There are parallels between the military’s planning for sixth generation fighter aircraft and medicine’s sixth generation surgical theater.  Surgery has evolved from 1) the ages of the scalpel; 2) anesthesia; 3) asepsis and antiseptic practices ; 4) bypass machines and minimally invasive tools; and 5) surgical robots.  Now, a sixth generation awaits the integration of several rapidly developing technologies: 1) wearable, ingestible and implantable sensors that track multiple vital signs and environments of the patient during a procedure; 2) computer vision headgear that allow surgeons to navigate with voice, glance or gesture commands and use artificial intelligence for guidance; 3) laparoscopic tools that feed “smoke” to mass spectroscopy machines for margins’ analysis; 4) high definition ultrasound imaging; 5) autonomous surgical robots; and 6) 3D printing of customized instruments and implantable tissues.  Capturing this wealth of data will not only serve to train future surgeons and their staff using 3D video, but also find new cost saving measures as well as provide a record trail if anything should go wrong.

Digital data is the common thread, but being interconnect computer assisted may be vulnerable to hackers.  This may be the sixth generation’s greatest vulnerability, not only from malicious intent, but also those proverbial “glitches.”  These innovations will raise new ethical, legal, and social issues since surgery is the most personal of all personalized medicine. The benefit is improved health while aging.  Eventually, we may see surgical ambulances, in-home surgeries, and outpatient surgeries in Walmart stores (perhaps starting in El Paso, TX).