Laparoscopic surgery has been widely diffused since 1990, having exponential growth since then. Contributed to this fact the obvious benefits of the avoidance of large abdominal incisions, less surgical trauma, less perioperative morbidity, smoother and faster postoperative recovery, wide acceptance by patients, who started demanding technology. In addition, many surgeons quickly joined the laparoscopy and there was a great cooperative effort worldwide. Unprecedented and widespread dissemination of knowledge occurred, especially because the view on a monitor and its easy recording and retransmission, unlike open surgery everyone could see the proceedings, or repeatedly on videos.

Robotic surgery has been introduced from the year 2000 and has had marked increase in its use since them. The operations that are performed laparoscopically can be made through the robot, with more accuracy and safety. The use of robot favors a less invasive operation; with a much better view of the organs being operated; with great approximation of the structures; with the surgeon's vision in three dimensions; procedure even less invasive; and with less tissue trauma.

Who controls the movements of the robot is the surgeon through a special console, dominating every movement of the grippers and the camera. The clamps have more delicate movements, being literally controlled with fingertips.

It´s possible to have great accuracy, due to the interface of the "robot" between the arms of the surgeon and the patient's operated organs. Robotic grippers are specially designed to simulate the movements of the surgeon's hands, allowing dexterity never achieved by laparoscopic surgery. The surgeon do not use any force to control the robotic arms, doing movements with the extremities of the fingers; thus, there is much less fatigue in prolonged procedures. The robot heps the trained surgeon perform operations even more safe and accurate.

Another relevant feature of the robot, of great importance is the possibility of extensive training in simulators. There is an outfit named MIMIC with programs that simulate situations of object manipulation, movement, energy use, sutures, etc. The surgeon is aware of their performance by an assessment that appears immediately after exercise, showing numerous variables that exercise demand, directing the aspect that need to be improved, or if it was correctly done. The surgeon can thus become familiar with the equipment and thorough training, perform initial procedures with more skill and accuracy, reducing the learning curve (as demonstrated in controlled studies) and possibly reducing the risk of occurrence of accidents and complications, which occur in the learning curve of surgery, either open, laparoscopic or robotic approach.

Robotic prostatectomy has been achieving similar oncological outcomes to laparotomy, with the advantage of better preservation of erectile function due to the precise dissection of the pelvic nerves. It is now considered a standard of excellence in the operation of prostate cancer. Robotic gynecologic surgery got significant increase in recent years, also leading to very good results.

In the digestive tract, virtually all operations can be performed through the assistance of the robot. In obesity surgery allows better access to organs, maximized visualization and high precision in the sutures. In esophageal surgery provides precise, anatomic, minor assault procedures. When operating the intestine, the robot must allow release of the structures, preserving vessels and nerves which help to preserve continence and potency functions, important to patients. Assisted by the robot operations greatly help the surgeon to bring greater benefit and safety for their patients, especially when there are anastomoses or dissections requiring high precision and privileged view; reoperations or revisions are thus much better performed with the aid of the robot. The dual console allows second surgeon to assist or interfere, facilitating training during the learning curve.

However, the most important point of this new technology is the introdution of a new paradigm in surgery: the existence of a device (called robot, in lack of a better name) that allows the use of computer programs for performing tasks. No other surgical platform, at present, has this feature. Laparoscopic forceps are directly controlled by the surgeon's hands and, with the exception of the power instruments, little change occurred over the past 20 years.

On the other hand, are well known the incredible advances in diagnostic medicine since the introduction of computer programs in imaging and interventional equipment; innovations in these areas occur almost daily. This same feature is now available to the surgeon. Computer programs can, for instance, be inserted to allow different examinations during operation; identification of lymph nodes compromised by tumor; differentiation over vessels, nerves and other tissues. From this premise, the possibilities are almost endless bring new technologies in the future.

The technology using green dye - binds to blood proteins - injected by peripheral vein is commercially available. Through fluoroscopy in a special camera the surgeon may identify differences between healthy and tumor cells; check the vascular supply of the parenchyma or viscera; identify the bile duct during cholecystectomy. The surgeon can quickly change from normal to fluoroscopic camera. Allows more accurate removal of tumors; make safer intestinal anastomosis for making sure the proper irrigation of the extremities; increase the security of difficult cholecystectomy, where the anatomy is often inaccurate or anomalous. It has been said that, as this technology allows for much better accuracy in the identification of the structures of the hepatic hilum and reduces the risk of inadvertent bile duct injury, it could be considered unethical not to offer this technology to patients.

