**1. Introduction**

Medical and scientific researches in the last few years have become increasingly global, cross-national, cross-cultural, and collaborative. This reality is a reflection of the globalization of modern day life and easy communications and movement of health professionals and patients [1].

Acting on principle is better to give than to receive on the following pages I want to highlight the importance of the surgeon in the society, the need for international collaboration, and the key element—teamworking.

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

A team is made up of individuals with different opinions. That is why it is good to leave aside the personal interests and carefully watch those that are in the interest of the project. Sharing the workload within the team is an important milestone in the evolution of the project. Teamwork is based on that—each member does what he/she is best at. Surgery is teamworking. Through international collaboration, surgeons learn how to improve the performance and accelerate progress. A vast majority of surgical practitioners come into diversified career paths that enable them to use their various abilities in a wide variety of workplace environments. Surgeons have a demanding life but they have to realize that this profession allows them to put their skills to good use and will get more satisfaction as they will get even more involved in providing services for all people in need. Getting engaged in difficult situations and trying to find the best solution to resolve them reflect two great qualities: responsibility and leadership. There are seven major settings in which surgeons can put their education, training, and skills to valuable use: private practice, academic medicine, institutional practice, hospitals, ambulatory surgery settings, government service programs, and the uniformed services. Nevertheless, the primary responsibilities of a surgeon are to serve as a leader in their profession by diagnosing a patient's condition, performing the associated surgery, and following up with the patient to ensure continued proper care and treatment.

Humanitarian surgical missions can provide the much needed care for those who are otherwise unable to receive such care because of limited local health-care resources and cost. When most people think about volunteering, they think about going to a foreign country and doing something they've never done before. One of the great benefits for volunteers is the possibility to combine "to be useful" with to visit and to live temporarily in a foreign country, to learn a few of things about its culture, and to meet people of different nationalities. The participation in such missions requires dedicating time and resources but offers you a new experience with a new cycle of knowledge gained. For those within a medical profession are very beneficial as they allow for diverse communication and a transfer of knowledge that can vastly help those

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Successful humanitarian surgical mission requires careful planning and coordination and can be challenging for those tasked with the responsibilities to organize and lead these missions. Surgeons who go on humanitarian missions are definitely engaged in a noble cause. However, not infrequently, despite the best of intentions, errors are made in attempting to

Usually, the mission must be planned long before they can be achieved. A pre-mission plan is critical prior to arrival and a contingency plan must be in place for missing mission-critical items. Majority of these collaborations are still disorganized efforts, and they vary according to the centers and universities they are originating from. There are no coherent international collaborations, and many failures have been reported [6]. Necessary conditions and limitations of these actions are reflected in the "Seven sins of humanitarian medicine" [5] to which

**1.** most missions are deployed in disadvantaged countries, most of them being non-Europe-

**2.** time-limited missions: the activity of a mission lasts several days, and periodicity consists

**3.** local doctors do not have enough time to be trained or the medical supplies that have been

**4.** involves a small number of staff that often change due to availability, depending on the

**5.** recognition of the medical licenses to practice in that country (involves administrative

**6.** gathering the patients and the preparation for surgery and most importantly the follow-up of patients after surgery, because the surgeons who performed the surgery must return to

**7.** sometimes, the medical resources, which are donated do not have the best quality or the medical devices, need specific legislation to be put into practice in local hospitals.

Care or service should be provided to the patient in the right way consistent with scientific

brought cover the hospital's needs for short periods of time;

period and the country in which the mission will take place;

their country and all complications must be handled by local surgeons;

with a primary specialization.

help others [5].

others can be added:

an Union (EU);

in two to three missions by year;

problems and takes a long time);

knowledge and the highest-quality services.

Many publications are available on the best surgical techniques and treatment of incisional hernias with reports of experiences and randomized clinical studies at the two extremes of the evidence scale.

Recent medical advancements have allowed hernia to be repaired through a minimally invasive approach using a robotic surgery platform. The existing robotic surgery platform features a 3D-HD visualization system that will guide the surgeon's movement and small surgical instruments with the capabilities of moving with greater vision, precision, dexterity, and control than the human hand.

The ultimate proof of the best operative technique has, however, not yet been achieved. In practically no other field of surgery are the variability and the resulting potential aims of surgery so great [2].

