January 22, 2025 • 16 mins
Discover the journey of Dr. Nick Boston, a remarkable general surgeon who has transformed the landscape of surgical care with his expertise and dedication. From his roots in Centerville, Ohio, to his outstanding education at Ohio State University, Dr. Boston's story is both inspiring and informative. We dive into the world of general surgery, focusing on the significant advancements brought about by laparoscopic techniques. You'll gain insights into common procedures like gallbladder removals and appendectomies, and understand the crucial role that simulation labs play in training the next generation of surgeons.
Have you ever wondered what it's like to be in a surgeon's flow state? We'll explore how the operating room becomes a peaceful haven for surgeons like Dr. Boston, where focus and precision create a unique sense of fulfillment. Listen as we discuss the rewarding aspects of aiding cancer patients through essential services offered by St. Luke’s Surgical Consultants. We'll also touch on the profound importance of surgical judgment and the collaborative nature of patient care. Join us to learn how you can reach out for consultations or second opinions, as Dr. Boston shares his deep commitment to providing accessible and compassionate medical care.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to Doc Discussions.
This is Jason Edwards and I'mhere with my friend, dr Nick
Boston.
Nick is a general surgeon andNick, how are you doing today?
Speaker 2 (00:08):
Pretty good, Jason.
How about you?
Speaker 1 (00:09):
Yeah, doing well, Now tell folks where you're from,
nick.
Speaker 2 (00:12):
So I'm from Ohio originally, my whole family's
kind of from Ohio and you knowI'm an Ohio boy and went to Ohio
High School and Ohio StateUniversity for undergrad and med
school.
Speaker 1 (00:26):
Very good, the Ohio State right.
That's right.
We own that article.
And what town were you from?
Speaker 2 (00:33):
originally I'm from Centerville, Ohio, which is a
suburb of Dayton.
Speaker 1 (00:36):
Okay, yeah sure, and a lot of people from St Louis
actually go to Dayton becauseit's a Catholic college and so
it's not uncommon to meet people.
Speaker 2 (00:44):
Yeah, I kind of noticed that when I got here too
, that Miami University.
There's kind of a connectionthere with St Louis which is
interesting.
Speaker 1 (00:51):
Yeah, and I've always heard that's the chapel at
Miami.
Is it Oxford?
Speaker 2 (00:55):
Yeah, it's in Oxford Ohio.
Speaker 1 (00:56):
It's one of the most beautiful buildings in the state
.
Speaker 2 (00:58):
Yeah, it's a beautiful campus.
Speaker 1 (00:59):
Yeah, and I've seen videos of a place called Hawking
Hills, ohio.
Have you ever been there?
Speaker 2 (01:06):
Yeah, I've been there .
It's a it's pretty beautifulplace.
A lot of great uh leaves, youknow, in the fall, uh for sure.
But that's kind of like wherethe um glaciers kind of stopped
and pushed a lot of you knowtrees and stuff and, uh, it kind
of created a lot of interestingyou know trees and plants that
create some pretty good leaves.
Speaker 1 (01:25):
And the topography is kind of cool there.
Speaker 2 (01:27):
Yeah, very kind of getting into.
You know Appalachia a littlebit.
Speaker 1 (01:31):
Yeah, yeah, and then yeah, and then once you get kind
of I guess it's Southeasttowards Portsmouth, you're like
very much in Appalachia.
Yeah, it's an interesting state.
I mean the Great Lakes, theAppalachia, it kind of has it
all there.
Yeah, the Appalachia, it kindof has it all there.
Yeah, definitely, yeah, a lotof variation for sure, yeah.
And so general surgery can youexplain to people what types of
(01:51):
surgery a general surgeon doestypically?
Speaker 2 (01:53):
Sure.
So general surgeons generallyconcentrate on the abdomen.
So most abdominal surgeries youknow we're kind of the experts
of the abdomen and other piecesare carved out by other
specialties, but we mostly doabdominal surgeries.
Gallbladders are the mostcommon, followed by hernias and
appendixes, and you know otherthings outside of the abdomen.
(02:16):
Some general surgeons do breastsurgery, but other lumps and
bumps are kind of bread andbutter as well.
Speaker 1 (02:22):
Yeah yeah, the cardiothoracic surgeons do the
chest, the ear, nose and throatdoctors do the neck, and so yeah
.
But a general surgeon is kindof pretty useful in any
situation though.
