New surgical technology is both blessing and curse. New devices and techniques hold out the promise of treating patients more effectively, safely, and efficiently, said Eric DeMaria, MD, chief of general and endoscopic surgery at the Medical College of Virginia. New devices and techniques also hold out the promise of increased training needs, costs, and safety problems immediately following introduction.
   "We are literally besieged by new products and techniques from industry," Dr. DeMaria reminded the American College of Surgeons Clinical Congress, meeting in San Francisco. "And for all the benefits they bring, you can predict that problems can and will arise."
   Patients are interested primarily in improved care, he noted, but professional stakeholders—surgeons, nurses, industry, and attorneys—all have different goals.
   Surgeons are motivated to save time with easier, more effective procedures as well as the desire to use the best and newest the field has to offer. Nurses are responsible both for enabling physicians to use the newest devices as well as enforcing hospital, quality assurance, and regulatory policies. Industry is focused on improving patient care in order to boost profits. The legal profession is largely interested in limiting liability exposure by improving patient outcomes and ensuring adequate training for the health care team that will actually use the new technology. "We too often have an 'adjust to it' mentality," agreed Michael Belkin, MD, chief of endovascular surgery at Brigham and Women's Hospital in Boston. "We bring a new technology into the OR and assume we will all get used to it. That's not good news for anyone."
   The reality, he said, is that hospitals and surgeons must evaluate new technologies before they are acquired, not afterward. Food and Drug Administration approval speaks to the safety and efficacy of a new device, but says nothing about how cost effective it might be in real world practice or how appropriate it is for a specific institution.
   Many hospitals have created technology assessment committees (TACs) to answer questions about cost, cost effectiveness, utility for specific patient populations, comparisons with existing technologies, and training needs. A TAC also looks at what might be lost when a new technology is deployed.
   Traditionally, Dr. Belkin said, conditions such as appendicitis were diagnosed through physical exam and patient history. Today, appendicitis is diagnosed largely by CAT scan. Technology may provide a more accurate diagnosis, but it also deprives clinicians of opportunities to hone their diagnostic skills, skills that are still needed in areas where technology has yet to penetrate.
   Training has become a significant issue in rolling out new surgical technology. Device manufacturers are responsible for training to some degree, noted Chuck Kennedy, director of professional education for United States Surgical. Both industry and clinicians now recognize that training is a continuing responsibility, not a one-time event.
   The ACS has also recognized the need for training. CESTE, the Committee on Emerging Surgical Technology and Education, and its subcommittees are responsible for developing guidelines and standards to ease the adoption of new technology and ensure appropriate training.
   A new ACS program, Accreditation of Educational Institutes, or AEI, was approved in June and launched at the Clinical Congress. One purpose of AEI is creating a national system of certified educational centers with common policies, procedures and standards, Dr. Belkin said.
   "The expense of these devices is overwhelming," he admitted. "You have to sell the usefulness of these technologies to your hospital. That is where CESTE and AEI come into the picture to assure committees that surgeons will know how to make best use of these technologies."