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  • Tolgay Şatana

Minimally Invasive Surgery as the Concept of God Physician Ends

Even twenty years ago, medicine and physicians, which were expected in front of them with endless respect and whose post-treatment debt of loyalty could not be paid with expensive gifts and money, do not exist anymore…

In fact, it would not be wrong to say that everything started with Hippocrates… The father of Egyptian medicine, Hermes Trismegistus, the representative of Toth’s teachings on earth, drew the surgical borders of Imhotep in 460 BC in Kos in Anatolia. While the principle of “first do no harm – primum non nocere” instilled the cult of Hippocrates in the Anatolian people, the option of treatment with drugs and the demonstration that abscesses can be healed without causing wounds brought surgical treatment to a level that almost made them forget. Then, in the centers of Pergamon built with temple architecture, medicine ceased to be a kind of alchemy-sorcery, and treatment of diseases was planned with certain formulas, as today’s medicine accepted as reference. In these years, medicine still retained the title of divine wisdom, because recognizing the disease and choosing the right Galenic preparation required an intuitive ability as well as knowledge.

The accuracy of diagnosis by using this intuitive ability of medicine is still valid today, but the last fortress in divinity was broken by computer technology, “wisdom for effective accurate diagnosis”. The newly developed computer-based generation can easily reach from disease symptoms to diagnosis and from there to the most accurate treatment option… Yes, physicians are not gods, they are even technicians, moreover, they are too flawed to need their knowledge… This profession group is no longer able to diagnose without engineering miracles. becomes defective and helpless. Advanced electronics, navigation, robotic technologies are about to add nanotechnological devices, in which case it seems not too far for the physician to be replaced by mechanical robots that take more information, go to diagnosis using the genetic code and do this with a small sample of palate-salivary fluid without the need for examination. .

Our genetic code is soon to be deciphered. Considering that a genetic defect is responsible for almost all diseases, it is not necessary to be psychic to predict that treatments will descend to the cellular level.

Many developments follow one after the other, from cellular level treatment options, from the widespread use of “stem cell-stem cell” therapy to organs obtained by cloning, to nanotechnological pharmaceuticals that are effective at the cellular level. Although it dates back long before stem cell cloning, it has had its share of ethical debates. Discussions about the ineffectiveness of the treatment have almost reached the level of forgetting the bone marrow treatment, which is used extensively in blood cancer treatment. I think that it is a waste of time to look for the ethical basis of transforming the cell into another cell, or even into tissues formed in advanced cells such as nerves, cartilage, and muscles that do not have the capacity to regenerate. While the ethical foundations of genetic treatments, cloning and stem cell treatments were rapidly established, the increase in high revenues from ‘off-shore’ treatments was inevitable and impossible to control.

Classical medicine has been in the process of extinction as long as it has received different trainings apart from a classical medical education and did not include trainings that have mastered engineering technologies. The name Asklepion, which was divided by breaking his divine staff long ago, has become unforgettable.

It seems extremely risky to leave technologies with a high learning curve, such as endoscopic devices, which require a lot of skill to use, with or without the development of navigation technologies in recent years, only to physicians who have received classical medical education. While the thought that it would be more accurate to practice medicine with an ultra-modern robot, all under the control of a good medical engineer, becomes widespread, I involuntarily take a nostalgic glance at our diplomas on the wall…

While divine medicine ended thousands of years ago, in these years when classical medicine came to an end, minimally invasive surgery with less trauma was defined in surgery, where Hippocrates’ expectations with endoscopic technologies have fallen short for now. With this method, which we have been using for decades, not only is the surgical wound smaller, but surgical trauma is reduced and magnified with optical devices, as well as the ability to perceive far beyond the limits of the human eye is gained. Even in this moribund period of medicine, “minimally invasive surgery” is a valuable development in terms of being a good reference for robots in the future.

One of the pioneers of minimally invasive surgery, “endoscopy” is actually the feat of an internist who performed thoracoscopy in the 1920s. After the oral and laryngeal endoscopic examinations over time, despite the developing optical technologies in the Second World War, endoscopic surgery has been stalled by the increasing number of brutal warfare surgeries. With the use of optical systems by urological surgery under endoscopy, arthroscopy began to be used in infancy, while endoscopies of body cavities, abdomen, chest, and skull ventricles followed it without delay. By 1980, endoscopic percutaneous (piercing the skin) spine surgery had completed its experimental work with Hijikata in Japan and defined its safety margins in the United States with Kambin. The use of laser energy in the intervertebral disc was described and applied by Daniel Choy, an internal medicine cardiologist. Thus, the combination of endoscopy and laser energy began to be used in treatments. The laser has been boldly used as an energy to complement the scanty endoscopic instruments that have been attempted to be used in spite of the crude surgical instruments. However, its negative effects on the tissue have shown that its use will be more effective in experienced hands.

While percutaneous surgery was developing rapidly, French Deramond was not a neuroradiology specialist and surgeon who first applied the cementing technique in spinal fractures. In this respect, minimally invasive surgery has filled the gap between interventional radiology and invasive internal surgery. The tendency of endoscopic and minimally invasive surgical internal branches to surgical interventional techniques must be a kind of betrayal or an irony to the Hippocrates cult. In fact, all types of interventional treatment, even percutaneous, should be performed by people with surgical training. It is a requirement of the philosophy of the intervention that the interventional physician should be ready for the necessary surgical intervention to manage a possible complication.

Minimally invasive surgery is a small temple that shows the divine and human qualities of medicine when technology is not always sufficient and intuitive ability is required. Although not as much as the Jedi knight who turns off all his computers and uses his intuition, I emphasize this approach that will forever bless the physician who has humanitarian qualities, and I emphasize the minimally invasive surgery by recalling Gandhi’s motto “science that has pushed human love down the ground” from the dangers that will destroy humanity. In this respect, I hope that minimally invasive surgery will leave the wand of the divine physician Asklepion, who continues to use his intuitive ability, in the hands of surgeons for a while.

Let’s not deny divine medicine, but wish it to use technologies that allow him to use his human qualities without making the physician a god…

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