Invited post by Ameera AlHasan: The future of surgery

“The best way to predict the future is to create it.”

Abraham Lincoln


Author: Ameera AlHasan, senior surgeon at Jaber Al-Ahmad Hospital, Kuwait

Surgery is an ancient craft that has withstood the test of time thus far. What the tides of the 21st century will bring can only be foretold by examining current trends and using them to steer our profession towards the future we hope to see.

Tweaking techniques through technology

As all aspects of modern life undergo a rigorous digitalization process, the practice of surgery is no exception.

Starting with minimally invasive surgery through the adoption of laparoscopy and robotics, surgical technology will continue to evolve in order to render operating a more comfortable experience for both surgeon and patient. The advent of human enhancement with advanced imaging and artificial intelligence means that the surgeon of the future will be able to see better and do more.

The improved understanding of the molecular basis of disease together with the advancement of nanotechnology has given birth to precision medicine. This novel field employs targeted therapy to address the subcellular, genetic and molecular determinants of disease. Speculations arise that this might completely obviate the need to operate on patients. Although this may be true at certain stages of a disease, it seems more likely that it will act as an adjunct, leading to a re-definition of the indications for surgery, and helping to create a multimodal approach to treatment of which one dimension will remain surgical.

Mending mental and mentorship models

The evolution of surgery from a mere apprenticeship into a science has led to the emergence of the “surgeon scientist”, an individual undergoing a metamorphosis from craftsman into profound thinker, dogma warrior and evidence generator.

As changes continue to occur in surgical culture and mentality, a dire call is being made for diversity, inclusivity and equity in surgery.  Once this is achieved, it will culminate in the creation of a melting pot brimming with talent, surgical prowess and novelty. The naturalization of women into the various fields of surgery is a leading example of how such inclusivity can capitalize on individual abilities to enhance overall performance and effect change.

Yet true revolutions can only be effectively brought about through conscientious mentorship. Mentorship has been crucial in the formation of surgeons across centuries, and the future will see a global plea for recruiting more surgical mentors. This is exactly where communication technology, social media networks and international associations will play a pivotal role in connecting mentors with mentees across the world.

Saving the surgical spirit

Finally, the question we’re all dying to ask is: Will we continue to operate?

The answer is YES, because that is what makes us who we are as surgeons.

However, in the face of technological advances and paradigm shifts, it will be crucial for the surgical community to foster a kindred spirit in order to continue to operate and prosper. The surgery of the future will no longer be a one-man/woman show as focus shifts onto coordinated teamwork and multidisciplinary management.  

Successful team management subsequently beckons for leadership as an indispensible skill for the thriving surgeon.

The quest has already begun to train and encourage surgeons to become leaders in the future, for the surgical messiah will not be chosen, but created.

Global Mentors – Mentores Globales

I was quite lucky. Not two, but three mentors I met along my training years.

  1. Jesús Alvarez Fernández-Represa
  2. Julio García-Aguilar
  3. Jeffrey B. Matthews

Being in the right place at the right time was the secret of my success. However, many others are not so lucky.

That is the reason why I have created a list on Twitter, which is directly related with the #SoMe4Surgery community: Global Mentors https://twitter.com/juliomayol/lists/global-mentors-surgery

Senior surgeons on Twitter who express their interest in becoming #GlobalMentors will be included in the list.

Surgical trainees just need to subscribe and connect with the #SoMe4Surgery mentors in the list.

No matter where in the world they are, trainees will find the right mentor to support their professional development. Mentors will find the right mentee.

With Jeffrey B. Matthews, J
ulio Garcia-Aguilar and Richard Hodin: the Boston’s Beth Israel Hospital/Hospital Clinico San Carlos Mentoring team

Value based surgery – the Journal of the ASGBI

Today, the Association of Surgeons of Great Britain and Ireland has published its Summer 2019 issue, including several contributions around a common topic: Value Based Surgery.

It has been an honour and a privilege to coordinate an outstanding group of surgeons, who have written thoughtful contributions regarding #Telemedicine, #PrecisionSurgery, #DigitalSurgery, #ERAS, and #Outcomes. The list of authors is as follows:

Muir Gray

Luis Sánchez-Guillen

Arfon Powell

Gemma Humm and Manish Chand

Mónica Millán

Rebecca Fish

I invite you to read their work here https://www.asgbi.org.uk/userfiles/file/journals/summer-2019-jasgbi.pdf

In order to transform the current practice of surgery into #ValuebasedSurgery, surgical leaders must address the following 5 common problems:

  1. Variability in quality and outcomes
  2. Harm
  3. Waste
  4. Inequities and Inequalities
  5. Lack of prevention

Coauthoring an article on #Valuebasedmedicine with Sir Muir Gray was particularly challenging, and funny. Quite an honour, and an unforgettable experience.

