Player is loading...
A-1130 The Future of Hand Surgery
Henk P Giele, Oxford, UK
Thursday, June 14, 2018 · 3:21 p.m. · 27m 55s
Embed
Embed code is not allowed
This talk is part of a Private webcast, embeding is not permited.Transcriptions
Note: this content has been automatically generated.
00:00:00
if you wanna shop for an estate during your precious souls be my guest
00:00:06
i have a question for you is it possible to stitch a balloon
00:00:11
is the heart audience
00:00:15
the possible searchable it or okay now i have your attention
00:00:30
green button
00:00:38
yep perfect
00:00:41
i think
00:00:47
so technical folk
00:00:52
so we can
00:00:54
so it might tops on the feature of hand surgery if you'd been here
00:00:58
nineteen seventy uh as a member of the european society of baggage
00:01:05
there we didn't talk about um innovation and the luggage been around since the
00:01:10
time of egyptians what size it should be what coverings uh how lodge
00:01:16
and of course never knows that we also been around for five thousand is
00:01:21
and yet it wasn't until nineteen seventy to that bad
00:01:25
send our thought about putting wheels on backs
00:01:30
can you believe that we send a man to the moon before we put wheels on backs
00:01:37
so was bennett said our a yeah genius a futurist now he sore problem
00:01:42
like into bags random report with the wife and child and he invited
00:01:48
so the feature hand surgery is innovation
00:01:52
what's innovation 'cause it's internally gets bandied around a lot and innovation
00:01:58
is that gap between creativity and then adoption of your idea
00:02:05
uh everybody has ideas but it's transferring the idea into a
00:02:10
practical solution which then gets adopted by everybody else
00:02:16
so but it had the idea anyone so far how long the innovation really to patient it
00:02:21
and then you try to sell and the department stores and shops said it when so
00:02:27
uh in a minute macho they want to carry x. so the advertising was directed at women
00:02:34
and they try different techniques and it wasn't until nineteen eighty seven categorical robot plath
00:02:41
uh removed to the wheels to have two wheels um invented the telescopic handle
00:02:47
'cause he was an airline pilot any gave it away to his a crew and then
00:02:52
all the passages saying that the a cruel wheeling these bags around want them
00:02:56
so it took a while from the idea generation until it became um accepted
00:03:04
fact and everybody has a we bag or three or four
00:03:11
everybody has ideas
00:03:14
so the step to take is that everybody can therefore in
00:03:18
effect and make their idea um something that gets adopted
00:03:24
why bother should be enough right
00:03:27
we didn't innovate surgery wooden progress we wouldn't venice these yeah and still be doing things like
00:03:33
that michael's to be looking out from the crowd we wouldn't have um fixation fractures
00:03:41
i mean i marker city no transplants the banana after school office topic
00:03:46
surgery and there's some you might argue that be a good thing
00:03:50
i'm not sure you can think of any examples so is surgery has to innovate in order to progress
00:03:57
and luckily surgeons on natural innovators
00:04:02
every time you operate you modify your procedure uh to see the
00:04:07
patients anatomy to see it a little bit their problem
00:04:11
um and to me the the mounds in a way that a physician never does a physician doesn't get his
00:04:16
covering give you half of this tablet and coral that and then the little branding on something else
00:04:21
you know they have a prescription they give your prescription there might be two prescriptions or ten
00:04:26
but they don't innovate the y. incision does every time i pick up my life
00:04:31
and your innovation can be something very simple like modifying incision here i modify
00:04:37
this indirectly really so included also wing flaps such that when you
00:04:43
um elevated the dorsal rectangle flat with the wings you could then close the defect
00:04:48
with that skinner off not a great innovation but something that achieved a nine
00:04:54
another example of a innovation is to take an existing technique here is second to
00:05:00
imitate also planned to join transfer and then use it for a new problem
00:05:05
this case a patient use have a respected statically weekly joint
00:05:10
and then using the filings plugged into the new broom and the minute also becomes the
00:05:16
me to clavicle the terry m. t. p. joint can functions unused unequivocally joint
00:05:22
so you extension of a existing technique in just into new indication
