Innovation Editorial

B Rogers, Editor-in-Chief Annals of the Royal College of Surgeons of England

Every November the Annals aims to publish an edition to coincide with the Royal College of Surgeons of England's Future Surgery conference, an event that has grown in size and reputation over recent years. The mandate of the conference is to afford delegates to “find out how innovation and new technology will change the way you care for patients…and learn the latest and upcoming techniques”.¹ The clinical research published in the Annals dovetails with this goal, and in particular the innovation-focused edition.

Imaging is an aspect of clinical care that continues to evolve as aligned technology becomes accessible. Aryasomayajula et al² report a proof-of-concept study, using artificial intelligence, to improve the diagnostic accuracy of paediatric distal radius fractures – frequently missed due to visible growth plate. The study size, utilising over 15,000 images, highlights the possible large datasets that are achievable with such studies, and the inherent statistical power. Sayed et al³ evaluate the diagnostic accuracy of 4D CT in localisation of parathyroid adenoma, a pathology of small anatomical size with significant clinical implications if quantified early.

Surgical planning is vital for all specialties and Thorn et al⁴ evaluate the benefits and feedback from surgeons who used 3D printed models prior to complex surgical cases. The study focused on surgical planning and diagnosis, economic impact, preoperative and intraoperative time, effect on communication and direct patient impact on patients. It is but a small step to evolve to virtual reality 3D models in surgical planning.

Two high quality systematic reviews are published this month. Tandon et al⁵ consider the global outcomes of using electronic/digital pathways for delivery of hip fracture care. Significant improvements in time to theatre, length of stay and secondary fracture prevention. Such pathways are widely used in other specialties and similar work is to be encouraged augment the potential benefits of these electronic systems.

Robinson et al⁶ publish a key systematic review of over 1300 articles to identify variations in carbon footprints and carbon ‘hotspots’ associated with surgery. Sustainability in healthcare is an evolved area of research and this study highlights some of the complexities in this field that our profession needs to address.

Surgical innovation will:

• • involve significant changes to practice;

• • have an associated financial cost;

• • take several years to adopted universally;

• • improve patient care;

• • may be doubted and debated.

As I write this editorial, the UK news media debate and discuss similar themes related to a railway line. Surgeons must scientifically evaluate technology and innovation, with a view to the wider long-term benefits. The Annals aims to continue to facilitate debate and evaluation.