On how to become the best surgeon in the world

The realm of surgical practice is intricate and demanding, requiring an amalgamation of technical skill, deep knowledge, and keen judgment. Among the various measures of a surgeon’s prowess, the ability to minimize postoperative complications stands paramount.

This essay explores why the minimization of complications is not just a desirable outcome but a fundamental attribute that distinguishes the best surgeons in the world.

Defining surgical excellence

Surgical excellence transcends mere technical skill. It encompasses a holistic approach towards patient care, where the surgeon’s priority is not only the success of the procedure but also the overall well-being of the patient. This involves pre-operative planning, intra-operative decision-making, and post-operative care.

The role of continuous learning and adaptation in a surgeon’s career. The best surgeons are those who stay abreast of the latest techniques and technologies, always seeking to improve their methods.

The impact of complications on patient outcomes

Complications can range from minor issues, causing discomfort or extended hospital stays, to major problems that can lead to long-term health issues or even mortality.

The psychological impact on patients and their families. A complication-free recovery is not just a physical relief but also a mental one, fostering trust in the healthcare system and the professionals within it.

Strategies for minimizing complications

Detailed pre-operative assessments to identify potential risk factors. This step is crucial in tailoring the surgical approach to each individual’s unique health profile.

Emphasis on minimally invasive techniques where appropriate, which have been shown to reduce recovery times and lower the risk of complications.

The importance of post-operative care, including monitoring for signs of complications and providing clear guidelines for recovery.

The role of teamwork and communication

Surgery is not a solo endeavor. The best outcomes are often the result of coordinated teamwork, including nurses, anesthetists, and other specialists.

Effective communication with patients about the risks and expected outcomes of surgery. This not only prepares them for the procedure but also engages them in their own recovery process.

The broader impact of surgical complications

On Surgeons and Surgical Teams

Surgeons carry the weight of responsibility for patient outcomes. Complications can have a profound psychological impact on them, sometimes leading to stress, self-doubt, and a phenomenon known as ‘second victim syndrome’.

Surgical teams also feel the impact. High complication rates can lead to decreased morale and increased turnover, affecting the cohesion and efficiency of the team.

On Healthcare Institutions

Complications often translate into longer hospital stays, increased use of resources, and additional procedures, which escalate healthcare costs.

The reputation of healthcare institutions hinges significantly on their surgical success rates. High complication rates can erode public trust and decrease patient referrals, impacting the institution’s financial health and standing in the healthcare community.

On Society

At a societal level, surgical complications contribute significantly to the overall burden of healthcare. They can lead to increased healthcare expenses, which may be borne by patients, insurance systems, or government healthcare programs.

There’s also a broader economic impact. Complications can prolong patient recovery times, delaying their return to work and contributing to productivity losses.


The best surgeons in the world are distinguished not just by their technical abilities but by their relentless pursuit of patient safety and well-being. Minimizing complications is a multifaceted challenge that demands excellence at every step of the surgical process. As the field of surgery evolves, this principle remains constant: the best surgeons are those who prioritize their patients’ holistic health, striving for outcomes that are as complication-free as possible.

The surgeon’s solitude

Have you ever felt lonely? I’m not talking about lacking company.

I mean facing nothingness head-on.

Nothingness – by Julio Mayol

It’s that feeling of emptiness and silence, when guidelines, clinical sessions, and even the opinions of the most experienced colleagues no longer matter.

It’s the solitude of an individual who must make a decision about another person’s life in a matter of seconds, when the unthinkable happens. When you’re terrified but know you can’t walk away.

Whipple Procedure.

I slip a clamp behind the pancreas, detach it from the portal vein, and…

«Damn! I’ve broken something!»

Everything fills with red fluid.


I try to clamp it shut to make it stop.


But it tears further.

«Damn it all!» – fear makes me shout.

A viscous lake starts to emerge from the laparotomy, visible even to the anesthetist, who keeps administering more crystalloid solution to the patient because the blood pressure drops abruptly.

He looks at me.

Eyes filled with fear.

Agitation and nervousness.


And deep inside me.

«I’m sorry. I know. I’m sorry!»

Here, evidence-based medicine doesn’t hold its ground anymore.

«I have to handle this,» I think.

  • «It’s going to bleed a lot!» – I softly whisper – «A lot! Keep it steady, no matter what! I’ll hold it!»

But within oneself, everything starts to accelerate.

And you’re alone.

Your ears are ringing.

Your legs are trembling.

But you’re alone.