#SoMe4Trauma by Dr. Ameera AlHasan

Trauma takes numerous lives every year, in both a civilian and military setting. Trauma is the bread and butter of the general surgeon and the humble beginning of every specialized surgeon thereafter. It is therefore imperative to foster a strong online community that brings together efforts to raise awareness, share ideas and ultimately improve trauma practice on a global scale. This is how SoMe4Trauma was born.


Raised under the umbrella of the bigger SoMe4Surgery initiative, SoMe4Trauma aims to breed a community of trauma and acute care surgeons, other medical and non-medical trauma care providers (including ER doctors, nurses, EMS, fire brigade etc.), trauma policy advocates and trauma victims. Some of our goals include connecting the trauma community, sharing tacit & explicit knowledge, advancing trauma education, and creating a friendly and entertaining learning environment. In such a brief time period, the SoMe4Trauma family has managed to grow exponentially and to generate impact on Twitter. Such success can be attributed to a number of factors including the relevance of trauma to the medical community and the public (and the high burden of disease it represents), the unconditional support of influential surgeons on Twitter some of whom are true pioneers of trauma surgery and the continuous interaction of the SoMe4Trauma and SoMe4Surgery members.


Contrary to what it may seem, SoMe4Trauma is not a random tweeting service. The “behind the scenes” work that goes on in preparing most tweets is tremendous. That includes scheduling, networking, emailing guests back and forth, designing posters and recruiting tweeters to help interact and support the conversations. A structured approach is essential as real life efforts get translated into mere tweets. It is our belief that “failing to plan is planning to fail”. Real value can only be generated with vision and vigilance. 
             

Finally, just as management in the trauma bay depends on team work so does the sustenance of an online community like SoMe4Trauma. We invite you not only to interact with us, but to contribute and become a trauma leader yourself. All you have to do is to follow and use the hashtags #SoMe4Trauma and #SoMe4Surgery as SoMe4Trauma continues to blow your mind…hopefully, without causing any injuries 😉

Global surgeons: Prof. O. James Garden

Edinburgh, 8th of June 2019, Prof. O. James Garden retires as chairman of the BJS Society.

Prof. Derek Alderson (left), president of the Royal College of Surgeons, and Prof. James Garden (right)

Looking back, I recall that on the 9th of May 2012, being Prof. O James Garden the honorary secretary of the BJS Society, I was appointed to the editorial board of the BJS. And over the following seven years I have had a meteoric career to become secretary of the BJS Society in June 2018.

Consequently, you might think that what I am about to say is biased, but I must warn you that you would be severely mistaken, because he has been the epitome of a global surgeon long before I even dreamed of becoming part of the BJS community.

Prof. O. J. Garden is an outstanding surgeon, researcher, educator and manager, but as you can read in The University of Edinburgh webpage, retired from clinical practice in the summer of 2018. Even so, he has remained committed to surgical research dissemination and global surgical training for longer.

Over the last two years, given my role as secretary, I have had the privilege of witnessing his chairmanship of the BJS Society. An extraordinary thinker and strategist, with a strong commitment towards the advancement of our two journals, BJS and BJS Open, and the promotion of global surgical training, James Garden will be deeply missed by all of us in the BJS Executive and Council, but be sure he will always be available if we need him.

Thanks a lot Prof. O.J. Garden. Live long and prosper.

Global surgeons

A brief reunion at #DDW19 in San Diego led me to give some thought to posting regularly about some surgeons who are currently in practice, no matter where in the world, and who I admire for their global impact on one or more of the following areas:

  1. Professional leadership
  2. Surgical research
  3. Education and training
  4. Technology and innovation
  5. Knowledge dissemination

So here I am, almost ready to start. Stay tuned for upcoming posts.

With Jeff Matthews, Julio García-Aguilar and Rich Hodin

What I’ve learnt on my second day at #SSAT19

Today has been an intense and long day at #SSAT19: plenary sessions, Foundation awards, presidential address, editorial board meeting, etc.

However, these are the things that come to my mind when I try to recall what I’ve learnt:

The SSAT must be transformed to meet new challenges and generate new opportunities for academic surgeons.

Obesity and bacteria are clearly linked. In mice.

IBD is linked to microbiota.

Bacteria have refined their genetic code for longer than humans. They may outsmart us.

Chemotherapy toxicity may be influenced by intestinal bacteria.

Microbiome may play a role in pancreatic cancer.

John Alverdy is THE expert surgeon in microbiome.

We must solve complex problems because the easy ones are already fixed (Marc Nivet)

Residents and younger surgeons include their Twitter handles in their presentations.

In order to achieve transformation one must challenge his/her biases, get comfortable with being uncomfortable, interrupt the usual, and be curious.

What I’ve learnt today at #SSAT19

On the first day of the #SSAT19 meeting, two of the most important take-home messages came from a a retired surgeon, Prof. Christopher Ellison:

  1. You’re only old once,
  2. You never retire too early.

Robin McLeod has reminded us that the role of women in surgery is… the same as it is for a man.

Alberto Ferreres has pointed out that surgery is a moral practice, guided by three values: self-sacrifice, altruism and unselfishness.