00:05:29
then stepping a bit be on that uh in innovation of principle
00:05:35
we're like top shape this patient has a this gimmick nonunion with profs proximal paul but has
00:05:42
already had they screw put across it and didn't make the hundred percent in that group
00:05:48
then head of ask ross bancroft didn't make a hundred percent and that group and so
00:05:52
the solution is a problem or a topic to mail for confusion or something else
00:06:01
and then something else happens to be a core record 'cause does all
00:06:05
your core core it looks very much like a a skateboard
00:06:10
and you can have a steel core record with the blood vessels so it can be of ask arise cork would
00:06:16
and you can use that to reconstruct the possible poll of y'all go for it
00:06:23
well this way you're combining techniques to try and to try and
00:06:27
innovate the patient the turtle flexes palsy too the only
00:06:32
options to try to get a belief flexion would be a
00:06:36
free function muscle transfer innovative within cost on those
00:06:41
but then you think well actually what then i take the muscle with the end customers and then i don't have to rely on your free
00:06:47
and so you can take a wrecked us on its into cost on those seven right now i'm some it on ten
00:06:53
a place for an interview gastric vessels transfer to the um like that the news intact
00:06:59
you don't have to do in your free and you can restore some elbow function
00:07:09
to surgeons very much like cox when you start at a new surgical training
00:07:14
you are trying to follow recipes you'll given the ingredients and tools to
00:07:19
do the job and you know that if you follow that recipe properly that
00:07:24
you produce a relatively reliable predictable outcome for your patients or clients
00:07:33
but you need to step the on that because if you just kept falling recipes
00:07:36
you never invented a new recipes and so a good cook should become chefs
00:07:42
where you invent especially ingredient to mix in
00:07:46
to your existing recipe you substitute things
00:07:50
you may invent a recipe by era so to top that time was an era
00:07:55
have wave uh was i rang that was put in a call of um um for example oh and if you don't
00:08:02
uh um experiment with new ingredients with new recipes new ways
00:08:06
of doing things when you went to invent new recipes
00:08:11
in in a
00:08:12
a reference to being in denmark copenhagen is really recipe
00:08:17
most famous restaurant best restaurant world with no mao and he's
00:08:22
a famous for the constructing recipes and then reinventing them
00:08:27
and so that's innovating whole new generation or chefs you see what's possible
00:08:34
so an innovative surgeon should be like chef not cock
00:08:40
so these are my top ten tips innovation white top ten because everything's top ten than because i spoke to
00:08:46
a i'm patient who helps organise the telex tools and he said yes have a
00:08:51
top ten because people like to talk to and uh because people like lists
00:08:57
people know where they are now supports no way oh so you know whether you how you can sleep full
00:09:04
how much only need to sit still fall if you're busting together tolerant with
00:09:08
the you can wait a bit will just do the whole road
00:09:12
you don't even have to finish the list
00:09:17
so
00:09:19
before i start on if you could just turn you had a bit so you're right here is a bit closer to me
00:09:24
because your language processing centres on the left and apparently if i talk
00:09:29
to write a a you believe i say and accept it easier
00:09:33
that they did a study of the night club and apparently if you proposition somebody in there right yeah they're more likely to say yes
00:09:41
you know believe me he can try tonight
00:09:45
motivation yet we motivated to innovate
00:09:50
so had this surgeon working with this scientist in this institution
00:09:55
uh the last five fifteen e. is get licensing
00:09:57
fees with over one billion us dollars
00:10:04
anybody know
00:10:06
the id wasn't even know it was an extension of a a idea
00:10:11
that i've been around and described hundred user more really uh
00:10:16
that they pay to the idea in the early nineteen nineties and the same
00:10:20
time that they paid that a russian surgeon painted the exact same idea
00:10:27
and they then licensed it to restructure physician cogent monica
00:10:32
used to make a loss plates were we going
00:10:36
this of course is the back
00:10:39
and with the help of summer surgeon zero research and no p. r. c. t.s that show it's effective at all
00:10:47
this was there to and
00:10:50
