The need for surgical innovation is no less pressing now than when humanity first learned to make a knife and, soon after, made its first surgical incision. Transplanting a heart in 1967 was revolutionary, and the success of transplant medicine is built upon a foundation of basic science research working symbiotically with innovative surgeons. However, we need to look beyond such historical landmarks.
Where are the bio-engineered organs that do not require a donor nor toxic anti-rejection therapies for the recipient? Where is the mainstream use of brain: computer interfaces and robotic prosthesis to restore function lost through trauma and disease? These ideas are entirely feasible yet, whilst progress is happening, it is unacceptably slow.
Why? It may be related to the fact that, in recent years, the numbers of surgeons engaging with (and driving) research has fallen. The proportion of grant funding allocated to surgical projects has dropped from already modest levels to even more poultry percentages. In parallel, and understandably, the number of basic science abstracts and high impact factor publications generated by surgeons has also fallen.
Surveys of US-based surgeons shed some light on the issue. Whilst many acknowledge the importance of basic science research, the majority feel that they lack time, departmental support, and – maybe most tellingly – motivation. In US hospitals, a significant proportion of hospital income comes from surgeons operating, not from surgeons doing research. This explicitly defines priorities. The UK’s NHS faces different but allied pressures; a perpetual squeeze on all aspects of funding can make research seem almost self-indulgent.
For some surgeons, the act of direct patient care and completing the surgical task at hand is what gets them up in the morning - not the slow burn of science. This outlook absolutely ought not to be vilified – indeed the contribution should be enthusiastically appreciated. However, an environment which makes research easier and which values this very different kind of contribution should also be sought.
Most surgeons, certainly early in their career, are enthused and energised by the idea of doing things better than before. How can this enthusiasm and excitement be maintained and harnessed during the attritional process of surgical training? One suggestion is to better embed the surgeon within the machine of science. It is maybe naïve now to think that surgeons ought to run laboratories in parallel with running their surgical practice. Better, perhaps, is to have a surgical team lending their insight to a larger team when it is at its most apposite. And vice versa, exposing basic scientists to frontline surgical care may help to clarify and contextualise the problem at hand.
However it is to be achieved, translational medicine needs engaged surgeons - and vice versa.
Skull-base fellow, Leeds General Infirmary