Towards the Future of Surgery (New Paradigms in Healthcare)

The book provides an overview of the characteristics and skills – both technical and soft - needed to become the surgical leaders of tomorrow. During the COVID pandemic, the methodological weakness in accessing and disseminating information in has become evident: this has fostered the digital development and has favoured the creation of networks and communities of individuals (not only physicians or surgeons) pointing the way to global knowledge sharing. The development of the technological offer applied to surgery has been very rapid, with the integration of minimally invasive and robotic surgery with artificial intelligence and computerization of decision-making processes, up to the extreme limit of space surgery. However, in the future of this discipline surgeons will no longer need to consider only improved access to knowledge and evolution of technology, as a great challenge will be represented by the parallel development of non-technical skills (leadership, communication, team-working) and by the careful application of healthcare management principles to clinical practice. Finally, in the near future (but already in the present), it will be impossible to ignore the economic impact of high-tech care and equity in access to care. The book describes a journey, which starts from the history of surgical education to cross the most relevant perspectives of present and future, exploring new learning models, the thousand applications of artificial intelligence, and surgical technology to the space and back. Preface Contents Part I: Introduction Chapter 1: How to Create a Surgeon: The Surgical Leaders of Tomorrow Technological Digital Manager Woman Amazing References Chapter 2: How to Create a Surgeon: History of Surgical Training Introduction Toward Surgical Education The Renaissance of Surgery Anatomy and Surgery Women The Revolution Present and Future References Part II: Research and Knowledge Chapter 3: E-Learning and Surgery: The Value of Sharing Knowledge Introduction Current Perspectives on E-Learning The IRCAD Experience The Quest for Standardization The Future of E-Learning References Chapter 4: Network and Social Media: The Digital Surgeon Definition of Digital Surgery The Role of Social Media Surgical Training and Artificial Intelligence Data Analysis, Collection, and Sharing Database Telemedicine and COVID-19 Age Limitations of the Digital Surgeon Future Perspectives References Chapter 5: Online Surveys and Collaborative Groups: Big Numbers, Low Evidence? Collaborative Research How Did It Start? What Has Happened Since WMRC? How Is It Organised? Advantages of Collaborative Research Controversies and Limitations Related to Collaborative Research Authorship of Manuscripts: Defying the Traditional Methodology Controversies Behind Multicentre Studies Is Collaborative Research the Future of Research? Survey-Based Research Definition and Type of Surveys Which Surveys Can Be Used for Surgical Research What Surveys Should Not Be Used for How to Plan and Execute a Survey Before Starting the Actual Survey Define the Population to Be Addressed How to Improve Response Rates Online Tools to Plan and Deliver Surveys References Part III: Technical Skills Chapter 6: When Surgery Meets the Metaverse Training Visualization: From Glasses to Holograms Navigation: Intraoperative Guidance Simulation: From 3D Reconstruction to Printing Patient Conclusion References Chapter 7: Towards the Future of Endoscopic Ultrasound Introduction History of EUS: Rapid Evolution in “Add-Ons”, Slow in Design Ongoing Developments in EUS and Possibilities for the Future Application of AI Systems: Computer-Aided Diagnosis for the Assessment of Pancreatic Disorders Navigation Tools Combining EUS with Other Diagnostic Modalities: Potential Arising from the Integration of Imaging Techniques for a Better Use of Technology Application of AI-Based Systems in Training and Education Robotics in EUS Development of Endosound: A Tool for Democratizing EUS Conclusions References Chapter 8: New Frontiers in Post-Surgical Rehabilitation Introduction The National Cancer Institute Case Study Conclusions References Part IV: Non-technical Skills Chapter 9: New Surgical Leaders Built on Non-technical Skills: Communication, Team Dynamics, and Leadership The Discovery of Non-technical Skills in Surgery Inside Non-technical Skills Training for Non-technical Skills The Surgeon of the Future References Chapter 10: High Reliability: The Next Frontier for Patient Safety in Surgery Introduction High Reliability