There is a general recognisable change of paradigms in the learning of the young generation that has also reached medical education and especially surgical training. In principle, there is a trend away from active to passive knowledge. In practice this means to know where and how to get information online but not to have the knowledge in detail. The trend is to quickly call the adequate source which delivers the detailed knowledge directly and comprehensively. On one hand, this is reproducible because of the fast-increasing information flood but on the other hand carries the risk that even basic details are not inside the active memory.

Following this trend there will be anatomical atlases being integrated into modern navigation systems that can be used for the specific case or patient with the help of special software. The navigation systems themselves will be controlled much more intuitively with the help of voice control and gesture recognition.

Thesaurus functions have been already integrated into many medical devices and this trend will continue. Learning surgical thesaurus systems recording all the information about decision algorithms and the associated surgical steps and their ubiquitary interconnection could deliver standardised recommendations about surgical indications and make the sense of single surgical manoeuvres statistically analysable. Such a continuously growing, knowledge-based digital surgical textbook is the basic requirement for autonomous operations. However, when discussing with leading experts from information technology and humanoid robotics, it seems that we are still far away from autonomously acting surgical robots.

Surgery at the skull base is a difficult procedure that requires complex and intelligent planning and active tactile realisation of this planning in very limited space. Here, situative, fast and experience-based decisions and a continuous adaption to a permanently changing scenario are basic requirements. Despite the huge and permanent advances in the field of artificial intelligence (AI), such complex decision algorithms that lead to an immediate, targeted, situatively logical, highly differentiated manual action are not imaginable to be done by an autonomously acting robot at present. The human brain has a huge performance advance due to its morphology and the given ability of parallel data processing of huge amounts of information compared to programmed machines. The extraordinary skill of the human brain of immediately reacting adequately to a changed situation is a crucial difference to programmed systems. When comparing autonomous driving with skull base surgery, there are massive differences since operating is an active acting in a three-dimensional space. Due to the very small dimensions and the highly precise, haptically controlled and targeted motor skills, it is not comparable with the relatively trivial task of moving a car on a road. Thus, the cybernetic movement control during surgery is much more complex than the control of a vehicle. The recent and the following generation of humanoid robots (the latter being recently under development) are overrated in terms of their performance and will definitely not replace well-trained skull base surgeons in the foreseeable future.

By means of appropriate 3D visualisation using virtual reality (VR), there will be simulations and digital surgical textbooks with realistic 3D animations but the latter with a lack of haptic tactile feedback which is essential for adequate and successful surgical training.