By Nickolaos A. Darlis, MD

If the question is “can you escape technology in your practice?”, the answer is absolutely not. Because electronic filling, imaging, prescriptions, all the wonders that reside in our cellphones, small joint arthroscopy,modern plate technology, bedside ultrasound, they are all here to stay and have, in some instances, revolutionised our practices. The real question should be “are we taking full advantage of the available technologies?”

I believe that, as hand surgeons, we are resistant to change. One reason is that we develop skills and gain knowledge that permit us to feel independent of “outside help”. We know our way around bones, tendons, vessels and nerves without the need to take the “guided tour”. The other reason is that, because of the relatively small numbers in our studies, the application of evidence based principles is difficult with us. We remain an eminence based science, and that means that senior surgeons dictate the way ahead, oftentimes with delays. In fact, we operate on tendons and nerves, more or less, as we did in the seventies.

Meanwhile technology is invading surgery unrelentingly. Orthobiologics, navigation and robotics  applications are in everyday use in most of the hospitals we work in. Although the real impact in the final patient outcomes is sometimes questioned, and medical marketing certainly plays a role, the fact remains that they are popular with surgeons and patients alike. And even if surgeons just want to stand out, are patients so wrong in asking for the most modern technique for their problem? Who can blame them; in their everyday life, technology has changed things for the better, why should this not happen with their surgery as well?

 

It is my opinion that  we are lagging behind in technology use. And we do not necessarily have to invent new technologies, there are plenty readily available. Why should we not use navigation to put in our scaphoid screws or robotics to improve our microsurgical skills? I understand that the clinical advantage of such approaches may not be immediately evident, and that it may delay our surgeries, however it may also  open new horizons in applications we have not imagined. Remember when it is  time to upgrade your cellphone or laptop; newer devices usually have tons of new useless features. Or, so you think at the time, only to discover in a few months, that you are now using everything that you thought was redundant.

The downsides are time and cost-effectiveness, but both of these have been shown to improve as technics and technologies reach their maturity. A less thought of downside is the ability to train surgeons. Because, the more technological  our surgeries become, the less surgeons will have access and meaningful training  in such techniques.

Hand surgery has evolved painfully slow and has largely depended on pioneers. I believe we should be pioneers in technology. And, in the end, our training permits us to use technology not because we have to, but because we want to.