You can’t tell anyone.

And they can barely support you; they’re weak.

The heart races.

Very fast.


Breathing is almost painful.

The air burns.

Now they don’t ring, they just buzz. Your ears.

Sounds from anywhere but your head are inaudible. They’re like senseless whispers.

You’re alone.

You either control it or everything ends.

You’re there. But alone!

That’s the solitude I’m referring to.

That exhausting black hole.

In that void, some learn to distinguish what’s essential from what’s accessory.

Others might even see my heart pounding through my chest.

Surgery and LLMs

Large language models have recently emerged as powerful AI technology with many potential applications. Surgical practice might benefit from its use. Therefore, I decided to investigate what two widely available chatbots, ChatGPT and BingGPT, based on GPT3.5 and GPT4 respectively, had to say.

Surgeons. Digital art by Julio Mayol

My prompt to ChatGPT was: Why and how can LLM be used in surgical practice?

Its response:

Large Language Models (LLMs), such as GPT-3 and GPT-4, can be used in surgical practice in a variety of ways to support surgeons and enhance patient care. Here are a few reasons why LLMs can be valuable in surgical practice:

  1. Knowledge retrieval and decision support: LLMs have access to vast amounts of medical literature and information. Surgeons can use LLMs to retrieve relevant research articles, guidelines, and clinical data to support decision-making during preoperative planning, intraoperative situations, and postoperative care. LLMs can provide up-to-date information on surgical techniques, complications, and treatment options, assisting surgeons in making well-informed decisions.
  2. Education and training: LLMs can be valuable educational tools for surgeons in training. They can provide access to a wide range of surgical knowledge, case studies, and procedural guidelines. Surgeons can interact with LLMs to ask questions, practice virtual simulations, and receive feedback, which can help enhance their surgical skills and knowledge.
  3. Natural language interfaces: LLMs can serve as natural language interfaces for surgical documentation and reporting. Surgeons can dictate operative notes, postoperative reports, and other clinical documentation, and LLMs can transcribe and format the information accurately. This can save time and effort for surgeons, allowing them to focus more on patient care.
  4. Clinical decision support systems: LLMs can be integrated into clinical decision support systems that provide real-time recommendations and alerts based on patient-specific data. By analyzing patient information, LLMs can assist in predicting surgical outcomes, identifying potential complications, and suggesting personalized treatment plans.

It is important to note that while LLMs can provide valuable support in surgical practice, they are not meant to replace the expertise and judgment of surgeons. They are tools that can augment and assist surgeons in their decision-making and knowledge acquisition process.

Additionally, the implementation of LLMs in surgical practice should consider factors such as data privacy and security, ethical considerations, and the need for validation and verification of the information provided by the models.

Overall, the use of LLMs in surgical practice has the potential to improve patient care, enhance surgical decision-making, and support the ongoing education and development of surgeons.

The GPT4 response to the same prompt:

Why and how can Large Language Models be used in surgical practice?

Large Language Models (LLMs) are artificial intelligence systems that can generate natural language texts based on a given input, such as a prompt, a query, or a context. LLMs can be used in surgical practice for various purposes, such as:

  • Providing pre-operative information and instructions to patients and their families, such as the risks and benefits of the surgery, the preparation steps, and the recovery process.
  • Generating operative reports and summaries based on the surgical data and images, such as the type and duration of the surgery, the instruments and materials used, the complications and outcomes, and the recommendations for follow-up care.
  • Enhancing surgical education and training by creating realistic scenarios and cases for simulation and assessment, such as the anatomy and pathology of the patient, the surgical plan and technique, and the possible challenges and errors.
  • Supporting surgical decision making and innovation by generating suggestions and alternatives based on the current evidence and best practices, such as the optimal surgical approach, the most suitable device or implant, and the potential improvements or modifications.

LLMs can be used in surgical practice by integrating them with other technologies and platforms, such as voice assistants, chatbots, electronic health records, surgical robots, and augmented reality devices. LLMs can also be customized and fine-tuned for specific surgical domains and tasks, such as orthopedic surgery, neurosurgery, or cardiac surgery.

LLMs have the potential to improve the quality and efficiency of surgical practice by providing accurate and timely information, reducing documentation workload, enhancing learning and skill development, and facilitating creativity and innovation. However, LLMs also pose some challenges and limitations, such as ensuring their reliability, validity, safety, ethics, and accountability. Therefore, LLMs should be used in surgical practice with caution and supervision, and in collaboration with human experts.