How Surgery is Like Fishing

The other day, my 12 year-old son and I were invited to go fishing on the Long Island Sound. We drove two hours to get to the Eastern end of Long Island, expecting to catch 3 or 4 fish. The three of us went out on a small boat just after high tide. It started slowly in the beginning, but around 2 hours after high tide, we were catching porgies every few minutes. Between my son and me, we caught well over 100 fish! We ended up keeping just under 50 fish due to size restrictions. This was the most amazing fishing experience I have ever had. My son was ecstatic, as he caught the vast majority of the fish.
There were a number of other boats in our area, but they caught only a handful of fish. Some caught none at all. 
You may be asking, what does this have to do surgery? 
It turns out that the friend that invited me had been fishing here for over 40 years. Despite having a small boat with basic equipment, his experience and fishing skills trumped all the other fishermen with bigger boats and fancier fishing equipment.
In the same way, you may think that surgeons who use the latest gadgets and cutting tools make better surgeons, but this is not always the case. One of the most common questions that I get asked is if I use a laser for surgery. I usually answer this question with my Tiger Woods analogy: If Tiger Woods bought a $60 Wilson golf set at K-Mark, he can still beat your pants off, no matter how expensive your golf clubs are.
It’s not how new or fancy or cutting-edge the tool you use. It’s the user’s skill and experience that makes the biggest difference, no matter how fancy or basic the tool. Similarly, a good surgeon will still be able to get great results, even with older, less fancy equipment. 
The good surgeon also knows when to use the right tool for the job. You can sometimes use the most expensive screwdriver to turn a Phillips screw head, but a basic Phillips screwdriver will work much better. You can use the latest laser to cut tissues for a tonsillectomy, but a simple knife or electrical cautery will get the job done much faster, with much less expense. 
Just last week, I had to perform a complicated sinus surgery. The patient had undergone sinus surgery previously by another surgeon, and the anatomy was difficult to navigate. For complicated or repeat sinus procedures, I usually order a sinus CAT scan with 3D image navigation. During the case, the navigation system had to be re-calibrated over and over again, wasting a lot of time. I had to use the standard CAT scan images to do the operation, which made it go much smoother and faster. Image navigation can be a very useful tool for certain situations, but in many cases, it can actually hinder good surgical outcomes. Especially if the surgeon uses it as a crutch, rather than relying on basic anatomy fundamentals.
Everyone has preconceived ideas about what it takes to be a good surgeon. I have to admit that being into gadgets myself, I’m also guilty being attracted to the latest technology. But my recent fishing experience reminded me again that focusing on the fundamentals of any trade, or skill is what makes you a true professional.

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