Speaker 1: 0:24

Welcome to Doc Discussions. This is Jason Edwards and I'm here with my friend, dr Nick Boston. Nick is a general surgeon and Nick, how are you doing today?

Speaker 2: 0:32

Pretty good, Jason. How about you?

Speaker 1: 0:33

Yeah, doing well, Now tell folks where you're from, nick.

Speaker 2: 0:37

So I'm from Ohio originally, my whole family's kind of from Ohio and you know I'm an Ohio boy and went to Ohio High School and Ohio State University for undergrad and med school.

Speaker 1: 0:51

Very good, the Ohio State right. That's right. We own that article. And what town were you from?

Speaker 2: 0:57

originally I'm from Centerville, Ohio, which is a suburb of Dayton.

Speaker 1: 1:00

Okay, yeah sure, and a lot of people from St Louis actually go to Dayton because it's a Catholic college and so it's not uncommon to meet people.

Speaker 2: 1:08

Yeah, I kind of noticed that when I got here too, that Miami University. There's kind of a connection there with St Louis which is interesting.

Speaker 1: 1:15

Yeah, and I've always heard that's the chapel at Miami. Is it Oxford?

Speaker 2: 1:19

Yeah, it's in Oxford Ohio.

Speaker 1: 1:20

It's one of the most beautiful buildings in the state.

Speaker 2: 1:22

Yeah, it's a beautiful campus.

Speaker 1: 1:23

Yeah, and I've seen videos of a place called Hawking Hills, ohio. Have you ever been there?

Speaker 2: 1:30

Yeah, I've been there. It's a it's pretty beautiful place. A lot of great uh leaves, you know, in the fall, uh for sure. But that's kind of like where the um glaciers kind of stopped and pushed a lot of you know trees and stuff and, uh, it kind of created a lot of interesting you know trees and plants that create some pretty good leaves.

Speaker 1: 1:50

And the topography is kind of cool there.

Speaker 2: 1:52

Yeah, very kind of getting into. You know Appalachia a little bit.

Speaker 1: 1:55

Yeah, yeah, and then yeah, and then once you get kind of I guess it's Southeast towards Portsmouth, you're like very much in Appalachia. Yeah, it's an interesting state. I mean the Great Lakes, the Appalachia, it kind of has it all there. Yeah, the Appalachia, it kind of has it all there. Yeah, definitely, yeah, a lot of variation for sure, yeah. And so general surgery can you explain to people what types of surgery a general surgeon does typically?

Speaker 2: 2:18

Sure. So general surgeons generally concentrate on the abdomen. So most abdominal surgeries you know we're kind of the experts of the abdomen and other pieces are carved out by other specialties, but we mostly do abdominal surgeries. Gallbladders are the most common, followed by hernias and appendixes, and you know other things outside of the abdomen. Some general surgeons do breast surgery, but other lumps and bumps are kind of bread and butter as well.

Speaker 1: 2:47

Yeah yeah, the cardiothoracic surgeons do the chest, the ear, nose and throat doctors do the neck, and so yeah. But a general surgeon is kind of pretty useful in any situation though.

Speaker 2: 2:58

Yeah, we're, you know, kind of can do a lot of stuff you know, and aren't quite as specialized as some of the other specialists are.

Speaker 1: 3:07

Yeah, and so you know I was reading. The first laparoscopic cholecystectomy was performed in 1985 by a guy named Eric Mueh in Germany, and you know, today 90% of gallbladder removals are done laparoscopically, and so it's really like the standard of care. Can you explain to people what the difference is between, like an open surgery and a laparoscopic surgery?

Speaker 2: 3:28

Sure, whenever we're talking about surgery, at least on the abdomen, we're talking about either open or laparoscopic, and really that just means the you know the size of the incision and if you're using insufflation to you know, give your root, give yourself space to work in the abdomen. So laparoscopic surgery uses small incisions, so there's less trauma, it's less invasive, less pain, less complications, versus an open surgery where you make a big incision and kind of open things up and kind of do it more with your hands as opposed to long instruments.

Speaker 1: 4:01

And one of the things that I found interesting was when laparoscopic surgery was first introduced. It had a higher complication rate initially, but they showed that there was kind of this learning curve and typically, once you had about 50 procedures, the complication rates were actually lower or the same or lower with laparoscopic surgery. What's the main advantage you get from a laparoscopic surgery?

Speaker 2: 4:22

Mainly it's for the patient. You know it would definitely be easier on the surgeon maybe to do it open, but you know the laparoscopy is better for the patients. It's, you know, less trauma to the body. It's a quicker recovery. You know earlier return to work and you know um less complications as well. You know less risk of. You know intestines being slow after surgery. You know less pain, less bleeding, less infection definitely.

Speaker 1: 4:46

Yeah, and so this is kind of one of the few areas where it's better for the patient and the insurance company because it's less time in the hospital, and so that's a win-win.

Speaker 2: 4:55

Yeah, exactly, especially with gallbladder surgeries when it was open surgery. Those are super painful. You know being in the hospital for days and days versus.

Speaker 1: 5:03

You know a pretty routine laparoscopic gallbladder removal is outpatient, so you go home the same day laparoscopic gallbladder removal is outpatient, so you go home the same day and during your training, you know, one of the things that we had was like simulation labs. Did you guys do that too to try to cut down on that 50 cases where you could get experience, not necessarily in the operating room?

