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The arrival of new technologies in the operating theatre raises questions about surgical practice, in a context of societal changes and hospital reorganisation. These innovations will bring changes to the ethos of the profession and ethical issues will be raised by the increase of the surgeon., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Introduction: Surgical practice in gastro-enterology is concerned by deep technological advances. In the past century, the technological advances were conducted by clinical challenges and strategies. The 21th century is clearly led by the inversion of the paradigms. Medical practice does not only depend on the access to the technologies, but it seems submitted to her. Should the physician follow the engineer ? Does the clinical data collection, depend on the computer ? Who decides ? The doctor, the patient or the Artificial Intelligence ? Materiel et Methods : The present essay that definitely does not answer all these questions, is achieved thanks the practical experience of our colleagues. We also collected the recent literature devoted to new and promising technologies. The PUBMED review is completed by several think tanks reports coming from the industry., Results: Among the multiple aspects of present and future progresses, 6 among them could be pointed out: the benefit of augmented reality, mini and micro invasive techniques, robotic, news energies, big data and artificial intelligence., Conclusions: Progresses in data collection and treatment, imminent advances in micro mechanics, will completely change our clinical practice. The role of the doctor is in the center of this approach. We have to prepare young people to this human revolution.

The augmented reality on smart glasses allows the surgeon to visualize three-dimensional virtual objects during surgery, superimposed in real time to the anatomy of the patient. This makes it possible to preserve the vision of the surgical field and to dispose of added computerized information without the need to use a physical surgical guide or a deported screen., Technique: The three-dimensional objects that we used and visualized in augmented reality came from the reconstructions made from the CT-scans of the patients. These objects have been transferred through a dedicated application on stereoscopic smart glasses. The positioning and the stabilization of the virtual layers on the anatomy of the patients were obtained thanks to the recognition, by the glasses, of a tracker placed on the skin. We used this technology, in addition to the usual locating methods for preoperative planning and the selection of perforating vessels for 12 patients operated on a breast reconstruction, by perforating flap of deep lower epigastric artery. The "hands-free" smart glasses with two stereoscopic screens make it possible to provide the reconstructive surgeon with binocular visualization in the operative field of the vessels identified with the CT-scan., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)