It’s Friday at 2 o’clock in the afternoon, and I am about to begin my second sigmoid colon resection of the day, this time for Mr. A, a 49-year-old male accountant. A former smoker and father of two, Mr. A lives in Manhattan and was diagnosed with colon cancer two weeks ago after undergoing a colonoscopy prompted by ten days of rectal bleeding. Understandably, he has many questions about the surgery he is about to undergo. I explained to him that there would be four small incisions in his abdominal wall, each about half a centimeter in size, which would be covered with bandages postoperatively. The resected portion of his colon would be removed through the anus, and the connection between the proximal and distal sections of the intestine would be made using robotic instruments to suture internally. I informed him that he would be encouraged to walk the same evening and would likely be discharged either one or two days after his surgery. 

Once my anesthesia colleagues put Mr. A to sleep, my resident assists me in inserting metal trocars—resembling bubble tea straws—into his abdomen. These trocars are then connected to the robotic arms, to which I attach the surgical instruments. Following this, I walk about 10 meters away from the patient and sit at a console where my hands control the robotic arms and my feet operate the pedals, allowing me to manipulate the instruments inside the patient’s abdomen. For the next three hours, I will navigate through Mr. A’s abdominal cavity, observing a 3D view of his internal organs on the console as I proceed to excise the malignant portion of his colon.

Since the time of Galen, the field of surgery has gradually and progressively evolved. There have been pivotal moments when the introduction of certain chemicals and advancements in understanding propelled surgical progress. However, throughout the history of surgery, significant advancements have often relied not on surgical technology itself, but on developments in related fields.

Lister’s understanding of microbiology contributed to the adoption of sterile techniques, significantly reducing infections in surgical patients. The development of antibiotics has allowed us to prevent postoperative infections, and the discovery of anesthetic drugs has made surgery far safer.

However, in recent years, the advent of laparoscopic surgery has dramatically improved the quality of care and patient safety, while also shortening recovery times from major operations. As a surgeon who has witnessed this technological evolution over the last 25 years, I feel as though I am standing at a precipice. It is truly remarkable to see the same procedures now being performed with far greater accuracy, safety, and, therefore, increased patient satisfaction.

I speak specifically from the perspective of a colorectal surgeon, as this is my area of practice. When I began medical school in the 1990s, after reading *The House of God*, I perceived surgery as a laborious and bloody occupation, imbued with a certain masculine allure. Indeed, my residency training in a major trauma center reinforced this view, with 90% of my operations being open procedures and only 10% involving the nascent laparoscopic techniques. However, during my fellowship, this ratio was reversed. I performed 90% of my surgeries laparoscopically and only 10% as open procedures.

In my practice following my fellowship, I continued to focus primarily on laparoscopic surgery. Within five years, I further advanced my technique by incorporating single-incision laparoscopic surgery (SILS). SILS pushes the boundaries of laparoscopic surgery, as it involves performing the surgery through a single incision at the umbilicus, with all the instruments inserted through that one opening. This technique allowed for better cosmetic outcomes but also presented new challenges, particularly because the surgeon must often contort their body to achieve the necessary angles for the operation.

My motivation for advancing surgical techniques was not merely professional but also personal. I began experiencing debilitating spine herniation, which forced me to seek alternative ways to perform surgery. In 2014, I transitioned to robotic colon resections, and by 2017, I had fully adopted robotic techniques for all my procedures. As I continually review my performance data, it has become clear that, while the success rates of my operations have remained consistent since 2004, there has been a marked improvement in patient outcomes, particularly in terms of length of stay, infection rate, postoperative hernia rates, and patient satisfaction. The average length of stay decreased from 6.5 days in 2017 to 4.2 days in 2020, and further down to 2.2 days in 2023. This is a significant change. I recall as a surgical resident rounding on patients who had undergone colon resection more than two weeks prior, with extended hospital stays required for wound care, pain management, and the return of bowel function. While such cases still occur, they have become far less frequent.

Mr. A was discharged two days after his surgery, though he complained of a bruise at his IV site on his left arm. Today, he is cured of his colon cancer.