um at the time that the pages run that
00:10:54
usually got the bottom
00:10:57
you made three hundred dollars an hour
00:11:01
for a couple weeks work he was the russian depicted at the same time so in
00:11:05
order to avoid a claim they um how to manage to do some consulting work
00:11:11
was it a billion dollars looks like
00:11:15
it does wanna piece of that anyway we're not here for the money we're here for the other
00:11:20
benefits of innovation personal satisfaction uh doing good for
00:11:24
mankind leaving a legacy i'm helping people
00:11:31
but just keep that picture in your mind as well
00:11:37
you have to think
00:11:39
don't be is on the doctor
00:11:41
don't do what you're told them believe what you told don't just follow blindly
00:11:48
you have one hundred billion you runs okay some of you pay less
00:11:53
but you have to use them to think
00:11:58
have ideas write them down then ignore them
00:12:03
some people say with your ideas come from well i come from frustrations so um
00:12:09
i said i was frustrated by turning his luggage and they pilot company is off to him was just as
00:12:15
i'm frustrated so he he developed his bag called rolling luggage another one in every airport in the world
00:12:24
clinical problems are great specifically those with which don't have an established solution
00:12:29
are great source of ideas because you don't have to fix it
00:12:33
that can come problems which are ready have solutions but the solutions amount great a much more challenging to
00:12:40
think and have ideas about but you need to always ask yourself is there a better way
00:12:46
can this be done more effectively with a better outcome
00:12:53
sometimes it helps of inexperience which i'll get into later
00:12:57
and every idea you have has to fulfil some
00:13:00
basic uh or advance human need um and
00:13:06
fulfil some sort of feeling what is ah is known point inventing something nobody wants
00:13:14
you need to watch out for idea murderers
00:13:17
okay and the biggest id emitters yourself because you you think i'm not
00:13:22
good enough this ideas cheaper than no nothing you have doubts
00:13:26
before we've even started you've cut your idea of a nice because you predict
00:13:31
where work will have feasibility problems you create let limitations for it
00:13:37
it's much easier to stick with the status quo then to challenge what is done vertically when
00:13:42
they're other experts in the room who will do no better off in a better
00:13:47
the fear of rejection and failure and embarrassment is um strong then be embarrassed it can be costly
00:13:57
if you use a good the uh um u. k. garment for that
00:14:01
a big tent that we could no longer use penrose strains
00:14:05
all clauses finger twenty case because every three is fourteen fingers have
00:14:10
to be amputated because of twenty kids that were left on
00:14:13
so you had to use a c. e. mark twenty k. and at the time it was a very limited
00:14:18
a number of choices and say hi invented this
00:14:25
a digital twenty k. which is a little
00:14:27
piece of silicon strip with a breaking strain so you can't put too much tension on
00:14:33
and being so embarrassed about the simplicity of this idea i gave it to a company to sell and market
00:14:40
they now sell ten thousand units amount don't be embarrassed
00:14:48
if you have ideas you have to notice them write them
00:14:51
down think about the uh protect them from being murdered
00:14:57
and continued development talk about them with friends uh read about the subject
00:15:03
try to prioritise of them because you'll have thousands of ideas and many of them we picks
00:15:11
knowledge is a good thing
00:15:13
knowledge is power and that's why the movers in the room uh will
00:15:18
rely on having too much power in order to better your idea
00:15:22
but you will use that knowledge to confirm a urine beliefs and see happy
00:15:28
very careful not to have confirmation bias because the knowledge may be wrong
00:15:33
i was greatly influenced when i was a medical student because
00:15:37
uh so yeah invest wasn't straight in nineteen eighty two
00:15:42
uh i'm a pathologist um who's teaches at the time they're just
00:15:46
on some gastric biopsies that there was some weird looking things
00:15:51
not that time all the teaching all the box all the operations told you
00:15:57
gastric ulcers because by acid and operation was forgotten way power plus
00:16:02
the all these horrible things which all shown to work
00:16:08
uh and of course things like tiger matt big industry me um
00:16:14
and roll the help of barry marshall who was a a.