The robotic platform is evolving exponentially. There is, at present, only one company with equipment released by the authorities for human use. There is already a new generation released for use next year, and new prototype is currently being tested. When released some patents, several new equipment, already in testing, will be available on the market. Then, it is possible to have important decrease in costs, which is now the main obstacle to its widespread use.

The robots are here to stay. The possibilities of computer programs interact are almost endless. Costs will decrease considerably in the next years. So, the future has arrived!

The Brazilian health system is mixed: public and private. There is a public system - SUS and the system of supplementary health (health insurance companies). The SUS was very well designed and implemented for about 25 years (1988). ANS - National Agency of Supplemental Health is even younger, created in January 2000. ANS is the regulatory agency under the Ministry of Health. The two systems coexist, but do not interact properly.

A hundred and fifty million people depend exclusively on SUS and health operators have about 52 million users. Several of these users also use SUS on health demands and, in different ways, all Brazilians use SUS (health surveillance, for example).

Public health funding has not been sufficient to meet the demands of the people. The share of spending occurs in three levels, but there is a progressive exemption from federal portion, sacrificing increasingly the federative states and especially the municipal budget. About 12 years the share of federal spending on health was around 60% of the whole. Today only 42%, as around 58% come from states and municipalities. Municipalities must apply at least 12% and states at least 15% of its budget on public health. The supplementary system, which serves about 25% of the population, has more resources than the public system.

While we recognize improvements in the public health system, its management is not qualified, because there is predominant political and electoral bias in the choice of the managers; instead of this, we should expect to have strong technical influence. Also, is not used adequately the largest and most qualified efficiency of the supplemental health care sector. Besides not having enough resources, they are badly applied and associated to the rampant corruption that persists in our country, that has good, orderly and worker people.

We believe that public-private partnerships and effective prioritization of the health sector could bring more gains to the system, directly benefiting the population, especially the poor and needy, already suffering a lot due to poverty, delays in education, infrastructure and safety.

Not only suffers the health care, but also teaching and research. The assistance should prioritize access to quality, ensuring the two main entry points to the system: primary or basic and emergency care. An integrated network should exist, with permanent control and evaluation, with referral and counter-referral of patients using SUS.

The teaching in the sector has been less than optimal. Several medical schools were opened, in the majority as private schools and without conditions for functioning: good physical structure for practical activities, as well as current curriculum for Brazilian medical needs and qualified teachers. The federal government claims that our medical schools train few students each year, and insists to authorize new vacancies, 40-50 every year. We need to better educate our doctors and other healthcare professionals. The same happens in post-graduate level where it is also prioritized the quantity, over quality. Let us form the required amount with proper qualifications; it is possible and is the best way.

The residency, which has been the gold standard for care, has suffered from misplaced interventions with high dictatorial meddling. There is no planning for the number of health professionals (doctors, nurses, dentists, physiotherapists etc.) for today or for the next 10, 20 or 30 years. We continue improvising, wanting to import models from other countries, making use of them with patterns that are not adequate to our reality. Why the government managers say they want in Brazil 2.7 physicians per 1,000 population? To be equal to the UK? Well, today we have several cities that outperform this index: Brasília, Rio de Janeiro, São Paulo and others; even there, the public system keep on being chaotic - analyzed by the offered quality. The waiting list of patients for consultations, complementary exams and surgical procedures is enormous. Several of these patients rely upon themselves in emergencies, overloading them and many die from preventable causes.

Clinical research in Brazil, the world's seventh largest economy, also shames us when compared to many countries. There stubborn bureaucracy and overlapping of powers, among many inefficiencies, greatly delays the analysis of several studies. We are behind in clinical research from the point we are able to be. All of us lose: patients, researchers and our country Brazil. Some patients fail to participate in studies that can mean gains in quality of life and even cure. Our researchers lose several opportunities, especially studies in phase I and II. At the end, Brazil loses because the gain is undeniable; research leads to the development, create wealth and currencies.

However, if much can and must be done, and if we realize that the people in charge cannot do, we should use our democratic power to change this sad scenario. Brazil is much more than any of us, any political party. The health is our greatest duty and the Brazilian population deserves respect!

