Preface to the book This is life: the journey of uniportal VATS

Uniportal video-assisted thoracic surgery (VATS), also known as single port VATS or single incision VATS has taken the world of minimally invasive thoracic surgery by storm. The technique originated more than a decade ago for minor procedures and stood still, until recent developments in surgical technique and instrumentation allowed the most complex of thoracic procedures to be performed by the uniportal approach. However, it is also the determination, courage, skill and unshakable belief of an individual, Dr Diego Gonzalez-Rivas that has shaped the uniportal world as we all know it today.

Armed with a rough drawing of port placement in 2-port VATS from Duke University Medical Centre, Diego returned to his home town of a Coruna, and started performing 2-port VATS major lung resections in 2007. Realizing the inferior camera port can be omitted, he performed the first uniportal VATS major lung resection for a left lower lobe cancer in 2010. His path has not always been plain sailing, and perhaps few people are aware that his first hurdle, apart from convincing his immediate colleagues (some of whom are more senior) of the feasibility and safety of the technique, was to get his case report accepted in mainstream academic literature. One of the journal reviewers of his initial work, who also happen to be my mentor, Prof. Anthony Yim was sceptical and rejected the article. Subsequently, Yim has become an advocate of the uniportal approach, realizing that Diego’s experience is akin to a reflection of his own when he was struggling to convince the thoracic community to embrace VATS in the mid-1990s. From his first publication in 2011, Diego’s has not looked back, showing the world the uniportal approach can be safely performed for bronchoplastic sleeve, vascular sleeve, double sleeve, lung with chest wall resection, post neo-adjuvant therapy lung cancers, and even in non-intubated patients.

My first encounter with Diego was in Hong Kong for the 1^st Asian Single Port VATS Symposium and Live Surgery event in March 2013. I remember fondly his immediate email reply to my invitation, and for a nobody like myself, I was surprised and touched by his generosity and enthusiasm. Over the years, it is clear to me that these characteristics of his, as well as his humanity, loyalty and integrity have been the cornerstone of his success. Perhaps this is the temperament and behaviour of a man who has survived a surfing accident that very nearly took his live, or who was just seconds from a terrorist bomb detonation in Bali Indonesia that destroyed many other people’s lives. From some of the most war torn countries in the Middle East to the resource stricken countries of Cuba and Eastern Europe, he has unreservedly travelled to demonstrate and preach the uniportal approach. Through lectures, workshops, surgical models, animal carcasses, cadavers, live animal models of sheep, goats, dogs and pigs, and live surgery, Diego has dedicated his career to share with others his knowledge and skill. His obsession has led him to record for teaching purposes videos of every lobectomy performed by uniportal VATS in a sheep and pig. No doubt, his charisma and enthusiasm have infected everyone he has touched and everywhere he has been, to follow his teaching of uniportal VATS.

Many will notice that this preface has deliberately neither commented on the evidence for the benefits and efficacy of uniportal VATS, nor discussed the technique or its future. I believe this book should focus on celebrating Diego’s achievements and inspirational journey, as well as provide reflection upon the influence this gentleman has had on our surgical practice all over the world. I once hypothetically asked, “what would you do after you have visited and conquered every country and hospital in the world with uniportal VATS?” Diego jokingly replied, “There are many more lives to be saved in the veterinary world”, as he showed me his latest video recording of uniportal subxiphoid porcine lobectomy! An important lesson I learnt from Diego comes from an ancient Chinese saying, “Wherever you go, go with all your heart.” (Confucius, 551-479BC).

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Video-Assisted Thoracic Surgery. The article did not undergo external peer review.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/vats.2016.08.16). CSHN serves as an unpaid editorial board member of Video-Assisted Thoracic Surgery from Jun 2016 to May 2018.

This editorial is preface of the new book This is life: the journey of uniportal VATS.

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