Editorial: 10th anniversary of Frontiers in Surgery - celebrating progress and envisioning the future of multidisciplinary surgery
Year: 2026
Type: editorial
Abstract: The 10th Anniversary of Frontiers in Surgery offers an opportunity to reflect on how surgery has changed-not only through incremental technical advances, but through several broad paradigm shifts that now cut across nearly every sub-specialty. To date (4/15/2026), 6,659 papers have been published. Over this period, surgical progress has been built on 3 overall pillars: 1) Precision surgery, 2) data-driven decision making, and 3) integration of biology with technology. Precision surgery is best reflected in the boom in robotics but also in better visualization through microscopes, 3D printing, navigational systems and improved imaging. Data-driven decision making has allowed surgeons to better analyze their data, more efficient literature reviews and quality improvement initiatives which allow us to better counsel our patients on the pros and cons of proposed surgical procedures, as well as emerging AI-enabled decision support. While subspecialties have advanced along different trajectories, these common themes have repeatedly enabled safer operations, better selection of patients and procedures, faster recovery, and improved long-term outcomes. In this anniversary editorial, we highlight both the broad advances as well as specific advances in subspecialties and make some predictions of how we may view an exciting future. This list is clearly not comprehensive but shows how each of these domains is present in the sub-specialties reviewed.Figure 1. AI-generated conceptual diagram (Gemini) illustrating three cross-cutting pillars of surgical advancement over the last 10 years. This figure is intended to show the power of AI in concept visualization. This is an illustrative synthesis based on the text of this editorial, generated by Gemini (May 3, 2026).Microsurgery has become safer and more reliable, with further improvements achieved through the refinement of supermicrosurgical techniques, perforator flap surgery, lymphovenous anastomosis, and enhanced perioperative management. The integration of three-dimensional imaging, virtual surgical planning, and patient-specific devices has improved precision in craniofacial surgery, breast reconstruction, and complex reconstructive procedures.In aesthetic surgery, the development of minimally invasive techniques and energy-based devices has improved safety and postoperative recovery. Collectively, these advances demonstrate the evolution of plastic and reconstructive surgery toward more precise, biologically grounded, and patient-centered care.Large database retrospective studies have provided longitudinal data which synthesizes the risks of procedures, providing clinicians with real world data to advise patients. These data have been important in areas of informing patients of risks of rare tumors associated with breast implants.The field of regenerative medicine has also advanced significantly, with expanded clinical applications of biomaterials and tissue-engineering strategies. At the same time, deeper insights into mechanobiology and wound healing have fundamentally transformed the concept of scar management. In particular, the treatment of keloids and hypertrophic scars has progressed dramatically, with the establishment of multimodal strategies that combine surgery, radiotherapy, pharmacologic therapy, and tension-reduction techniques based on biomechanical principles. Furthermore, the use of high-resolution imaging and molecular profiling has enhanced our understanding of the pathophysiology of pathological scars, paving the way for more targeted therapies.Over the last 10 years, substantial improvements have been seen across various aspects of visceral surgery. Although the ultimate goals remain unchanged, whether to restore the integrity of the abdominal wall, remove a sick organ, or monitor an intestinal obstruction, the measures taken to achieve these objectives have undergone great development.The development of robot-assisted laparoscopy has also become routine in bariatric surgery. Various strategies have been suggested to modify intestinal anatomy, thereby managing obesity and its metabolic effects. In a pilot study of two cases using robot-assisted laparoscopy, severe obesity with type 2 diabetes mellitus was managed with ileal interposition, duodenal closure, and sleeve gastrectomy (Filho AJB, 2025). By also performing sympathectomy during the same procedure, autonomic dysfunction could, at least in theory, improve peripheral perfusion and insulin sensitivity. The study may show the way for future studies that incorporate the anatomical advantages of robot-assisted surgery with improved understanding of metabolism in obesity and diabetes.The basic principles of open and laparoscopic groin hernia repair, including the anatomical positioning of the mesh, have changed little in the last thirty years. By applying the principles of enhanced recovery after surgery, the safety of emergency hernia surgery and postoperative recovery have been improved (Zhu X, 2025). Such advances may be achieved without introducing new technology or acquiring advanced resources.The long-term outcome after treatment of pancreatic cancer remains poor, despite great efforts to detect the tumors at an early stage and attempts to improve oncological treatment. The short-term outcome may, however, be improved if carried out under epidural anesthesia. A study from Dubai showed that this is feasible if the patients are well informed and adequately selected (Hassan I, 2025)The laparoscopic technique has revolutionized gallstone surgery during the last three decades. Visualization of bile ducts, however, has remained a great challenge. Using indocyanine green fluorescence, bile ducts may also be visualized in cases of extensive local inflammation. In a cohort study on patients undergoing laparoscopic cholecystectomy with fundus first approach, it was found that the use of indocyanine green fluorescence