The German immigration to the state of Rio Grande do Sul (RS), Brazil, began in the 1920s. Between 1824 and 1922, 142 German colonies were created in Rio Grande do Sul, and it is estimated that, in this period, about 50 thousand Germans arrived in the state.

In this group of immigrants, Augusto Heinrich Rohde, Luiz Rohde's great-grandfather, arrived in 1857. On January 14, 1936, Luiz Rohde was born, the youngest son of Augusto Emílio and Erna Rohde, fruit of a union that generated eight children, in the locality of Paraíso do Sul, in the municipality of Cachoeira do Sul, 200 km from Porto Alegre (RS), in the central region of the state¹.

After an initial school education in his region, in Cachoeira do Sul, Luiz completed the high school and soon the inclination to study medicine arose. Since then, it could be noted in the young Luiz Rohde marks that would be perennial in his character and in the example he would set for all those who were his students in the future: discipline, rectitude, education, and concern for the well-being of all with whom he had the opportunity to know and relate to.

He studied medicine at Universidade Federal de Santa Maria, where he joined in 1955 and concluded in 1961, having been chosen valedictorian of the class. At the same institution, another characteristic of Rohde was already evident: in the graduation speech, he drew attention to the need for creating a local university hospital to improve the training of doctors. Therefore, very early on he had the vision of what would be most important for the education of medical students. After completing the medical course, he was accepted, by a public tender at the University of São Paulo (USP), in the state of São Paulo (SP), in the residency in General Surgery, from 1962 to 1964.

What is the feeling of the editors of a medical journal when it reaches the significant mark of 1,000 published new scientific articles?

On this occasion, the editors and reviewers looking back about what meant these 1,000 papers published in the period of 27 years, from 1986 to 2013, confirms that they worked very hard to reach this target. Let suppose, if each article has at least 1,000 words, 1,000 articles addressing all possible issues related to digestive surgery will reach a million words, and this amount certainly corresponds to an encyclopedia!

The first article published in 1986 was written by the creator and founder of the Brazilian Archives of Digestive Surgery (ABCD), Prof. Dr. Henrique Walter Pinotti, about surgeonpatient relationship¹. And in the presentation of a new journal he emphasized that: "This surgical breakthrough resulted in the publication of many scientific articles and editing books and journals. But even so, due to the majority of surgical patients are in Gastrointestinal Surgery area, there are few specialized sources to disseminate up the new information. For some time we have been considering publishing a journal dedicated to this specialty, with articles by Brazilian and foreign authors to be distributed abroad, as well as in Brazil. Since English is commonly used in medical and scientific specialties, would be published in both languages".

Professor Pinotti, in his speech at the beginning of the activities of the Brazilian College of Digestive Surgery (CBCD ) in 1988 emphasized that : "With education we not only inform, but we forge high level professionals, which can develop their knowledge, applying correctly their resources and thus able to benefit the patient. Knowing the limits of their competence, he will be able also to serve his patient avoiding the worst result of surgery, which is the iatrogenesis. Our College, in education, should develop the spirit that every person who wants to teach must have, and also finding the ones that want to learn. And the success achieved in the safe training can constitute stimuli for new frontiers of knowledge".

On April 14, 1913, Monday, the young surgeon of 36 years, Ernst Heller, assistant professor of Erwin Payr, Director of the Surgical Clinic of the University of Leipzig in Germany, while operating a patient with idiopathic achalasia of the esophagus, performed for the first time a cardiomyotomy extramucosal, leaving his enormous contribution to the history of esophageal surgery, in the 20th century¹.

Ernst Heller was born in 1877 and as a young surgeon had in its formation the influence of various known surgeons of the time, such as Gottstein and Heyrovsky. Between 1914 and 1918 he served as a surgeon in the first World War, in the front. He returned to Leipzig in 1918 as chief surgeon of Saint George County Hospital. In 1949 he became Professor at the University of Leipzig and died at the age of 87 on November 2, 1964, and published over 80 scientific papers during their academic life².

The record of his first extramucosal cardiomyotomy was published in the journal Mitt Grenzgeb Med Chir, describing in detail the clinical case, the surgical technique employed including figures, the evolution of the patient and reviews about the disease¹^,² .

