Raising the technology bar in minimally invasive surgery: look how far we’ve come

Excerpt

Bringing computer-based technology to a high level in the operating room can be the stuff that dreams are made of. This month’s multimedia manuscript entitled “Mixed Reality for the Robotic Treatment of a Splenic Artery Aneurysm” by Pietrabissa et al. may be the quintessential example of making such a dream a reality to date. This is an extraordinary video that has to be viewed because only seeing is believing. The treatment of splenic artery aneurysm is varied. These lesions have been treated by coil, open or laparoscopic ligation, aneurysmectomy and splenectomy, and even aneurysmectomy and distal pancreatectomy/splenectomy. Image guidance for these techniques has included angiography, computed tomography, or perhaps a combination of the two. This video illustrates the diagnostic resolution of three-dimensional reconstructed tomography demonstrating the fine detail of the vasculature of the aneurysm as well as the blood supply to the spleen. This allowed for the preoperative planning of a unique solution for this lesion. While the utility of the surgical robot has been debated in a variety of arenas, few will deny that the arterial reconstruction of the splenic vasculature would be possible utilizing conventional laparoscopic techniques. Perhaps the real future of robotics is in microsurgery? Yet as envious as I am of this astonishing technologic accomplishment, I cannot help but wonder where this fits in the current health care debates going on in this country and around the world. How will we introduce these technologic marvels? Who will decide just which patients have access to these techniques—will aneurysmectomy with or without splenectomy be deemed “good enough” for the masses? As surgeons we need to participate in these debates. If we are bystanders, the decisions will be made for us. I encourage you to watch the video and wonder, “Am I seeing the future or just another mountain successfully climbed?” Regardless of how you feel, we need to be the active managers of technology introduction in the surgical world. …