Lately, I’ve been reading headlines about full autonomous surgery – claims that gallbladders can be removed without a human hand. It makes me wonder: is the operating room being handed over to machines?
The reality is complex – and more human than you might think.
While automation continues to advance, the true future of surgery lies not in removing the surgeon from the loop, but in equipping them with better tools to navigate it. That’s the principle behind Performance-Guided Surgery
: an emerging approach that combines surgical expertise with real-time data, digital guidance, and continuous insight.
Performance-Guided Surgery is not a machine-driven substitute for clinical judgment. It’s a surgeon-led model of care that reinforces decision-making, enhances consistency, and supports the surgical team in delivering more consistent outcomes. As this approach becomes more widespread, it raises a critical question:
Are we preparing the next generation of surgeons to lead in this digitally enabled operating room?
Redefining Surgical Mastery
Surgical mastery was once built through sheer case volume and learned through repetition, observation, and time but, in today’s training environment, that model is no longer sustainable. Hands-on opportunities are fewer, while expectations for performance remain high.
Performance-Guided Surgery represents a shift from experience alone to experience plus insight. It enables surgeons to receive real-time information about anatomy, while also creating a data-rich record for post-operative review. The goal isn’t automation. It’s elevation – helping surgeons see clearly, think critically, and deliver care with greater confidence and consistency.
This shift in surgical practice demands a shift in surgical education. Today’s trainees must be prepared not only to perform procedures, but to interpret performance data, engage with digital systems, and lead in a more connected, intelligent operating room.
As Hashimoto et al. wrote in Annals of Surgery, technologies used in the OR must be “interpretable, actionable, and usable” by the clinicians who rely on them. That doesn’t happen automatically. It requires deliberate integration of digital tools into training environments; not just as afterthoughts, but as foundational elements of modern surgical education.
In this new model, the surgeon is not just an operator, but a decision-maker equipped with data-driven insight. Surgical training must evolve to build confidence in using real-time information to guide technique, anticipate variability, and refine performance.
This isn’t just a shift in skill – it’s a change in mindset. It requires a framework that supports continuous learning, situational awareness, and digitally informed decision-making in the OR.
To fully realize that promise, our training programs must evolve. Digital literacy, cognitive adaptability must become core competencies, not just peripheral skills. We need to move beyond the idea of “using” technology and begin preparing surgeons to lead with it.
Transforming Surgical Education As We Know It
Entering into the modern era of surgical training means rethinking how we structure surgical education itself. For more than a century, training has been shaped by a mentor–mentee model, which still works, but is no longer enough.
The location and environment in which a surgeon is trained often dictates the type of surgery they choose to pursue – even more so than meeting standardized case volume numbers. And yet, the expectation is that every surgeon, regardless of where they train, leave residency capable of delivering safe, standardized, reproducible care, something that is simply unrealistic given the wide variability in training across facilities.
Digital tools create an opportunity to fill this gap. Remote mentorship, video procedure libraries, and AI-driven feedback, better standardize resident exposure to best practices across institutions. With the help of these digital tools, a resident in a low-volume hospital can now learn directly from a global expert in real time. A trainee preparing for a complex case can rehearse the procedure step-by-step in a virtual environment. These innovations help ensure consistency while reinforcing local, hands-on training.
Digital mentorship can broaden access and consistency, while direct clinical experience continues to shape the surgeon’s instincts. The future of training will be hybrid: bedside teaching paired with scalable, digital learning environments that help young surgeons build confidence and judgment.
Surgical training doesn’t stop with the completion of a residency program. Technology can be used to help surgeons better lean into a paradigm of lifelong learning. This balance ensures technology is not simply another tool, but an enabler that prepares surgeons to lead safely, effectively, and consistently in the modern OR.
The growing presence of automation in the OR should spark discussion, not fear. The future of surgery is not about removing the human touch. It’s about redefining it. In the age of AI, surgical excellence won’t be measured by the absence of humans in the room. It will be measured by the presence of those who still know why they’re there. It will be measured by the presence of those who know how to lead it.
About Dr. Ed Chekan
As VP of Medical Affairs and Professional Education, Dr. Chekan leads the company’s clinical, training and education, and scientific matters. Before joining Asensus, Dr. Chekan held positions in Medical Affairs within Ethicon Endosurgery and Teleflex. He worked as a consultant for several strategic and start-up medical device companies, where he led training and education programs and developed new products.
Dr. Chekan completed his minimally invasive surgery fellowship at Duke University, is certified in General Surgery by the American Board of Surgery, and holds an adjunctive position within the Duke Department of Surgery.