00:16:18
g. on a registrar thirty g. yeah it would be written off as sort of a waste role by his scene is
00:16:24
and and barry and and did some experiments to try on
00:16:28
growth this thing that they found on the gatorade biopsies
00:16:33
unlike pastor there was but a serendipity at work because for
00:16:36
the first thirty three experiments he couldn't write anything
00:16:40
on the thirty fourth and the fifth the bogus plated and was
00:16:44
one weekend and when he returned he noticed that he
00:16:48
great this thing which i thought was a topic um product to and of course it's you go back to now
00:16:55
very and um i warned tried to convince the
00:17:01
rest the world's that actually gastric ulcers were
00:17:04
caused by he'll come back to that nobody believed them the stomach is star all
00:17:10
there's a three billion dollar industry in doing guest ross copies prescribing tiger
00:17:16
matt doing operations and it took over a decade before um
00:17:22
before was adopted and now it's treated by taking calls and products
00:17:28
that's very important to you
00:17:32
sorry question everything
00:17:35
leans burst also the cause by putting all says you know they
00:17:39
used to think that the circulation went from skin to
00:17:43
muscle not the other way around and if that hadn't changed we would be doing any the facts we do today
00:17:50
and that tendons any healed by occasions and we could go on you have to ask one question everything
00:17:58
oh this is an example of um garner stupid questions okay can you believe you can buy em differ brighter of course go
00:18:05
i mean they have cost gay and in denmark we have that england you can buy home
00:18:09
start your own defibrillator and then this courses f. a q.'s that go with that
00:18:15
uh
00:18:17
had our user so this instruction manual you need no training you just read the manual machine tells you what to do
00:18:25
uh is it safe depends how you use it
00:18:29
and so on
00:18:31
and then finally the question is can i use on myself
00:18:35
they are not stupid questions
00:18:38
okay in experience is a good thing
00:18:41
i'm not because when you then challenge a problem you know
00:18:45
nothing there no preconceptions no barriers to what you're thinking
00:18:49
uh there's no false logic you have no idea what you're doing is you have to make
00:18:54
it up and you have to go back to first principles or no principles sometimes
00:18:59
and that's what i started doing some transplant work and having no barrier having no prior
00:19:04
knowledge was kind of a useful thing and has worked very well for this guy
00:19:10
from say
00:19:14
they have an idea and the process you have to stop thinking about at at some stage and just do it
00:19:21
um i can tell that to learning but that's not a very catchy to
00:19:24
um although i say jeez just do it 'cause it's commercial connotations
00:19:29
either this challenge where you get given a bunch of spaghetti some tape uh and a marshmallow
00:19:37
and so the challenges that you have twenty minutes to design and
00:19:40
build a spaghetti tara using just the spaghetti the tape
00:19:44
and that in you put that much not at the top of the town and the highest how wins
00:19:50
and this particular experiment they had a group of um engineers from
00:19:54
mit a bunch of uni students and some promise schoolchildren
00:20:01
and then she's been fifteen minutes planning making calculations five minutes building age discover that the
00:20:10
the um p. they tell wasn't strong enough to hold the much maligned
00:20:15
you shouldn't spend twenty minutes chatting each other up
00:20:19
showing off letting get for a file and the children
00:20:24
i didn't think they just started building when something didn't work they just to get down
00:20:29
and build another one of course you know the the toast out was the children's
00:20:35
so the there is much to be said about just doing it
00:20:41
a lot of ideas come from cross stabilisation which i think is um vertically
00:20:45
true in hand c. g. with the intersection between plastics of pretty general
00:20:51
and um there's been much benefit but there has to be more and some across that lies asian has to occur
00:20:57
um but talking reading convincing not just with medics other specialities
00:21:03
but also with other groups i love going to
00:21:07
d. r. weiss tool to wander around that the wall fixes
00:21:10
whatever because they are trying things that may be transferable
00:21:16
go forth crossword lines
00:21:21
when you face for the problem it's sometimes too easy just to
00:21:24
ask your mental colleague a balk what the answer is
00:21:30
and you have to challenge yourself before you start looking for the ounces would you think the solutions be
00:21:37
what possibilities all options could you come up with if we start looking at the at the box that was confront
00:21:47
failing is important you have to embrace fairly you have to celebrate it because at least you trying
00:21:54
and you have to look at the alternatives if you do files uh you it may just be that uh the design is wrong
