The surgical zeitgeist

Every few years surgery gets a new obsession A decade ago it was keyholes Then came lasers Now the flavour of the month or perhaps of the decade is robotics and AI Everyonersquos either getting robotic surgery selling robotic surgery or secretly Googling whether a robot will replace themPatients have begun to talk like tech critics ldquoDoctor do you use the robotrdquo they ask the way people ask if yoursquove upgraded your phone If I say no they look mildly betrayed as if Irsquove confessed to using dialup internet If I say yes they beam as if my robot and I cohabitLast week a gentleman with a slipped disc told me ldquoDoctor I want robotic surgeryrdquo ldquoSirrdquo I enquired ldquodo you mean minimally invasive surgeryrdquo ldquoNo nordquo he replied ldquoIrsquom talking about the one where you donrsquot do anything mdash the robot does it allrdquo I told him that in that case he should just stay home and let his washing machine operateWe are living through what philosophers call a zeitgeist a German word meaning lsquothe spirit of the timesrsquo The term first appeared in the 18th century and was used by thinkers like Hegel and Goethe to describe the invisible cultural current that shapes collective thought Every age has its own the 1920s had jazz the 1960s had revolution the 1970s had disco the 1980s had bad hair and the 1990s had Nokia phones that could survive the apocalypse The surgical zeitgeist today is one of automation and precision where machines promise to remove the last traces of human errorhellip and possibly the humans tooThe truth as always lies between the hysteria and the scepticism Robotics navigation and AI have genuinely improved spine surgery They help us plan trajectories reduce radiation exposure and improve the accuracy of screw placement The robot doesnrsquot tire doesnrsquot sneeze doesnrsquot flirt with the scrub nurse and never complains about the temperature in the operating theatre But it also doesnrsquot know when the tissue feels different when the nerve looks unhappy or when a patientrsquos anatomy politely decides to differ from the textbookIn our quest for perfection we sometimes forget that surgery is still a biological act The human body isnrsquot a 3D printer file It swells bleeds and sulks It canrsquot always be persuaded to behave according to an algorithm A robot can calculate it cannot improviseSome years ago a patient came in insisting on lsquoendoscopic spine surgeryrsquo His neighbour had had one and was back to golfing within a week I looked at his MRI and explained that his disc had ruptured into several pieces compressing the nerve like a badly folded wallet ldquoYou may need a conventional microdiscectomyrdquo I explained He frowned ldquoBut isnrsquot that oldfashionedrdquo he asked ldquoSo is gravityrdquo I said ldquobut it still worksrdquoGive us a new gadget and wersquoll arrange a conference around it Technology is seductive because it promises control and medicine is full of uncertainty The temptation to delegate our fallibility to a machine is strongBut if you depend entirely on it you stop thinking The danger is not that robots will replace surgeons but that surgeons will start behaving like robotsWhen used wisely though these tools are magnificent Irsquove used navigation systems that guide screw trajectories with millimetric precision and endoscopes that slip through incisions smaller than a buttonhole Irsquove also seen what happens when someone uses these tools without judgment it would be akin to watching a novice pilot attempt to take off in a jet because the manual looked easyA friend once said ldquoTechnology should extend intuition not erase itrdquo Thatrsquos the sweet spot The best surgeries are still a symphony between hand eye and mind not a solo by silicon The robot can aim but itrsquos the surgeon who must decide where to aim and whyPatients too are adjusting to this brave new world One recently asked if ChatGPT could possibly plan her surgery I said it would most probably write a very flattering post about it but the sutures could turn out messyAnother wanted to know if Irsquod considered using a drone for spinal screws mdash it would be cheaper he claimed ldquoOnly if it comes with Amazon Prime deliveryrdquo I quipped We used to measure surgical brilliance by scar length and then by incision size but now we do so by the number of screens we can stare at simultaneously Some of my younger colleagues reckon that if an operation isnrsquot accompanied by a 3D animation it may not be worth doingTherersquos also the practical side Robots donrsquot complain but they do malfunction Once midway through a surgery the robotic arm froze We restarted the console thrice even called the engineer but finally finished the surgery manually The patient recovered beautifully The robot however took longer to reboot mdash and probably still holds a grudgeAs a profession wersquove constantly evolved Trephination transformed into craniotomy open surgery became minimally invasive surgery and microscopes gave way to endoscopes The best surgeons adapt not because fashion demands it but because improvement does The trick is to stay current without becoming a slave to the currentI tell my younger colleagues that being modern doesnrsquot mean discarding the tried and tested It means understanding the why behind the new It means knowing that a robot can insert a screw straighter than you can but it still needs you to know when not to insert one It means remembering that empathy cannot be automated and that no app can replace the quiet reassurance of a surgeon saying ldquoYoursquoll be finerdquoTechnology should help us see better not think less It should make our hands steadier not lazier And if it does replace us one day I hope it at least inherits our sense of humour mdash because surgery without it would be unbearable The zeitgeist will keep changing mdash from open to keyhole from keyhole to robot from robot to whoknowswhatnext The trick is not to resist it but not to drown in it either Surf the wave but keep one hand on the shoreAs I finished my OPD clinic last evening a patient asked if Irsquod soon have a robot doing my job ldquoPossiblyrdquo I said ldquoBut until it learns to drink cold coffee respond to WhatsApp messages from three family members of a patient all at once and smile when someone calls it Doctor Google I think Irsquom saferdquo The real trick I told him is simple keep up with technology but donrsquot get carried away by it Be its master not its minionHe nodded thoughtfully ldquoSo Doctor what do you call this approachrdquo ldquoThe human interfacerdquo I said ldquoItrsquos still in beta but itrsquos running quite wellrdquoFor all its brilliance AI still struggles with something profoundly human mdash hope It can predict outcomes but it cannot promise comfort It can read scans but not emotion It cannot understand why a patient reaches for your hand before anaesthesia or how a kind word steadies a trembling family in the waiting room AI has surpassed our speed our precision even our memory but can it look someone in the eye and give them courage Can it look itself in the eye and accept failure Surgery at its heart is still an act of faith between two people mdash one who trusts and one who must be worthy of that trustThe writer is practising neurosurgeon at Wockhardt Hospitals He posts on Instagram mazdaturel mazdaturelmiddaycom