Innovation in surgery: A historical perspective

  • Riskin D
  • Longaker M
  • Gertner M
 et al. 
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Objective: To describe the field of surgical innovation from a historical perspective, applying new findings from research in tech-nology innovation. Background: While surgical innovation has a rich tradition, as a field of study it is embryonic. Only a handful of academic centers of surgical innovation exist, all of which have arisen within the last 5 years. To this point, the field has not been well defined, nor have future options to promote surgical innovation been thoroughly explored. It is clear that surgical innovation is fundamental to surgical progress and has significant health policy implications. A process of systematically evaluating and promoting innovation in surgery may be critical in the evolving practice of medicine. Methods: A review of the academic literature in technology inno-vation was undertaken. Articles and books were identified through technical, medical, and business sources. Luminaries in surgical innovation were interviewed to develop further relevance to surgical history. The concepts in technology innovation were then applied to innovation in surgery, using the historical example of surgical endoscopy as a representative area, which encompasses millennia of learning and spans multiple specialties of care. Results: The history of surgery is comprised largely of individual, widely respected surgeon innovators. While respecting individual accomplishments, surgeons as a group have at times hindered critical innovation to the detriment of our profession and patients. As a clinical discipline, surgery relies on a tradition of research and attracting the brightest young minds. Innovation in surgery to date has been impressive, but inconsistently supported. Conclusion: A body of knowledge on technology innovation has been developed over the last decade but has largely not been applied to surgery. New surgical innovation centers are working to define the field and identify critical aspects of surgical innovation promo-tion. It is our responsibility as a profession to work to understand innovation in surgery, discover, translate, and commercialize ad-vances to address major clinical problems, and to support the future of our profession consistently and rationally. (Ann Surg 2006;244: 686 – 693) O ver the last decade, the concepts and principles of innovation have largely been defined through research and publication in the business literature. 1–3 These concepts in innovation may now be applied to other professions. Surgery, as one of the oldest and most respected fields, built upon continuous innovation, has a unique culture and deep tradition. While some aspects of research in the broad field of innovation are directly applicable to surgery, many unique aspects of our craft and practice require specialized thought. As such, perhaps it is the surgeon's responsibility to describe and study innovation as it applies to our field. " The abdomen, the chest and the brain will forever be shut from the intrusion of the wise and humane surgeon. " So opined Sir John Ericksen, Surgeon Extraordinaire to Queen Victoria in 1837. Today our surgeon colleagues will perform an average of 80,000 operations each day, many in the abdomen, the chest, or the brain. Innovations that took us from then to now can be thought of in several broad catego-ries (Fig. 1). While innovation in surgery has a rich tradition, the field and study of surgical innovation are new. Ten peer-reviewed articles focusing specifically on surgical innovation have been published in the last 10 years, 5-fold the total number of previous publications. An increasing number of surgical leaders think that innovation may be the only way to maintain the quality of their profession. 4 To date, attempts have been made to systematically evaluate broader concepts in technology innovation as they apply to surgery. Within a context of surgical history, specifically that of surgical en-doscopy, we have tried to reference current concepts in the broadest context of technology innovation to the field of surgical innovation. Each section of this article will describe an aspect of innovation followed by support from historical references. Our goal in writing this article is to initiate a dialogue on surgical innovation practice and policy that builds upon emerging concepts in technology innovation research. Cur-rent thought will be reviewed and new terms and concepts

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  • Daniel J. Riskin

  • Michael T. Longaker

  • Michael Gertner

  • Thomas M. Krummel

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