Foreword

We live in a technological age, and the practice of surgery is not exempt from this. Furthermore, predictions are that the inevitable trend in surgical practice is toward increasing dependence on high-technology equipment. Thus, Emerging Technologies in Surgery edited by Richard Satava, Achille Gaspari, and Nicola Di Lorenzo, is timely and appropriate. My experience with use of medical technologies together with my involvement in related research and development work over many years has led me to classify these technologies in four categories all expertly covered in this book: (1) fa-cilitative—improve the e^ciency of performance and reduce the degree of dfflculty of execution of speciKc tasks; (2) additive—bring technical sophistication and accuracy to surgical manipulations/interventions that are not considered essential to existing practice; (3) enabling—make possible certain surgical interventions or open new therapeutic approaches; and (4) disruptive—technologies that, by breaking new ground, underpin real progress. The term "disruptive technologies" was Krst coined by Clayton M. Christensen in 1997 in his book The Innovators Dilemma (Harvard Business School Press), to refer to technologies that, as they mature, alter the way humans live and work.

Wisely, the three editors of this book, rather than pigeonholing the technologies covered in this excellent monograph, have adopted a dfflerent layout more suited—from a practical and educational standpoint—to the current and future practice of surgery; however, examples of all these categories are included in the various sections. The contributions to all these sections are by leading-edge experts in the respective Kelds, and after reading all the chapters, I have no doubts that the editors chose their contributors wisely. Emerging Technologies in Surgery should be of interest to both the surgical trainees and their trainers, because it contains a wealth of useful and practical information on the subject. It is appropriate in my view that emphasis has been made on education and training, as they are axiomatic to quality care in surgical practice. The advances in virtual surgical simulation that, after a shaky start, have in the last few years progressed to a stage where no surgical training program can a^ord to overlook their importance; the apprenticeship system of training is no longer su^cient, especially with the curtailment of the training period. The World Wide Web and progress in medical informatics in general (disruptive technologies in the extreme) have removed all possible excuses for all healthcare providers—let alone surgeons—to be misinformed or be lacking in medical up-to-date information, because the technology brings accurate information to the shop Koor of medical practice. There is, however, one issue directly related to the increasing dependence of surgical care on high technology that I feel has been overlooked in all training programs and which needs emphasis: Surgeons and other interventionalists increasingly use sophisticated energized equipment often and regrettably, without an adequate understanding of the physical and engineering principles involved. This cognitive de^cit of current training program needs correction.

It seems to me that the approaches covered in the various sections of Emerging Technologies in Surgery are breaking down turf barriers between disciplines, such that patient management is slowly changing from isolated, single-discipline treatment to multidisciplinary treatment by disease-related treatment groups, which surgeons must buy into. The spate of integrations, witnessed on both sides of the Atlantic between vascular surgeons and interventional vascular radiologists over the past 5 years, is a pertinent example.

The editors are to be congratulated for an immensely readable and informative monograph. It deserves to be read and will, I am sure, be well received. I suspect, however, that we shall witness several future editions since one thing is sure: Medical technology does not stand still ... for long.

Sir Alfred Cuschieri, FRS

Professor of Surgery Pisa

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