Preface

Writing a textbook of medicine in the 21st century may seem like a daunting and obsolete challenge. We live in an age where information travels quickly and becomes outdated even faster.

The rapid evolution of technology makes writing a textbook on robotic surgery even more paradoxical. Since the initial procedures were performed with the Da Vinci at the onset of the 21st century, at least 4 generations of robotic surgical systems have been deployed. The global, logarithmic growth in surgical applications and indications requires a constant reassessment and expansion of the basic knowledge. In addition, new devices continue to emerge in the clinical setting, each with its own peculiar features influencing how procedures are performed.

As robotic surgery has grown so rapidly, there is a lack of scholarly materials and standardized approaches. Today, initial training in robotic surgery mostly consists in familiarizing the surgeon with the system’s mechanical controls. I realized, with time and experience, that such an approach will lead many young surgeons to confuse their skills in controlling the robotic system mechanically with the actual know-how associated with performing surgery. The basics are often unclear due to the absence of a standardized, codified approach where steps can be analyzed, measured, and repeated consistently.

The purpose of this textbook is to facilitate students’ learning of surgery while applying robotic technology. Each chapter presents a “paradigmatic” procedure, explained step by step, providing notes, suggestions, and insight into common mistakes and approximate timing.

The material includes intraoperative images and video clips to add a visual, sensory dimension to the learning experience, thus facilitating comprehension of the surgical technique. Great emphasis is placed on the explanation of anatomy and its variants with numerous original drawings included to help with understanding anatomical details.

Past centuries saw the study of anatomy at the center of the surgeon’s education. Even more emphasis should be placed on anatomy today, since robotic surgery can also be defined as “image-guided surgery.” I often tell my students that good surgery begins with a love for anatomy’s beauty. Through that lens, surgery becomes a fascinating journey inside the human body infused with a sacred respect for anatomy’s structure and functions.

In the future, robotic surgery may allow us to perform the perfect, dream operation: functional, selective, bloodless, painless, and scarless. The path to achieve such an ideal procedure is still long, but dreaming and anticipating the future is the only way to make it a reality.

The title of this book, The Foundation and Art of Robotic Surgery, reflects this dual component, from the basic, scientific concepts toward the perfection of the details, which is typical of art.

A perfect operation becomes like a masterpiece, where the artist is going beyond the basic technical skills, adding personal talent, conceptual insights, harmony, search of beauty, and ethical inspiration. Robotic surgery and artificial intelligence will give us “superhuman powers” and will pave the way to surgical perfection.

I do hope that along this way we’ll not lose the ethical commitment, the compassion, the dedication, and the “holy” respect for human life. Even masterpieces may become meaningless without ethical values.

I would like to dedicate this textbook to the surgeons who inspired me at the beginning of my career, Prof Mario Selli and Giovan Battista Sarteschi. And to my family, my wife and beloved companion, Paola, who helped and constantly supported me, and my kids, Lorenzo and Chiara, who grew up waiting for their dad.