Current and future developments in surgery

Surgical techniques and instrumentation have experienced a spectacular development in the last decades. The development of microsurgery, bioengineering, imaging techniques and endoscopy, as well as the development of robotics have allowed progress of surgical procedures unimaginable only a few years ago. Advances in fields such as minimally invasive surgery, tissue engineering, robotic surgery, bariatric/metabolic surgery and transplantation, are clear examples of the rapid development of surgery.

Some of the most interesting and innovative techniques that have been developed over the past few years in different areas of surgery are explained below. Most of them are already in use, but in further development at the same time.

Minimally Invasive Surgery can be defined as the set of diagnostic and therapeutic techniques using natural orifices or minimal approaches to introduce surgical tools and perform surgery inside the human body. Today, more than 65% of surgeries performed in the USA use Minimally Invasive Surgery techniques. Examples include theSILS (Single Incision Laparoscopic Surgery):

or SPL (Single Port Laparoscopy) also known as SPA (Single Port Access Surgery):

Natural Orifice Translumenal Endoscopic Surgery (NOTES) is another minimally invasive surgical technique which consists in entering into the peritoneal cavity through natural orifices (mouth, vagina, anus or urethra) and then through an internal incision in the stomach, vagina, bladder or colon to enter the peritoneum avoiding any external incisions.

Actually there are some innovative transplants that were inconceivable some years ago. For example, the face transplant which is not a skin graft transplant, but where the graft of a whole donor's face is placed onto the patient's disfigured face, attaching nerves, blood vessels and muscles. It allows the patient to have facial expressions whilst skin grafts do not. It is important to note that the patient will not adopt the donor's facial likeness, since the bone structure, and the nerves that move the muscles are different. Examples of recently performed face transplants are shown in the following picture:

  

Recent developments in intrauterine surgery allow surgeons to act on the fetus as if it was a patient, not only administrating medication, but practicing open surgery without interrupting the pregnancy. It can be used as a palliative measure or as a permanent solution. It is normally used to deal with spina bifida and diaphragmatic hernia.

Some of these procedures could not have reached reality without the development of robotic surgery systems. The most extended one is the Da Vinci Surgical System, a sophisticated platform designed to expand the surgeon's capabilities to perform complicated surgical procedures with minimal invasion. It is mainly used for prostatic surgeries, reparation of cardiac valves, and gynecologic procedures:

One of the most recent advances in technology with applications in surgery as well as in telesurgery is Google Glass, a wearable computer with an optical head-mounted display (OHMD):

Google glass was used for the first time in 2013 by the Spanish Dr. Pedro Guillén (Clínica CEMTRO, Madrid) to broadcast a surgery (chondrocyte implantation in the knee) while interacting with other doctors and students in Stanford University (California):

Familiarize yourself with the main innovative surgical techniques explained in class:

• Minimally invasive surgery
• Innovative transplants
• Robotic surgery
• Intrauterine surgery

Scientific Writing

Today we have addressed the topic of how to present data in written form, focusing mainly on writing papers for biomedical journals. Why is writing important in science? Scientists need to communicate their findings and this is usually achieved via publishing their work in scientific journals. Thus, a critical aspect of the scientific process is to share your information and experience with the scientific community. Reporting your new results in biomedical journals is a quick way to disseminate the information to the specialized community contributing to increase the knowledge within a discipline as well as to help others interpret their own results.

Types of articles

We have mentioned in class the different types of articles and their main characteristics. While most articles published are original research papers, there are also reviews, editorials, commentaries, perspectives, case reports or letters to the editor, among others.



Fundamental style considerations

In the International Committee of Medical Journal Editors - ICMJE) you can find the Uniform Requirements for Manuscripts. Most biomedical journals have their own format, structure and writing styles. Therefore, it is important that you are familiar with the Instructions for Authors of the specific journal you aim to submit your manuscript.

Your text should conform to the conventions of standard written English (sentence form, grammar, spelling, etc.). Structure your sentences carefully using the basic division into subject, verb, and complement. In addition, the structure of the sentence will convey emphasis, draw attention to the most important part at the same time as help readers to interpret your meaning correctly. Moreover, you should structure your sentences and paragraphs to flow, conferring your article cohesion and coherence.
 
Your ideas will have little impact, no matter how good the research is, if they are not communicated effectively!

Keep in mind that scientific terminology has precise meaning. Thus, be certain you select your words correctly and adequately; write clearly and concisely. Writing and thinking are very closely linked, "fuzzy writing reflects fuzzy thinking". When people have difficulties in translating their ideas into words, it generally reflects that they may not be fully aware of what they want to transmit.

• Adapt to the special requirements of your selected audience, journal and type of article.

• Be precise and accurate: Scientific terminology carries specific meaning; learn to use it appropriately and consistently. In fact, it takes a deeper understanding to explain a complex topic simply and succinctly. 

• Be clear and concise: Write briefly and to the point. Say what you mean simply and clearly avoiding embellishment with unnecessary words or phrases. Brevity is very important. Do not use colloquial speech or slang; do not use contractions like for example "don't" or "isn't".

"Brevity is the soul of wit" (W. Shakespeare)

Considerations for the preparation of a research article

One of the initial considerations is to choose the appropriate readership for your article. Usually you will be writing to your peers. Knowing your audience will help you to decide what information to include. Obviously, you write a very different article for a highly specialized, technical, disciplinary journal as opposed to a more general publication that covers a broad range of disciplines.  Another relevant aspect to take into account is the impact factor of the journal. 

