This talk was recorded live on the final of DFTB17 in Brisbane.
Craig McBride is a paediatric surgeon at Queensland Childrens Hospital in Brisbane. Here he talks about how we have moved on from the days of maximally invasive surgery when a barber-surgeon was not judged on the neatness of their sutures but on the sharpness of their blade.
We are not quite at the level of Raquel Welch/Stephen Boyd or Dennis Quaid/Meg Ryan just yet, but we are standing on the precipice of a revolution in minimally invasive surgery. The essential component of the pyloromyotomy is the same now as described by Ramstedt way back in 1911. The real change is in how we get to the pylorus.
If you want to read more about how far we have come, look at this paper…
McBride CA, Holland AJ. Theatre of paediatric surgery. Journal of paediatrics and child health. 2015 Jan 1;51(1):98-102.
Minimally Invasive Surgery: Less is More for Patient Care
In a world where medical advancements are ever-evolving, minimally invasive surgery (MIS) has emerged as a beacon of progress, showcasing how “less is more” can redefine the landscape of surgical procedures. Craig McBride, a prominent figure in pediatric surgery, delves into this transformative shift in his talk “Moving away from maximally invasive surgery” at DFTB17. By examining the evolution of surgery over the past century, McBride sheds light on the journey from a surgeon-centric approach to a patient-centric one, where the goal is to minimize harm while achieving maximum benefits.
Surgery Through the Ages: An Evolution
McBride takes his audience on a historical journey, reflecting on the metamorphosis of surgery from a spectacle of surgical prowess to a patient-centred endeavour. A century ago, surgeons were at the forefront of the drama, with patients serving as mere participants in their own medical narratives. This perception has undergone a radical transformation, with modern surgery focusing on maximizing patient outcomes while minimizing harm and trauma.
The Three Pillars of Minimally Invasive Surgery
McBride introduces three key strategies that embody the “less is more” philosophy in modern surgical practices:
1. Minimize the Operation Itself
Surgical procedures have gradually evolved to become more streamlined and focused. For example, pyloric stenosis is a condition treated through various surgical techniques. Over the years, surgeons have progressed from radical pyloricectomy to less invasive methods, such as pyloroplasty and myotomy. This evolution showcases the surgical community’s constant quest to perform the least invasive yet effective procedure. Minimizing the operation itself can lead to enhanced patient outcomes.
2. Minimize Harm to Normal Tissue
As surgeries target deeper organs within the body, minimizing harm to surrounding tissues during the approach becomes paramount. There is a paradigm shift towards laparoscopic and keyhole surgeries. These approaches retain the essence of traditional procedures while significantly reducing damage to normal tissue, enhancing patient recovery and long-term quality of life.
3. The Ultimate Goal: Avoid Surgery Altogether
While the surgical community remains committed to performing essential operations, the concept of interceptive approaches is gaining momentum. By avoiding surgery altogether, the risk of harm is inherently eliminated. Examples such as intussusception management and ureteric reimplantation for vesicoureteral reflux underscore the surgical community’s determination to explore non-operative solutions when appropriate.
The Promise of Advancements: 3D Printing and Beyond
Advancements like 3D printing hold tremendous potential for the field of surgery. McBride envisions a future where 3D printing could be used to create custom grafts and implants for patients, aligning with the philosophy of minimal invasiveness and maximum efficacy. Furthermore, the application of 3D printing in congenital malformations, such as diaphragmatic hernias, showcases the potential for groundbreaking patient-specific solutions.
Embracing the Philosophy
Craig McBride’s talk offers a profound perspective on the trajectory of modern surgery, where the shift from maximal invasiveness to minimal invasiveness is not only possible but also pivotal. Surgeons worldwide are uniting under the banner of “less is more,” demonstrating that the ultimate goal is to achieve successful surgeries and elevate patient well-being to new heights. As advancements continue to reshape the landscape of surgery, patients and medical professionals alike can look forward to a future where the balance between minimal harm and maximal benefit is expertly achieved.
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