Autumn—The Era of the Robot

| December 1, 2022

by George Fielding, MD

Dr. Fielding is a surgeon with NYU Langone in New York, New York.

Bariatric Times. 2022;19(12):19.

Is it “Now is the winter of our discontent made glorious summer,” or is it simply, as the late, great George Harrison wrote, “All things must pass?” For, as he said, it’s true. All things must pass away. Shakespeare was writing about a violent civil war and the rise of a man seen by history as a tyrant, who thought he could save England. George was writing about lost love. His wife had fallen in love with his best friend. The rise and the fall. That’s what history is, really. Even the Roman empire declined and fell. It seems inconceivable. Imagine how it felt then, as the Goths came down from Germany, then through the gates in 410 AD, to sack Rome.

I was the first Anglo to visit Mouret in Lyons, in 1989, to watch him do some lap choles. I went home to Brisbane, and when my boss at the Royal Brisbane, the biggest hospital in Australia, asked me what I’d learned in my two and a half years away, I told him, with the arrogance of my 32 years, “Sir I’ve seen the future.” He smiled and asked me what I needed, and I told him. Boom. Welcome to laparoscopic surgery. I wasn’t initially greeted with open arms. I was a Goth at the gates, and my old bosses knew it. Then my dad gave me great advice: teach everyone how to do it. So, I did. I operated all over Australia, then all over the world, teaching surgeons how to do it. It worked.

It seemed it would never end. 

Suddenly we are in autumn, the autumn of laparoscopic surgery, for robotic surgeons are the new Goths at the gate. Actually, they’re through the gate and into the city. 

My young partner, Megan Jenkins, and I went to a day course trying it out about three years ago, at Columbia Hospital in New York. It seemed fun. Then, we visited Steve Scott in Kansas to watch some cases. He was great. It seemed fun. I’ve got grey hair, done innumerable operations, and don’t really want to start again. Enough, buddy. Megan grasped it with both hands, and her practice has exploded. My wife, Christine Ren, had carpal tunnel issues and thought “Why not?” Now she’s almost completely doing robotic surgery. Sleeves, bypasses, lap choles, fundoplications, bands. Who would have thought it? My best friend at New York University (NYU), Paresh Shah, does incredibly complicated pancreatic operations with the robot, time after time. Flavio Malcher reconstructs the abdominal wall robotically day after day. Thoracic surgery at NYU is almost all robotic. 

We have a new 4th year resident on the service, visiting from St. Elswhere on a rotation. He has never seen a laparoscopic bariatric operation. It’s all robotic where he comes from. I’ve got five cases next week, to show him the olden days.

Me, I’m a T-rex. It’s all I know, and I’m at the end of my career. But the thing is, I think this change is fabulous. It obviously works. And you don’t even need to scrub. And you could probably smuggle in a coffee while you do it.

Now I know how the men who taught me felt when I started all this nonsense in 1990. “No way.” I imagined Billroth in his grave in Vienna turning when I took out a stomach with a laparoscope in 1991. I believe he would have cheered, for his early patients suffered so much. I can tell you what Les Blumgart said when he watched the video of my first lap right hepatectomy. He said, in his Yarpie, South African drawl that I loved so much, “Nuts, but well done, boy.” Was he going to do it? No way. All things must pass.

Horizons change. We are in the era of the robot. We are in the autumn of laparoscopic surgery. The colors on the trees are beautiful, and they’re going to float down to the ground, as they always do. It’s been a wonderful ride. We have helped so many people, reduced so much pain, and prevented so much suffering. Young surgeons will have probably never done a gigantic Kocher incision for a cholecystectomy, as I did as a resident. The pain from biliary colic is the pain from hell. The pain from the cut is worse, likewise, the pain of an open gastric bypass. Laparoscopic surgery saved millions of people from that pain.

All things must pass, fade away. Let’s hope robots become more affordable and available, so that smaller hospitals can afford them and more surgeons can help people with this new technology. Hopefully, it’s a glorious summer indeed.


Category: Letters to the Editor, Past Articles

Comments are closed.