MD, Ph.D., professor, head of the surgical service of the Swiss University Hospital in Moscow. The founder of the Scientific-Practical School of Laparoscopic Surgeons and trained more than 400 students in 20 countries. The director of the Training Center of Clinical and Experimental Surgery. In 2006, as a result of practice, through the Russian Association of Endoscopic Surgeons, named the best Russian and laparoscopic surgeon and awarded the honorary badge «Golden laparoscope». He has completed more than 12,000 laparoscopic surgical procedures. He is a full member of the Russian Society of Endoscopic Surgeons, a member of the European Association of Endoscopic Surgeons and the first Russian to become a member of the Asian Association of Endo­scopic Surgeons. The Medal «Gold Star» was awarded to him, in 2011, for his outstanding contribution to the development of laparoscopic gynecology.

We are honoured to have secured an exclusive interview with the esteemed surgeon of international renown, Professor Konstantin Puchkov. The professor operates on European patients with various surgical diseases at a clinic in Geneva, Switzerland. In addition, the professor regularly lectures and demonstrates operations in international centres. His specialty in endoscopic surgery is recognised at teaching hospitals in France, Italy, China and Kazakhstan.We met with Mr. Puchkov in Moscow and talked about the possibilities and advantages of laparoscopy for patients.

Laparoscopy is a modern method of operating. What about a situation when the patient is afraid to resort to laparoscopy?

Yes, of course. A third of patients ask about the risks. This situation is only associated with outpatients who do not know about the possibilities of laparoscopy or who may be illiterate patients in the hospital. In these conditions, we orient patients to traditional surgery through incision. I know all the methods of operating (open, laparoscopic, through a single puncture, N.O.T.E.S. — transvaginal), so I choose the optimal patient technique, which is the best for him in a particular clinical situation.

The physician should not be tied to one method. It is limiting and does not cure the patient completely or successfully. I try to convince the patient to consider a particular method of operation. My goal is to explain and highlight the advantages and disadvantages of each procedure and to give the right advice that, in my opinion, is better. The patient makes the choice himself/herself. In almost 100% of the cases, if there is evidence and the ability to perform, he/she chooses laparoscopy or minimally invasive method of intervention.

What are the advantages of laparoscopic surgery?

The main advantage is that 70% of any laparoscopic operation can be performed better than incision operations and offer better results. They do not involve any incision in the abdominal wall. The essence of laparoscopy is to conduct surgery under video; working with several tools of 5 to 10 mm in diameter. Modern HD cameras allow us to utilise a large increase in the operative field, exposing the finest vessels and nerves, which allows us to perform bloodless intervention, while maintaining neural structures and avoiding excessive injury. Thus, the surgeon’s hands are not in the stomach, as in a normal operation, but outside of the abdominal cavity. The result is minimal trauma to the body, minimal blood loss, minimal adhesion formation, rapid recovery, excellent cosmetic effect and a sharp increase in the quality of life in the post-operative period.

What diseases can be cured with the help of laparoscopic surgery?

I operate on almost all diseases of the abdominal cavity, pelvis and retroperitoneal space. I have five specialties — gynaecology, surgery, urology, proctology and oncology. This allows me to do a lot of co-operating, in terms of the various organs of the abdomen and pelvis, which makes it even more attractive as a laparoscopic approach. For example, through a puncture in the umbilical region, I can simultaneously remove the gall bladder and the uterus in order to perform an operation on a patient. It’s fantastic that this is a distinct possibility in the present day.

The innovation of laparoscopy is that the operations are carried out through small openings. How, in such a case, can the surgeon operate on the affected organ given the lost dexterity of movement and perception of depth and size?

Indeed, a laparoscopy surgeon sees an image in two dimensions and movement is necessarily performed in a mirror. Still, the human brain is limitless and can be adapted to fit any situation. As an example, the child who, after birth, in the first 2 months, sees the world upside down by a factor of 180 degrees, will see his brain restore images into the desired projection, without changing the design of the eye. In laparoscopy, sufficient training is required to adapt to the demands of surgery, without hesitation. Several years and countless hours of training are needed. It is not unlike practicing the violin or mastering a sport. Every day, you sweat through the training and make progress. As a student, I knitted daily and trained on anything that I could find. I reached a speed of 120 units per minute. With laparoscopic surgery, I also practice regularly on sutures under laparoscopic control, performing up to 60-70 units per minute. It brings automatism of your movements and dismisses the head during an operation, so that the surgeon is free to concentrate on the more important aspects of the operation.

