{"id":24524,"date":"2013-02-18T11:41:48","date_gmt":"2013-02-18T10:41:48","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=24524"},"modified":"2013-02-18T11:41:48","modified_gmt":"2013-02-18T10:41:48","slug":"krishnan-ganapathy-is-surgery-not-more-than-stitching-and-cutting","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2013\/02\/18\/krishnan-ganapathy-is-surgery-not-more-than-stitching-and-cutting\/","title":{"rendered":"Krishnan Ganapathy: Is surgery not more than stitching and cutting ?"},"content":{"rendered":"

\"Ganapathy<\/a>The genesis for this blog was listening to\u00a034 fascinating, highly technical\u00a0 lectures including “How I do it” sessions at an international neurosurgical update for young neurosurgeons.<\/p>\n

Operating theatres resembled the control room of the Mars mission.\u00a0\u00a0 As one trained in\u00a0 the BC era (Before Computers = Before Christ)\u00a0 it is\u00a0obvious to me that surgery is\u00a0changing. Brain surgeons will now have to be brainy surgeons with\u00a0 Ph.Ds in engineering, technology, physics and imaging.<\/p>\n

Surgeons will be injecting genes piggy backing on viruses, into tumors.\u00a0 They will be observing a brain needle on a giant screen , automatically and\u00a0 dexterously avoiding blood vessels, on a highly illuminated super highway leading to the tumour.\u00a0 3D MRI\u00a0 tractography\u00a0 with annotations, describing\u00a0 specific functions of nerve fibres on the way, will also\u00a0 be displayed. Surgeons will intuitively selectively “tie” blood vessels (several centimeters away leading to the tumour)\u00a0 thus starving tumours,\u00a0resulting in their eventual\u00a0 death.<\/p>\n

Operating on the unborn patient could\u00a0 be a logical sequel to sophisticated antenatal\u00a0 diagnosis. Deep brain stimulation, now carried out for Parkinsonism, may even\u00a0 be extended to management of obesity and\u00a0 hypertension.<\/p>\n

The rapist of the next decade will be on parole with an electronic chip implanted in the amygdala. When even a thought of an antisocial nature occurs, the change in electrical activity could\u00a0 be detected, and further impulse propagation to the effector organ arrested.\u00a0<\/p>\n

Brain tumours will eventually be visualised\u00a0 through the intact skin and skull. (Sony had to withdraw see-through infra red\u00a0 cameras after protests from women\u2019s organizations \u2013 the technology already exists). The neurosurgeon needs to be an engineer and technologist,\u00a0 a master craftsman adept in\u00a0 neurobiology –\u00a0 a plumber and carpenter par excellence, a truly multi faceted skilful individual. New skills must be constantly acquired \u2013 what got you where you\u00a0are now will not keep you there.<\/p>\n

However, should not the young neurosurgeon, to\u00a0whom I would certainly give my brain to repair, look\u00a0 beyond\u00a0 technology\u00a0 and surgical\u00a0 expertise? Rudyard Kipling\u00a0\u00a0once remarked “What do they know of England, who only England know?”\u00a0\u00a0 The first step is to understand that\u00a0developing traits, quality, character and\u00a0 sterling values will ultimately make one a better surgeon,\u00a0 than mere access to sophisticated armamentarium.<\/p>\n

The empathising surgeon should learn to communicate and communicate.\u00a0 S\/he\u00a0 should be the embodiment of clinical judgement and wisdom. Even today there is a role for no intervention, delayed\/less aggressive intervention . One must treat\u00a0 the family, treat the individual with the tumour, not just the tumour or the image on the MRI. One should never forget that we\u00a0 can die\u00a0 with a benign timour, and\u00a0not\u00a0 necessarily of one.<\/p>\n

Operatis prurandi often afflicts the most skilful aggressive surgeon. The surgeon may be bold, but often it is the patient who is\u00a0 bolder in giving consent. Today, unlearning\u00a0 and\u00a0\u00a0 relearning\u00a0 is more\u00a0 important than learning. Mid course corrections and\u00a0 responding, rather than\u00a0 reacting, is crucial.\u00a0 We are what we repeatedly do, and for success one has to do the job\u00a0one hates the most.<\/p>\n

Looking far afield\u00a0 helps one to see better what is closer to home. Focusing\u00a0 on long term results and\u00a0 goals, acknowledging uncertainty, and using one\u2019s\u00a0 support network\u00a0 are all essential traits. A leader willing to listen and\u00a0 look\u00a0 from the balcony, a frontrunner who has realised that there is no I in TEAM (Together Everyone Achieves More ), a head who understands\u00a0 strategy, planning\u00a0 and execution.<\/p>\n

Raising the bar –\u00a0 not being\u00a0 content with low hanging fruits and looking\u00a0 at every failure as a learning experience \u2013 these qualities should be in the very DNA of every surgeon. The ability to take a quick\u00a0 effective decision, retreating if necessary, defines a surgeon as much as a platoon commander\u00a0<\/p>\n

An astute\u00a0 clinician never ever discounts history\/and observations of the patient and the family.\u00a0 Harvard Business School, citing decisions taken by Fortune 500 CEOs, concedes that there is a place for Emotional Intelligence.<\/p>\n

We are healers first and technologists later. A combination of the surgical skills of the Indian surgeon Sushrutha<\/a>, (who several millenia ago introduced surgery to the rest of the world), the\u00a0 compassion of\u00a0 the erstwhile Kolkata based Mother Teresa<\/a>, the scientific acumen of of India\u2019s first Nobel Laureate in Physics Sir CV Raman<\/a> (who exemplified\u00a0 innovation in the 1930s), the pragmatic \u201c Karma Yoga<\/a>\u201d (enunciated in the Indian scriptures where the highest form of worship is work without seeking rewards) , shrewdness and IT skills\u00a0 exemplified by the Indian IT industry will produce\u00a0Superman, which is what the surgeon of today needs to be.<\/p>\n

Krishnan Ganapathy<\/strong> is\u00a0a\u00a0 neurosurgeon and\u00a0 telemedicine specialist was a\u00a0 former Secretary and Past President of the Neurological Society of India . He was also Secretary General of the Asian Australasian Society of Neurological Surgery. A Past President of the Telemedicine Society of India, he is currently President of the Indian Society of Stereotactic and Functional Neurosurgery See www.kganapathy.com<\/a><\/p>\n

See also:<\/strong> The surgeons who are not doctors<\/a><\/p>\n

See also:<\/p>\n","protected":false},"excerpt":{"rendered":"

The genesis for this blog was listening to\u00a034 fascinating, highly technical\u00a0 lectures including “How I do it” sessions at an international neurosurgical update for young neurosurgeons. Operating theatres resembled the […]<\/p>\n

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