We Must Close the Global Innovation Gap in Surgery

Innovation has drastically improved the practice of surgery, saving lives and further developing the skills of surgeons across the world. The latest tools and techniques have enabled better precision and shorter patient recovery times, preventing complications and improving patient outcomes.

But what happens when some surgeons are left behind? When barriers prevent access to knowledge and equipment, and the benefits of innovation only reach the few?

Although state-of-the-art technologies and approaches are being rolled out in many places across the globe, the disparities caused by the growing chasm in countries' pace of progression should give us all cause for concern.

Unequal Access to New Technologies

Laparoscopic surgery, also known as keyhole surgery, is the recommended surgical approach for many colorectal conditions. Yet, globally, this approach is being adopted at different rates.

Data from European Union member states show that the proportion of inguinal hernia repairs completed laparoscopically, for example, varies between 5% and 66%. In Bulgaria, only 30.2% of cholecystectomies were performed laparoscopically in 2019, compared with at least 94% in Denmark, Lithuania, and the Netherlands.

Robotic surgery is another area where development is happening at lightning speed in some countries while being virtually nonexistent in others. The reasons for this are clear: Robotic systems cost hospitals millions of dollars, presenting a major barrier. Regulatory approval within countries can also delay access.

As a result, robotic surgery is becoming commonplace in places like the United Kingdom and the United States but is still completely unexplored territory to many surgeons working in less developed countries or less well-resourced hospitals, impacting their opportunities to upskill, advance their careers, and deliver better outcomes to patients.

Like many organizations, the European Society of Coloproctology is working to improve access to robotics training through online webinars and funding fellowships. However, more remains to be done to widen surgeons' access to these tools.

Crucially, the industry needs new business and regulatory models that enable surgeons in all countries to access the most effective technologies. But this can only be achieved through close collaboration among stakeholders, including policymakers, manufacturers, and healthcare leaders.

Driving Equitable Research

Of course, while surgeons in Western countries are embracing new techniques, many surgeons in developing countries are still working in hospitals without access to the most basic equipment.

These surgeons cannot be left behind, and we therefore need healthcare leaders to change the narrative. With the emergence of new technology, it has become the norm to reward case volume and futuristic techniques. But we must also encourage the development of frugal innovations that can make a significant impact in both high- and low-resource settings.

Creating more equitable opportunities to facilitate research that supports new, cost-effective surgical techniques is crucial. Historically, research opportunities were disproportionately available to surgeons living in the most resource-rich regions with access to grants, support, and equipment. Opportunities are now being created to accelerate research at a truly global level.

The National Institute for Health Research's GlobalSurg collaborative, for example, was designed to enable more inclusive access to major medical research projects for surgeons, students, and researchers — including grassroots surgeons who usually miss out. Through international, collaborative networks, the initiative is identifying new techniques that are both safe and effective to improve surgical outcomes globally, particularly in developing countries.

Expanding Access to Surgical Education

A lack of access to education and training is also a key barrier preventing surgeons from leveraging certain tools and techniques. Limited resources often mean that surgeons in less developed regions are equipped to deal only with the most common cases and lack highly specialist knowledge.

But change here is possible, and greater investment in technology that improves access to education could be part of the solution.

In 2014, Professor Shafi Ahmed made history when he streamed a live operation using Google Glass, reaching over 14,000 students across 132 countries. He has since been using other technologies to improve access to medical training — including Snapchat and virtual reality — to teach surgical methods remotely to thousands of surgeons, particularly in developing countries.

Global Partnership to Effect Change

Continued innovation is key to driving surgery forward to provide the best possible solutions to our patients, but this must not be to the detriment of our peers working in underresourced environments.

Of course, healthcare systems and practices cannot develop perfectly in tandem. But the sizeable gap in development from one country to the next seriously risks increased inequality and slowing of advances in regions that are multiple steps behind.

Stronger collaboration across borders is crucial to drive more equal access to tools and techniques globally. By sharing ideas and knowledge, creating international research networks, and working in partnership to advocate for equitable regulatory and pricing frameworks, we can help to reduce unequal access to surgical tools and techniques worldwide.

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