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October 23 2013
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PDD

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Surgical Innovation – Pioneering doctors and devices

Surgery is a fascinating branch of medicine; rooted in science, yet still very much a craft and (whether we like it or not as a patient) frequently dependent on the skills of improvisation by the surgeon and their team. Surgery has come a long way since its early days but the pace of innovation has anything but slowed down. On the contrary, new technologies are creating new possibilities to improve safety and efficacy of procedures, and cost pressures are creating an imperative to achieve more with less.

As one of PDD’s experts in the field of surgery and interventional medicine, I will be looking at some of the trends occurring in this exciting field through a series of blog posts over the coming months. Today though, I will start by reviewing some of the pioneering work that has laid the foundation for where we are today.


Image credit: Modern high tech hybrid operating room from Maquet Getinge Group

Surgery on the heart is probably one of the most awe-inspiring procedures surgeons perform, both for functional and symbolic reasons. Nowadays, hearts are routinely repaired or transplanted, but someone had to try it first!
The first successful surgery on a beating heart was performed by Dr Ludwig Rehn a German surgeon who, in 1896, repaired a stab wound to the right ventricle of his patient, thus challenging the wide-spread belief that surgery on the beating heart was not feasible.
Decades later, it would be South African surgeon Dr Christiaan Barnard who, in 1967, performed the first successful heart transplant, another major milestone in the history of medicine.

Image credit (left): Pioneering surgeon Dr Ludwig Rehn, image source: Aerzteblatt
Image credit (right): Dr Barnard’s heart surgery team performing the first human heart transplant on 54 year-old grocer Louis Washkansky in Cape Town, image source: The British Heart Foundation (Corbis images)
Orthopaedic surgery is another branch of surgery that has very high visibility. One of its pioneers is Sir John Charnley, a British orthopaedic surgeon. He is recognized as the founder of modern hip replacement, creating the procedure known as total hip replacement, in which both the ball and the socket of the hip are replaced.

Image credit: Dr Charnley and the hip replacement system he pioneered, image source: My Joint Space
Sir Charnley exemplifies a very important aspect of many pioneers of surgery; efforts in charting a new road forward are as much about attempting new procedures, as they are about inventing the tools and devices that are required to be able to achieve their desired outcome. There are many remarkable inventions across the field, some of which are highlighted below.
The first pacemaker was implanted by Swedish cardiologist and engineer Dr. Rune Elmqvist together with his Professor Ake Senning in 1958. Their patient, Arne Larsson, suffered from cardiac arrhythmia which had led to a drastically reduced heart beat causing frequent fainting that meant he had to be revived. For the first implant, the inventors coated two electrodes and the necessary electronics in an epoxy cup to protect the components from the ‘adverse environment’ in the body. The first pacemakers only lasted three hours, but they were quickly replaced and the prototypes that followed would last longer and longer. Mr Larsson lived another 44 years and used a total of 26 pacemakers.


Image credit: The first fully implantable pacemaker, image source: Wikipedia

Laparoscopy, also known as ‘key-hole surgery’ or minimally-invasive surgery (MIS) has been around for over 100 years, with the first laparoscopic procedure in humans being reported by Dr Hans Christian Jacobaeus of Sweden in 1910. The benefit to the patient of less invasive surgery is a reduced risk of infection and faster recovery times; however, laparoscopic surgery requires the mastering of an advanced level of skill by the surgeon. With experience and improved technology such as better mechanisms, better materials and also better cameras to be able to see through the keyhole, MIS has gained ground and really established itself as an integral part of the modern surgical landscape.

Image credit: Modern laparoscopic device for liver surgery, image source: Covidien
Robotic surgery has come onto the scene gradually over the past 20 years, pushed by technical possibilities and also driven by the desire to address some of the shortcomings of both open and laparoscopic surgery. The pioneer of robotic surgery has arguably been the company Intuitive Surgical. Having acquired a number of surgical robotic technologies invented at NASA and MIT, amongst others, the company went ahead to successfully bring robotic surgery to the masses with its Da Vinci surgical system. While the clinical benefits of robotic surgery remain the subject of a heated debate, no one can argue the fact that the use of robots has expanded what is possible clinically and paved the way for future innovations.


Image credit: Da Vinci surgical robot from Intuitive Surgical

Today, the surgical device industry is facing a multitude of pressures; cost pressures as healthcare systems globally are being strained, regulatory pressures as agencies demand ever more assurance for the safety and efficacy of devices, and also a lack of capital to invest in start-ups who nowadays are frequently the source of breakthrough ideas.
Over the next few posts in this series, I will be looking at some of the technical trends that are enabling breakthrough innovation in this space. I will also explore how Human-Centred Design (HCD) techniques can be used to reduce commercial risk and drive focused development of new devices and systems.
Stay tuned, and if you have any comments on this post please don’t hesitate to get in touch!
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Posted by PDD
@pddinnovation

Languages spoken: Global.
The last thing that inspired me: Design and Innovation.
My dream project: A project that makes a difference in the world.
My obsession: Develop successful, award-winning and world-first products and experiences.

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