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Innovation in Surgery: A Historical Perspective

Riskin, Daniel J. MD, MBA*; Longaker, Michael T. MD, MBA; Gertner, Michael MD; Krummel, Thomas M. MD

doi: 10.1097/01.sla.0000242706.91771.ce

Objective: To describe the field of surgical innovation from a historical perspective, applying new findings from research in technology innovation.

Background: While surgical innovation has a rich tradition, as a field of study it is embryonic. Only a handful of academic centers of surgical innovation exist, all of which have arisen within the last 5 years. To this point, the field has not been well defined, nor have future options to promote surgical innovation been thoroughly explored. It is clear that surgical innovation is fundamental to surgical progress and has significant health policy implications. A process of systematically evaluating and promoting innovation in surgery may be critical in the evolving practice of medicine.

Methods: A review of the academic literature in technology innovation was undertaken. Articles and books were identified through technical, medical, and business sources. Luminaries in surgical innovation were interviewed to develop further relevance to surgical history. The concepts in technology innovation were then applied to innovation in surgery, using the historical example of surgical endoscopy as a representative area, which encompasses millennia of learning and spans multiple specialties of care.

Results: The history of surgery is comprised largely of individual, widely respected surgeon innovators. While respecting individual accomplishments, surgeons as a group have at times hindered critical innovation to the detriment of our profession and patients. As a clinical discipline, surgery relies on a tradition of research and attracting the brightest young minds. Innovation in surgery to date has been impressive, but inconsistently supported.

Conclusion: A body of knowledge on technology innovation has been developed over the last decade but has largely not been applied to surgery. New surgical innovation centers are working to define the field and identify critical aspects of surgical innovation promotion. It is our responsibility as a profession to work to understand innovation in surgery, discover, translate, and commercialize advances to address major clinical problems, and to support the future of our profession consistently and rationally.

While novel technology is as old as the discipline of surgery, the field and study of surgical innovation are new. Recent research in technology innovation is just now being applied to surgery to develop rational strategies to promote innovation and surgical technology development. A discussion of critical factors to be considered is initiated and a possible course for the emerging field of surgical innovation suggested.

From the *Department of Surgery, UCLA, Los Angeles CA; and the †Department of Surgery Stanford University School of Medicine, Stanford, CA.

Partial salary support (to D.J.R.) was received from the Lucile Packard Foundation for Children’s Health, Palo Alto, CA.

Reprints: Thomas M. Krummel, MD, FACS, Department of Surgery, Lucille Packard Children’s Hospital, 701B Welch Road, Stanford, CA 94305-5748. E-mail:

© 2006 Lippincott Williams & Wilkins, Inc.