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J Thorac Cardiovasc Surg 2003;126:625-630
© 2003 The American Association for Thoracic Surgery

Editorial

The Janus syndrome: a perspective on a new era of computer-enhanced robotic cardiac surgery

^a Department of Cardiothoracic Surgery, Cleveland Clinic Florida, Weston, Fla, USA

Received for publication October 9, 2002; accepted for publication October 22, 2002.

^* Address for reprints: W. Douglas Boyd, MD, FRCS(C), Director, Minimally Invasive and Robotic Surgery, Section of Cardiothoracic Surgery, 2950 Cleveland Clinic Blvd, Weston, FL 33331, USA
boydd1@ccf.org

The first 300 words of the full text of this article appear below.

It is what we know that makes what we don’t know so much harder to learn.

—Dr. Christopher Kraft, Mission Control Director,

NASA Manned Flight Program

Since the time of Joseph Lister, more than 150 years ago, the core task of "surgery" (that is, "cutting and sewing") with hand instruments and direct visualization of and contact with the organ or tissue has remained the same. During the last quarter of the 20th century, however, and especially during the last decade, there has been a paradigm shift in the methods by which surgery is performed. The "invasiveness" of many procedures has been dramatically reduced and the outcomes significantly improved, as evidenced by improved survival, fewer complications, and quicker return to functional health and productive life. This focus on less or "minimal" invasiveness has gained momentum and has been the subject of intense investigation in the past few years. It is an established fact that catheter-based intervention has long surpassed coronary artery bypass grafting (CABG) as the cornerstone of treatment of coronary artery disease, and although surgical interventions continue to decline, there has been no apparent reversal of this trend. Despite the fact that rates of angina recurrence and need for reintervention is significantly higher after catheter-based interventions as compared with surgery,¹ patients continue to vote with their feet: They consistently choose and will continue to choose the least invasive option. We are presently at a strategic inflection point in the treatment of coronary artery disease. As described by the founder of Intel Corporation (Santa Clara, Calif), Andy Grove, this is a time in the life of a business or specialty when its fundamentals are about to change.² Our response and adaptability when we hit these points dictate our future; we either rise up and transgress the shackles of established paradigms or . . . [Full Text of this Article]

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				J.W. R. Bolton and J. E. Connally Results of a phase one study on robotically assisted myocardial revascularization on the beating heart Ann. Thorac. Surg., July 1, 2004; 78(1): 154 - 158. [Abstract] [Full Text] [PDF]