Sachiyo Nomura has showed us how it is possible to manage a perfect balance between workload and well being in Japan.

Finally, Bruno Silverstein has reflected on the moral injuries that surgery inflicts on surgeons and, subsequently, lead to burntout.

Se cumplen 5 años

El 30 de septiembre se cumplirán 5 años de la jubilación de «mi jefe», el Profesor Jesús Alvarez Fernández-Represa, jefe del extinto Servicio de Cirugía I del Hospital Clínico San Carlos y catedrático de Cirugía de la Universidad Complutense de Madrid, además de Presidente de la Real Academia de Doctores.

Y lo confieso, le echo de menos.

Después de haber sido, durante mi carrera de Medicina en la Universidad Complutense, alumno interno con el Profesor Durán Sacristán en el Servicio de Cirugía I, resultó natural la elección de hospital y servicio cuando me llegó la hora de tomar la decisión en el recinto ferial de la Casa de Campo, después de superar el examen MIR.

Desde enero de 1991 hasta el 30 de Septiembre de 2012, durante 22 años, fui su residente, facultativo especialista interino, profesor asociado, facultativo especialista fijo, jefe de sección y profesor titular. Así que yo no sería quien soy sin él. Me enseñó a operar, pero también otras cosas más importantes; me demostró como un cirujano nunca pierde los nervios, ni desprecia a sus ayudantes, ni les maltrata de palabra u obra por muy compleja que sea la intervención. Eso sólo demuestra miedo, incapacidad y falta de preparación. Me mostró como, cuando te juegas la vida de otro ser humano encima de una mesa, la autoridad se consigue con el silencio no con los chillidos. O tarareando la música de «Los hombres de Harrelson». Además, me ayudó a investigar en cosas alocadas, como el transporte de cloro y la regulación de canales de membrana en el epitelio intestinal. Me dejó tener mi propio laboratorio de patobiología del epitelio intestinal y escribimos capítulos de libros juntos y fuimos co-autores de más de 40 artículos científicos.

Me dio libertad para que me confundiera a lo grande. Y respetó mis éxitos, sin sentirse amenazado. No tenía por qué. El estaba muy por encima de eso.

Nuestra relación a lo largo de los años no fue una balsa. Yo siempre le exigía más. Como jefe, le pedía cambios, criticaba sus decisiones, me peleaba con él, más en privado que en público.

Y cinco años después, ahora que soy director médico del Hospital, he comprendido que fui injusto e infantil, «inmaduro» como él me llamaba, que le pedía cosas sin entender lo complicado que es conseguirlas, sin asumir que no estaba en su mano.

Un día en mi despacho, después de su jubilación, se lo reconocí: «Ahora comprendo lo difícil que era su situación, lo difícil que resulta ser jefe».

He tenido suerte, mucha suerte. Porque algunos logros me los he ganado yo, pero el esencial, el trabajo como facultativo especialista en el Hospital Clínico, se lo debo a él.

El confió en mi.

Nunca se lo podré agradecer lo suficiente.

ESCP 2016 en Milán

Entre el miércoles 28 y el viernes 30 de Septiembre se celebró en Milán el Congreso de la European Society of Coloproctology. En la ciudad italiana se dieron cita especialistas de todo el mundo para presentar y debatir sobre la asistencia, la docencia, la investigación y la innovación en cirugía colorectal.

El congreso ha sido un verdadero éxito en términos de asistencia y calidad de las presentaciones. También ha sido importante el refuerzo de los grupos de investigación colaborativos a nivel nacional e transnacional. Los estudiantes han tomado un papel preponderante Pero la verdadera novedad ha sido la apuesta de la ESCP por la transformación digital de la reunión. Para ello se organizó, primero, una mesa redonda el día 28, moderada por el doctor Steve Wexner de la Cleveland Clinic en Florida, bajo el título «Coloproctology. How to start to engage online and future developments in surgical social media».

escp1

Además, durante todo el congreso se ha animado y facilitado la difusión de los contenidos en los medios sociales, incluyendo la transmisión por Periscope de algunas intervenciones.

Sin duda, eso ha llevado a un gran impacto del congreso. Esto ha podido cuantificarse a través de symplur.com. La participación individual e institucional ha sido variada y se ha visto reforzada por la interacción con profesionales que no estaban físicamente en el congreso.

El impacto global ha superado los 9 millones de impresiones, es decir, los tuits marcados con el hashtag #escp2016 han sido vistos más de 9 millones de veces. Con ello, también se ha incrementado el impacto de la comunidad creada alrededor de #colorectalsurgery.

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Finalmente, hay que resaltar la implicación de múltiples profesionales, pero también de sociedades científicas como la propia European Society of Coloproctology y, además, la Asociación Española de Cirujanos o la American Society of Colon and Rectal Surgeons.

escp3

Sin duda, la capacidad de los cirujanos para conectar, infectarse con nuevas ideas y conocimientos, y crecer como profesionales y como sociedad, ha quedado de nuevo demostrada.