Table 1:

Phases of innovation in minimally invasive surgery and surgical decision-making.

		Phases of innovation
Surgical innovations		Introduction of new technology	Achievement of a performance advantage	Arrival at a performance plateau
Minimally invasive surgery	Rigid endoscopy	Visualization of internal structures through natural orifices	Light sources, sheaths for instrument insertion	Inability to triangulate, limited working space
	Laparoscopic Surgery	Trocar used to establish pneumoperitoneum	Improved outcomes for select procedures, higher costs than open surgery	Minimal advantages for natural orifice laparoscopy
	Robotic Surgery	Computed tomography-guided brain biopsy	Improved outcomes for select procedures, higher costs than laparoscopic and open surgery	Requires skin and fascial defects to insert instruments
	Autonomous microrobots	Ingestible robot repairs a gastric defect in five minutes	Has not yet been demonstrated	Have not yet been observed
Surgical Decision-making	Additive risk scores	Single static variable thresholds can yield high sensitivity	Risk scores using multiple variables can achieve good accuracy	Can underestimate risk for adverse outcomes among high-risk patients
	Regression modeling	Estimates relationships between inputs and outputs	Patient-specific predictions may affect preoperative risk reduction strategies	Inability to accurately represent complex, non-linear associations
	Machine learning	Computer learns from data rather than conforming to rules	Improved predictive accuracy, opportunities for phenotype discovery	Predictions and phenotypes indirectly inform decision-making
	Reinforcement learning	Recommends optimal actions for discrete choices and states	Has not yet been demonstrated	Have not yet been observed