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Editorial: Imaging and Robotics in Surgical Practice
Volume 7, Number 4
December 2005
Editorial: Imaging and Robotics in Surgical Practice
G
et ready, here comes the future, again. While many of us are still playing catch-up with laparoscopic techniques of surgical practice, the next wave of surgical change is not just coming, but is here already. As evidenced by this issue of Operative Techniques in General Surgery, robotic techniques (and augmented imagery) are already defined and practiced in all areas of surgery. And if you have any doubt that such “telemanipulators” will play an increasing role in the practice of the general surgeon, I refer you to that final arbiter of surgical science, Newsweek, which recently reported in a 6 page article, that such procedures are competing with “established techniques like laparoscopic surgery”.1 Such exposure of robotic surgery in the lay press may be in part sensational, but nonetheless, reflects (and affects) the public’s perceptions and interests. It is incumbent upon the general surgeon to become knowledgeable in such changing techniques of surgical science, if only to answer our patients’ questions in the office. The theoretical potential of such robotic and enhanced imagery techniques is wonderfully attractive and borders on science fiction. Imagine a single adept surgeon operating on different patients, in several different hospitals from a single central site. Or first practicing an operation on an exact “virtual image” of the patient before the actual event. Or electronic elimination of tremor allowing microsurgery of a degree never seen before, possibly approaching the single cell level. If seemingly far fetched, remember what has been accomplished with intra-uterine fetal surgery and the dramatic potential of stem cell research. Combining robotic surgery and precise stem cell implantation may redefine surgery and medicine (and treatment) as we presently know them. Of course it remains to be seen how the techniques of robotic surgery will play out on the field of broad surgical
1524-153X/05/$-see front matter © 2005 Elsevier Inc. All rights reserved. doi:10.1053/j.optechgensurg.2006.01.001
practice. Some would suggest that robotic surgery is purely an academic pursuit, with little applicability to the large majority of surgical cases performed. However, the reality is that, as with any new procedure, this technique will soon find its niche and become one more tool in the surgeon’s armamentarium. The trickle-down will occur and soon robotic manipulators will justify their existence based on safety, clinical outcomes, cost-effectiveness and ease of use. The novel will become routine. So in addition to becoming educated about these various techniques, the reader should recognize the inevitable acceptance of at least some of them in the not too distant future into common use, and prepare for the retraining that will be necessary. The pattern of surgical innovation is familiar. First, there is conceptualization and experimentation, then understanding, and finally technical competence. The various contributors to this issue of OTIGS are doing the first two. The present issue of OTIGS hopes to provide the reader with some of the third, but it will be incumbent upon the individual surgeon to be responsible for the last part of this inevitable process. Walter A. Koltun, MD Professor of Surgery, Peter and Marshia Carlino, Professor of Inflamatory Bowel Disease, Chief, Section of Colon and Rectal Surgery, Penn State College of Medicine, Milton S. Hershey Medical Center Editor-in-Chief
References 1. Barrett J: Health for Life: Cutting Edge. Newsweek, December 12, 2005, 50-54
153
December 2005
Editorial: Imaging and Robotics in Surgical Practice
G
et ready, here comes the future, again. While many of us are still playing catch-up with laparoscopic techniques of surgical practice, the next wave of surgical change is not just coming, but is here already. As evidenced by this issue of Operative Techniques in General Surgery, robotic techniques (and augmented imagery) are already defined and practiced in all areas of surgery. And if you have any doubt that such “telemanipulators” will play an increasing role in the practice of the general surgeon, I refer you to that final arbiter of surgical science, Newsweek, which recently reported in a 6 page article, that such procedures are competing with “established techniques like laparoscopic surgery”.1 Such exposure of robotic surgery in the lay press may be in part sensational, but nonetheless, reflects (and affects) the public’s perceptions and interests. It is incumbent upon the general surgeon to become knowledgeable in such changing techniques of surgical science, if only to answer our patients’ questions in the office. The theoretical potential of such robotic and enhanced imagery techniques is wonderfully attractive and borders on science fiction. Imagine a single adept surgeon operating on different patients, in several different hospitals from a single central site. Or first practicing an operation on an exact “virtual image” of the patient before the actual event. Or electronic elimination of tremor allowing microsurgery of a degree never seen before, possibly approaching the single cell level. If seemingly far fetched, remember what has been accomplished with intra-uterine fetal surgery and the dramatic potential of stem cell research. Combining robotic surgery and precise stem cell implantation may redefine surgery and medicine (and treatment) as we presently know them. Of course it remains to be seen how the techniques of robotic surgery will play out on the field of broad surgical
1524-153X/05/$-see front matter © 2005 Elsevier Inc. All rights reserved. doi:10.1053/j.optechgensurg.2006.01.001
practice. Some would suggest that robotic surgery is purely an academic pursuit, with little applicability to the large majority of surgical cases performed. However, the reality is that, as with any new procedure, this technique will soon find its niche and become one more tool in the surgeon’s armamentarium. The trickle-down will occur and soon robotic manipulators will justify their existence based on safety, clinical outcomes, cost-effectiveness and ease of use. The novel will become routine. So in addition to becoming educated about these various techniques, the reader should recognize the inevitable acceptance of at least some of them in the not too distant future into common use, and prepare for the retraining that will be necessary. The pattern of surgical innovation is familiar. First, there is conceptualization and experimentation, then understanding, and finally technical competence. The various contributors to this issue of OTIGS are doing the first two. The present issue of OTIGS hopes to provide the reader with some of the third, but it will be incumbent upon the individual surgeon to be responsible for the last part of this inevitable process. Walter A. Koltun, MD Professor of Surgery, Peter and Marshia Carlino, Professor of Inflamatory Bowel Disease, Chief, Section of Colon and Rectal Surgery, Penn State College of Medicine, Milton S. Hershey Medical Center Editor-in-Chief
References 1. Barrett J: Health for Life: Cutting Edge. Newsweek, December 12, 2005, 50-54
153