This hugely inspirational session focussed on how the exponential development of technology currently being seen has the potential to revolutionise how we work in the colorectal speciality - from collaboration across borders sharing best practice and extending research, to engaging with patients and harnessing cutting-edge techniques to improve procedures.

Richard Brady at Coloproctology 3.0
Richard Brady addresses Coloproctology 3.0 symposium

As well as chairing the session, Richard Brady was first to the stage to offer insights on colorectal research in a social media age. He explained that web 3.0 is about web based connective intelligence - connecting data, concepts, applications and ultimately people.

So, taking that to Coloproctology 3.0, Brady proposes that five elements are key:

  1. Semantic data
  2. Artificial intelligence
  3. 3D Graphics VR gamification
  4. Ubiquity of access
  5. Connectivity

In terms of colorectal research, social media can be useful in a number of ways. In terms of conception you can use it to refine ideas, connect with relevant groups, undertake collaborations, initiate debate and link with organisations. When it comes to recruiting participants, social media is increasingly useful in educating, engaging and ultimately involving patients. But, Brady pointed out social media can also have a negative influence with the advent of ‘fake news’. The recent stories relating to surgical mesh are a case in point.

Once the research is underway social media again is a great platform for collaboration on studies as well as dedicated study sites and updates. Then, once the research is complete – there is a massive potential to spread the word about it effectively with visual abstracts, GIFs, tweet chats, blogs, podcast and online journal clubs.

Brady posed the question - how can we advance future coloproctology safely in an age of information overload, increasing cost, increasing litigation, financial austerity and time pressures?

He underlined that it is important to evaluate effectively and ask specific questions such as - What does this technology actually improve/deliver? Who should be using it? Who is actually using it? What does this technology actually cost? Does it raise ethical issues? Are the complications known? What is the scientific evidence? Am I contributing to the evidence?

He challenged the audience to think about new ways of working; to build on robust frameworks and quality of data, to maximize tech capabilities; to utilise the correct evidence based hardware, at the right time, with right training, on right patient, in right setting, for the right disease!

Brady is sure that Coloproctology 3.0 will affect our future practices and patients’ lives. We need to direct it to meet the needs of our patients and our future practices.

Gianluca Pellino (Italy) was next up. He gave an insight into EuroSurg and massive online research collaboratives: the Italian Experience. He started by saying that the way research is being done is revolutionising and, after initial scepticism, it has been welcomed. He talked about his involvement in collaboratives such as EuroSurg and then ItSurg and what he's learnt.

He looked at whether it is worth engaging with collaboratives and whether national groups are necessary. Ultimately his experience is that they are a chance to make an impact.

Pellino said that they provide a scientifically sound methodology and also provide global training opportunities. They allow for dissemination of novel findings. At a country level they provide national support for country-specific issues. There is the opportunity to involve patients via national associations. Being involved in a collaborative give the chance to acquire skills gradually which can then be used to run national studies.

He did urge the need to respect ethics and rules and warned of collaborators only interested in authorship.

Michael Seres (UK) is a patient advocate and spoke about the potential for E-patients and colorectal surgery innovation.

He stated that the role of the patient is changing massively and suggested that this requires bravery - not from the patients but from the surgeons and care professionals - to engage and let down their guard with patients.

He talked about creating a culture in healthcare where everyone is trusted and respected for the expertise they bring. In this approach openness and experimentation is the norm and people have ownership of their health. This is a culture in which the patient voice and choice is a part of the decision process.
Seres was 11th person to undergo a bowel transplant in the UK and started a blog about his experiences. He wanted to talk to people who understood what it felt like to live with a bag. He also developed a strong, trusting relationship with his consultant who agreed that it would be good to have consultations over Skype rather than Michael having to travel miles to the hospital for a short meeting. However, for 18 months the hospital wouldn’t let his surgeon Skype from hospital due to data security concerns.