Speaker 2 (02:33):
Yeah, we're, you know , kind of can do a lot of stuff
you know, and aren't quite asspecialized as some of the other
specialists are.
Speaker 1 (02:43):
Yeah, and so you know I was reading.
The first laparoscopiccholecystectomy was performed in
1985 by a guy named Eric Muehin Germany, and you know, today
90% of gallbladder removals aredone laparoscopically, and so
it's really like the standard ofcare.
Can you explain to people whatthe difference is between, like
an open surgery and alaparoscopic surgery?
Speaker 2 (03:04):
Sure, whenever we're talking about surgery, at least
on the abdomen, we're talkingabout either open or
laparoscopic, and really thatjust means the you know the size
of the incision and if you'reusing insufflation to you know,
give your root, give yourselfspace to work in the abdomen.
So laparoscopic surgery usessmall incisions, so there's less
trauma, it's less invasive,less pain, less complications,
(03:27):
versus an open surgery where youmake a big incision and kind of
open things up and kind of doit more with your hands as
opposed to long instruments.
Speaker 1 (03:37):
And one of the things that I found interesting was
when laparoscopic surgery wasfirst introduced.
It had a higher complicationrate initially, but they showed
that there was kind of thislearning curve and typically,
once you had about 50 procedures, the complication rates were
actually lower or the same orlower with laparoscopic surgery.
What's the main advantage youget from a laparoscopic surgery?
Speaker 2 (03:58):
Mainly it's for the patient.
You know it would definitely beeasier on the surgeon maybe to
do it open, but you know thelaparoscopy is better for the
patients.
It's, you know, less trauma tothe body.
It's a quicker recovery.
You know earlier return to workand you know um less
complications as well.
You know less risk of.
You know intestines being slowafter surgery.
You know less pain, lessbleeding, less infection
(04:21):
definitely.
Speaker 1 (04:22):
Yeah, and so this is kind of one of the few areas
where it's better for thepatient and the insurance
company because it's less timein the hospital, and so that's a
win-win.
Speaker 2 (04:31):
Yeah, exactly, especially with gallbladder
surgeries when it was opensurgery.
Those are super painful.
You know being in the hospitalfor days and days versus.
Speaker 1 (04:38):
You know a pretty routine laparoscopic gallbladder
removal is outpatient, so yougo home the same day
laparoscopic gallbladder removalis outpatient, so you go home
the same day and during yourtraining, you know, one of the
things that we had was likesimulation labs.
Did you guys do that too to tryto cut down on that 50 cases
where you could get experience,not necessarily in the operating
room?
Speaker 2 (04:58):
Yes, definitely.
Yeah, my training program atMizzou in Columbia was pretty
heavy on the minimally invasivesurgery.
So we did a lot of labsactually working on, you know,
box plastic trainers, as well asabout a monthly or every other
month pig labs.
So we would operate on, youknow, pigs as well to practice
(05:21):
getting our skills, especiallywith surgeries that weren't as
common.
You know that we didn't get ourhands on much.
You know, in training we got tokind of get our hands dirty and
do it on the pigs, yeah, withthe swine, the, the.
Speaker 1 (05:34):
You know, one of the things that people don't realize
is that a pig anatomy is almostexactly the same as human
anatomy.
There's very, very littledifference.
Speaker 2 (05:42):
Yeah, definitely with surgical.
You know what's the wordSurgical research.
It's definitely the go-to modelfor research.
Speaker 1 (05:58):
Yeah, for sure, and I think the pig proteome like
just if you just like look atproteins, you know more proteins
are the same as humans than not, and so I mean that just kind
of speaks to evolution too.
Speaker 2 (06:09):
Right, exactly.
Speaker 1 (06:11):
So the now the robotic assisted surgeries.
So this is like the da Vincidevice.
In 2000, there were like 1000procedures worldwide, and then
now there's almost a millionannually.
And now we have a da Vincidevice here that some of the
surgeons use, and that's kind oflike they don't use it for
(06:32):
gallbladder removal, but theyuse it for others, do they?
Or do they use it forgallbladder?
Yeah, you can use it forgallbladder removal too.
Speaker 2 (06:38):
Yeah, there are definitely advantages of that as
well.
But Kind of to go back, roboticsurgery kind of started with
mostly urology surgery, soprostatectomies really were very
difficult to dolaparoscopically and open
prostatectomies were probablyeven more difficult.
So with the introduction of therobot that's allowed almost all
(07:02):
of the prostatectomies,prostate removals, be done
minimally invasively, which isgreat for patients.
