By Matthew Brady Advanced imaging, robotic platforms and AI-assisted navigation are beginning to transform surgical practice, but uneven adoption, legal uncertainty and implementation fatigue continue to constrain progress, speakers said during a panel discussion on the future of operating theatres during MedTech World Middle East in Dubai.
The session, titled “Inside the OR of the Future: Evidence-Driven Innovation, Smart Navigation & Real-World Impact,” featured Mare Lensvelt, Editor-in-Chief of Dutch Health Hub and vascular surgeon; Prof. Shafi Ahmed, CEO of MedicalXR; Dr David Laith Rawaf, Clinical Director for Clinical Strategy & Partnerships at VitVio; and Habeel Gazi, Managing Director of MedApp USA.
Progress falls short of earlier predictions
Asked what would surprise a surgeon from 2015 stepping into a modern operating room, Prof. Ahmed—who has practised for 35 years—acknowledged visible changes, particularly the increased prevalence of robotic surgery and digital imaging systems. Yet he described the overall pace of change as disappointing.
“We haven’t delivered the promises 10 years ago of what a connected OR could look like,” he said, adding that outside high-resource settings, many operating rooms remain “fairly basic” and “fairly crude.”
Dr Rawaf agreed, noting significant disparities even within wealthy nations. He described working in NHS facilities with exposed wiring and outdated infrastructure resembling operating theatres from the early 2000s, while other hospitals in the same country feature cutting-edge technology. “The democracy of access to technology is obviously not very fair, even within the Western world,” he said.
Augmented Reality and AI struggle to reach clinical maturity
Discussion centred on emerging technologies including augmented reality, surgical navigation and artificial intelligence as potential drivers of future change.
Gazi highlighted recent developments in specialised AR hardware for surgery, noting that earlier consumer devices from companies including Microsoft and Magic Leap failed to deliver the precision required for clinical use. Purpose-built surgical headsets with advanced sensors are now in prototype stages, he said, though widespread adoption remains years away.
Critical to AI integration, panellists agreed, is access to high-quality procedural data—recordings of surgeries, instrument movements and clinical decision-making. Dr Rawaf noted that while healthcare has accumulated vast amounts of digital information over the past decade, much of it relies on inconsistent manual input. “Once we have more of that collected, we’re excited to see what’s possible with overlaying more live guidance during the surgery,” Gazi said.
Several speakers drew comparisons with aviation, arguing that healthcare must adopt structured safety systems, simulation-based training and objective data analysis to manage increasingly complex operating environments.
Legal Frameworks and Cultural Resistance Hinder Adoption
Beyond technical challenges, panellists identified governance, liability and change management as fundamental barriers.
Technologies that track surgical movements or automate clinical decisions raise unresolved questions about legal responsibility. Gazi questioned whether technology companies would assume liability if AI-driven systems contributed to adverse outcomes, and whether surgeons would accept systems that record their actions in ways that could be used against them.
Dr Rawaf advised innovators to design tools that support rather than surveil clinical teams. Video data should be deleted immediately, he said, and systems should focus on improving workflow efficiency rather than identifying errors. “You’ve got to make sure that in order to change that management, change that approach, you have to build something that will help the team,” he said.
Prof. Ahmed emphasised that physicians remain among the most resistant to change within healthcare systems. Successful innovation requires investment in workforce adaptation equal to that spent on technology itself. “You have to spend as much money and effort on change management as the technology,” he said.
He referenced radiologist Geoffrey Hinton’s 2015 prediction that AI would eliminate radiology within five years—a forecast later revised to emphasise augmentation rather than replacement. Surgeons who adopt AI tools will outpace those who do not, Ahmed suggested, though the technology itself will not replace human clinicians.
Financial pressures demand return on investment
Hospital financial strain emerged as a critical constraint on innovation. Dr Rawaf noted that institutions worldwide face reduced reimbursements and regulatory pressures, making cost-effectiveness essential for any new technology. “At the moment, a lot of hospitals across the entire world, including in the US, are struggling for cash,” he said.
Gazi described how shifting insurance coverage in the United States is forcing hospitals—particularly those in rural areas—to prioritise operational efficiency over technological advancement. Many are closing entirely due to insufficient patient volumes.
Panellists warned against “point solutions” that require separate logins, training programmes and system integrations, contributing to implementation fatigue among clinical staff. Dr Rawaf urged developers to build platforms capable of addressing multiple workflow challenges rather than isolated problems.
Envisioning 2040: Automation, diagnostics, and global access
Looking to 2040, panellists acknowledged the difficulty of long-term forecasting but outlined several possible trajectories.
Prof. Ahmed noted that 120 companies were developing surgical robots in 2025, compared with one in 2000, suggesting rapid expansion of automated systems. He displayed an early Google Glass device used in a 2012 surgical demonstration, noting that while the technology failed to gain traction, current developments may prove more viable.
Dr Rawaf envisioned operating rooms expanding beyond treatment spaces to integrate diagnostics, with robots handling routine procedural elements under human supervision. He advocated for expanding ambulatory surgical centres globally, supported by remote collaboration and AI-assisted workflows that reduce staffing requirements.
Gazi pointed to semi-autonomous systems already in clinical use, including robotic platforms for knee surgery that operate with limited human oversight. He suggested that some procedures may eventually be supervised by nurse practitioners rather than physicians.
However, he stressed that accessibility must remain central to development. “How do we make all of this more accessible globally?” he asked, noting the stark disparities between government and private hospitals in countries including India. Developers must decide early whether to integrate technologies into expensive capital equipment or create standalone systems affordable in lower-resource settings. “A lot of companies, when they pay you that big check, whether it’s half a billion or whatever, they’re not expecting to give it away for free,” he said.
As the session concluded, panellists agreed that surgical technology stands at a critical juncture. While hardware and software capabilities continue to advance, realising their potential will require parallel progress in governance frameworks, legal structures, workforce development and equitable distribution.
The challenge, speakers suggested, lies not in what technology can achieve, but in ensuring it reaches the 8 to 9 billion people who might benefit from it.
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