is feasible and safe (Haverinen S, (2025).Modern gynecological surgery is undergoing a transformative shift toward ultra-minimally invasive surgery (UMIS) (Wu, T., 2025) and data-driven approaches. UMIS utilizes micro-instruments with a diameter as small as 2 mm to 3 mm, effectively performing complex laparoscopies through incisions the size of a needle. This approach, often referred to as "needlescopic surgery," results in negligible scarring and a significant reduction in post-operative analgesia requirements. Parallelly, Single-Port Laparoscopy (or LESS -Laparoendoscopic Single-Site Surgery) consolidates all surgical access into a single 1.5 cm incision, typically hidden within the umbilicus. A major innovation is the rise of VNOTES (Vaginal Natural Orifice Transluminal Endoscopic Surgery), which allows surgeons to perform procedures like hysterectomies through the vaginal canal, leaving no visible abdominal scars and significantly reducing recovery time (Siciliano, A. 2024).Robotic-assisted platforms are evolving with the integration of Artificial Intelligence (AI) to provide realtime intraoperative decision support, such as identifying tissue characteristics and vascular distributions to enhance surgical precision. Next-generation systems, like the Medtronic Hugo™, are expanding the accessibility of complex robotic procedures (Afonina, M., 2024) meanwhile the introduction of the da Vinci Single Port (SP) system has addressed previous ergonomic challenges by providing 360-degree range of motion through one entry point.Non-incisional treatments like the Sonata procedure, which utilize ultrasound-guided radiofrequency energy to treat fibroids, epitomize the trend toward preserving uterine integrity while minimizing patient trauma. These advancements collectively aim to shift major surgeries into the outpatient setting, prioritizing faster return to daily activities and improved quality of life.The Head & Neck section of Frontiers in Surgery has illuminated a series of converging advances that have reshaped oncologic, functional, and organizational paradigms in head and neck surgery. (Frontiers in Surgery, Otorhinolaryngology -Head and Neck Surgery section overview). At the conceptual level, a decisive achievement has been the translation of Donabedian's classic triad of structure, process, and outcome into a contemporary definition of "best practice" tailored to malignant tumors of the upper aerodigestive tract. (Licitra, G., 2020) This modern framework emphasizes not only technical excellence in the operating theatre, but also the environment in which surgery is delivered, the robustness of care pathways, and the systematic auditing of results over time.²Parallel to this structural transformation, the last decade has witnessed a profound revolution in surgical access, dominated by the rise and refinement of minimally invasive transoral and endoscopic techniques. (Licitra, G., 2020,, )² ²,³,⁴,⁵ Transoral laser microsurgery (TLM) has evolved from a niche modality into a widely accepted organ-preserving approach for selected tumors of the oropharynx, hypopharynx, and larynx, permitting piecemeal resections with exquisite margin control and, in experienced hands, oncologic outcomes that rival those of traditional open procedures.² Transoral robotic surgery (TORS), initially confined to early HPV-related oropharyngeal cancers following regulatory approval, has progressively expanded its indications to encompass more challenging subsites, including the supraglottic larynx, hypopharynx, and parapharyngeal space, always under the admonition that adoption must be evidence-driven and tempered by rigorous patient selection.²,⁴,⁵ The shared thread uniting these approaches is the deliberate retreat from morbid external incisions and mandibulotomies, in favor of routes that preserve external appearance, shorten hospitalization, and expedite functional recovery, all while maintaining an uncompromising commitment to negative surgical margins.³,⁴ Reconstructive surgery has undergone its own quiet revolution, driven by the convergence of microvascular technique, perforator flap design, and enhanced recovery principles.² Free tissue transfer is now firmly established as the standard of care for reconstruction of complex composite defects of the oral cavity, pharynx, and facial skeleton, with large national series documenting high flap survival rates and increasingly sophisticated strategies for salvage in the rare event of failure.² The evolution toward perforator flaps has, in turn, allowed surgeons to minimize donor-site morbidity and to tailor the tissue envelope with greater precision to the three-dimensional requirements of the defect, thereby improving both functional outcomes, particularly speech and swallowing, and aesthetic integration.² These technical refinements are closely intertwined with the implementation of Enhanced Recovery After Surgery (ERAS) protocols specifically designed for major head and neck procedures involving free flaps.² Such pathways, grounded in evidence-based perioperative care, have reduced complication rates, shortened hospital stays, and optimized resource utilization, without eroding the complexity or ambition of the reconstructive effort.²Centralization of care in high-volume centers and in the hands of high-volume surgeons has emerged as a consistent determinant of improved survival and reduced perioperative morbidity in head and neck squamous cell carcinoma, reinforcing the notion that complex oncologic surgery should be concentrated in specialized units with mature multidisciplinary infrastructures.²A comparable shift has occurred in the management of sinonasal malignancies and anterior skull base tumors, where endoscopic techniques have enabled an increasingly "histology-driven" strategy.² Carefully selected histologic entities, those with favorable patterns of local spread and predictable response to adjuvant therapy, may now be addressed via purely endonasal or combined endoscopic approaches, with complete radiologic resection (gross total resection) and negative margins as explicit goals.