So you know that technology hasbeen around, like you said, for
now 25 years or more.
We're on about the fifthiteration of the robot now and
over time other practices of orother specialties in surgery
(07:22):
have taken this device and kindof applied it to their own
surgery.
So you know, myself I've done Idon't know 700 or 800 robotic
surgeries, and those are, youknow those are almost anything.
You know that I do a lot ofhernia repairs, a lot of colon
resections and even somegallbladders here and here and
(07:43):
there, as well as some of themore complex surgeries we do.
The robot definitely has somebenefits.
Speaker 1 (07:48):
Yeah.
And so to people out there whodon't know what this is, I mean
you're almost like at a like anarcade station and you're not
actually like right, you're notfacing the patient, right, but
there's a robot surrounding thepatient with multiple arms that
works electronically.
Speaker 2 (08:05):
Yeah, so it's.
It's a robotic surgery is apiece of laparoscopic surgery,
so it's still laparoscopicsurgery, but the robot is not
truly a robot.
It's just a really really smart, expensive computer that helps
the surgeon have a little bitmore dexterity, a little bit
less pain for the patient, lesstrauma to the patient afterwards
(08:26):
and allow probably morepatients to have a minimally
invasive surgery than withoutthe robot.
Speaker 1 (08:33):
basically, and there's no artificial
intelligence with it.
It doesn't have its own mind.
You're controlling everything.
But the articulations of whereit bends are kind of closer to
the instrument, so it can getinto tight spots.
Speaker 2 (08:51):
Right, yeah, you have more dexterity, as you know,
compared to laparoscopic surgery, so you're able to do things
you know, minimally invasively,that you weren't able to do with
traditional laparoscopicsurgery.
But, yeah, so with roboticsurgery, you know the surgeons
in the room the whole time.
We're controlling the machinethe entire time, so it's not
like you're having a robotoperate on you.
Speaker 1 (09:08):
We're not there yet we're not there yet and that of
course, works well for thepelvis, because internally the
pelvis is kind of like an upsidedown traffic cone and it's very
hard to kind of get inlaterally when there's not a lot
of space there.
And then I would think forsomething like an adrenal gland
or something like that, it wouldbe very helpful, because that's
a pretty tight spot as well.
(09:28):
Yeah, definitely.
Speaker 2 (09:29):
Yeah, I do.
You know, adrenal ectomies withthe robot as well.
Those aren't super common butthe robot's a good tool to use
that for.
I do do foregut surgery.
Foregut means, you know,operating on the upper stomach,
(09:50):
you know, for hiatal hernias orother less common diseases like
achalasia or anti-reflux sort ofsurgeries, and the robot's
definitely a huge benefit to beable to do that operation.
Speaker 1 (09:54):
Is that like a fundoplication?
Yeah?
So a lot of people haveanti-reflux surgeries, the
fundoplication when they kind oftake part of the stomach and
wrap it around the upper partand kind of create a new
sphincter.
Speaker 2 (10:04):
Yeah, For people who have bad reflux, the sphincter
between the stomach and theesophagus isn't working great,
so we wrap the stomach aroundthe esophagus in a very
controlled manner to help thatprevent reflux.
Speaker 1 (10:15):
Yeah, I'm kind of saying it crudely.
It's obviously much morecomplicated than that of course.
But yeah, actually you did anadrenal glycemic on a patient of
mine and that I mean, that'sall I remember in general
surgery.
That was that's a hard surgeryto do and you did great, and so
I was very happy with that.
And that was kind of like.
You know, when we first startedworking with each other a few
years back, that's when I waslike, okay, this guy's a legit
(10:37):
good surgeon and so, um, yeah,those are memorable.
Those are, you know, enjoyablecases and especially helping out
at you know a cancer patient isalways enjoyable and rewarding,
for sure, and so therobotic-assisted surgery is kind
of like the next iteration intolaparoscopic surgery.
And then I think they arelooking at AI to enhance a
(11:01):
surgical visualization, but Idon't know if this is ready for
prime time yet, but the thoughtis it may help with surgical
planning.
Now I don't know if is thatmore of a neurosurgery thing, or
does that have?
Speaker 2 (11:14):
applications in general surgery as well.
