The roots of the ISSiS can be found in the very early 1970s, when the ability to simulate stress in biological tissues using mainframe computing technology led me to explore and develop a digital computer simulation of the orbital blowout fracture in 1974. As desktop computers developed, and gained in computing power in the early 1980s to rival whole-room mainframe systems, the ability to use three-dimensional computer graphics started to become available to the average surgeon. Successful pioneering work on computer simulation surgery in the early 80’s from Drs Jeffrey L Marsh and Michael W Vannier led me to explore and develop the concept of simulation surgery in 1989.
It was felt by many that some forum was required to help develop and improve existing computer functions for the simulation of complex reconstructive procedures without having to wield the scalpel on a living patient. In addition, I felt is was also necessary to marry these computer simulations with the hands-on simulative skills which are the art and essence of the plastic and reconstructive surgeon. Towards fulfilling these aims, we founded in Japan the Japan Society for Simulation Surgery (JSSiS), in 1991, followed in December 9th -11th of 1992 by the inaugural meeting and official establishment of the International Society for Simulation Surgery, at which I had the honour of being the Founding President. The ISSiS was successfully born.
I believe it was an enormously important step forward, and we concluded the 1992 meeting on a wave of real optimism and excitement for the future of applications in computer-aided simulation surgery, looking ahead to development not only of computer programs and virtual reality to simulate completely three-dimensional surgical procedures in the two dimensions of the computer monitor, but also the ability to create life-sized, detailed and workable three-dimensional models. In addition to true hands-on practice of the actual surgical process and post-operative reconstruction of life-sized target tissues and structures, these tactile models could be used in education: education of the medical students, and an excellent tool for education of the patients and their families in the informed consent process. In my way of thinking, we were well on the way of marrying the advances in computer simulation of surgical procedures with the real art of simulation surgery, which is what we plastic and reconstructive surgeons practice.
The Second ISSIS congress was successfully held in conjunction with ISCAS at CAR'95 in Berlin, Germany, on June 21-24 1995, under the co-presidency of myself and Prof Jeffrey Marsh. A third ISSiS/ISCAS congress was held, again in conjunction with CAR'96, in Paris, France, on June 26 1996, under the presidency of Prof J Thomas Lambrecht, Despite these two good meetings, unfortunately the way forward was not as smooth as we had hoped, and gradually the original aims of the ISSiS became cloudy as other, principally radiology, factions imposed their criteria on our original ISSiS ones, much more concentrated on imagery and much less on the simulative art of the plastic and reconstructive surgeon. The ISSiS seemed doomed to fade into history.
Thus, in 2004, it was decided to resurrect the true spirit of the ISSiS, once again starting in Japan, with the 4th ISSiS meeting held in Roppongi Hills, under the Presidency of Prof Yu Maruyama, and myself inaugurated as Honorary President. This very successful meeting was followed by a series of well-attended meetings: the 5th ISSiS meeting in Chang Mai, Thailand under the Presidency of Prof Charan Mahatumarat, the 6th ISSiS meeting in Taipei, Taiwan, with President Prof Lun Jou Lo, the 7th ISSiS in Hawaii, USA, under Prof Don Parsa, and the 8th ISSiS congress in Seoul, South Korea, with Prof Yong Ook Kim as President. Now we are preparing for the 9th ISSiS meeting in December of this year, once again returning the ISSIS to Japan, to the ancient city of Nara, under the Presidency of Prof Keisuke Imai, and looking forward to the 10th ISSiS meeting in the USA in 2018.
Naturally, compared with the concepts we had in 1992, (almost a quarter of a century ago, come to think of it), computer technology, hardware and software have advanced in leaps and bounds, so that the smartphone of today has more computing power and better graphics than the best desktop computers of the early 1990s. Very realistic computer simulations coupled with the fast-developing field of virtual reality allow hands-on surgical simulations on soft tissues, with tactile feedback and realistic ‘bleeds’ in the event of an ‘oops’ moment when the scalpel is just too near a major blood vessel. Rather than the incredibly expensive three-dimensional layer-by-layer resin modelling of the turn of the Millennium requiring lasers and large tubs of light-curing resin, we can now use comparatively inexpensive three-dimensional printers to produce precise anatomical models, complete with hollow inner cavities and detailed anatomical structures, allowing the quick replication of these models for the surgeon to practice on without harming a single hair of the patient.
However, despite the enormous advances in computer simulation and simulated surgery, the final step remains in the hands of the plastic surgeon, and whether or not the reconstruction will simulate the desired result is still well-based on the skill of the surgeon in assimilating the computer data and empirically simulating the missing hard and soft tissue, just as Sushruta was doing without any computer assistance over 2,500 years ago. In conclusion, I am immensely proud, and humbled, to have been able to be at the forefront of the development of computer-assisted simulation surgery and the ISSiS, the only society dedicated to this art, because an art it still remains, and to welcome you to the ISSiS home page!