Foreword: uniportal VATS, more than an approach, a philosophy of life

This book is about a scientific, personal and cultural journey built upon many personal sacrifices and difficulties. But moreover, a journey which has gifted me with gratifying and unique experiences, the luck to have met many worthy people, discover cultures and do activities in many remote corners of the world…This is life.

Uniportal has given me the opportunity to operate in places where I would’ve never imagined I could do it. With different resources available, sometimes very scarce, but which have led to creativity and open mindedness when facing numerous challenges or extreme situations. This has enriched me both at a personal level as well as from a surgeon’s perspective and I realized that nothing is impossible, if you really want to achieve something.

I am pleased to have been able to provide my humble contribution to bring a less invasive thoracoscopic surgery to many different hospitals, even to somewhere it had never been done before.

In my opinion, uniportal has achieved what no other surgical technique development in medical history has ever obtained; to bring together a group of very different people around the world with different backgrounds and mentalities but with at least a single common thing. A philosophy to do better every day. And day by day throughout this journey a group of friends (which almost every day increases) has been created. This is a group of friends and virtual family that share the same ideal and stimulus to advance, improve and get better. In definitive, uniportal has led to good friendships and a large group of like-minded people where everything can be done with care, passion, enthusiasm and dedication.

Sometimes when we get confronted with different cultures or people with different backgrounds we may think we cannot learn anything, but there is always something that you can take away. You can always learn with or without resources. Travelling extensively has helped me be consistently aware of this and has allowed me to form ideas to continue evolving. If I would have stayed comfortably in my hometown the evolution and adoption of uniportal would have probably not spread so quickly and consistently. At the same time, my travels enable me to take bits and pieces from each place and person and direct them into further improvements to the uniportal approach. This is the reason why in only 6 years there has been such a development and quick adoption rate of a surgical technique in the history of medicine.

It is also important to surround yourself of the best, at what they may be. Extract the positive and the best in their fields of each person or group whether surgeons, physicians, nurses, companies, friends or family and use it to continue improving. The key of success is sacrifice, persistence and hard work.

The industry has also been taken by the uniportal approach by being stimulated to innovate less invasive thoracic devices. During the last years, uniportal VATS has created new opportunities to push the boundaries on minimally invasive surgery, allowing a rapid progress in instrument design and technology.

Uniportal is thus, not only one incision less or a progress to less invasiveness but also a way of living life by constantly evolving and getting better at what we do. From there the ramifications of uniportal. Think of non-intubation, subxiphoid, subcostal, single port robotics…i.e., the least invasive surgical approach for our patients. We will continue to make our lives just a tad more difficult every time by stepping out of our comfort zone. This is where the magic and evolution of medicine happens…An open door to the future, because less is more.

So remember:

• “The beauty of life begins when you are out of your comfort zone” (Figure 1);
  

  Figure 1 Skydiving in Namibia, Swakopmund, Namibia. August 2016.
• “You must know the past to understand the present and guide your future” (Figure 2);
  

  Figure 2 Petra, Jordan. February 2016.
• “Don’t limit your challenges; challenge your limits” (Figure 3);
  

  Figure 3 Mentawai Islands. Sumatra, Indonesia. May 2005.
• “Surround yourself of the best people in their fields and learn from the positive they have to offer. You never stop learning” (Figure 4);
  

  Figure 4 With the NBA basket player Pau Gasol. Coruña, Spain. June 2016.
• “There is only one person who can prevent you from reaching the top, and he looks back at you everyday from the mirror” (Figure 5);
  

  Figure 5 Everest base Camp, 5300 meters altitude. Tibet, January 2016.
• “Do not follow where the path may lead. Go instead where there is no path and leave a trail” (Figure 6);
  

  Figure 6 Great wall. Beijing, China. October 2014.

Finally I would like to thank the many people who have contributed to the uniportal way of life, whether supporting me as a person or as a surgeon, but above all thank you to those who have caught on with the enthusiasm of this philosophy. Timmy, Alan, Dani, Marc, Raul.

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.2016.08.11). DGR serves as an unpaid editorial board member of Video-Assisted Thoracic Surgery from Jun 2016 to May 2019.

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

Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.