Speaker 1 (11:15):
It has a few applications in general surgery
and laparoscopic surgery as well, but probably just not quite as
important as it is, for youknow the other specialties yeah
yeah, and so you know I want toswitch gears a little bit and I
was recently reading about aresearcher and I'm going to
(11:38):
butcher this name, but the nameis Mahaly Cheeksentmihai and I
actually have read a couplebooks that talked about these
studies that they did and it wasin the 1970s and they would
hand people pagers and theywould ask them like how they're
feeling at different times, andthey actually, and so it wasn't,
it was like less thancontrolled, less of a controlled
(11:59):
environment.
So they had a, a, a journal, andthey would get a page and they
would say I'm feeling good hereor not good here, and this is
what's happening.
And that's what's happening.
And one of the things that theywere able to find from these
studies, amongst multipleinteresting things, was that
patients or people can enterthese flow states and you know,
you might think of like anathlete who's like, you know,
(12:20):
jordan's, like hitting everyshot Right, but it's it's when
you're performing a complex taskthat kind of meets your skill
set, that requires some intensefocus and precision.
And I would think that doingthese surgeries, that you've
done a lot of surgeries and soyou're familiar with the surgery
(12:41):
Do you ever feel like in the,or you kind of hit one of these
flow states, like when you'redoing the surgeries.
Speaker 2 (12:46):
Yeah, I think that's definitely true.
You know for sure.
You kind of get, you know inthe zone, but more so you kind
of you know.
It's almost just like you're soused to doing it that you're
(13:15):
kind of disconnected from yourbody, but you're just in the
zone, doing what you love to doand know how to do and were
trained to do.
Speaker 1 (13:23):
Yeah, and I think sometimes there is like an
ambiance to the operating room,like sometimes the lights are
down and the music's going andyou're just kind of a man
working in your craft and andand you know, I would think that
you kind of feel like that'swhere you're supposed to be in.
The universe is like in theoperating room doing your work.
Speaker 2 (13:43):
Yeah, it's definitely our happy place, for sure, as
surgeons.
You know we, we see patients inthe office.
We see them in the hospital.
You know we, we see patients inthe office, we see them in the
hospital.
Speaker 1 (13:53):
You know we do a lot of talking, but our happy place
is definitely in the operatingroom.
Yeah, and one of the nicethings I remember too is that
the you know you're, you'regetting calls all day and people
are coming at you with allkinds of stuff and, like in the
operating room, you're kind ofprotected from that.
Speaker 2 (14:03):
Right and it's, it's.
Speaker 1 (14:04):
There is some peace there.
Speaker 2 (14:06):
Yeah, you're definitely protected and you
kind of, for the most part, knowwhat to expect.
Yeah, and you're doingsomething that's important too.
Yeah, very important.
Yeah, for sure.
Speaker 1 (14:14):
That's awesome, man.
And so what's the name of yourgroup, your surgical group,
because we know some of yourpartners here.
Speaker 2 (14:22):
Yeah, so we're actually, you know, part of the
St Luke's medical group now, butwe're the St Luke's surgical
consultants.
Yeah.
Speaker 1 (14:29):
And and and um, and you know you and I, you know um
kind of uh cross paths when you,when you guys put ports in our
patients for chemotherapy.
You know one of the many, youknow smaller surgeries that you
guys do.
I'm sure that's a chip shot foryou guys.
Speaker 2 (14:42):
Yeah, those are, those are fun and you know again
, it's always, um, you know, uhnice to take care of cancer
patients and to help them out.
Speaker 1 (14:51):
Yeah.
Speaker 2 (14:52):
Because that's definitely rewarding for us.
So you know I know they loveyou, jason, and you know I think
you're a great doc as well.
But you know we appreciateeverything you do and we love
helping you.
Speaker 1 (15:03):
You know, this is a requisite.
Anybody has to come on the show.
They have to, you know, saylike how great.
Speaker 2 (15:07):
I am, that's right.
Speaker 1 (15:16):
And so I may have used this line before, but
you're never as good or as badas people say.
You are All right, Nick, andhow would somebody get ahold of
you or your office if theywanted to talk about surgery or
a?
Speaker 2 (15:21):
second opinion?
Sure, so you can always callour office to make an
appointment.
It's pretty easy.
Just call us at 314-434-1211.
And we'll be happy to see youin consultation in the office.
You know, and I'm happy to, youknow, talk things out in the
office.
You know, before we make anydecisions about surgery, that's
always an important part.
Speaker 1 (15:39):
Yeah, for sure.
I think I've sent you patientsand you said hey, this, you know
this person.
It was a, it was a bowel issue,and you said you could probably
just watch this.
