The Good Surgeon
How do current surgical advancements change what it means to be a good surgeon, and what skills do you think will be most important for surgeons to develop?
There used to be a time when the greater the surgeon’s incision, the more the patient was sure of recovery. In early 18th-century England, the metric for a successful surgery was not the survival of the patient afterwards, for they seldom survived,1 but the heroism and speed of the attending surgeon, who was the captain of the operating theatre. It was only until 1846 that ether and nitrous oxide gas were used for anaesthesia, and suddenly speed was no longer the definitive factor of a surgeon’s skill. The survival of patients skyrocketed after 1867, when antiseptic techniques were introduced by Joseph Lister, and surgical professionals shifted from barber-surgeons2 that habitually provided medical services in medieval Europe, to doctors who now balance manual dexterity and digital fluency to command the sophisticated machinery in today’s operating suites.
The Evolution of Modern Surgery
In the modern day, the development of X-rays and imaging technologies have improved a surgeons’ ability to locate and treat diseases with increasing accuracy.3 Laparoscopic and robotic-assisted surgery are also now considered cornerstones of current practice, improving surgical technique and patient outcomes such as less pain, and shorter hospital stays. As such, the definition of a good surgeon no longer depends on manual skill alone, but the ability to interface with teleoperated consoles such as robotic-assisted systems like Da Vinci,4 or laparoscopic visualization systems such as SpyGlass, in order to ensure accurate and precise procedures that are as minimally invasive as possible. Moreover, in today’s operating rooms it is not just the surgeon who is the captain of the surgery anymore, and while they still hold the ultimate responsibility, they are a strategic lead and the first among equals in a multidisciplinary team5 of professionals.
The First Among Equals in a Multi-disciplinary Team
I was shadowing a doctor at King Hamad University Hospital in mid-autumn when I witnessed many of these qualities, firsthand, right there in the operating theatre, as the team was preparing for an endoscopic retrograde cholangiopancreatography (ERCP) with electrohydraulic lithotripsy. This was a procedure that involved a very thin endoscope, a SpyGlass, being guided from the patient’s oral cavity into the common bile duct. I watched as the doctor deftly navigated the endoscope through the biliary tree via the console, taking targeted biopsies and using electrohydraulic probes to break up large gallstones in a patient with cholelithiasis.
I was awestruck by his display of soft leadership and the pleasant atmosphere he had created, which was so different to my expectations of a frigid and aloof room. He maintained light-hearted conversation with the nurses and the staff, jokingly asking about their lunch plans or telling an amusing story about his brother’s trip to India. Earlier, I had seen him reassuring a patient before an endoscopy, offering the same warmth and humour to ease the patient’s anxiety. Even when the surgeon was visiting post-op patients, all of them immediately lit up once he started speaking to them.
The ability to lead and communicate with an interdisciplinary team of medical professionals in the operating room, and to use “people skills” such as empathy and humour, are skills that are irrefutably necessary for a surgeon to be considered good, and to ensure the highest quality of care for a patient. A study6 measuring surgeons’ leadership styles found a strong correlation between positive interactions and higher team leadership ratings, enhanced team performance and a reduction in errors. These leadership qualities contribute to improved patient outcomes and recovery, and a better overall quality of life post-procedure, just as I had seen with my own eyes.
Skills for the Future
As the past recedes farther behind us and we pivot towards a new direction of human-machine interplay, surgeons must become proficient with a wide array of digital tools. Artificial intelligence7 can simulate environments for complex cases and provide real-time feedback, while robotic-assisted and fully-robotic autonomous systems,8 such as STAR,9 can provide greater precision and less invasive procedures. With the rise of such technologies, there are also important ethical considerations. Surgeons must become ethical stewards,10 maintaining human control and accountability at all times during these autonomous and semi-autonomous surgeries. Despite all this, the hallmark of a good surgeon remains unchanged: it is the ability to bridge that which is cold and technical with all that is empathetic, strong, and essentially human.
References:
1. British Association of Urological Surgeons. The 19th Century. BAUS Museum.
https://www.baus.org.uk/museum/1325/19th_century. Accessed February 22, 2026.
2. Vretenarova T, Atanassov T, Todorova K. Surgery – from the barber-surgeon era to
modern times. Bulgarian Society of Medical Sciences Journal. 2024. doi.org.
3. Gawande A. Two Hundred Years of Surgery. N Engl J Med. 2012;366(18):1716-1723.
doi:10.1056/NEJMra1202392.
4. Azizian M, Liu M, Khalaji I, et al. The da Vinci Surgical System. In: Abedin-Nasab MH,
editor. Handbook of Robotic and Image-Guided Surgery. Elsevier; 2020. p. 39-55.
doi:10.1016/B978-0-12-814245-5.00003-7.
5. Taberna M, Gil Moncayo F, Jané-Salas E, et al. The Multidisciplinary Team (MDT)
Approach and Quality of Care. Front Oncol. 2020;10:85. doi:10.3389/fonc.2020.00085.
6. Stone JL, Aveling EL, Frean M, et al. Effective Leadership of Surgical Teams: A Mixed
Methods Study of Surgeon Behaviors and Functions. Ann Thorac Surg.
2017;104(2):530-537. doi:10.1016/j.athoracsur.2017.01.021.
7. Silva C, Nascimento D, Dantas GG, et al. Impact of artificial intelligence on the training
of general surgeons of the future: a scoping review of the advances and challenges.
Acta Cir Bras. 2024;39:e396224. doi:10.1590/acb396224.
8. Medical Design Briefs. Autonomous Surgery: Engineering the Next Generation of
Surgical Robots. 2024. www.medicaldesignbriefs.com. Accessed February 22, 2026.
9. Johns Hopkins University. Smart robot performs first laparoscopic surgery without
human help. The Hub. 2022.
https://hub.jhu.edu/2022/01/26/star-robot-performs-intestinal-surgery/. Accessed
February 22, 2026.
10. Hashimoto DA, Rosman G, Rus D, Meireles OR. Artificial Intelligence in Surgery:
Promises and Perils. Ann Surg. 2018;268(1):70-76. doi:10.1097/SLA.00000000002693