There is a great imbalance in hernia care: in some regions, the science of prosthetic material continues to develop, being supported by the largest supply chain standards system in the world and focusing on laparoscopic or robotic technique repair, while in other countries they do not even have the basic materials to perform an open surgery. Therefore, we need to focus on raising the quality of hernia care and to maintain a balance for hernia repair in all regions bringing greater value to all patients.

All the effort of a surgeon lies in the benefit of the patient. We can achieve better outcomes for this purpose by creating an international network, specialized programs and centers which are stable and internationally recognized. Understanding and targeting the needs identified by the surgical community has cultivated a critical working environment that has had a profound effect on expanding surgical care in UE and non-UE countries.

Access to surgery is being increasingly recognized as a global health issue, as the poorest countries in the world—representing a third of the global population—only account for a small percentage of operations performed annually [3, 4].

Humanitarian surgical missions can provide the much needed care for those who are otherwise unable to receive such care because of limited local health-care resources and cost. When most people think about volunteering, they think about going to a foreign country and doing something they've never done before. One of the great benefits for volunteers is the possibility to combine "to be useful" with to visit and to live temporarily in a foreign country, to learn a few of things about its culture, and to meet people of different nationalities. The participation in such missions requires dedicating time and resources but offers you a new experience with a new cycle of knowledge gained. For those within a medical profession are very beneficial as they allow for diverse communication and a transfer of knowledge that can vastly help those with a primary specialization.

A team is made up of individuals with different opinions. That is why it is good to leave aside the personal interests and carefully watch those that are in the interest of the project. Sharing the workload within the team is an important milestone in the evolution of the project. Teamwork is based on that—each member does what he/she is best at. Surgery is teamworking. Through international collaboration, surgeons learn how to improve the performance and accelerate progress. A vast majority of surgical practitioners come into diversified career paths that enable them to use their various abilities in a wide variety of workplace environments. Surgeons have a demanding life but they have to realize that this profession allows them to put their skills to good use and will get more satisfaction as they will get even more involved in providing services for all people in need. Getting engaged in difficult situations and trying to find the best solution to resolve them reflect two great qualities: responsibility and leadership. There are seven major settings in which surgeons can put their education, training, and skills to valuable use: private practice, academic medicine, institutional practice, hospitals, ambulatory surgery settings, government service programs, and the uniformed services. Nevertheless, the primary responsibilities of a surgeon are to serve as a leader in their profession by diagnosing a patient's condition, performing the associated surgery, and fol-

lowing up with the patient to ensure continued proper care and treatment.

the evidence scale.

10 Hernia Surgery and Recent Developments

surgery so great [2].

and control than the human hand.

bringing greater value to all patients.

Many publications are available on the best surgical techniques and treatment of incisional hernias with reports of experiences and randomized clinical studies at the two extremes of

Recent medical advancements have allowed hernia to be repaired through a minimally invasive approach using a robotic surgery platform. The existing robotic surgery platform features a 3D-HD visualization system that will guide the surgeon's movement and small surgical instruments with the capabilities of moving with greater vision, precision, dexterity,

The ultimate proof of the best operative technique has, however, not yet been achieved. In practically no other field of surgery are the variability and the resulting potential aims of

There is a great imbalance in hernia care: in some regions, the science of prosthetic material continues to develop, being supported by the largest supply chain standards system in the world and focusing on laparoscopic or robotic technique repair, while in other countries they do not even have the basic materials to perform an open surgery. Therefore, we need to focus on raising the quality of hernia care and to maintain a balance for hernia repair in all regions

All the effort of a surgeon lies in the benefit of the patient. We can achieve better outcomes for this purpose by creating an international network, specialized programs and centers which are stable and internationally recognized. Understanding and targeting the needs identified by the surgical community has cultivated a critical working environment that has had a pro-

Access to surgery is being increasingly recognized as a global health issue, as the poorest countries in the world—representing a third of the global population—only account for a

found effect on expanding surgical care in UE and non-UE countries.

small percentage of operations performed annually [3, 4].

Successful humanitarian surgical mission requires careful planning and coordination and can be challenging for those tasked with the responsibilities to organize and lead these missions. Surgeons who go on humanitarian missions are definitely engaged in a noble cause. However, not infrequently, despite the best of intentions, errors are made in attempting to help others [5].