And so you know, I always say asurgeon's best tool is not
their hands, it's their judgment.
Speaker 2 (15:51):
Yeah, that's absolutely true.
You know, surgery is not alwaysthe option or not always the
best option, but you know that'swhat we're here for to make
that decision.
Speaker 1 (16:01):
That's why we've, you know, trained for this.
Well, nick, we're glad to havea Buckeye here on the staff and
I want to thank you for all thegreat care that you give our
patients.
Speaker 2 (16:08):
You bet Absolutely.
Welcome to Doc Discussions.
This is Jason Edwards and I'mhere with my friend, dr Nick
Boston.
Nick is a general surgeon andNick, how are you doing today?
Speaker 2 (00:08):
Pretty good, Jason.
How about you?
Speaker 1 (00:09):
Yeah, doing well, Now tell folks where you're from,
nick.
Speaker 2 (00:12):
So I'm from Ohio originally, my whole family's
kind of from Ohio and you knowI'm an Ohio boy and went to Ohio
High School and Ohio StateUniversity for undergrad and med
school.
Speaker 1 (00:26):
Very good, the Ohio State right.
That's right.
We own that article.
And what town were you from?
Speaker 2 (00:33):
originally I'm from Centerville, Ohio, which is a
suburb of Dayton.
Speaker 1 (00:36):
Okay, yeah sure, and a lot of people from St Louis
actually go to Dayton becauseit's a Catholic college and so
it's not uncommon to meet people.
Speaker 2 (00:44):
Yeah, I kind of noticed that when I got here too
, that Miami University.
There's kind of a connectionthere with St Louis which is
interesting.
Speaker 1 (00:51):
Yeah, and I've always heard that's the chapel at
Miami.
Is it Oxford?
Speaker 2 (00:55):
Yeah, it's in Oxford Ohio.
Speaker 1 (00:56):
It's one of the most beautiful buildings in the state
.
Speaker 2 (00:58):
Yeah, it's a beautiful campus.
Speaker 1 (00:59):
Yeah, and I've seen videos of a place called Hawking
Hills, ohio.
Have you ever been there?
Speaker 2 (01:06):
Yeah, I've been there .
It's a it's pretty beautifulplace.
A lot of great uh leaves, youknow, in the fall, uh for sure.
But that's kind of like wherethe um glaciers kind of stopped
and pushed a lot of you knowtrees and stuff and, uh, it kind
of created a lot of interestingyou know trees and plants that
create some pretty good leaves.
Speaker 1 (01:25):
And the topography is kind of cool there.
Speaker 2 (01:27):
Yeah, very kind of getting into.
You know Appalachia a littlebit.
Speaker 1 (01:31):
Yeah, yeah, and then yeah, and then once you get kind
of I guess it's Southeasttowards Portsmouth, you're like
very much in Appalachia.
Yeah, it's an interesting state.
I mean the Great Lakes, theAppalachia, it kind of has it
all there.
Yeah, the Appalachia, it kindof has it all there.
Yeah, definitely, yeah, a lotof variation for sure, yeah.
And so general surgery can youexplain to people what types of
(01:51):
surgery a general surgeon doestypically?
Speaker 2 (01:53):
Sure.
So general surgeons generallyconcentrate on the abdomen.
So most abdominal surgeries youknow we're kind of the experts
of the abdomen and other piecesare carved out by other
specialties, but we mostly doabdominal surgeries.
Gallbladders are the mostcommon, followed by hernias and
appendixes, and you know otherthings outside of the abdomen.
(02:16):
Some general surgeons do breastsurgery, but other lumps and
bumps are kind of bread andbutter as well.
Speaker 1 (02:22):
Yeah yeah, the cardiothoracic surgeons do the
chest, the ear, nose and throatdoctors do the neck, and so yeah
.
But a general surgeon is kindof pretty useful in any
situation though.
Speaker 2 (02:33):
Yeah, we're, you know , kind of can do a lot of stuff
you know, and aren't quite asspecialized as some of the other
specialists are.
Speaker 1 (02:43):
Yeah, and so you know I was reading.
The first laparoscopiccholecystectomy was performed in
1985 by a guy named Eric Muehin Germany, and you know, today
90% of gallbladder removals aredone laparoscopically, and so
it's really like the standard ofcare.
Can you explain to people whatthe difference is between, like
an open surgery and alaparoscopic surgery?