The first step in the process of writing is to order and organize the information you wish to present. Another critical point when preparing your first draft is to decide the authors and their specific order. The choice of a good title is also extraordinarily important; it should be informative at the same time as attractive and objective. Some people work well from an outline, others do not. Whatever system you follow, be aware that scientific writing requires special attention to order and organization. Because the paper will be divided into sections, you need to know what information will go into each.

The following video very nicely summarizes the main sections of an article and their content.

• You need to know the different types of articles (original research papers, reviews, editorials, commentaries, perspectives, case reports and letters to the editor, among others) together with their main characteristics and usefulness.

• In addition, you have to be familiarized with the main sections of a research article, how to structure and develop them in order to communicate effectively. 

 

Practical elements for oral communications

Conferences or oral communications are usual methods for the transmission of scientific knowledge in biomedical congresses, scientific meetings or academic work presentations (i.e. research works, Master or PhD thesis). There are some key elements for an excellent scientific presentation:

1. Appropriate presentation and order of the data

Before starting your scientific presentation, you need to study the most recent information on the issue that you are going to expose in order to select and prioritize the key points of the exposition. Nowadays, we have very potent bibliographic search tools that can help you to achieve this aim.

You have to keep in mind that the main goal of your presentation is to transmit a clear message.

2. Audiovisual material

Please, remember when preparing the slides of your presentation that "less is more" in order to get across a clear message to the audience:

3.Speaker's attitude

Public speaking is not always a question of talent. You can be a good speaker if you learn some skills for a successful presentation. A speaker must show confidence, clarity and conviction, since if you are not convinced of your words, the audience will conclude that your results are not convincing.  If the presentation is long, you should introduce stories, relaxing slides or some humour to entertain your audience. Speaking manners should always be polite and respectful.

The voice is also important: use a powerful voice, clearly pronounce the words and do not use "filler words" (i.e. um, ah, eh). Maintain the eye contact with your audience.

The body language conveys confidence: balance your body and use gestures supporting the key moments of the speech.

And never forget the courtesy: be grateful with the people that have invited you at the beginning of the presentation, and acknowledge the people that have contributed to your work at the end of the presentation.


A great presentation does not just happen. The excellence at public speaking just takes a lot of practice, determination and willingness to adopt helpful habits.

 

 

Some tips for preparing and delivering a good presentation:

• Do not give a speech about issues that you are not aware of.
• Adapt the complexity of the information regarding your objectives and the audience.
• Do not read the slides and avoid preparing too many slides.
• Explore the room and the audiovisual media before starting. 
• Use graphics of good quality. If you are using the images of a publication, please cite the corresponding reference.
• Avoid exaggerated animation.
• Do not use more than 10 words/line (big font size).
• Prepare readable tables: no more than 6 rows and 6 columns. If a complex table is required, the key information should be highlighted in bold colours.
• Use contrasting colours: this is OK, but this is not OK.
• Expose the slide at least 20 seconds.
• Highlight the important features of the slide.
• "Take home message": What is the main information of your presentation?  

Do you know what type of cells are and what type of staining has been used in the image of the HEAD of the BLOG? And do you know what type of mouse is the one of the PROFILE of the BLOG?

ANSWER FOR THE PICTURE OF THE HEAD OF THE BLOG: The image corresponds to differentiated adipocytes obtained from stromal cells of the murine subcutaneous adipose tissue and stained with Oil Red O, a lysochrome dye used for staining lipids in red. This image was captured by Beatriz Ramírez, Technician of the Metabolic Research Laboratory, key member of our group involved in obesity research. Beatriz entitled her photography "Frutos rojos" and this work was presented at the National Science Photography Competition FOTCIENCIA07.

ANSWER FOR THE PICTURE OF THE PROFILE OF THE BLOG: this photography entitled "Super ratón" was captured by Dr. Sara Becerril, another member of the Metabolic Research Laboratory. The image illustrates a mouse simultaneously lacking the genes encoding leptin and inducible nitric oxide synthase obtained during her PhD in order to study the effects of the absence of both genes on body weight, food intake and metabolism. This picture was selected in the category "MACRO" of FOTCIENCIA07 for the itinerary exhibition and inclusion in the catalogue of the competition.

During the competition of FOTCIENCIA07, a picture captured by Dr. Amaia Rodríguez, entitled "El planeta Adipocito", was also selected for the exhibition and inclusion in the catalogue of the competition in the category MICRO of FOTCIENCIA07. This image captured with an optical microscope shows the adipocytes obtained from an obese patient. The round morphology as well as the varying adipocyte size ranging from 10 to 300 micras that depends on the triglycerides accumulated in the unilocular lipid droplet of the fat cells, can be clearly observed.

Another photography obtained by Dr. Sara Becerril and Beatriz Ramírez, entitled "Cambio climático" was selected in the "MACRO" category of FOTCIENCIA10. This special picture was captured with a termographic camera, a device that forms a thermal image using infrared radiation. In this photography you  can observed five recipients containing elements with very different temperatures: dry ice (-80 ºC), ice (0 ºC), air (20 ºC), water (25 ºC) and boiling water (100 ºC).

As you can see, researchers can also be great artists!!!

The Fundación Española para la Ciencia y la Tecnología (FECYT) and the Consejo Superior de Investigaciones Científicas (CSIC) have recently opened the National Science Photography Competition FOTCIENCIA12. We encourage you to send your macroscopic or microscopic pictures!!