Modern Surgeons: Still Masters of Their Trade or Just Operators of Medical Equipment?
When after 40 years of work, I look back at my professional career; I wonder whether I owe my proficiency in surgery to my experience and dexterity or, like many others, to technological progress.
Two of the great Polish surgeons were my mentors and teachers. Professor Zdzisław Łapiński was the one I met first. He was a manual genius and an unusual operational strategist. Granted, he had one character defect, but nobody's perfect after all. In 1975, I defended my dissertation. I was convinced that I should continue my education at a center abroad, preferably within a postdoctoral scholarship. Professor Łapiński wanted me to learn everything about surgery from him. I decided otherwise, and in 1978 with his tacit agreement, I obtained a Humboldt Fellowship and went to Heidelberg, to the department headed by none other than Professor Fritz Linder.1 I started my research for the habilitation thesis at the Experimentelle Chirurgie Abteilung of his Department.
The second of my 2 most important mentors in the field of surgery was Professor Jerzy Szczerbań. He instilled in me an interest in liver surgery. He was the master of portocaval shunts in patients with portal hypertension (which was at that time the method of choice in such patients), and although he had never transplanted a liver himself, I and other doctors in our department received training in liver transplants. It was because of his encouragement that in 1993 I decided to go to Villejuif, to learn from the great master of liver surgery, Professor Henri Bismuth. Just then Professor Bismuth and his team celebrated the 1000th liver transplants at his center.
Undoubtedly, I can still say I belong to those surgeons who received a highly comprehensive education. My surgical training included a variety of urological, neurosurgical, and thoracic surgery procedures, but also the opening an abdominal aortic aneurysm or a femoropopliteal bypass. I have always excelled in abdominal surgery – such as any large intestine, pancreas, and stomach operation. Back then, other surgeons had the same professional training. However, we were witnessing a unique phenomenon. Technological development helped us perform various operations and offer better therapy, but forced us to change our approach to the art of surgery. We had to adapt our manual dexterity in order to operate new equipment, and thus to be able to perform, among others, minimally invasive surgery. I learned laparoscopic techniques from Sir Alfred Cuschieri of the University of Dundee, and I am one of the first surgeons in Poland to have performed such operations.
Let us move on to a historical overview of surgery and surgeons.
During the Napoleonic Wars, Dominique Jean Larrey2 was the most popular surgeon; according to records dating back to the Russian campaign, he performed 200 amputations of limbs in just 24 hours. One must admit that to achieve such a feat, he had to be a truly great surgeon. Please note that the speed with which he operated was of key importance then, as it was not until about 1830 that the first anesthetics – ether, nitrous oxide, and chloroform – were introduced. However, the likes of Larrey were soon no longer admired due to the development of pathophysiology in surgery, diagnostics, and technology.