Speaker 2 (03:04):
Sure, whenever we're talking about surgery, at least
on the abdomen, we're talkingabout either open or
laparoscopic, and really thatjust means the you know the size
of the incision and if you'reusing insufflation to you know,
give your root, give yourselfspace to work in the abdomen.
So laparoscopic surgery usessmall incisions, so there's less
trauma, it's less invasive,less pain, less complications,
(03:27):
versus an open surgery where youmake a big incision and kind of
open things up and kind of doit more with your hands as
opposed to long instruments.
Speaker 1 (03:37):
And one of the things that I found interesting was
when laparoscopic surgery wasfirst introduced.
It had a higher complicationrate initially, but they showed
that there was kind of thislearning curve and typically,
once you had about 50 procedures, the complication rates were
actually lower or the same orlower with laparoscopic surgery.
What's the main advantage youget from a laparoscopic surgery?
Speaker 2 (03:58):
Mainly it's for the patient.
You know it would definitely beeasier on the surgeon maybe to
do it open, but you know thelaparoscopy is better for the
patients.
It's, you know, less trauma tothe body.
It's a quicker recovery.
You know earlier return to workand you know um less
complications as well.
You know less risk of.
You know intestines being slowafter surgery.
You know less pain, lessbleeding, less infection
(04:21):
definitely.
Speaker 1 (04:22):
Yeah, and so this is kind of one of the few areas
where it's better for thepatient and the insurance
company because it's less timein the hospital, and so that's a
win-win.
Speaker 2 (04:31):
Yeah, exactly, especially with gallbladder
surgeries when it was opensurgery.
Those are super painful.
You know being in the hospitalfor days and days versus.
Speaker 1 (04:38):
You know a pretty routine laparoscopic gallbladder
removal is outpatient, so yougo home the same day
laparoscopic gallbladder removalis outpatient, so you go home
the same day and during yourtraining, you know, one of the
things that we had was likesimulation labs.
Did you guys do that too to tryto cut down on that 50 cases
where you could get experience,not necessarily in the operating
room?
Speaker 2 (04:58):
Yes, definitely.
Yeah, my training program atMizzou in Columbia was pretty
heavy on the minimally invasivesurgery.
So we did a lot of labsactually working on, you know,
box plastic trainers, as well asabout a monthly or every other
month pig labs.
So we would operate on, youknow, pigs as well to practice
(05:21):
getting our skills, especiallywith surgeries that weren't as
common.
You know that we didn't get ourhands on much.
You know, in training we got tokind of get our hands dirty and
do it on the pigs, yeah, withthe swine, the, the.
Speaker 1 (05:34):
You know, one of the things that people don't realize
is that a pig anatomy is almostexactly the same as human
anatomy.
There's very, very littledifference.
Speaker 2 (05:42):
Yeah, definitely with surgical.
You know what's the wordSurgical research.
It's definitely the go-to modelfor research.
Speaker 1 (05:58):
Yeah, for sure, and I think the pig proteome like
just if you just like look atproteins, you know more proteins
are the same as humans than not, and so I mean that just kind
of speaks to evolution too.
Speaker 2 (06:09):
Right, exactly.
Speaker 1 (06:11):
So the now the robotic assisted surgeries.
So this is like the da Vincidevice.
In 2000, there were like 1000procedures worldwide, and then
now there's almost a millionannually.
And now we have a da Vincidevice here that some of the
surgeons use, and that's kind oflike they don't use it for
(06:32):
gallbladder removal, but theyuse it for others, do they?
Or do they use it forgallbladder?
Yeah, you can use it forgallbladder removal too.
Speaker 2 (06:38):
Yeah, there are definitely advantages of that as
well.
But Kind of to go back, roboticsurgery kind of started with
mostly urology surgery, soprostatectomies really were very
difficult to dolaparoscopically and open
prostatectomies were probablyeven more difficult.
So with the introduction of therobot that's allowed almost all
(07:02):
of the prostatectomies,prostate removals, be done
minimally invasively, which isgreat for patients.
So you know that technology hasbeen around, like you said, for
now 25 years or more.
We're on about the fifthiteration of the robot now and
over time other practices of orother specialties in surgery
(07:22):
have taken this device and kindof applied it to their own
surgery.
So you know, myself I've done Idon't know 700 or 800 robotic
surgeries, and those are, youknow those are almost anything.
You know that I do a lot ofhernia repairs, a lot of colon
resections and even somegallbladders here and here and
(07:43):
there, as well as some of themore complex surgeries we do.