00:22:02
or the application is wrong and you just need the right operating for your design
00:22:07
or that you design just need to be tweaking these uh rubber polygon so in fact
00:22:13
although the or wheels on the shape just to get a smooth ride is already
00:22:20
um
00:22:21
and you can have the right idea but be at the wrong time all the wrong
00:22:25
circumstances so if you go back to the we bag in fact in the eighteen
00:22:29
hi i'm hundreds eighty ninety somebody pay tinted trunk with wheels on it
00:22:35
and the nineteen forties a suitcase with wheels on that but it was
00:22:39
the wrong time wrong place at that time travel was for the
00:22:43
for the very well off and they had um porches so it wasn't all
00:22:48
it travel became more popular that that that that id could take off
00:22:55
so it's important to celebrate fairly yeah if you get the the learn from i'll say is a car that's gone
00:23:02
into the sea and get obvious you get a crime to fish it out that seems to be going okay
00:23:11
but that's not so good
00:23:13
so just a little quite celebration failure later
00:23:18
so um then get another crime
00:23:23
bigger better stronger different from your lesson and then you fish out the car and then the truck
00:23:32
so you have to learn from the lessons
00:23:36
and you can take great comfort from these people who a serial file
00:23:41
yes any to eventually succeed j. k. rallying of the top
00:23:46
rejected twelve times this says or another article that said thirty six pounds or
00:23:50
whatever rooms pretty then took a gamble and the rest is history
00:23:57
um then got nervous all sold one painting did so any visitors and yet now you know
00:24:03
there with hundreds of millions in famously others and you know try ten thousand ways to
00:24:10
get a light filament we're gonna ball which you refuse to call failures he said they were another step forward
00:24:20
in order to invade you have to take risks and break rules and um there's a risk in that
00:24:27
but if you don't risk then you keep don't get the reward and you don't get the growth that you need
00:24:34
this is a slightly scary uh
00:24:38
risk of innovation that tend to like in the last couple years in
00:24:42
the u. k. with decision was doing cleavage baring mastectomy is um
00:24:48
which were and what he thought weren't innovation and he ended up in jail for fifteen years
00:24:55
is actually gel because he was telling people that can't someone they didn't doing on this or operations
00:25:00
but one of the criticisms was that he was business innovative surgery without support
00:25:07
so if you gonna be an ally is very important that you have support
00:25:12
um support for new leadership support from your partnership support from your friends
00:25:17
so that if things go wrong and you have to go to defend yourself uh you have people who will support you
00:25:24
and say that you discussed the audio with them that seem sensible at the time
00:25:30
um but such support gives you bravery to innovate and to take the risks
00:25:38
leadership also relates to the fact that you're only does and say you should lead you would
00:25:42
change to be more creative and innovative because the culture when change without you needing
00:25:50
and surgery when change that you're leaving
00:25:55
the environment you working is very important for the growth of your
00:25:59
ideas the development of ideas the adoption of your ideas
00:26:02
and unfortunately it seems that the instructions
00:26:08
uh becoming more more risk of us which makes innovation a
00:26:12
more difficult so on one hand they say great going
00:26:16
to something new exciting on the other hand they say don't do that because um that make spaces to risk
00:26:26
the way serial killers vertically experts these are great quite it's like you know
00:26:31
watson from i. b. m. there will be uh will market for five computers ago more than five and my study align
00:26:39
and the reason why so much of a computer in their home and this telephone extremely short comings
00:26:45
and the experts think they know what all which is why you should uh he'd the experts listen to them but then ignore them
00:26:56
so i'm probably please do not be zombie doctors i want you to be a chef not cox
00:27:06
now i'm gonna try and this this uh purses playing against each this balloon
00:27:12
if i fairly gay and we cheer me
00:27:16
when we got it on dying okay and if i succeed on t. v.
00:27:31
i i
00:27:35
shaking so much
00:27:40
oh
Conference Program
A-1127 President's Lecture: What 37 years with Hand Surgery have taught Me: Controversial Procedures that I still Perform and Procedures that I have Abandoned
Michel Boeckstyns, Copenhagen, Denmark
June 14, 2018 · 2:04 p.m.
137 views
A-1128 Honorary Lecture: The human hand: the most wonderful tool of nature
Zsolt Szabo, Miskolc, Hungary
June 14, 2018 · 2:31 p.m.
A-1129 Past, Present and Future of Hand Microsurgery
P. N. Soucacos, Greece
June 14, 2018 · 2:52 p.m.
A-1130 The Future of Hand Surgery
Henk P Giele, Oxford, UK
June 14, 2018 · 3:21 p.m.
226 views