Surgical news

A.M. James Shapiro, MD PhD

Dhananjaya Sharma, MBBS, MS, PhD, DSc, FRCS, FCLS (Hon), FRCST (Hon)

Virve Koljonen MD, PhD

Virve Koljonen MD, PhD

Virve Koljonen MD, PhD

Virve Koljonen MD, PhD

Begum Pekbay

Virve Koljonen, MD, PhD

Virve Koljonen, MD, PhD
Department of plastic surgery
Helsinki University and Helsinki University Hospital
Helsinki, Finland
@plastiikkaope

I am a big fan of Pokémon Go. I play it regularly and by that, I mean, every day. The inventiveness of the appearance of Pokémon characters and their witty back stories appeal to me. It is nice to look at a new character and try to find out its real-world counterpart. Further, the structure of the game is to collect as many as possible Pokémon or walking a certain amount of kilometers doing projects within the specified time, perfectly aligning with my competitive personality. Some time ago I was browsing through the medical literature. I am always trying to keep up with new literature, although nowadays it is very difficult. It has been estimated that medical knowledge doubles in just 73 days 1. I do really miss those golden old days when you just did a brisk walk to the library to find what you were looking for. I cannot overestimate my joy when I found out that my favorite leisure time hobby, Pokémon go was employed to expose predator publishers2! Pokémons have helped to reveal that predatory publications have no peer review, nor editing, and what is most choking, not even a reality check2. I am not going the reference these publications, since I feel that the journal gets undeserved glory for including them in the reference list. However, I will walk you through some of these genius publications. For the purposes of this article, I also made AI images in the Pokémon go -style.

Virve Koljonen, MD, PhD
Department of plastic surgery
Helsinki University and Helsinki University Hospital
Helsinki, Finland
@plastiikkaope

I vividly remember when attending congresses was in real life only. Today that seems like another reality. I do remember the awkward moments, when I had like one microsecond to decide how to greet my congress acquaintances. Should I greet them with familiarity, or formally, or just casually wave my hand when walking by. As a person coming from a northern country, apart from choosing the right way to greet acquaintances, another custom of the continental Europe is causing me quite a lot of anxiety: air kisses. Which cheek comes first and how many are appropriate, because I don’t want to seem like a stalker, and what if I accidentally belch simultaneously. So many things to consider and be afraid of. Traditionally the success of congresses have been measured by the number of participants and by the number of abstracts 1. This obviously translates to money made by the organizing entity. Before the advent of internet, medical congresses were truly occasions where top scientific innovations were presented, new techniques were introduced, and with a chance to learn from experts 2. Nowadays knowledge is available for anyone at anytime and anywhere. Of course, I will not dismiss the value of face-to-face interactions, that has led to great innovations and is personally meaningful to those participating in such actions. What about the keynote speakers – superstars of their specialty. The more famous the keynote speaker, the more attractive congress is likely to be. In social media, there are events that are called meet-and-greet events. By definition, these events are arranged so that a famous person i.e. influencer can meet and talk to the people. Or is it vice versa actually. Meet-and-greet events are not quite the normal fan event, but almost. Well, to me it sounds a lot like inviting keynote speakers.

Virve Koljonen, MD, PhD Department of Plastic surgery Helsinki University and Helsinki University Hospital Helsinki, Finland @plastiikkaope

Since ancient Egypt and ancient times, there have been female surgeons.1  The earliest image of a female surgeon at work was found in the tomb of Ramses II.2  The papyri that survived to the present day show that medicine and surgery in ancient Egypt was systematic, although it was infiltrated with magic and religion. It has been suggested that in ancient Egypt  there were medical specialties and specialised physicians.3 Women surgeons played an active role in the development of surgery and medicine. Women surgeons operated on breast tumours, treated wounds, placed bone fractures in the correct position, performed births, and performed caesarean sections1.  So, everything was going pretty smoothly until the Middle Ages came. The Middle Ages were not a good time for women surgeons. Women were prevented from training as doctors and surgeons. This has been attributed to male-dominated church and state rulers, which led to a deterioration in the position of women physicians, surgeons, and women1 overall. Women, together with carpenters, smiths and weavers were banned practising surgery and taking part in the Company of Barbers and Surgeons.1 During the Middle Ages, however, there were a couple of exceptional cases when a woman was allowed to practice her profession as a surgeon; if they were found qualified by a “competent” jury.4  Hey, did we just accidentally find the basis for current competency-based specialisation? Another career path for women to achieve the profession of surgeon was death of surgeon husband. Widows of surgeons, were allowed to practice surgery.4  That is, inherit the profession. Fortunately, women continued to practice our profession.