The robot definitely has somebenefits.
Speaker 1 (07:48):
Yeah.
And so to people out there whodon't know what this is, I mean
you're almost like at a like anarcade station and you're not
actually like right, you're notfacing the patient, right, but
there's a robot surrounding thepatient with multiple arms that
works electronically.
Speaker 2 (08:05):
Yeah, so it's.
It's a robotic surgery is apiece of laparoscopic surgery,
so it's still laparoscopicsurgery, but the robot is not
truly a robot.
It's just a really really smart, expensive computer that helps
the surgeon have a little bitmore dexterity, a little bit
less pain for the patient, lesstrauma to the patient afterwards
(08:26):
and allow probably morepatients to have a minimally
invasive surgery than withoutthe robot.
Speaker 1 (08:33):
basically, and there's no artificial
intelligence with it.
It doesn't have its own mind.
You're controlling everything.
But the articulations of whereit bends are kind of closer to
the instrument, so it can getinto tight spots.
Speaker 2 (08:51):
Right, yeah, you have more dexterity, as you know,
compared to laparoscopic surgery, so you're able to do things
you know, minimally invasively,that you weren't able to do with
traditional laparoscopicsurgery.
But, yeah, so with roboticsurgery, you know the surgeons
in the room the whole time.
We're controlling the machinethe entire time, so it's not
like you're having a robotoperate on you.
Speaker 1 (09:08):
We're not there yet we're not there yet and that of
course, works well for thepelvis, because internally the
pelvis is kind of like an upsidedown traffic cone and it's very
hard to kind of get inlaterally when there's not a lot
of space there.
And then I would think forsomething like an adrenal gland
or something like that, it wouldbe very helpful, because that's
a pretty tight spot as well.
(09:28):
Yeah, definitely.
Speaker 2 (09:29):
Yeah, I do.
You know, adrenal ectomies withthe robot as well.
Those aren't super common butthe robot's a good tool to use
that for.
I do do foregut surgery.
Foregut means, you know,operating on the upper stomach,
(09:50):
you know, for hiatal hernias orother less common diseases like
achalasia or anti-reflux sort ofsurgeries, and the robot's
definitely a huge benefit to beable to do that operation.
Speaker 1 (09:54):
Is that like a fundoplication?
Yeah?
So a lot of people haveanti-reflux surgeries, the
fundoplication when they kind oftake part of the stomach and
wrap it around the upper partand kind of create a new
sphincter.
Speaker 2 (10:04):
Yeah, For people who have bad reflux, the sphincter
between the stomach and theesophagus isn't working great,
so we wrap the stomach aroundthe esophagus in a very
controlled manner to help thatprevent reflux.
Speaker 1 (10:15):
Yeah, I'm kind of saying it crudely.
It's obviously much morecomplicated than that of course.
But yeah, actually you did anadrenal glycemic on a patient of
mine and that I mean, that'sall I remember in general
surgery.
That was that's a hard surgeryto do and you did great, and so
I was very happy with that.
And that was kind of like.
You know, when we first startedworking with each other a few
years back, that's when I waslike, okay, this guy's a legit
(10:37):
good surgeon and so, um, yeah,those are memorable.
Those are, you know, enjoyablecases and especially helping out
at you know a cancer patient isalways enjoyable and rewarding,
for sure, and so therobotic-assisted surgery is kind
of like the next iteration intolaparoscopic surgery.
And then I think they arelooking at AI to enhance a
(11:01):
surgical visualization, but Idon't know if this is ready for
prime time yet, but the thoughtis it may help with surgical
planning.
Now I don't know if is thatmore of a neurosurgery thing, or
does that have?
Speaker 2 (11:14):
applications in general surgery as well.
Speaker 1 (11:15):
It has a few applications in general surgery
and laparoscopic surgery as well, but probably just not quite as
important as it is, for youknow the other specialties yeah
yeah, and so you know I want toswitch gears a little bit and I
was recently reading about aresearcher and I'm going to
(11:38):
butcher this name, but the nameis Mahaly Cheeksentmihai and I
actually have read a couplebooks that talked about these
studies that they did and it wasin the 1970s and they would
hand people pagers and theywould ask them like how they're
feeling at different times, andthey actually, and so it wasn't,
it was like less thancontrolled, less of a controlled
(11:59):
environment.
So they had a, a, a journal, andthey would get a page and they
would say I'm feeling good hereor not good here, and this is
what's happening.
