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A Perspicacious View

Wolf, Randall K. M.D.

Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery: Fall 2005 - Volume 1 - Issue 1 - pp 1-2

Over the last 40 years cardiothoracic surgery has evolved at a metered pace. While we no longer utilize catgut or resterilize needles (at least in most parts of the surgical world), surgeons still suture by hand like Alexis Carrell did in 1912. Beginning 40 years ago coronary artery bypass surgery revolutionized the treatment of coronary artery disease, the number one killer of Americans. Many would have never imagined a day when this major procedure would be replaced by minimally invasive techniques, not to mention the consideration of the abandonment of the bypass machine, or the procedure! But now we go by the adage, “less is more.”

We have also seen the amazing advancement of imaging in the medical world. Surgeons still review left heart catheterizations and CT scans of the chest just before major operations. Studies are referred to as “preop studies,” as almost all diagnostic studies are performed prior to surgery. As we progress, imaging will be performed in the operating suite more frequently, and surgeons will rely on realtime data. Current application of this is realtime duplex imaging of the heart. I submit to you that this is the tip of the iceberg in surgical intervention, and the operating room of the future will also be an imaging center.

But where would all of these advancements be without the contributions of biomedical engineering? Who would put the great ideas of medical doctors into practice, if not for engineers? Our civilization has continued to progress because great minds and forward thinkers work together. The marriage of medicine and engineering is no exception. In order to continue to move forward, this relationship must be promoted.

The timing for a more forward-looking cardiothoracic journal is propitious, as technology continues to drive medical advances, particularly in the field of surgery. Technology touches us all, whether we are a cardiologist, surgeon, radiologist or biomedical engineer. The key to discovery over the next several years will be melding the technology from many, sometimes disparate disciplines into what will be called biosurgery or biointervention. There will be many seemingly ephemeral events that will catalyze this transformation of surgery as we know it today. Innovations will sort out the technology that will drive minimally invasive cardiothoracic surgery, from the superficial to the seminal events. Over time, this will prove to be of lasting value as we redefine what surgery means in this new millennium. Innovations will supply you with a perspicacious view of the technology shaping the surgery of this new era. The editors are fortunate to introduce an editorial board that reads as a “Who’s Who” of leaders in minimally invasive cardiothoracic surgery from around the world.

Innovations will serve as the official journal of ISMICS, and selected presentations in manuscript form will be considered for publication in future Innovations volumes. In order to join minimally invasive cardiothoracic surgery with evolving technology, Innovations will feature novel imaging and biomedical engineering ideas and projects and applications as they relate to cardiothoracic and vascular surgery. This marriage of biomedical engineering and imagery with cardiothoracic surgery will help ensure that we, as surgeons, take advantage of opportunities and evolve our specialty. Innovations will introduce nontraditional areas of technology in a cardiothoracic surgical journal, leading to insight into new applications in our field.

But the overriding goal of this new journal will be the final goal for us all—the improvement of patient care to benefit society. How many patients prefer to have their sternum cut and spend one week in the hospital to a minimally invasive procedure and a three day stay? Ask yourself—“would I choose remain on medication the rest of my life to treat my atrial fibrillation and risk a stroke or have my problem cured by a minimally invasive procedure?” While these are not difficult questions to answer, the challenge for us is to continue to make these options a reality.

We are fortunate to be on the space shuttle of cardiovascular surgery as it speeds through time. But we cannot accomplish our goals without contributions from the great medical and engineering minds. While you enjoy reading this issue of Innovations, please consider your possible contributions. Submit your work and allow others to continue to improve patient care.

Stay tuned to Innovations for the surgical journey of the century.

© 2005 Lippincott Williams & Wilkins, Inc.