Virve Koljonen M.D. PhD.
Department of Plastic surgery
Helsinki University and Helsinki University Hospital
Helsinki, Finland
@plastiikkaope

I read with great interest Post reproductive female killer whales reduce socially inflicted injuries in their male offspring in Current Biology.1 I was intrigued to learn that in only a few animal species apart from humans, females experience menopause, and live past it. Currently, only humans and toothed whales; killer whales and short-finned pilot whale females live, as it is called, a post reproductive life.2 To be brutally honest, I had not contemplated about the menopause in other animal species nor in humans. But now that I think if it, I have never heard of post-menopausal ants or menopausal lionesses. Another term linked to this is the grandmother effect, that basically means that older female kins can take care of the younger.3 Is this beneficial or not, results are contradicting?3 We should not focus on gender; thus I suggest that we talk about the grandparent effect in surgery. Surgical departments consist typically of surgeons of different ages. Every individual brings their experience, vision and  insight to benefit the community. It has long been the case that the views of senior surgeons are listened to and respected more than those of newcomers. Thus, as they get older, surgeons expect their opinions to be automatically respected more. Of note, I strongly disagree. Our profession is highly physical, and we use a lot of neurocognitive skills. Physical decline together with chronological ageing is a fact. We acknowledge this in our patients, but not with ourselves. Hearing, vision, dexterity, strength and reaction time usually tend to deteriorate with aging,4,5 although I must note that this is highly individual. Likewise, age-related neurocognitive changes such as processing speed, problem solving and adaptive thinking, and critical and analytical reasoning usually decline.5,6 Together these natural ageing-related phenomena pose a risk both to the surgeon and the patient.  Add to this that, in general, doctors take poor care of their physical and mental health and do not consult physicians,7 other than themselves. So, it is clear that older surgeons may be a serious risk factor for poor outcome.

Recommendation and Article by Teresa Perra and Alberto Porcu Azienda Ospedaliero Universitaria di Sassari, Sassari, Italy

Anatomical knowledge is an essential asset for every surgeon. This book is a useful and handy guide for every student, surgical resident, or young surgeon. It provides a brief anatomical description for each site, followed by the surgical technique. The Editor-in-chief of this book, Professor Skandalakis, shares his experience in the field of surgical anatomy and technique. The result is a book that explains everything in a simple language and is full of beautiful illustrations to explain relevant anatomical details and fundamental steps of surgical procedures. The latest edition has been updated to include robotic surgery techniques and to reflect recent advances in surgery with the relevant anatomy. It is well-written and every chapter is well-structured. Why surgeons should read it: This handbook is a very useful resource for surgeons in the early stages of their career or medical students with an interest in surgery. Every anatomical region is described. The main basic surgical interventions are explained. In the latest editions, new chapters have been added. Whether you need to perform a simple skin biopsy or a complex procedure such as a pancreatoduodenectomy, anatomical knowledge is critical. This book opens your mind and highlights key points of anatomy relevant to performing surgery. This is a book that you can quickly consult to review the anatomy of a particular site and the key steps of a surgical procedure. It allows you to relate the anatomy to the surgery. It is a pocket manual and an online version is available.

