Evidence-based, peer-reviewed commentary and analysis on the future of surgery. Written for clinicians, researchers, industry, and the organisations shaping the future.
Each editorial is permanently archived and citable.
Marginal gains in wound closure: the case for technology-driven bundles and the start of a new Impact Surgery series
Wound complications after gastrointestinal surgery remain an everyday problem despite three decades of research. The marginal gains principle offers a practical framework for change. This editorial launches a new Impact Surgery series on wound closure technology.
Policy
AI Implementation in the NHS: The Responsibilities of MedTech Beyond Sales
AI is increasingly presented as central to the NHS's future. But successful adoption depends on whether the NHS is prepared to implement these tools effectively; and whether MedTech companies accept responsibilities that extend beyond the point of sale.
Policy
Beyond waiting times: The case for a delay framework across colorectal cancer pathways
Despite national targets and continuous investment, improvements in colorectal cancer survival over the last 25 years have been modest. Current NHS waiting time metrics tell us little about where or why delays actually occur. It is time to build a validated delay framework.
Research
Evidence, Adoption, and the Paradox of Surgical Innovation: Lessons from STITCH and the Rise of Robotic Surgery
The STITCH trial provides near-definitive evidence for small-bite fascial closure; yet only one in five UK surgeons use it. Meanwhile, robotic surgery has swept through health systems with limited evidence. What does this paradox reveal about how surgical innovation actually works?
Policy
Patient-centred outcomes in perioperative and surgical care: Days Alive and Out of Hospital
Days Alive and Out of Hospital (DAOH) has become established as a primary outcome in surgical and perioperative research, serving as a proxy for patients' return to function, survivorship, and timely recovery.
Research
Robotic surgery and the evidence challenge in value-based health systems
Robotic-assisted surgery is being implemented at a pace, challenging the capacity of our health systems to appraise its long-term value.
Industry
The growth of robotic surgery: from novelty to necessary infrastructure
Robotic-assisted surgery has now progressed beyond early adoption, and across the world is moving from niche to mainstream.
Analysis
Concepts of robotic surgery in Africa: the prospects for surgical advancement in Nigeria
Only Egypt and South Africa have majorly adopted robotic surgery across Africa. In Nigeria, the economics, infrastructure, and training challenges remain formidable but the future is not without hope.
Robotic Surgery
The role of robotic telesurgery and telementoring in low- and middle-income countries
Robotic surgery alone will not close the surgical gap in low- and middle-income countries. Telementoring — remote guidance using simple video links — offers a more sustainable and scalable route to improving surgical access than telesurgery.
Robotic Surgery
Accelerating the path to sustainable robotic surgery
Robotic surgery generates 43% higher greenhouse gas emissions than laparoscopic alternatives. Reducing that footprint is possible but requires coordinated action from surgeons, manufacturers, hospitals, and policymakers.
Robotic Surgery
The role of the surgical care practitioner in robotic thoracic surgery
A trusted, skilled bedside assistant is essential in robotic surgery. At one UK thoracic unit, surgical care practitioners have become the foundation of a flourishing robotic programme enabling three complex cases per day.
Robotic Surgery
Is there a time when the robotic thoracic surgeon should limit or stop VATS?
As robotic thoracic surgery matures, a provocative question emerges: at what point, if ever, should an established robotic surgeon limit or stop their VATS practice altogether?
Robotic Surgery
We Need to Talk About the Robot in the Room: Orthopaedics
Orthopaedics has grappled with robotics for three decades. Adoption has often outpaced evidence, only now are large-scale RCTs underway to assess whether the investment is truly justified.
Robotic Surgery
Robotics Training: Residents Perspective
UK surgical residents face limited access, steep learning curves, and industry-led pathways with little trainee input. Several mechanisms have been proposed to address this and some are already proving effective.
Training
The Big Five: Training in Robotic Surgery
Robotic-assisted surgery is growing exponentially, but without high-quality, equitable training today, there will be no competent robotic surgeons tomorrow. Five priorities for the field.
Training