Usually, the mission must be planned long before they can be achieved. A pre-mission plan is critical prior to arrival and a contingency plan must be in place for missing mission-critical items. Majority of these collaborations are still disorganized efforts, and they vary according to the centers and universities they are originating from. There are no coherent international collaborations, and many failures have been reported [6]. Necessary conditions and limitations of these actions are reflected in the "Seven sins of humanitarian medicine" [5] to which others can be added:


Care or service should be provided to the patient in the right way consistent with scientific knowledge and the highest-quality services.

Millions of hernia operations are performed each year, making hernia the world's most common of all surgical operations. The increased number of patients with hernias led to the need for a specialized surgical field. In adults, the only treatment for a hernia is surgical, and there are several different approaches with different results. The aim consists on patients getting access to the care or service they need, no matter where they are, regardless of their material situation.

**7.** academic publications, papers, presentations, textbooks, and letters will be issued by this

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**8.** will enable access to part-time or temporary full-time experienced Research & Clinical

**9.** discussing cases will be done by videoconference or will be the possibility of forming an international commission composed of one member of each country, to meet twice a

Whether the condition of one of the patients requires care from one specialist or an entire team, the surgeons work side by side with the patient explaining to him/her the entire treatment to develop a personalized care plan to treat his/her condition. In some cases, such as complex reconstructions, collaboration will be needed by working with surgeons from the Division of Plastic and Reconstructive Surgery to perform procedures and help coordinate the

I want to reinforce the statement made by Dr. Halfdan Mahler: that surgery has a key role in health-care, and unfortunately although medicine has evolved so much lately by getting to work with robotics, body parts transplants, the appearance of new different surgical materials, the majority of the world's population has no access whatsoever to skilled surgical care because of the poverty. Much more can be done if we share common goals meet in working,

Conventional solutions are not likely to be very satisfactory. So what should the international

The magnitude and importance of achieving solidarity and cooperation in an interdependent world calls for a major program and considerable support. For decades, hernias have been managed by all general surgeons, but now top-tier medical systems are recognizing the value of standalone hernia centers, staffed with physicians equally adept at open surgery and mini-

Hernia literature is more and more focusing on developing surgery techniques, discussion focused mostly on surgical meshes, mesh repair versus tissue repair, robotic surgery, roboticassisted procedure versus the laparoscopic approach and so on. What about hernia healthcare system? A commitment to patient care and success necessitates that the requirements be

Even if private institutions began to greatly develop the terminology of "hernia center" as not yet well understood, that is why it is more used as a marketing instrument. Google has approximately 6,560,000 links associated to "hernia center" from a single search inquiry. There are very few scientific articles in which the term "hernia center" is explained as a model of how surgical care might be integrated within a health system. As a result of this lack of

comprehensive, research-based, and verified through a rigorous site inspection?

month to discuss all types of complex cases and to individualize patient care.

hernia centers;

most appropriate course of care for the patient.

learning, practice, all for the benefit of the patients.

surgical community do?

mally invasive techniques.

**2. International hernia centers and surgical care**

Trials;

When deciding which surgical service to offer facility capabilities and infrastructure must be considered. A well-equipped facility is necessary to support a strong education program in undeserved areas. According to the World Health Organization Safe Surgery Initiative, operating theaters must be of adequate size, have appropriate lighting, and have dependable electricity and water to a minimum [7].

Advancements in health-care always come down to collaboration. It benefits both the healthcare system and the population as it may provide new treatments which are probably not already available in that country [6].

By focusing on collaboration with institutions around the world rather than the simple provision of short-term services, hope is to promote a culture of training and investigation to be shared equally among all partners.

There are no data in the study on the integration of surgical services within a health system or as a component of health system strengthening. Conceptual models should be proposed based on the international meetings, knowledge gained across the international collaboration, infrastructure or patient population, resources and materials, and knowledge transfer tools to facilitate communication. A preliminary model presenting a concept of surgical care integration within a health system is being presented in association with various medical literature resources that further the World Health Organizations vision of a health-care system model [8].

What if dedicated hernia experts would collaborate through hospital networks (hernia centers) committed to providing surgical excellence and best patient outcome. The opportunity to develop this hernia center networks would provide a hernia international collaboration:


Whether the condition of one of the patients requires care from one specialist or an entire team, the surgeons work side by side with the patient explaining to him/her the entire treatment to develop a personalized care plan to treat his/her condition. In some cases, such as complex reconstructions, collaboration will be needed by working with surgeons from the Division of Plastic and Reconstructive Surgery to perform procedures and help coordinate the most appropriate course of care for the patient.
