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Improving
Surgical Skills
and Outcomes
AMulti-Perspective Approach
StephenLash
Improving Surgical Skills and Outcomes
Stephen Lash
Improving Surgical Skills
and Outcomes
A Multi-Perspective Approach
Stephen Lash
Southampton Eye Unit
University Hospital Southampton
Southampton, Hampshire, UK
ISBN 978-3-031-66689-6 ISBN 978-3-031-66690-2 (eBook)
https://doi.org/10.1007/978-3-031-66690-2
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2024
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse
of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and
transmission or information storage and retrieval, electronic adaptation, computer software, or by similar
or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or
the editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional affiliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
If disposing of this product, please recycle the paper.
Yes Mr. Blackadder, How lucky I am that my
https://t.me/med1917
job is also my hobby.
Blackadder 1989
The journey of surgery is long and arduous
https://t.me/med1917
and it has not been possible without the
support of my wonderful wife of over 25
years, Victoria. She tolerated my suggestions
that I would ‘Quite like to go back to
University and study Medicine’, to ‘Train as
a surgeon’, to ‘Do an MBA’ and then to ‘Go
off to Australia with our three children for a
year with a suitcase but nowhere to live!’ I
am also grateful to my children, Jonah,
Abigail, Oscar and Esther for their support
and tolerance of my often-long hours! Two
are mad enough to try to follow me at the
time of writing. And finally, all those who
have given me their time and effort in
training me, there are many. It’s a privilege to
be able to do this job and also great fun.
Foreword by Andrew Luff
https://t.me/med1917
Given the ever-expanding breadth of the medical school curriculum and volume
of essential knowledge, it is no surprise that traditional medical training can be
dominated by currently popular ‘facts’ and the science underpinning perceived good
medical care. Having qualified in medicine in 1982 and spent the last 40 years of my
working life in surgical specialties, I have witnessed the somewhat haphazard way
we are taught (or, more frequently, not taught) the myriad of skills required to work
safely, effectively and enjoyably as a surgeon.
Many patients tell me their job is a bit like mine, and they are probably right. Being
a surgeon involves many skills, some obvious (a degree of manual dexterity is a big
help) but others more nebulous, and less easy to acquire or perfect. We may be lucky
enough to find a senior, or a contemporary, during our life-long learning who sees
surgery as so much more than a technical exercise, bringing real meaning to what
should be a beautiful art. This art must then be delivered in a cost-effective manner
to an increasingly challenging health economy. Simultaneously, we hope to train the
next generation of surgeons, learn from audit and contribute to research. All of this
must be achieved remaining empathetic to our patients, colleagues and managers
whilst (increasingly importantly) avoiding the disillusionment which threatens our
profession.
In his book, Steve covers a variety of apparently disparate topics, which come
together to help surgeons learn, operate safely, practice efficiently and teach. Once
aware of these potentially neglected facets of our development I believe surgical
trainers and educationalists will come to view these topics as core knowledge. As
some of this may be completely new to the reader it might take time to assimilate
and translate into real-world practice, but for each of us there may be gems which
could improve care (for all patients, not just the ones currently in front of us) and
enhance our working lives.
ix
x Foreword by Andrew Luff
https://t.me/med1917
There are endless books about surgical technique, but a woeful lack of information
on how to be a surgeon. This book helps fill that gap.
Florence, Italy Prof. Andrew Luff, MA, MBBS,
FRCS, FRCOphth
Consultant Vitreoretinal Surgeon
Foreword by Giampaolo Gini
https://t.me/med1917
I first met Stephen Lash a few years ago during my time at Southampton University
Hospital.
It did not take me long to become good friends with him and to realise that this
was no ordinary individual I had come across.
As we sat each morning for a brief coffee break just before commencing a day’s
work, Steve would talk to me about his plans, ideas and aspirations … his eyes
beaming with a contagious enthusiasm.
With time (and a growing addiction to coffee on my part) I began to understand
Steve’s unique and unconventional approach not only to the medical world but to life
in general.
We found a common bond in an unwavering passion for surgery.
I do not use the word ‘passion’ lightly.
Passion is what keeps you up at night, mentally rehearsing the possible scenarios
you will find in the next day’s particularly complex case. It is the driving force
which makes one look for innovative approaches to improve surgical and functional
outcomes. It is what enables one to accept failure and learn from it.
Passion is what makes my every day in the operating theatre special and allows
me to find gratification in solving a particularly challenging situation even after so
many years of practice.
It is this passion which I try to instil in my fellows for I am convinced that this,
not just the technicalities they learn, will make the difference in becoming a truly
Great Surgeon.
This book is for anyone who i s passionate about surgery, any branch of it.
It is divided into three main parts to simplify the presentation of the different
topics but one can seamlessly glide from one box to the other.
Yet, I believe there is more to the book than making better surgeons.
As you read through its chapters you will see that you will not only be lead to
thinking of ways in which you can improve your surgical skills but I believe you
will also be challenged to consider other aspects of your everyday life and your
personality.
xi
xii Foreword by Giampaolo Gini
https://t.me/med1917
Topics such as understanding one’s reactions to stress (Individual Zones of
Optimum Function).
Performance Mental Skills Training (PMST), individualised learning curves and
Lean surgery are not only aimed at making you a technically better surgeon but can
equally be applied to your everyday life experiences.
A chapter such as the one on ‘Failure’ and the concept of ‘failing well’ really goes
beyond the realms of surgery and is an invitation for deeper reflection.
Equally compelling the one on ‘Learning to Accept Responsibility’ in a world
where both in public life and in private relationships this concept is becoming
obsolete.
In conclusion, a truly well-written and thoroughly thought-through book which
synthesises the teachings learnt from many years of practice in the operating theatre.
I am convinced that it will not only appeal to the surgeons for which it was written
but to a wider public as well.
After all what is an operating theatre if not an open window on the real world?
Giampaolo Gini, MD, Ph.D.
President of the European Vitreo
Retinal Society
Consultant Vitreo Retinal Surgeon
University Hospitals Sussex
Sussex, UK
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