Konstantin, you practice both at home and abroad. In some clinics, you are working diligently. Who can access your services?

Currently, my main place of work is a Swiss university hospital in Moscow, which has all of the necessary equipment and tools to perform the operations of any complexity using the laparoscopic approach and the machines of European and American manufacturers. Lately, I’ve done fewer operations in Europe. This is due to the fact that, in Europe, patients are more willing to visit me in Moscow, so there is no need for me to leave the country.

A second point to make is that there has been a change in the quality assessment of parameters of medical care in the direction of reducing the requirements for examination and the types of operations on the part of insurance companies. For example, in Switzerland, the insurance companies did not pay for the patient tested for HIV or hepatitis. They will not pay for MRI studies in cases where there is an Uzi, although this study would allow me to adequately assess the clinical situation. In Moscow, I know that one can point to the fact that I should examine the patient with cost in mind, but it may, in fact, be less expensive if I assess and then perform the operation in order to reduce the cost to the insurance company. For me, the most important thing is the quality of the operation and the final result. Clearly, this sometimes makes the operation more expensive, but also more reliable.

For your achievements, you are recognized as one of Russia’s best laparoscopic surgeons. Was it a goal to which you go strove in your career?

For me, all my life, I had a goal to become a good doctor and a good surgeon. Awards are separate parts of one’s life that allow you to verify and see that you are moving in the right direction. It is a long journey that few manage to pass. The main problem is that we should very much like our job. You should immediately understand that all depends on you. Surgery is not possible to teach. It is a learning process that is the responsibility of the individual. We must absorb all the best around us and be sure to give knowledge and experience to others. Only in this way can one become a unique human who is capable of being a master who can implement and teach. By teaching, you have the ability to free up space in your mind and your heart to new knowledge. This is the purpose of life.

You have perfected your knowledge during your work abroad in Europe and in the United States. This suggests that, in Russian surgery, they have not reached the level of the West?

Practical Surgery is divided into two sections. The first is to work with new materials and tools. In the West, they appear more quickly and, thus, they learn to work with them quickly as well. Although much of the research done in Russia and has been adopted by American and European partners, there is still a lag in practice.

The second is the work with hands and the ability to get out of the most difficult situations during an operation. There is no equal to the Russian surgeons, who are the best school out of our country. I see a lot of live operations of doctors from different countries and I can say, with confidence, that the Russian school is one of the strongest.

Still, how to identify among the many professionals experienced surgeon? After all, patients are always afraid to get into the hands of an incompetent doctor.

The perfect combination of humanity and good manual skills is rare and such doctors, as a rule, everyone knows who they are. The worst option is to have a surgeon in front of you who cannot think on his/her feet and will do surgeries only for financial gain.

In this situation, patients are simply material for teaching and material enrichment. The fate of the soul of those who need help is of little concern. This is very significant in such specialties as gynaecology. A good doctor is a person who should not only understand the diagnosis, but also a part of themselves while entering into the fate of a woman. The operation may be a traumatic event, with the removal of the uterus, ovaries or fallopian tubes. It is important to offer a woman the nephron-sparing treatment option that would allow her to become pregnant naturally.

As a rule, before the surgery, patients experience fear. What are you afraid of?

I’m not afraid of anything, but I am very worried about each patient, especially in the case of failure. Fear paralyzes and the surgeon should be relaxed and concentrated. He should proceed gently and methodically during the operation, making sweeps and trusting in intuition, experience and solid knowledge. He must believe in God and understand who and what gave him the gift. With drive and ambition comes the understanding that this is a very fine line that one can not cross over. Kindness and love for people allows one to properly and adequately react to any unforeseen situations. These are always very much in a surgeon’s life.

Surgery — this is an area of medicine that requires constant concentration and complete involvement in the process. How do you relieve stress?

Sports and sleep, although there is not always enough time and, like I said before, love for your profession is paramount.