This is a briefing of original Heller´s report:

"In the first section of the Archiv für Chirurgie klinische 1913, described a Heyrovsky subdiafragmatic esofagogastric anastomosis that performed successfully in two cases of so-called "idiopathic dilatation of the esophagus". Shortly after the publication of this notice, came to the care of the surgical clinic of Leipzig, a patient with chronic saculiform cardiospasm and marked dilation of the esophagus, which seemed appropriate the surgical treatment for elimination of suffering. Under the impression of Heyroyvsky successes, I intend to perform the surgery in the same way. During the surgery, however, due to certain difficulties and after theoretical considerations, I ended up running a different intervention from the original plan, performing a cardioplasty extramucosal. In advance as I want to note that the functional point of view was very exceptionally satisfactory, and this change in the surgical procedure has, in my view, important practical advantage compared to the operational measures proposed and followed in the treatment of cardiospasm by esophageal dilatation, I wish allowing me to share briefly the case ....

Liver metastases are a frequent event in the course of colorectal cancer and some studies indicate them as the cause of two thirds of deaths from this disease. Treatment is complex and involves a range of therapeutic options that vary through behavior and timing of metastases diagnosis, as well as the background of the patient. The volume of medical knowledge published every year on this topic is on the rise, with information with different levels of evidence, coming as a torrent of data that daily challenges those involved in the care of these patients. These professionals, in turn, should belong to multidisciplinary teams able to evaluate together the best treatment options as well as their sequence, according to the specifics of each case.

These are the premises that supported the initiative to hold the First Brazilian Consensus of Multimodal Treatment of Liver Metastases from Colorectal Cancer, including, unprecedentedly in Brazil, the specialty societies involved in this care, namely the Brazilian Chapter of the International Hepato-Pancreato Biliary Association (BC-IHPBA), the Brazilian Society of Surgical Oncology (BSSO), the Brazilian Society of Clinical Oncology (BSCO), the Brazilian College of Digestive Surgery (BCDS) and the Brazilian College of Surgeons (BCS), also relying on the support of the Americas Hepato-Pancreato-Biliary Association (AHPBA). Experts from other areas were also involved in specific points of the discussion, such as radiologists, interventional radiologists and pathologists. The Consensus meeting was held on August 23, 2014 during the X International Symposium on Cancer of the Digestive Apparatus of CEPGIO / International Symposium BC-IHPBA / Postgraduate Course of AHPBA at A.C. Camargo Cancer Center in São Paulo.

Professor Edmundo lived all his moments intensely. He was not a man of mincing words; he would say what he felt and what he wanted, but always at the right time and in a fair, polite, and caring way.

People who do not take a stand, those who are reluctant, and those who wish to be okay with everything and everyone will certainly make few enemies, but they will also have few admirers, few friends, and, above all, very few followers. They will not form leaders.

More than students, doctors, and surgeons, Professor Edmundo formed eager citizens: citizens who seek better working conditions; citizens who are not satisfied with poor quality medicine, provided by uncommitted people; and citizens who do not accept to offer different treatment to public patients compared to private ones. He formed citizens who protest by working and setting examples; citizens who, in times of conflict, work twice as hard, so that the neediest population is not penalized; and citizens who do not resign and who propose changes. This is the profile of Professor Edmundo’s disciples.

He lived his professional life intensely. He studied cutting-edge Medicine at a public hospital in the Brazilian Northeast. His dedication, commitment, and care for patients who would come to the University Hospital of Universidade Federal de Pernambuco were with a true unanimity of work and seriousness. He would always say: “Be the first to arrive and the last to leave. If you do that, you will earn the admiration and respect of everyone.”

Few public servants had the dedication that Professor Edmundo showed throughout his university life. I followed this dedication closely. For over 20 years, I assisted in all the private surgeries performed by him, always after 7 p.m. There were countless times that we left the surgery in a private hospital and went straight to the University Hospital, as the surgery lasted until dawn. Nothing, absolutely nothing, could compromise Professor Edmundo’s work schedule at the University Hospital.

Henrique Walter Pinotti was born in São Paulo to Italian immigrants. He began attending the Hospital das Clínicas of the Medical School of the University of São Paulo (FMUSP) when he was admitted to the Medical School, in 1950, participating in the Clinical Gastroenterology Service as an academic trainee under the guidance of the then head, Professor José Fernandes Pontes. He went through all sectors of the specialty, having contact with the pathophysiological and clinical bases of gastroenterology, deciding on surgery on the eve of his graduation, in December 1955. Then, he was selected as a second-year resident physician of the Department of Surgery of the Hospital, a position held until May 1958. During those years, he also attended the Department of Pathological Anatomy as a volunteer.

