Surgery is a critical treatment delivered by NHS. Pre-COVID19 data (2004-2014) suggest a 27% increase in surgeries in England (>10 million operations performed). Despite >1.5 million cancelled or postponed surgeries in 2020 due to COVID19 (~33.6% reduction in England and Wales) and rocketed waiting lists for cancer surgery likely resulting in more deaths, tumour resection surgeries have recently resumed and remain high (e.g. ~51% of diagnoses received a kidney tumour resection in 2021). The total UK economic burden of surgery was ~£54.6 billion between 2009-2014 (£10.9 bn pa), amounting to 9.4% of the total NHS budget (£117 billion, 2013-2014). There is a clear clinical need for minimising surgical operations, healthcare costs, patient waiting lists, and associated patient complications. To address this need, we aim to digitally transform future surgery, particularly for cancer, by creating a ground-breaking real-time digital twin assisted surgery (DTAS) technology. The patient is at the core of this technology, with significant and measurable benefits for their quality of life and healthcare. DTAS can be applied to several types of surgery (open, minimally invasive, or robotic surgery), for high precision tumour removal even in a partial organ resection. A parallel goal is to revolutionise surgical training, offering a new paradigm of patient-centred personalised surgical rehearsal. This project is timely and will be delivered by an internationally competitive, highly experienced multidisciplinary team, capable of delivering our vision. Our team covers several disciplines, including the lived experience from patients; health technologies; bioengineering; digital twin (DT) technology; artificial intelligence (AI); mathematical science; numerical simulation.

Minimally Invasive Surgery (MIS) has altered operative medicine in the past decades in many ways, through reduction of surgical trauma, pain and complications, as compared to open surgery. However, factors such as the requirement for highly trained surgeons and assistants, high cost of devices, aged non-ergonomic instrumentation, lack of precision in 2D videos during laparoscopic operations, loss of three-dimensionality and haptic sense, instrument and operational limitations, and others4, have hindered the use of laparoscopic surgery in wider applications. Recent advances in technology and medicine have the capacity to radically change the future of surgery as we currently know it. Our research vision is driven by the need to deliver ground-breaking healthcare technologies for safer, more intelligent and effective surgeries via the introduction and integration of next-generation innovations in artificial intelligence (AI), digital technologies, regenerative medicine, biofabrication, modelling, robot-assisted surgery, digital health, medical devices, and transplantation. The development of novel drug-loaded biomaterials and cell therapy procedures can further offer creative prophylactic approaches to surgery. The ultimate overarching goal is to transform the use of surgery by 2050, from just treating to also preventing recurring diseases. Thus, our high risk/high gain ambition is to revolutionise surgery through the development of innovative healthcare technologies that improve patient care and extend the quality of life for an increasingly ageing population, focusing also on disease prevention. Disease prevention is meant here in the context of early intervention, prophylactic operation, and prevention of illness recurrence or effective management of chronic conditions.