Recommendation and article by Nadia Henriksen; Staff Specialist, MD, PhD, FEBS-AWS, Ass Professor. Herlev Hospital, University of Copenhagen; Denmark; @DrHenriksen

Atul Gawande is an American surgeon, writer, and public health researcher. Being Mortal is about the inevitable process of aging and dying, which are hard subjects to face, but Gawande is an imminent storyteller, who takes the reader through an important journey with the use of personal experience, facts, and patient stories. The first part of the book is about being old and the natural process of aging. Gawande discusses the importance of maintaining independence and freedom in the elderly population thereby giving them a purpose for living. There are ways to improve nursing homes using alternative designs such as including pets and children. The second half of the book is not only about death in the elderly population but also in younger people with severe illnesses. Talking about death is difficult for most doctors; however, Gawande guides the reader through the hard conversations. Lastly, Gawande addresses bravery and courage, which are needed for both doctor and patient to accept being mortal.

Recommendation and Article by Gianluca Pellino, BJS Academy SoMe and Associate Professor of Surgery at University of Campania, Naples, Italy, @GianlucaPellino

When he is diagnosed with cancer, Tiziano Terzani, an Italian journalist and writer, looks back at his whole life, and realises it has been a long ride on a merry-go-round, for which he never paid a ticket. When “sentenced” with cancer, he feels that the ticket collector is demanding his dues. After being seen by several doctors and Western-medicine specialists, he starts to have existential doubts, questioning the role of physicians, and asking himself whether the cancer is an enemy to be destroyed or a part of himself. During his entire life, he had always been a traveler; so, it becomes natural for him to start a new journey. around the world and inside his soul. Travelling leads him to India, where his most difficult trip begins. Every choice is linked to his own survival, oscillating between science and magic. Eventually, this becomes an inner journey, one which will lead him to the roots of man. Why surgeons should read it: Diagnosing cancer is something most surgeons have become used to doing. Most are used to communicating such information to patients and relatives, which requires a human touch and communication skills. However, even the most empathetic surgeon might find it difficult to understand what it really means to receive such a diagnosis, which to many patients, sounds like a sentence of death and suffering, frequently involving their family and the people around them. This book provides insights on what patients can experience, offering a perspective of them as a person rather than a patient, each different from the other. Readers will also find themselves questioning some truths they take for granted and will embrace alternative ways of looking at things. Some episodes described will make readers smile, others will move them to tears; but at the end of this poetic description of a potential tragedy, they will be enriched, and, hopefully, also become better doctors and surgeons.   

Recommendation and Article by Deborah Verran; Surgeon; Ramsey Healthcare; Sydney; Australia

You may have heard about the Sackler family who, until recently, were better known for some of their philanthropic work around the world, including in the arts. Until relatively recently, it was not clear how members of this family were in a position to fund all of their philanthropic activities. This forensic exposé of the Sackler family by journalist Patrick Radden Keefe explores in detail their close involvement with the pharmaceutical industry over several decades. It is an eye-opening read as it provides background context on how some of the pharmaceutical agents were both developed and then widely marketed by those holding an interest. This is a long book rather than a weekend read. However, those of you who persist will be left with a feeling that you have learnt something worthwhile. Why surgeons should read this book: All surgeons involved in operative procedures will be aware of the challenges involved in adequately managing pain relief in their patients. Plus, it has only been in relatively recent times that powerful oral medications have come in to mainstream practice as part of the armamentarium for managing acute pain. Oxycontin is a medication that has become the focus of increasing attention, and not always for positive reasons. This book delves into details on how Oxycontin came to be such a widely used medication around the world, along with many of the problems which have subsequently arisen. Reading this book provides surgeons with some additional background information on Oxycontin which is not readily available elsewhere. This information may be of benefit in practice, or at least can potentially lead to important conversations with other colleagues in the workplace. Empire of pain serves as a timely reminder as to why the sound regulation of newly developed and powerful pharmaceuticals is so important in practice.

Recommendation and Article by Dr. Afsheen Zafar, Professor of Surgery at Islamic International Medical College, Riphah University, Islamabad.