He was granted his first academic title in March 1959, when he was appointed by Professor Alípio Corrêa Netto, upon recommendation of Professor Arrigo Raia, Teaching Assistant of Surgical Clinics. Later, in 1960, he was appointed FMUSP Assistant.

Since then, he had the opportunity to monitor the activities and absorb the teachings of renowned surgeons, notable school leaders, such as Benedito Montenegro, Edmundo Vasconcellos, Eurico da Silva Bastos and, especially, Alípio Corrêa Netto, from whom he received great encouragement for his university career, as well as from his followers, Euryclides de Jesus Zerbini and Arrigo Raia, with whom he enjoyed a close and long-term relationship.

He presented his Doctoral Dissertation at FMUSP in 1964 and became an Associate Professor, by public official examination, in Surgical Clinic in 1967, and the dissertations of both programs were related to Megaesophagus.

In 1968, a new academic order was established: the chairs were extinguished and Departments were created. Disciplines and departments were established; the former, in fact, are specific teaching programs, and the later, the bunion of related disciplines. At that moment, the Discipline of Digestive Surgery was established at FMUSP, as well as the respective Digestive Surgery Division at the Hospital das Clínicas, to house surgeons specialized in this area from the former chairs.

He always sought to follow the specialty in its entirety, performing activities in all areas. With the structuring of this Discipline, he assumed, from 1974 onwards, the Head of the Esophageal Surgery Service, where he promoted great development to Brazilian esophagology.

Complete tumor resection in the liver is the only chance to obtain long-term survival in patients with hepatic tumor or metastasis from other primary cancers. In patients with a large load of tumor within the liver, multiple strategies have been employed to improve resection, especially when a small liver remnant is expected. Staged hepatectomies, in which the surgeon perform partial resection in one side of the liver, and after four to six weeks proceed with the resection of the other side, and strategies to induce hypertrophy of the future liver remnant that include percutaneous portal vein embolization or intraoperative portal vein ligation, have also been largely employed by specialized liver surgery teams.

Hans Schlitt from Regensburg, Germany developed a new procedure, called liver bi-partition, for the first time by chance, in 2007. Planning to perform an extended right hepatectomy in a patient with hilar cholangiocarcinoma - being the future cholestatic liver remnant too small to sustain the patient postoperatively - he decided to perform intraoperatively only a selective hepatico-jejunostomy on the left biliary system, dividing the liver parenchyma along the falciform ligament, thereby completely devascularizing segment 4. Finally, the right portal vein was ligated to induce hypertrophy on segments 2 and 3. On the 8^th postoperative day was performed a CT scan and observed a huge hypertrophy of the remnant liver. Recently, de Santibanes and Clavien² proposed the acronym "ALPPS" for Associating Liver Partition and Portal vein Ligation for Staged hepatectomy. The ALPPS procedure has become an advance that represents an important tool to surgically induce fast liver hypertrophy.¹ ² ³

In any business relationship - contracts, provision of services or outsourcing -, the contracting party (public or private) has the sacred duty and the full right to audit. The control and evaluation is vital sector for the zeal, care, probity, proper application of funds dispensed to purchase inputs, procedures execution and personnel payment.

To assist in this thorny, but necessary task, there are several instruments as analysis of historical series, protocol obedience and/or guidelines, virtual audits by sampling or, then, permanent in person auditing.

The regulatory team is authorized to question certain procedures, and must have the authority to call the patient to clarify the need of exams that helped in the treatment indication, with the ethical prerogative to contact the applicant professional and discuss unclear aspects. Should call for enlightening conversations doctors who take very different approaches from the usual curve of a control group.

They should be analyzed by the agent that pays for treatment, items on the quality of material to be made used, to avoid arguments that the material of the brand "X" is much higher than brand "Y", forcing, directing the patient to a particular supplier, throwing him against the health plan. It should be established that if certain material is unreliable, ANVISA/MS must be notified to banned it from national use. But, the acting person must be responsible enough to sign the declaration and to have proof about the complaint.