Nanotechnology is the material science of objects under 100 nm in size.
Over the last decade, we have come to realize that the oldest nanotechnologist alive is Mother Nature- a five billion year-old expert, who has found optimal molecular pathways to solve problems of energy (plant “solar cells” through photosynthesis, or mitochondria synthesis), hardness and elasticity (Google “nanomechanics of spider silk”), and many more. For a great collection of Nature’s nanotechnological solutions, I urge you to visit the Ask Nature website.
This trend of finding and copying ready-made natural solutions in common engineering problems is called biomimetics, and has lately gained considerable momentum.
Let’s talk about surgery now. Surgeons operate on the macro scale, and have made great advances (watch the BBC documentary Blood and Guts: The History of Surgery to see what I mean) over the last century. Surgery has evolved from “no more science than butchery” to a highly respected science, and even an art. However, we still do not treat diseases and we do not heal. We only open the way for the body to heal itself, as gently as possible.
But even the gentlest microsurgeon is very crude in terms of the nanotechnological scale of tissue. After all, a scalpel is millions of times bigger than a cell. We need to decode how the body’s tissues heal themselves, copying their methodology and bionano pathways, in order to learn from the bottom up.
Consider current trends in surgery. We started creating better tools for our hands, before realizing the importance of being minimally invasive. This led to the creation of laparoscopic, and later robotic, surgery instruments, such as the da Vinci System: a laparoscopic tool with a high-tech 3-D field of vision inside the body, and tools with three axes of movement designed to cancel out human hand tremors.
Endovascular surgery is also seeing advances in minimally invasive surgery techniques, using artificial materials, which are unfortunately not as durable as the tissue they replace in the long term.
A similar trend towards nanotechnology is evident in the miniaturization of surgical tools. Experimental microrobots are already available, and being tested in live tissues (see my presentation below, and Google “ microrobots in medicine”). It seems likely that in one or two decades, microrobots will be in common use in surgery, before their eventual replacement by nanorobots.
Microrobots will resemble minute machines from the macroscale. But what will nanorobots look like? They won’t be akin to artistic representations of miniature submarines placed beside erythrocytes. Most likely, they will bear some resemblance to the body’s existing nanomachines, such as mitochondria.
Nanorobots will be scavengers for atherosclerotic plaque, just like artistic representations you may find online, but not with exactly the same mechanics. We will witness a gradual transition from surgical repair, to prevention. Atherosclerosis, which is in fact the gradual stenosis of the arteries due to plaque formation, will be solved at the genomic and proteomic level, and this will lead to a great enhancement of the human life span. Minimally invasive microrobots will be used instead of stents inside arteries, for repairs that are currently being performed laparoscopically.
Labs on a chip will provide the patient-specific data for personalized and individualized treatments. These data will include genetic predispositions, reactions to drugs, and personal proteomics interactions. You will be able to share your data with other patients, and find individualized solutions tailored to your specific genetic and biochemical profile.
Nanoparticle-assisted surgery already illuminates cancers so that surgeons can completely remove them, or even visually scan the body for metastasis. Nanoparticle-based local drug delivery will also soon help to diagnose and treat cancer in a more cell-to-cell fashion; that is, detect and treat cancer in the very first stage of the disease. Individualized therapies, with cancer specific nanoparticle vehicles, will be available and enhanced by personalized genomics for every patient.
Last but not least, one of the greatest achievements of nanotechnology in surgery will be what we call the “ideal graft”; that is, biocompatible and durable “repairs” of parts of the body like arteries, joints or even organs. At first, these repairs will be used for healing, but soon afterwards, they will be used for transcendence: to enhance current human abilities. This trend is already apparent in plastic surgery that aims at appearance enhancement. Expect this trend to appear in other surgical specialties, like orthopedics for enhanced athletes, transplantation of organs from bioprinting or stem cells, new coronary arteries delivered with angioplasty balloons, enhancement drugs with DNA modifications, and many many others. It seems that surgery will be the vector of our first steps towards transcedence, gradually moving towards less and less invasive procedures until surgery becomes almost obsolete.
Of course, this will have an impact on our training as surgeons. Many of my mentors have been overtaken during their careers by the radical advances in their respective specialties, and I know many great surgeons who have not sought training in laparoscopic surgery, and now feel themselves to have been surpassed in this field. I also know many vascular surgeons who are skilled in open repairs, but lack training in endovascular techniques, and feel redundant.
What is the lesson for new surgeons? Expect to be surpassed by surgical advances in your lifetime. Nevertheless, be vigilant about upcoming trends, and prepare yourself to adapt to them. DO NOT underestimate any new technique; instead learn about it and study the trend. A new meme (meme = idea-concept in evolutionary contest with other ideas) that is successful will evolve into a completely new field….
The author is a surgery resident in Athens, Greece.
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