Based on Brené Brown’s research work on connection and vulnerability and building on her previous books, this book has been written for anyone who works in a team and is in a leadership role. The epigraph of the book is the famous quote by Theodore Roosevelt about the critic and the arena and she builds the definition of courage and vulnerability around it. She then portrays what daring leadership looks like in real life compared to armored leadership, a term she uses for the conventional response to fear and the feelings of the team or the leader himself. Contrasting these two, she gives practical tips and actionable concepts to practice the daring leadership qualities. The book has a lot of real-life examples from her own and others’ experiences and is relatable to anyone who has ever worked in a team and dared to lead. Why Surgeons should read this book:

Recommendation and Article by Gianluca Pellino, BJS Academy SoMe and Associate Professor of Surgery at University of Campania, Naples, Italy, @GianlucaPellino

The book describes the personal path of David Nott, a well-known vascular surgeon from the UK, who has contributed immensely to help countries during war crisis, both operating on the field and training local colleagues to perform common operations, and to deal with casualties. Mr Nott provides vivid images of what it was like to be a surgeon in such difficult times and places, putting at risk his own career and life. The style is captivating and gives a clear and unfiltered picture of the difficulties encountered whilst serving during conflicts: facing authorities and restrictions, fighting a war inside the war, with no other weapons but surgical knowledge and will to help who is suffering. There are very painful-to-read pages, which are likely to hurt the reader, who will wet some pages with tears; but they are instrumental to show the brutality of war and how surgeons can contribute to make a change.  Why surgeons should read this book: The strive to help who is suffering has motivated many surgeons to become doctors, and specifically doctors who can perform operations: making something tangible and resolutive. Some surgeons will still feel that they can do more to share the knowledge they have been accumulating through years of hard study and training with colleagues that did not have the same opportunities. Humanitarian missions can enrich the soul of surgeons, and they really make a change in people’s lives. Sadly, wars are still afflicting our world, and with violence come suffering and injuries to civilians and innocent members of the society. Serving in difficult situations requires skills and preparation, which are clearly described in the book. This book does not teach how to become a hero, rather it prepares those who are considering such an experience to what they can expect. It motivates those who are living the conflicts in every day life to carry on and seek for collaborations, and it provides an inspiration and example of many ways to contribute to alleviating the suffering.

I trained at the Johns Hopkins School of Medicine (1972-1976) followed by a  surgery residency at the Johns Hopkins Hospital (1976-78 and 1980-1984) including 2 years as a research fellow at the Mayo Clinic (1978-1980) under the direction of Dr Keith Kelly, a truly remarkable surgical scientist. I spent a year as a postdoctoral fellow at Johns Hopkins Hospital (1984-1985) under the tutelage of John Cameron and Gregory Bulkley; both formidable mentors.  I was groomed to become the classic academic general surgeon of the times with a primary clinical and research interest in GI surgery and physiology and so I was appointed as an academic surgeon with an NIH-funded laboratory studying GI motility and absorption. My career then spanned the next 37 years at Mayo Clinic with extramural leadership positions in several national and international societies, a 5-year stint as a Director on the American Board of Surgery, Chair of the Department of Veteran’s Affairs Merit Review Committee (1995-1998), and editor of the journal SURGERY for 22 years (2000-2020). If I let my mentors down, it was that I never became Chair of a department of surgery, because I never wanted it.  I would never have wanted the administrative responsibilities to interfere with my laboratory pursuits, hands on teaching and clinical interests.  All of this is ancient history. What is more important is what follows and hopefully will help young surgeons find their way in our house of surgery. What made you decide to become a surgeon? My dad was a urologist, and as a kid looking at his medical books, I decided I could never be a urologist, but the father of one of my girlfriends was a paediatrician and I really admired him’, so I entered medical school thinking I was going to be a paediatrician ,that is, until I rotated through paediatrics. Two hour rounds 3 times a day and dealing with well-meaning but difficult parents and paediatric nurses who always thought we were barbarians out to hurt the kids (yes, it’s true) was enough to convince me that this was not my calling.  I was a very serious student and at Hopkins was being groomed to be an academic physician, so I tried rotations in most specialties. I left the surgery rotation until last, because all I had heard from others was that surgeons were ‘jerks’, were not academic and not scientists. At the end of my third year, I had to do surgery and after 2 weeks, loved it. I enjoyed the work, the challenges, and the surgical personalities, but how could I be an academic as a surgeon? Then I met a several surgeon scientists (there were quite a few at Hopkins) who ran laboratories, were great teachers, and were exciting. From then on, I knew that surgery was my calling.