Seres flagged that according to Dan Ariely, big data is like teenage sex – everyone talks about it, nobody really knows how to do it, everyone thinks everyone else is doing it, so everyone claims they are doing it.

He posed the question of how you achieve change and pulled on a Steve Jobs quote:

“The ones who are crazy enough to think that they can change the world are the ones who do.”

Seres started 11 Health with the desire to deliver smart care for ostomy patients that allows the patients to live at home but delivers appropriate care. It is a Care Management company that combines Smart Technology with highly personalised Human Interventions to deliver unprecedented outcomes for both patients and clinicians. It puts patients at the heart of the care system.

One of the outcomes is the ‘ostomy smart bag’ which uses temperature and capacitive sensing to detect volume. It detects flow rates to differentiate between liquid, solid and gas. It uses wireless connectivity and has a camera capability to look at stoma injuries and blood in stool. It also has a memory foam inner layer for extra comfort.

Another aspect of the initiative is harnessing the power of the patient-to-patient ecosystem.

Seres concluded by saying that too often solutions are delivered to patients not with patients. If we really want to change colorectal surgery Seres believes in the potential of putting patients first.

Sam Atallah (USA) took the audience in the Plenary hall through some of the cutting Edge of technical advances happening in colorectal surgery.

Atallah started by underlining the rate of the technological growth - sharing a prediction that in thirty years our current technological ability will have advanced by a billion times.

He then looked at what direction the future is taking coloproctology. Specifically he talked about the augmented hand, the augmented eye and the augmented mind and what they might mean for challenges that are faced in coloproctology such as the quest for precision in transanal total mesorectal excision.
He referenced the progress that is already being made with robotics which started as telepresent surgery. Now robotics is about robots performing remote tasks – they’re ‘tele-manipulators’. From 2003 robotics in surgery has been about delivering better precision. From 2010 that has shifted to whether we can go places not otherwise accessed with open or laparoscopy?

Another area that excites Atallah is the potential for use of enhanced navigation in surgery akin to flight navigation which will allow surgeons to have greater accuracy in knowing where their target is compared to where they are to allow them to decide the best way to get there. He predicts that in the future we will operate more by data and instruments and less by direct vision. Such virtual navigation is already being used in Neurological Surgery, Orthopedic Surgery and in ENT.

He also looked an innovations in relation to vision – including ICG, Near-infrared Venous Imaging, fluorescence, dye imaging and ‘surgery beyond the visible light spectrum.

Atallah concluded that technological advancement in colorectal surgery is booming and it is time to get engaged in the process because the idea of digital surgery is about to be real. Computer Assisted Surgery, Navigation, AI, Dye Imaging are just beginning to show their potential. These advances will be part of the solution to safe surgery and improved outcomes in complex surgery.

Steven Wexner (USA) was last up in this session and he focussed on the use of global hashtags in colorectal research. He started by disclosing he is a self-confessed Twitter addict.

He stressed that social media is where patients are going - ‘I diagnosed myself on the internet’ is not an uncommon claim!

Wexner talked of the reasons to use social media and research saying it develops and supports professional collaborative audits and research networks. He also referenced the potential to develop high quality peer-reviewed research protocols which are disseminated through SM channels. Additionally it helps with data collection and can targets large populations in a highly responsive, interactive manner. As has been said by other speakers in the session it promotes collaborator opportunities. Crucially it can also enhance participation at a minimal cost.

He talked of harnessing different hashtags (memorable, unique and relevant):

  • #colorectalsurgery - a campaign to raise the profile of colorectal on social media. Discussions of clinical cases and research initiatives among a global community of coloproctologists
  • #CRStrialschat
  • #SoMe4Surgery

Wexner finished with a quote from Bobby Prasad, MBBS, FACP, FRCP, FASGE Chelsea and Westminster Hospital; London Gastrointestinal Associates, London:

“I would like to leave you with the image of social media as being the equivalent of a surgical scalpel - both are excellent tools but only if they are used appropriately and wisely.”

ESCP Affiliates