And that's what's happening.
And one of the things that theywere able to find from these
studies, amongst multipleinteresting things, was that
patients or people can enterthese flow states and you know,
you might think of like anathlete who's like, you know,
(12:20):
jordan's, like hitting everyshot Right, but it's it's when
you're performing a complex taskthat kind of meets your skill
set, that requires some intensefocus and precision.
And I would think that doingthese surgeries, that you've
done a lot of surgeries and soyou're familiar with the surgery
(12:41):
Do you ever feel like in the,or you kind of hit one of these
flow states, like when you'redoing the surgeries.
Speaker 2 (12:46):
Yeah, I think that's definitely true.
You know for sure.
You kind of get, you know inthe zone, but more so you kind
of you know.
It's almost just like you're soused to doing it that you're
(13:15):
kind of disconnected from yourbody, but you're just in the
zone, doing what you love to doand know how to do and were
trained to do.
Speaker 1 (13:23):
Yeah, and I think sometimes there is like an
ambiance to the operating room,like sometimes the lights are
down and the music's going andyou're just kind of a man
working in your craft and andand you know, I would think that
you kind of feel like that'swhere you're supposed to be in.
The universe is like in theoperating room doing your work.
Speaker 2 (13:43):
Yeah, it's definitely our happy place, for sure, as
surgeons.
You know we, we see patients inthe office.
We see them in the hospital.
You know we, we see patients inthe office, we see them in the
hospital.
Speaker 1 (13:53):
You know we do a lot of talking, but our happy place
is definitely in the operatingroom.
Yeah, and one of the nicethings I remember too is that
the you know you're, you'regetting calls all day and people
are coming at you with allkinds of stuff and, like in the
operating room, you're kind ofprotected from that.
Speaker 2 (14:03):
Right and it's, it's.
Speaker 1 (14:04):
There is some peace there.
Speaker 2 (14:06):
Yeah, you're definitely protected and you
kind of, for the most part, knowwhat to expect.
Yeah, and you're doingsomething that's important too.
Yeah, very important.
Yeah, for sure.
Speaker 1 (14:14):
That's awesome, man.
And so what's the name of yourgroup, your surgical group,
because we know some of yourpartners here.
Speaker 2 (14:22):
Yeah, so we're actually, you know, part of the
St Luke's medical group now, butwe're the St Luke's surgical
consultants.
Yeah.
Speaker 1 (14:29):
And and and um, and you know you and I, you know um
kind of uh cross paths when you,when you guys put ports in our
patients for chemotherapy.
You know one of the many, youknow smaller surgeries that you
guys do.
I'm sure that's a chip shot foryou guys.
Speaker 2 (14:42):
Yeah, those are, those are fun and you know again
, it's always, um, you know, uhnice to take care of cancer
patients and to help them out.
Speaker 1 (14:51):
Yeah.
Speaker 2 (14:52):
Because that's definitely rewarding for us.
So you know I know they loveyou, jason, and you know I think
you're a great doc as well.
But you know we appreciateeverything you do and we love
helping you.
Speaker 1 (15:03):
You know, this is a requisite.
Anybody has to come on the show.
They have to, you know, saylike how great.
Speaker 2 (15:07):
I am, that's right.
Speaker 1 (15:16):
And so I may have used this line before, but
you're never as good or as badas people say.
You are All right, Nick, andhow would somebody get ahold of
you or your office if theywanted to talk about surgery or
a?
Speaker 2 (15:21):
second opinion?
Sure, so you can always callour office to make an
appointment.
It's pretty easy.
Just call us at 314-434-1211.
And we'll be happy to see youin consultation in the office.
You know, and I'm happy to, youknow, talk things out in the
office.
You know, before we make anydecisions about surgery, that's
always an important part.
Speaker 1 (15:39):
Yeah, for sure.
I think I've sent you patientsand you said hey, this, you know
this person.
It was a, it was a bowel issue,and you said you could probably
just watch this.
And so you know, I always say asurgeon's best tool is not
their hands, it's their judgment.
Speaker 2 (15:51):
Yeah, that's absolutely true.
You know, surgery is not alwaysthe option or not always the
best option, but you know that'swhat we're here for to make
that decision.
Speaker 1 (16:01):
That's why we've, you know, trained for this.
Well, nick, we're glad to havea Buckeye here on the staff and
I want to thank you for all thegreat care that you give our
patients.
Speaker 2 (16:08):
You bet Absolutely.
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