² These developments have forced the community to revisit seemingly settled questions, such as the precise definition of a "clear margin" in the context of piecemeal or endoscopic resections and the acceptable incidence and management of cerebrospinal fluid leaks as a quality metric for skull base surgery.² The discourse has thus moved beyond feasibility to a sophisticated debate on standards, benchmarks, and the limits of minimal invasiveness in an anatomically constrained region.Equally transformative has been the maturation of neck management as a cornerstone of curative treatment, rather than a secondary adjunct to resection of the primary tumor.² High-level evidence, now broadly disseminated, has definitively established elective neck dissection in early T1N0 oral cavity cancer as superior to a "wait-and-see" policy, conferring gains in overall and disease-free survival by preemptively addressing occult nodal disease.² At the same time, the Robbins classification of neck dissections has achieved near-universal adoption as a common language, enabling precise communication of the extent and intent of cervical surgery across institutions and studies.² Within this framework, sentinel lymph node biopsy in cN0 oral cavity cancer has emerged as one of the most consequential minimally invasive innovations: by accurately staging the neck with minimal morbidity, it offers a means to spare selected patients from the functional and cosmetic burden of more extensive dissections without compromising oncologic safety.² Finally, perhaps the most far-reaching change chronicled in recent years is the integration of surgical innovation into broader oncologic and systemic trends, namely de-escalation, personalization, and relentless quality oversight. The advent of HPV-related oropharyngeal carcinoma, with its distinctly favorable prognosis, has catalyzed a wave of de-escalation trials that seek to reduce treatment-related toxicity while preserving cure rates, whether by attenuating the intensity of CRT or by leveraging minimally invasive surgery as the principal modality in selected, well-stratified cohorts.²,³ At the same time, the growing armamentarium of systemic therapies, targeted agents, immunotherapy, and adaptive radiotherapy, has further underscored the centrality of complete surgical resection (R0) and appropriate neck control as the foundation upon which sophisticated multimodal strategies can be constructed. Parallel advances in diagnostics, including narrow-band imaging, autofluorescence, high-resolution imaging, and emergent liquid biopsy technologies, have begun to influence both the selection of candidates for conservative surgery and the early detection of local recurrence, thereby tightening the feedback loop between diagnosis, treatment, and surveillance. The cumulative effect of these intertwined developments is a discipline that has deliberately moved from the "art of large operations" to a rigorously standardized, outcomes-driven surgical oncology, one that aspires to reconcile maximal oncologic radicality with minimal invasiveness and the best possible restoration of function.There continues to be an evolution in orthopedic implants and medical devices which are now commonly customized for an individual patient. Many of these can be 3-D printed in advance for use by the surgeon. 3-D cutting guides can also be useful in doing tumor resections.Orthopedic conditions limit the lives of most adults with an estimated 30 million orthopedic procedures performed annually. In the US, 1 in 3 Americans report a musculoskeletal condition; they may be suffering from chronic back pain, have been involved in a motor vehicle related trauma or have passed away after sustaining a geriatric fragility hip fracture. The greatest global advancement we have made against orthopedic problems may indeed be the combination of recognition of the burden of disease (https://www.ors.org/boneandjointburden/) and international efforts -through surgeons, physicians, health providers, scientists, engineers, concerned citizens, policy-makers and patients -to improve the musculoskeletal human condition every day. There are certainly important themes to be found: we create greater surgical impact with smaller surgical footprints, more and more using technology such as image guidance and robot assistance; our diagnostics are safer and more accurate.Integration of Biology and Technology.Biologics are not only emerging but more on-target; our clinical studies are better executed and more applicable to the patient right in front of us; our shared patient conversations continue to be refined and electronic health records nudge us toward better decision-making beyond the "burden" they can be perceived to be. Perhaps one day, our policy makers, health providers and consumers will all see as one.Vascular surgery has demonstrated enormous progress during the last decade. Standard endovascular aneurysm repair (EVAR) has been revolutionized with the use of dedicated endografts dealing with neck anatomy, including and the for open the is associated with a and morbidity while results to 10 years and beyond will be to the of this approach for patients with an abdominal aneurysm repair of complex and has also to a safer repair for a challenging patient where open repair has a high in selected patients. The the has the and now the and the long-term data found in of our guides to better particularly to type and open minimally invasive techniques. In wound have been a large of studies on and devices to healing in patients with disease has seen a of endovascular such as use of and The vascular community has that of patients with and disease is the most significant related to that and the is managed with but the combination with such as and the oral to achieve has revolutionized patient AI generated image (Gemini) for the future of surgery over the 10 years. 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Source: Frontiers in Surgery
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7165648576