Surgical techniques on the horizon

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The fast pace of surgical innovation means new surgical technologies are constantly coming onto the market. Many of these innovations are less-invasive alternatives to traditional surgery, which aim to result in fewer complications and shorter recovery times. Will any of these new surgical techniques change the future of surgery? It’s hard to predict the future. But, CADTH can give us a peek into what the future could look like.

CADTH is continually scanning the horizon for emerging drugs, medical devices, and procedures likely to have a significant impact on patient care and the health care system. CADTH horizon scanning involves systematically summarizing the available information on technologies that are not yet licensed for use in Canada, not yet widely available, or not in routine clinical use. The resulting horizon scanning reports — called Issues in Emerging Health Technologies — are peer-reviewed, concise bulletins that describe the emerging technology, patient indications, and regulatory status; summarize any available information on its adverse effects, costs, anticipated diffusion rates, and implementation issues; and discuss the available evidence and its reliability and quality.

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One recent horizon scanning bulletin — Tympanostomy Tube Insertion System for Children With Otitis Media — reviewed the TULA System, which is a new technology for placing tubes in the ear drums of children with recurrent ear infections. While tympanostomy tube insertion in young children is usually performed under general anesthesia by surgeons in an operating room (OR), the TULA system allows it to be performed outside of the OR in an outpatient setting. This is more convenient for children and their caregivers, and requires fewer health care resources. Also, because TULA uses local anesthesia, it avoids the potential risk of adverse drug reactions and complications associated with general anesthesia. The studies of the TULA system identified in the bulletin suggest that it is effective and tolerable in terms of both the delivery of local anesthetic and the placement of tympanostomy tubes in children as young as 12 months, with few complications. At the time the CADTH bulletin was published, TULA had not yet been approved by Health Canada; and the review also noted that, because none of the studies followed patients beyond two weeks after the procedure, the longer-term safety and efficacy of this technology is not yet known. Still, this is a technology to watch — to see if it turns out to be a safer and more convenient option to traditional tympanostomy tube insertion for thousands of Canadian children.

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Another CADTH horizon scanning bulletin — Femtosecond Laser-Assisted Cataract Surgery — looks at a novel use for the femtosecond laser. For more than a decade, this technology has been used for vision correction (i.e, correcting nearsightedness or farsightedness), but it has recently been introduced as a new and less-invasive approach to cataract surgery. Femtosecond laser-assisted cataract surgery — or “FLACS” for short — is thought to result in more precise incisions and require less ultrasound energy to break up the lens prior to removal, potentially resulting in improved safety and clinical outcomes. However, it is unclear from the limited studies identified in the CADTH review if FLACS results in improved clinical outcomes compared with conventional surgery. And FLACS is substantially more expensive. But, with conventional cataract surgery being the most commonly performed surgery in the world, keeping an eye on any potential advances in the field is important.

CADTH — an independent, not-for-profit agency that assesses health technologies ― finds and summarizes the research on drugs, medical devices, and procedures. By regularly scanning the technology horizon to identify noteworthy emerging trends and themes, CADTH provides a glimpse into the future of health technology in Canada. To browse CADTH’s horizon scanning reports on a variety of medical technologies that are not yet available or widely used in Canada, visit www.cadth.ca/horizon-scanning.