3D printing, genomics and the future of surgery: an interview with Richard Kerr
In this interview with Richard Kerr, Chair of the Royal College of Surgeons Commission on the Future of Surgery and Neurosurgeon at Oxford University Hospital (UK), we discuss innovative technologies, the future of surgery and the next generation of surgeons.
Mr Richard Kerr qualified from The London Hospital (UK) and trained in surgery and neurosurgery in London (UK), Oxford (UK) and Melbourne (Australia). Based at the John Radcliffe Hospital in Oxford (UK), he has been consultant for 30 years. With a wide cranial and spinal practice, he has subspecialty interests in skull base tumors, oncology and vascular disease. He devised and runs the Oxford Skull Base Practice and is a member of the NFII clinic, a nationally coordinated regional service. His research has led to publication of over 40 peer reviewed articles and 15 book chapters. He was Co-Principal Investigator in the MRC funded International Subarachnoid Aneurysm Trial (ISAT). The publication of this trial has led to a global change in the management of aneurysmal subarachnoid hemorrhage, with invitations to speak to learned societies from all over the world. Active in management, and trained as a civil and commercial mediator, he has been Lead Clinician of the Neurosurgical Department, Clinical Centre Chairman of the Radcliffe Infirmary and Chairman of the Relocation Steering Committee of Services to the John Radcliffe Hospital. Elected to the Council of the Society of British Neurological Surgeons (SBNS) in 2003, he was appointed Treasurer of the SBNS in 2010 and Member of the Neurosurgical SAC in 2011. He is President-Elect of the SBNS, taking up office of President of the SBNS from September 2014-2016. With interests in co-operation between the specialist surgical associations, audit and surgical outcome data, he was elected to council of The Royal College of Surgeons of England in 2013 and was re-elected in 2019 having served as Trustee from 2015-2017. He chaired the independent commission on the Future of Surgery, published in December 2018.
Could you tell us more about the RCS Commission on the Future of Surgery?
This was a very exciting project for me to Chair. The Commission brought together expertise not just in surgery but from the world of industry, patient representatives’, people from the charity sector and also junior surgical members.
The aim of the Commission is to look at what is going to happen in surgery over the next 20 years, given the huge changes in technology that are ongoing at the present time.
I think we established that the changes are going to be driven particularly by genomics, but also by advances in digital technology when it comes to data collection and data analysis, as well as the way we actually deliver our surgery. So very exciting times!
How could innovative technologies be used to transform general surgery?
I think there are a vast number of ways that innovative technologies can be used to change the way we deliver surgery.
If you look at a patient journey from health and hopefully prevention of disease, to early diagnosis, to treatment, to follow-up and then monitoring, there are uses of many technologies in the overall journey. For example, if we look at data analytics using AI, if we are able to analyze big data, we will find out much more about disease processes, disease profiles, and we can pick out of that aspects to personalize care. If we look at genomics - that will give us the opportunity to potentially predict who is likely to get a particular disease. We can even diagnose that disease early and I think what that means is that we potentially move away from what we are doing at the moment - which is organ removing surgery - to much earlier treatment, therefore organ sparing surgery, which is less invasive and will hopefully have better outcomes.
You mentioned genomics as an innovative technology, but looking more specifically at 3D printing, how do you think 3D printing could be best used to improve the patient journey?
3D printing again is very exciting, but it is already being used and I think what we are able to see is the platform for its use gradually expanding into more and more diverse fields. 3D printing has been around since 2006/2007 - it’s already used as a teaching and training tool, it is used for preparation for surgery and it is used in developing various prostheses that are implantable.
I think all of that would expand, particularly as we look into 3D bioprinting where we may start to see printed tissues utilized in the future.
What are the challenges associated with developing and implementing these new or modern technologies into a health service, such as the NHS?
Clearly, bringing in new technology is something we all want to do, but we all want to do in a way that we know is going to be advantageous to the patients. It has to be done in a very cost-conscious way.
The health service is financially challenged at all times, so we want to make sure that these new treatments do bring benefits in a cost-effective way.
I think actually that’s the biggest challenge, doing this. It is a matter of collecting data, it is matter of following patients over time, but equally it is very important that we research, that we support such innovation to make sure that these technologies are brought to the marketplace in this country. There is a huge amount of research going on and we need to benefit from that.
What does innovation mean for the training of surgeons? What training will the next generation of surgeons need to meet the next generation of technologies?
I think that’s a very important point and I think we are looking at a change in the way we train not only our surgeons but our healthcare professionals, generally.
We are looking at new languages that they, again, need to learn in terms of genomics. We are looking at the importance of communication, the importance of team working, the importance of human factors of training and that’s on top of all the basic sciences they have to be aware of as well. If we are ready to get the benefits of all of these new technologies, I think that we are looking at a different training platform to what we currently have. I think we are looking at a different career structure, in that careers could be much more flexible and much more adaptable as these new technologies come on board.
In your opinion, what does the future hold for innovative technologies in surgery? What will the operating room of the future look like?
I think future innovations are going to be hugely important and will continue to expand but the building blocks of which is already there.
The importance of connectivity, the importance of digital technology, the recognition that they need to work in teams with diversity in training - those building blocks are already there.
The future operating theatre, I think, will have an ever more sophisticated digital technology for us to monitor the patients and monitor their well-being through theatre. I suspect we will get to the point of having intelligent theatres whereby instruments will be reordered when you run out, that there is streamlining of patients through the block of theatre according to the length of time their procedures will take. I think we will take advantage of all of those technologies. What will be at the heart of this, and what has to remain a part of this, is the relationship between patients and clinicians, and that we will never lose.
If you had to say you have a favorite technology, which would it be and why?
I have been a surgeon 30 years, I have spent my life in the operating theatre, but in terms of the new technologies that really excite me, actually it is the genomics which I think is going to drive enormous changes. I think our ability to predict those who may suffer from disease, diagnose that disease earlier, personalize treatments according to their genetic profile - I think it is going to make huge difference to treatments in future. That’s not just surgery, that’s across the entirety of medicine.