Professor Abe Fingerhut | Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria.
Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai.
Minimally Invasive Surgery Center, Shanghai, China
As an experienced colorectal surgeon with an interest in anastomotic leakage, could you provide a brief overview of your experiences?
I’ve been interested in anastomotic leakage for a long time. I can honestly admit that perhaps this might be because when I was a resident surgeon, I had a lot of leaks. I didn’t understand why they were happening and why my boss at that time was unable to help me, besides stating that I was doing something wrong. Therefore, I tried to understand exactly what I was doing wrong. My various other interests have helped me understand that the mindset of the surgeon has a lot to do with the way anastomotic leakages occur. In many cases, surgeons don’t adhere to the rules. They know, or at least should know, what they should do, but choose not to because they are pressed for time. They think they know better than everyone else and don’t want to take instruction from anybody else. For instance, take the example of staples. It is well known and recognised that when you put a linear stapler on a piece of tissue that you have to wait 10–15 seconds for the tissue to creep out and even up, ensuring that the stapler jaws are parallel before you fire. Unfortunately, no one does this. Another cause of anastomotic leakage beside the surgeons being in a hurry is the fact that they don’t test for air leakage, which is a very a simple test to perform, whether that’s the additional air test or the reverse air test that’s becoming popular today with transanal surgery. It’s so easy to do if it works. If it’s positive, we have a leak: if it doesn’t, then the negative predictive value is not so high. These are the easy things surgeons certainly can do that they don’t.
You presented a very inspiring session on improving the surgeon’s mindset at the International Colorectal Disease Symposium in Jerusalem. Could you please provide the key takeaway message for our readers?
My talk focussed on surgical mindset and how that mindset may lead to intraoperative complications or even postoperative complications. A major aspect of this is that surgeons can be very egoistic and narcissistic. They have a very strong ego. While having an ego can be positive, it can also be a negative trait. Sometimes bad aspects of the surgical ego such as: ‘I know better than anybody else, I don’t have to listen to what people are telling me, I know how to do this and I’ve done it many times before and never had a problem’ become a surgeon’s predominant mindset. Therefore, surgeons continue to make mistakes because of errors and behaviour patterns like this.
Considering your long-standing career, how many articles have you peer-reviewed and book chapters have you written to date? Furthermore, could you elucidate what personally drives you to continually contribute to literature?
I cannot tell you exactly how many articles I have reviewed because I don’t keep them saved on a computer. However, I estimate that during my prime I was reviewing around 40–50 a year and that was for around 15 years. Potentially, I may have reviewed a couple thousand. My mission when I write a paper or when I run a project stems from a core value of mine. I think surgeons have a basic role as researchers as much as being practitioners. There are a lot of questions that have to be resolved and those questions cannot be answered other than through well-conducted scientific research, which is something that surgeons have to learn and be a part of. The same applies to statistics, which all surgeons have to know about. We cannot write a message without having the scientific background of what we’re trying to say and prove. Writing a paper is a way of diffusing information and that information has to be correct. It has to be understandable without any ambiguity, the most difficult part of medical writing, and it has to be reproducible because people are going to use that information to do their own research within their own care of patients in that same way. This is very important.
You contributed to the 2016 Emergency Surgery Course (ESC®) Manual as an Editor. What are your thoughts on emergency surgery and what inspired you to write the manual?
My feeling about emergency surgery, especially during my time in Europe, was that it was not a specific discipline. It was a part of general surgery. People performed numerous general and elective surgeries and when emergencies arose, we tried to do the best we could; however, we had no formal education or training for emergency surgery. Importantly, something I consider very crucial today, the decision-making process was completely wrong. This is something I did not know at the time but serves as one of the reasons why I wrote the manual or started to write the manual. We learned decision-making through our mentor when we were residents. We were told that in these situations this is what I do so you do it too. However, there was no general procedure and no thinking process behind that. The thinking process of emergency surgery today is recognising the situation, recognising a pattern, recognising what I am capable of, how I can do it, but above all, doing it.
Reflecting on your memories from medical school, what do you consider to be your favourite memory?
My medical training was very special because I was supposed to attend Johns Hopkins University in 1961, which is a renowned medical school. However, like many others at that time I went to Europe to celebrate my accomplishments and never came back. Therefore, I went to medical school in Paris, but I didn’t speak a word of French, making it very difficult for me. It took me 11 years to complete school although the French system only takes 6 years.
Since your graduation in 1971, what has been the most profound change within the medical/surgical field?
I would have to say that laparoscopic surgery granting minimal access is a profound change. However, it’s important to note that it’s only the access which is minimal, because the surgery is always as invasive as anything else. I also think that things such as medical writing, medical research, and making surgeons conscious of the fact that they must be scientists at the same time as practitioners has been very important. While not well known, this is one of my holy grails.
What do you consider to be your fondest memory during your run as Chief of Gastrointestinal Surgery in the Centre Hospitalier Intercommunal of Poissy, France, which lasted from 1987–2006?
Today my best memories of my time when I was chief of surgery is when I see my students and how well they’ve done. I have some that are professors and others that are well-known experts, some of whom have attended this congress. It’s personal pride. I’m not stating that I’m a good teacher but it’s something to be proud of. I can see the results of something I have helped.