Lately I’ve been reading headlines about fully autonomous surgery: claims that the gallbladder can be removed without the help of a human hand. It makes me wonder: is the operating room being handed over to the machines?
Reality is complex and more human than it seems.
While automation continues to advance, the true future of surgery lies not in removing the surgeon from the vicious circle, but in equipping him or her 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 substitute for machine-driven clinical judgment. It is a surgeon-led care model that reinforces decision making, improves consistency, and supports the surgical team to achieve more consistent results. As this approach becomes more widespread, a critical question arises:
Are we preparing the next generation of surgeons to lead in this digitally enabled operating room?
Redefining the surgical domain
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. Practical opportunities are fewer, while performance expectations remain high.
Performance-guided surgery represents a shift from experience alone to experience plus knowledge. It allows surgeons to receive real-time information about anatomy while creating a data-rich record for postoperative review. The goal is not automation. It’s elevation: helping surgeons see clearly, think critically, and deliver care with greater confidence and consistency.
This change in surgical practice requires a change in surgical education. Today’s students must be prepared not only to perform procedures, but also to interpret performance data, interact with digital systems, and lead in a more connected and intelligent operating room.
As Hashimoto et al. wrote in Annals of surgeryThe technologies used in the operating room must be “interpretable, actionable and usable” by the doctors who depend on them. That doesn’t happen automatically. It requires the deliberate integration of digital tools into training environments; not just as afterthoughts, but as fundamental elements of modern surgical education.
In this new model, the surgeon is not just an operator, but a decision maker equipped with data-driven insights. Surgical training must evolve to build confidence in using real-time information to guide technique, anticipate variability, and refine performance.
This is not just a change in skill, it is a change in mentality. It requires a framework that supports continuous learning, situational awareness, and digitally informed decision making in the operating room.
To make that promise a reality, our training programs must evolve. Digital literacy and cognitive adaptability must become core competencies, not just peripheral skills. We need to move beyond the idea of “using” technology and start preparing surgeons to lead with it.
Transforming surgical education as we know it
Entering the modern era of surgical training means rethinking how we structure surgical education itself. For more than a century, training has been determined by a mentor-mentee model, which still works, but is no longer sufficient.
The location and environment in which a surgeon trains often dictates the type of surgery they choose to perform, even more so than meeting standardized case volume numbers. And yet, the expectation is that every surgeon, regardless of where they train, will emerge from residency capable of providing safe, standardized, and 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 mentoring, video procedural libraries, and AI-based feedback better standardize residents’ exposure to best practices across institutions. With the help of these digital tools, a resident at a low-volume hospital can now learn directly from a global expert in real time. A student preparing for a complex case can rehearse the procedure step by step in a virtual environment. These innovations help ensure consistency while reinforcing local practical training.
Digital mentorship can expand access and consistency, while direct clinical experience continues to shape the surgeon’s instincts. The future of training will be hybrid: bedside teaching combined with scalable digital learning environments that help young surgeons develop confidence and judgment.
Surgical training does not end with completion of a residency program. Technology can be used to help surgeons better adapt to a lifelong learning paradigm. This balance ensures that technology is not just another tool, but an enabler that prepares surgeons to lead safely, effectively and consistently in the modern operating room.
The growing presence of automation in the operating room should spark debate, not fear. The future of surgery is not about eliminating human contact. It’s about redefining it. In the age of AI, surgical excellence will not be measured by the absence of humans in the room. It will be measured by the presence of those who still know why they are there. It will be measured by the presence of those who know how to drive it.
About Dr. Ed Chekan
As vice president of Medical Affairs and Professional Education, Dr. Chekan He leads the clinical, training and education, and scientific aspects of the company. Before joining assentDr. 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 fellowship in minimally invasive surgery at Duke University, is board certified in General Surgery by the American Board of Surgery, and holds an adjunct position within the Duke Department of Surgery.
