the matter is that no one really knows what is to come.

The fast-paced development of AI and its claims of superiority over human intervention may lend itself to an all-robotic operating theatre in 25 years’ time. However, alike clinical trials, or any clinical intervention for that matter, the efficacy and safety of AI in surgery requires vigorous scrutiny. The development of autonomous operative robots is still in stages of development, with systems such as the da Vinci still requiring full surgeon operator control for full functional capacity. The most advanced system to date is capable of suturing and bone drilling, with fully autonomous systems still purely conceptual. However, the promise of complete autonomy is supported by integration of multi-industry AI technology and is currently receiving significant investment for its evolution.

One of the many benefits to an all-robotic theatre is the ability to standardise operative techniques, a higher accuracy, and elimination of human fatigue and bias. One may argue however, that removal of human surgeons is the removal of the very essence of surgery. It could be argued that the operating theatre of 2050 may gain uniformity but lose innovation. Can a robot ‘think on its feet’ and deal with a situation that isn’t part of its programmed responses? Can it pioneer a new solution to circumstances beyond its database? Whilst the development of safety and accuracy is paramount, and its application in combat zones or hostile environments notable, the push for development of these technologies is arguably ignoring the importance of surgeons -humans- in surgery.

Human or droid, the environment in which surgeries take place will likely also change considerably by 2050. The advancement in technology will continue to move towards minimally- or non-invasive procedures, and with that, minimally scaled operating theatres. The developmental timeline of semantic segmentation and its place in laparoscopic surgery is an example for the rate at which we can expect technology to infiltrate surgical protocol. To what extent this will minimise staff, as well as invasiveness, is yet to be observed. With the comparable efficacy of minimally invasive surgery to open methods still under dispute, particularly pertaining to hernia surgery, the movement away from hospital theatres will not be without challenge. Notwithstanding the clinical impact of such changes, but the current economic and financial standing of health services worldwide suggest the repurposing or retrofitting of premises to present its own barriers.

In conclusion, it can be predicted that the operating theatre will change by 2050. The performance and those which perform may change, but ultimately, the patient will always be centre stage.