(This is the spoken text presented by Prof. Dr. Nicole Bouvy at TEDxMaastricht, October the 4th 2015)

The knifeless future of surgery

Imagine you’re sleeping and I would enter your room with a knife in my hand. And this is the moment I’m about to cut you open. And indeed, take some valuable organs away from you. You will agree with me that this can be regarded as a criminal act. But not in my case, you see, I’m a surgeon. I actually get paid for this job. Don’t you think it sounds a bit like a medieval profession – surgery – using a knife in this age of innovative technologies?

For me it sounds like the clock-maker who has become obsolete, due to the invention of the rubber boot. Or like the blacksmith who disappeared with the appearance of the car engine. Of course a patient needs surgery and often he hasn’t got a choice. But surgery can also cause terrible complications. Complications which can influence the quality of life, for the rest of your life. As a young surgeon – some 20 years ago – I decided to make it my personal mission to abandon complications related to the mutilating surgical knife. About 10% of the patients who underwent abdominal surgery will develop adhesions, a situation in which bowel contents cannot pass. And you have to be operated again. Another 10% of the people who are operated via midline incision develop an incisional hernia. This is a situation in which the bowel can get stuck and again the patient had to be re-operated. Over the past 20 years surgeons have developed several new procedures, new techniques and the use of new materials, to avoid these terrible complications. Laparoscopy or keyhole surgery has led to a faster recovery, shorter hospital stay and less pain. But still the surgical knife is needed.

When I started operating with the first four-armed robot here in Maastricht, I felt excited. This top-notch technological device made it possible to really perform very precise operations. As a surgeon you sit in a console with two joysticks and four foot pedals, and the robot is actually hanging over the patient with very advanced laparoscopic instruments. But you will agree that the real robot will perform the surgery on its own. Without the interface of a surgeon. For me it’s clear. Developments go on very fast. And it must be possible – the coming years – to have a self-driving surgical robot, just like the self-driving car. And I am convinced that like the car who drives itself, the robot probably drastically can reduce traffic accidents in the Operation Room.

It isn’t so hard to think of surgical procedures without the use of a surgical knife. We all have our mouth, our anus and half of you the vagina. Recently in Maastricht we performed a procedure through the mouth. We managed to make a reduction of the stomach without the surgical knife. We introduced this device through the mouth, and were able to significantly reduce the volume of the stomach in a patient with morbidly obesity. No incisions, no scars. I really am a surgeon without a knife. This is just an example, but we are working on several other techniques via the natural openings. The question is: have I now accomplished my mission of twenty years ago? Wouldn’t it be even better if we can avoid patients to become ill? Do I need to refine my mission into a healthy life without a surgeon? The speed of innovative developments is immense.

Opportunities in the field of nanotechnology and information science have convinced me that the old-school surgery will disappear. I believe the three magic words are Information, Prevention and DNA-Intervention. The current medical profession will be subject to revolutionary change. And I believe that it is happening as we speak. Just go to the Internet, to websites like 23andme and let your whole, really your whole genome, be investigated and commented upon. It not only gives you insights into your genes and possible short and long-term risks, it also gives you information about the effectiveness of certain medication. Wearables become an integral part of your body. This is the smart lens of Google which makes it able to give a continuous measurement of your glucose levels in your blood. Imagine this will make the life of a person with diabetes so much easier.

Colorectal cancer will be detected long before it becomes symptomatic. With this nano pill you get information about the cancer DNA in your intestines. And if cancer is detected you will directly give this information to your mobile phone. One of the most fascinating consequences of this enormous amount of information that will be available for every person, is the relationship to your doctor. The doctor won’t have patients who come to you with complaints or symptoms. But we will only get healthy customers with a very early detected disorder. And while Information and Prevention are the key drivers for future health, things will really get exciting, when we are able to do an intervention on your DNA. And I think it will be possible to repair your DNA with the help of nanorobots. Some scientists even believe that if we can enter the nucleus of our cell, we will be able to repair all the changes that makes a person old and mortal. And if we become immortal, then the only thing we have to concern is ethical concerns. For now, I stick to my mission: A healthy life without a surgeon. By the way, if I succeed in this mission, I will be very happy to join the clock maker and the blacksmith on local village fairs, to demonstrate the suturing and cutting skills that once belonged to very high esteemed profession. Thank you for your attention.