Editorial
The Downside of Technological Advances in the Surgical Training Environment
Jeffrey M Whitaker*
Department of Podiatric Medicine/Surgery, Cleveland VA Medical Center, USA
*Corresponding author: Jeffrey M. Whitaker, Department of Podiatric Medicine/Surgery, Cleveland VA Medical Center, 10701 East Boulevard - 112 (W), Cleveland, OH 44106, USA
Published: 01 Dec, 2017
Cite this article as: Whitaker JM. The Downside of
Technological Advances in the Surgical
Training Environment. Clin Surg. 2017;
2: 1793.
Editorial
There is no question that sales representatives from surgical device companies are effective in
convincing surgeons to use their products. In fact, this activity can be seen to unfold in and around
operating rooms on a regular basis. Though I have strong opinions about the value of this activity,
I am not here to claim whether it is right or wrong. However, as a surgeon regularly involved in the
training of residents, I do have significant concerns regarding the effect of “new technology” on the
development of surgeons.
Surgeons rely on sound principles to help them navigate through the challenges and inevitable
pitfalls of every case which has their name on it. These principles (and associated nuances) are
related to human tissue and how it responds to the manipulation and purposeful violation of any
invasive procedure, to three-dimensional hand dexterity, and to the mechanical orchestration of
surgical instruments. Surgeons acquire these principles and nuances through repetitive exposure in
their own residency training. Then, they repeat and fine-tune those practices over and over as they
care for many patients during their careers.
For those involved in the development of surgeons, it is the passing on of these core standards
and principles that is most important. A new surgeon armed with tried and true techniques is a
surgeon equipped to handle adversity, including adversity which comes in the form of the failure of
new instrumentation. However, when residents are exposed again and again to “new technology”,
the acquisition and honing of reliable techniques and principles is impeded. This, in turn, is likely
to dissuade new surgeons from pursuing full integration of these reliable techniques and principles
into their own practices.
One simple example of interchanging new instrumentation for sound and predictable technique
in podiatric surgery is the use of power reamers for joint preparation in the first metatarsophalangeal
joint arthrodesis procedure. The goals of joint preparation in arthrodesis procedures are: 1) Articular
cartilage removal and 2) Subchondral bone plate fracturing. When these goals are attained using
hand instrumentation such as curettes and osteotomes, the result is a stable (and therefore, fixationfriendly)
and injured (and therefore, ready to heal) subchondral bone plate with a maintained
contour. While powerful and efficient, reamers rapidly claim cartilage and bone as they churn down
through opposing joint surfaces. In novice hands, shortening of the metatarsal as well as weakening
and modification of the subchondral plate can occur. These undesired effects on fusion construct and
outcome are less likely to occur with the more predictable and reproducible hand-based approach.
While surgical company representatives have little concern for surgical resident development
beyond encouraging those residents to use their products in their eventual practices, it is the
responsibility of the surgical attending to ensure each resident receives a steady diet of sound
techniques. Certainly, this will require the staff attending to routinely use these standardized
approaches in their own practices, even at the cost of disappointing the company representative.