July , 2019
What’s new in surgical care in the 21st century?
16:17 pm

Dr. Sarfaraz Baig

It is said that the only constant thing in this universe is change. In the last two decades, with the advent of the internet, the world has changed exponentially.

Here are some of the important changes in the field of gastro surgery during this period -

l Rapid progress has taken place in the last two decades in the field of computers, internet, telecommunications and artificial intelligence. These have penetrated each and every discipline. In the field of healthcare, this has led the doctors from

around the world to come together on social mediaplatforms to discuss thoughts, cases and problems. This rapid transfer of knowledge and skill has allowed simultaneous and increased treat-ment pace of progress.

l Teaching and training is fast becoming web based. A lot can be learnt without the need to travel. For instance, one can watch videos on operative procedures and hear world class lectures on YouTube. I have a couple of hundred of videos on operative procedures, lectures with a 1000 subscribers globally.

l Improving vision system has allowed surgeons to perform simple and complex operations in the abdomen by the laparos-copic method. Gone are the days of cutting open the abdomen for stones, hernias, infec-

tions or even tumours. All this can be managed by

the keyhole technique.

l The way we cut tissues in surgery has also changed drastically. The procedures are becoming increasingly suture less with the advent of modern energy devices. Even the way we cut intestines has changed with instruments such as staplers. Robotics has shown that surgeries in difficult situations can be made easier. These individual technological progress has allowed complex surgeries such as bariatrics (weight loss surgery), transplant and cancer surgery to become easier and even responsive to keyhole technique in certain situations.

l Evidence based science has replaced experience based practice. It is essential to have data and evidence to back up a clinical practice. Large published data are analysed to influence the way we treat patients. As an example, data from Scandinavian registries have shown that the way we treated large hernias was unsatisfactory and newer techniques

such as component separation have been incorporated to improve outcome.

l There is more multi-disciplinary approach to diseases than before. Nowadays, a cancer is more likely to get a discussion between surgeons, oncologists, radiologists, pathologists and radiotherapists. Even in benign abdominal diseases such as achalasia, hiatus hernia, diverticulitis and pancreatitis, a treatment based on joint collaboration between a gastro physician and a gastro surgeon is common.

l Attempts are being made to ensure more safety in surgery. And it is not only about improving techniques and incorporating technology. There are a lot of check lists in place to prevent mishaps such as wrong operation, patient misidentification, etc.

l Communications has become a vital part of clinical practice. It is not sufficient to execute a surgical plan for the patient without laying down the details of the treatment, its potential benefits and complications. Consent taking is an art that surgical science has had to incorporate.

l This is an era of specialisation and even super specialisation. Patients are looking for experts in the field. This has led surgeons to focus in their small area of interest and build their knowledge and skills around it.

l This final point is what I want my readers to ponder! More than a century back, Sir William Osler, Professor in John Hopkins, had emphasised that care of the patient at the personal level is more important than looking at him or her as a disease to treat or a problem to solve. He had stated,

“Care more particularly for the individual patient than for the special features of the disease.” In the world of pace, technology, data entry and objectivity, the human touch in healthcare seems to have taken a back seat. I strongly feel surgeons, who take out time to look into the eyes of the patients, strikes a conversation with a smile and builds a rapport with them are needed in the present context.

  The author is a specialist in Bariatrics, Hernia, and GI surgery. He is the Director, Digestive Surgery Clinic, Belle Vue, Kolkata, India.


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