Minimally Invasive Robotic Association

As a multidisciplinary Association, we invite not only surgeons, but also internists, radiologists, engineers and computer scientists interested in robotics, telerobotics, telepresence, teleconferencing, and telementoring to join MIRA.

I would like to mention Karl Popper, an Austrian philosopher, to make clear the core of MIRA. He divided specialization into two different kinds: Specialization of culture, that is the negative side of Society (impoverishment) and Specialization of techniques that has positive effects on Progress and Civilization. Today, Science tends to be hyperspecialized,  focusing on more self-contained areas, narrowing them down so much to lose its capability of lateral thinking, with the result to be a self- limiting process. This could be considered the "Specialization of Culture". MIRA, in its unique characteristics of gathering together many specialties, favours the development of a common Culture while  supporting the differentiation  of techniques.

To those who may argue that the paradigmatic shift of the XX century has been Laparoscopic Surgery, because of minimal tissue trauma philosophy, I would reply that the real breakthrough in medicine, starting an unrestrained revolution, is Robotics. It would be a very limited vision to consider the robot only a sophisticated and electromechanical device to improve laparoscopic instrumental control; the robot is a revolutionary concept of the total virtualization of the procedures. The robotic station is basically an information system, exchanging inlet and outlet data; the operation itself is the final result of a process of imaging manipulation. All data are transformed in numbers and bits, meaning that everything is measurable, recordable, comparable, and open to integration and implementation. All the potential developments of informatics are foreseeable, the only restrain is our fantasy, our capability of imagination: virtual simulations and training, diagnostic integration (augmented reality, preoperative simulation and planning), long-distance telesurgery.

Some developments are around the corner (NOTES, major surgery, solo surgery). The natural orifices endoscopic surgery is the new frontier of minimally invasive surgery and it is easy to predict that the only reasonable way to achieve full control of these micro instruments will be a robotic platform with a computer-controlled transmission of movements. Applications of robotics in major surgery are already a reality. Just a few years ago the possibility to perform extensive and challenging operations in a minimally invasive fashion seemed science fiction. Coronary bypasses, hepatectomies, and Whipple procedures are some of the mentionable examples. Robotic surgeons still need, of course, to make a selection of the best indications, understanding where and when it is worthwhile to use this sophisticated technology for benefiting the patient.

“Solo surgery” is another interesting model made feasible through robotics. The future shortage of resources, the increasing costs of technologies, the average prolongation of human life will make mandatory the reorganization of health care systems  in order to save money whenever possible. Simple operations like cholecystectomy and Nissen procedure are already done with the fourth arm alone. The availability of a wider range of tools, a better setup of the OR, and an improved knowledge of indications will make this model more and more appealing. The most important constraints on a wider diffusion of Robotics are: difficulty in education, training and lack of scientific proofs of clinical superiority in comparison to standard MIS. Addressing these three issues would be one of the main focuses of the Association. Costs are basically related to the market Rules, we can do very little to contain costs. Taking advantage of mininvasivity, reducing hospital stays, encouraging an overall faster recovery of patients are the only way, at the moment, to make affordable the increased burden on the health care system. Hopefully, the story will repeat itself on electronic devices with prices going down as soon as the  market expands  (my first computer was  an awful and cumbersome closet and cost my monthly salary!).

Today, one of the challenges ahead of MIRA is Training and Credentialing of Robotic Surgeons is to bear in mind the future developments of Robotics and telerobotic surgery. This rapid incorporation of technology needs to be balanced with a prudent approach in determining the right indications for the use of the robot to provide the advantages of  MIS to the patient without significantly increasing the cost factor for the system and the patients itself. The scientific and didactical role of MIRA are the most important activities of the Association that makes really worthwhile its ethical, moral existence and that will make it  a long-lasting one. We must give a contribution in organizing the training and establishing requirements for credentialing. The Association needs to grow and to exert an important role in the medical Community. While maintaining its original multidisciplinary vocation, it will be necessary to reinforce the Specialty individualities.

As mentioned earlier, MIRA is unique in the fact that it provides  a forum to discuss and learn new advances and common problems encountered in fields of  robotic surgery such as digestive, thoracic ,cardiac, vascular, bariatric, Urology, Gynecology, Otorinolaringology, and Paediatric surgery.

MIRA is also devoted to the development of the future technological breakthroughs of telerobotic surgery and surgical simulation which will give a whole dimension to health approach in the surgical fraternity and provide the best diagnostic and therapeutic care to human lives anywhere, even in distant and remote places  in the world.

The First international MIRA  meeting  was held  in  2005  at Innsbruck (Austria ) and the second one in 2007 at New York under the Presidency of Garth Ballanthyne, the first formal President of MIRA.

These meetings along with a series of academic ventures in association with other academic bodies like the European Association of Endoscopic Surgeons ( EAES ) Venice, Italy, June 2005, Society of Medical Innovation and Technology ( SMIT ) Naples , Italy, Sept 2005, and California, May 2006; The Society of American Gastrointestinal Endoscopic Surgeons ( SAGES ) Texas, April 2006, Las  Vegas April 2007,  Society of Laparoendoscopic Surgeons ( SLS ) Boston, Sept 2006  have increased the awareness and acceptance of robotic surgery across the globe.