Which is the direction of change in surgery? In so far as simple answers can be offered I believe these things are important. What can be done with less trauma, less blood loss, less suturing and less time is to be preferred. Prefer also that which causes less pain, illness and discomfort to the patient. It is noted that the doings of the surgical team and how the patient experiences the operation is focused, not the outcome.
The surgical act is focused on the assumption that the result stands proportional to how well the operation was conducted. I wonder if all surgeons believe this to be true. If they did so much of surgery would be different. Surgeons would search for simplicity and economy of the surgical act and hate everything that increases the complexity. They would avoid drains and nasogastric tubes and throw away retention sutures. They would switch to single layer anastomoses and change to a running suture with a single knot for the obvious reason that it is easier and saves time.
Surgeons would wonder why patients become ill after surgery and bedridden with pain. It cannot be blamed on the anaesthesia but rather on the surgery. Surgeons would find means to accomplish a bloodless and transfusion free surgery because bleeding and transfusion cause systemic effects. They would find means of a tension-free surgery because excessive suture and suture under tension induce ischaemic inflammation which is painful and trigger systemic responses.
Surgeons would master the use of their instruments so tissues can be cut and joined with the least of movements and force, and they would sharpen their minds to the point when the handicraft is nothing but the conception of the completed operation.
Above all, surgeons must acquire a clear understanding of the direction of change and the ways to promote it. There will be a day when surgery is done almost without patients suffering from it.