What made you decide to become a surgeon? I was the sixth child of a South African surgeon, a veteran of WWII, whose commitment to his patients, large family and community impressed me from childhood. Aged ten, he helped me stitch up a (brave) friend of mine who has gashed his forehead. I was hooked! But I wonder what his medical defence organization would have said in 2022? Who were your influences?

I am a surgeon specializing in gastric cancer. I graduated from the University of Tokyo in 1980, and after surgical training, spent 15 months at Institut Curie, Paris as a research fellow with a French Government scholarship. This flavoured my subsequent life with a European taste. For the past 30 years, I have concentrated on surgery and clinical trials on gastric cancer in the two largest cancer centres in Japan,  the National Cancer Center and the Cancer Institute, traveling around the world for lectures and live demonstrations of gastrectomy. I have been also involved in formulating domestic and international classifications and guidelines for gastric cancer. Nowadays, I have almost left the operating room and am engaged in management as Hospital Director of the Cancer Institute. What made you decide to become a surgeon? I was born in to a medical family going back many generations in a small castle town and had no alternative but to become a doctor! During the clinical classes in medical school, I was bored with reading the thick medical records written by earnest residents of internal medicine: lots of data, differential diagnoses, copies of references, but no clear solution. Surgeons’ patient notes were fascinating: simple description of surgery with drawings, uneventful postoperative days, sometimes followed by unexpected pathological results. A senior surgical resident confessed that he was not a diligent medical student (too busy with his soccer club) but was able to stand on the same starting position as other brilliant classmates. The story was quite convincing.

I have held the Chair of Surgery at the University of Adelaide for the past 30 years.   I trained as an HPB surgeon, became involved in rural surgery coordination within South Australia, surgical management of public hospitals and assessment of new surgical techniques for the Royal Australasian College of Surgeons.   For the past 20 years I have been Director of the Basil Hetzel Research Centre based at The Queen Elizabeth Hospital.   I have been predominantly working within the South Australian public hospital and university system with a research focus on surgical innovation.   I have held the Presidency of Health Technology Assessment international (HTAi) and chaired the International Network of Agencies for Health Technology Assessment (INAHTA) as well as serving on the Council of the Royal Australasian College of Surgeons for 9 years. What made you decide to become a surgeon? I grew up in a surgical household, my father was the first urologist in the city and I spent my early years accompanying him on weekend ward rounds as a young child and sitting in his consulting rooms after school before driving home talking about urology and football.   I never imagined any other career.

My surgical life What made you decide to become a surgeon? Art and design have always been a passion in life. I designed and sewed almost all my own clothes when growing up. When my twin brother was to get married, he wanted to wear a white dress suit. I tailored it for him as there was nowhere, we could find one. I have kept on tailoring abdominal walls.

I retired from clinical surgery in 2015. My main area of interest was surgery of the upper GI tract. I was Professor of Surgery at the Universities of Bristol then Birmingham for 18 years, President of the Royal College of Surgeons of England from 2017 to 2020 and have been associated with BJS for over 25 years, becoming joint chief editor of BJS in 2010 and founding chief editor of BJS Open in 2017. What made you decide to become a surgeon? At the end of my third year as a medical student in Newcastle, I had a 3 month elective. I had enjoyed my first surgical attachment, so I asked the Professor of Surgery where I might go to see if surgery was the specialty for me. He recommended and helped me get a place at the University of Chicago. At the end of that summer, I had made up my mind.