This article I wrote is the front page editorial of this June issue of General Surgery News, though the online version is not yet available.
Scientists, poor sods, say that a new species of animal or insect is discovered only once in every ten years or so. With scientific research booming, along with the explosion of the information technology industry, there is very little that is new. Somewhere in the chaotic interaction of gigabytes and Google, of genetic engineering and gamete storage, new species of human beings have evolved right under our very noses, and yet remained undiscovered. Amazingly, the mutation (for this is a sudden, unplanned change rather than the other, slowish sort of genetic change for which there surely is a name) has happened in a classa humanis that stubbornly resists change, almost like the Indian socialist: I refer to Homo surgicalis, the erstwhile, slowly extinctifying class of barber-ic surgeons.
If you are unaware of the evolution, and yet are part of the revolution, you are probably a laparoscopic surgeon. And if, God save you and your patients, you are unaware of both, you are likely a true-blue general surgeon, whose ancestors were knee-deep in blood and other unspeakably foul-smelling and distasteful body fluids, chopping gangrenous small bowel that looked like mutant, imported (from Italy, of course) tagliatelle, and expertly removing gall bladders that looked like last year’s aubergines bought at the Giants’ special offer!
Anyways, back to the point: what is my point, you ask?
If you consider the nature of the surgeon in the last decade and the coming one, you will understand.
The Laparoscopic Surgeon (LS) is stereotypically a very dynamic, ambitious animal possessed of more skills than wisdom, much like a New York senator wanting to be President. In the midst of a busy, lucrative practice, he has to use his frequent flier points and travel to Honduras or Nicaragua and show the natives how to do a TEP or a fundoplication. He also has to appear annually, sage-like, at the world’s premier endoscopic surgical conference and present his ‘innovation’ in laparoscopy that he noticed in a third world workshop last year. It is a different matter that the audience is more interested in seeing his impressive list of ‘conflicting interests’ than in his video, but men will be men: ‘yours is bigger than mine’ is a syndrome of comparative truth, from childhood to andropause.
An amazing thing about this new class of Homo surgicalis: the lap surgeon uses tiny incisions of around six or eight inches, sometimes, that are only a few nanometers smaller than the huge ones made by his evolutionarily challenged brother, called ‘HALS’ or ‘extraction ports’, that dramatically reduce operating time, hospital stay, and wound infections. The world has woken up to this New Reality: that an incision heals faster and easier if made in laparoscopic surgery, especially ‘mine’, and the old buzzards better, well, buzz off! The chapter of open surgery is now closed!
The LS is like a hypothetical animal that uses its long horns to snare fruits from the top of a tree because it is aware of its long horns. It forgets its jaws, its strong limbs, and its quick jump, just because its long horns are its pride, its quintessential hubris. The LS, likewise, uses his scope-vision to treat all his patients. The results are likely to be, for want of a better word, fruitful.
Homo laparoscopus (HL) has another peculiar feature: the species is taller and more dynamic than the Gandhian ‘internist’ class of physicians, known in informed circles as Homo prescriptus. A sub sect of HL is a sub-specialist working in Hernia Institutes or as a consultant to Ethical and un-Ethical mesh manufacturing companies. This is an example of Homo inguinus, a groinocological surgeon.
A new disease affecting the calcaneum and the plantar ligaments awaits existence, but the treatment is already, um, ready: laparoscopic fasciectomies, tenotomies and other incomprehensible ablations, in the new department prosaically named the Laparoscopically Accessed Sole Surgery (LASS) and to be socked to the customers as ‘Hole-in-the-Sole’. As a new procedure class, it is a shoe-in, experts say. A niche in this would be endoscopically guided surgery for paronychia and hangnail removal that has been estimated to reduce global loss of millions of man-days every year. This class of surgeon should be anointed Homo subunguous. Research on stapling these stubborn hangnails and microvascular sealing systems to control bleeding from incisions should be available once the disease is recognized as a silent killer, much like the obesity pandemic that affects the poorest of countries. In fact, new research states that the poorer you are, the more likely you are to get fat. Says how badly the US economy has been doing for so long, isn’t it?
To come back to the laparoscopic surgeon, he is too self-possessed now to notice that his existence in the near future is jeopardized, much like an MP3 player walloped in the south pole by the iPod. He is focused on refining newer ways of image-guided gymnastics to such an extent that he fails to notice the change in the world around him. The new world is, forget small-incision surgery, all about no-incision (no scar) surgery.
This new class of specialist puts in scopes through all natural body orifices and takes out organs like a magician takes rabbits out of a hat. Only that the magician gets paid a lot less and is a lot more fun to watch. The invader of the hole on either pole of the body belongs to a new class called Pokus neodigestivus. Enter the new digestive surgeon, a hybrid of endoscopist and hard-boiled laparoscopic surgeon. Rarely, if ever, has a chimera extinguished a parent species, but this could well be the case here.
The interested audience to the new, enchanting, global, industry-sponsored circus-dance of the robots, the neo-endoscopists and the increasingly archaical laparoscopic surgeon is, as always, the general surgeon (sub-species skepticus) and the internist (sub-species studious). Seated in the ringside, so to speak, is the friendly media, Slurpus sensationalis.