in Surgery The “Team Dynamics” Experience Surgical Safety Checklists Non-technical Skills Conclusion References Chapter 11: Women in Surgery: A Long Way to Equity The History of Women in Surgery Women in Medicine and Surgery The Foundation of Women’s Surgical Societies Women in Surgery: Statistics Type of Gender Discrimination Gender-Based Discrimination Discrimination in Leadership Positions Discrimination in Academia: Authorship, Research Productivity, Founding Discrimination in Surgical Societies Work-Life Imbalance Gender Pay Gap How Can the Gender Gap in Surgery Be Minimized? Conclusions References Chapter 12: Shared Decision-Making and Coproduction in Surgery: The Patient Is the Cure Coproduction and Shared Decision-Making in the Modern Healthcare Scenario Shared Decision-Making in Complex Surgical Contexts Results from the World Society of Emergency Surgery Experience Implications and Future Research Avenues Bibliography Chapter 13: A Multidisciplinary Approach to Surgical Care: The Case of Disease Units. A Delphi Consensus on the Newly-Born Pancreas Units Introduction The Need for a Multidisciplinary Approach to Pancreatic Cancer Care The Pancreas Units as Defined by the Lombardy Region in Italy A Multi-Stakeholder Approach to Pancreatic Cancer Care Methodology Results Section 0. Descriptive Statistics Section 1. Organisational Factors Section 2. Stakeholders Section 3. Non-technical Skills Section 4. Processes and Knowledge translation Facilitators Discussion Conclusions Appendix 1 Delphi Protocol (English Version) Section 0—Descriptive Statistics Section 1—Organisational Factors (14 Items) Section 2—Stakeholders (18 Items) Section 3—Non-technical Skills (1 + 16 Items) Section 4—Processes and Knowledge Translation Facilitators (32 Items) Delphi protocol (Italian version) Sezione 0—Statistiche Descrittive Sezione 1—Fattori Organizzativi (14 Elementi) Sezione 2—Portatori Di Interesse (18 Elementi) Sezione 3—Competenze Trasversali (1 + 16 Elementi) Sezione 4—Processi E Strumenti Di Traduzione Della Conoscenza (32 Elementi) References Part V: Healthcare Management Chapter 14: Dr Surgeon & Mr. Manager: The Hybrid Role of Surgeons Introduction Methodology Results Impacts Claimed New Skills Required Emerging Difficulties Strengths and Opportunities Identified for Improvement Surgeons as HMs Discussion and Conclusions References Chapter 15: Towards the Healthcare of the Future. A Delphi Consensus on Environmental Sustainability Issues Introduction Methodology Results Section 0: Descriptive Statistics Section 1: Sustainability Acceptance and Change Management Section 2: Sustainability Habits in Clinical Practice Discussion Conclusions Appendix Delphi Protocol (English Version) Section 0: Descriptive Statistics Section 1: Sustainability Acceptance and Change Management Section 2: Sustainability Habits in Clinical Practice References Chapter 16: Towards a Green Surgery: The Problem of Costs and Sustainability in Surgical Practice Introduction Waste Production Water Consumption Anesthetics Other Sources of Emission Further Controversies and the 5Rs Greening Surgery Is Greening People References Part VI: Over the Future Chapter 17: The Bionic Man: From Neuromodulation to Visual Prosthesis Introduction Brain Senses Limbs Heart Visceral Activity Pelvic Floor Conclusions References Chapter 18: Regenerative Surgery: Tissue Engineering in General Surgical Practice Biomaterial Science, Regenerative Medicine and Tissue/Organ Bioengineering Tissue Engineering Applications in General Surgery Abdominal Wall Reconstruction with Tissue-Engineered Solutions Innovations in Skin Engineering and Regenerative Medicine for Skin Replacement Tissue Engineering and Regenerative Medicine Applied to Gastrointestinal Tract Tissue Engineering Applied to Esophageal Replacement Tissue Engineering Applied to Stomach Organ Engineering Applications in Transplantation Surgery Bioengineering Liver Transplantation Bioengineering Pancreas Transplantation Bioengineering Kidney Transplantation Extracellular Matrix and Tumor Bioengineering Conclusions: Future Directions and Challenges References Part VII: Conclusions Chapter 19: Translating Knowledge in Surgery Introduction The Concept of Knowledge Translation and Its Facilitators Tools Based on Technology Tools Based on Technical Skills Tools Based on Non-technical Skills Educational Resources Creative Instruments Social-Activity-Based Instruments An Overview of Knowledge Flows and Translation Processes in Surgery Knowledge Translation to Promote Equity and Limit Surgical Disparities References