Speaker 2: 5:23

Yes, definitely. Yeah, my training program at Mizzou in Columbia was pretty heavy on the minimally invasive surgery. So we did a lot of labs actually working on, you know, box plastic trainers, as well as about a monthly or every other month pig labs. So we would operate on, you know, pigs as well to practice getting our skills, especially with surgeries that weren't as common. You know that we didn't get our hands on much. You know, in training we got to kind of get our hands dirty and do it on the pigs, yeah, with the swine, the, the.

Speaker 1: 5:58

You know, one of the things that people don't realize is that a pig anatomy is almost exactly the same as human anatomy. There's very, very little difference.

Speaker 2: 6:06

Yeah, definitely with surgical. You know what's the word Surgical research. It's definitely the go-to model for research.

Speaker 1: 6:22

Yeah, for sure, and I think the pig proteome like just if you just like look at proteins, 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: 6:33

Right, exactly.

Speaker 1: 6:35

So the now the robotic assisted surgeries. So this is like the da Vinci device. In 2000, there were like 1000 procedures worldwide, and then now there's almost a million annually. And now we have a da Vinci device here that some of the surgeons use, and that's kind of like they don't use it for gallbladder removal, but they use it for others, do they? Or do they use it for gallbladder? Yeah, you can use it for gallbladder removal too.

Speaker 2: 7:02

Yeah, there are definitely advantages of that as well. But Kind of to go back, robotic surgery kind of started with mostly urology surgery, so prostatectomies really were very difficult to do laparoscopically and open prostatectomies were probably even more difficult. So with the introduction of the robot that's allowed almost all of the prostatectomies, prostate removals, be done minimally invasively, which is great for patients. So you know that technology has been around, like you said, for now 25 years or more. We're on about the fifth iteration of the robot now and over time other practices of or other specialties in surgery have taken this device and kind of applied it to their own surgery. So you know, myself I've done I don't know 700 or 800 robotic surgeries, and those are, you know those are almost anything. You know that I do a lot of hernia repairs, a lot of colon resections and even some gallbladders here and here and there, as well as some of the more complex surgeries we do. The robot definitely has some benefits.

Speaker 1: 8:12

Yeah. And so to people out there who don't know what this is, I mean you're almost like at a like an arcade station and you're not actually like right, you're not facing the patient, right, but there's a robot surrounding the patient with multiple arms that works electronically.

Speaker 2: 8:29

Yeah, so it's. It's a robotic surgery is a piece of laparoscopic surgery, so it's still laparoscopic surgery, but the robot is not truly a robot. It's just a really really smart, expensive computer that helps the surgeon have a little bit more dexterity, a little bit less pain for the patient, less trauma to the patient afterwards and allow probably more patients to have a minimally invasive surgery than without the robot.

Speaker 1: 8:58

basically, and there's no artificial intelligence with it. It doesn't have its own mind. You're controlling everything. But the articulations of where it bends are kind of closer to the instrument, so it can get into tight spots.

Speaker 2: 9:15

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 laparoscopic surgery. But, yeah, so with robotic surgery, you know the surgeons in the room the whole time. We're controlling the machine the entire time, so it's not like you're having a robot operate on you.

Speaker 1: 9:32

We're not there yet we're not there yet and that of course, works well for the pelvis, because internally the pelvis is kind of like an upside down traffic cone and it's very hard to kind of get in laterally when there's not a lot of space there. And then I would think for something like an adrenal gland or something like that, it would be very helpful, because that's a pretty tight spot as well. Yeah, definitely.

Speaker 2: 9:54

Yeah, I do. You know, adrenal ectomies with the robot as well. Those aren't super common but the robot's a good tool to use that for. I do do foregut surgery. Foregut means, you know, operating on the upper stomach, you know, for hiatal hernias or other less common diseases like achalasia or anti-reflux sort of surgeries, and the robot's definitely a huge benefit to be able to do that operation.

Speaker 1: 10:19

Is that like a fundoplication? Yeah? So a lot of people have anti-reflux surgeries, the fundoplication when they kind of take part of the stomach and wrap it around the upper part and kind of create a new sphincter.

Speaker 2: 10:28

Yeah, For people who have bad reflux, the sphincter between the stomach and the esophagus isn't working great, so we wrap the stomach around the esophagus in a very controlled manner to help that prevent reflux.

Speaker 1: 10:40

Yeah, I'm kind of saying it crudely. It's obviously much more complicated than that of course. But yeah, actually you did an adrenal glycemic on a patient of mine and that I mean, that's all I remember in general surgery. That was that's a hard surgery to do and you did great, and so I was very happy with that. And that was kind of like. You know, when we first started working with each other a few years back, that's when I was like, okay, this guy's a legit good surgeon and so, um, yeah, those are memorable.

Speaker 1: 11:04

Those are, you know, enjoyable cases and especially helping out at you know a cancer patient is always enjoyable and rewarding, for sure, and so the robotic-assisted surgery is kind of like the next iteration into laparoscopic surgery. And then I think they are looking at AI to enhance a surgical visualization, but I don't know if this is ready for prime time yet, but the thought is it may help with surgical planning. Now I don't know if is that more of a neurosurgery thing, or does that have?

Speaker 2: 11:39

applications in general surgery as well.

Speaker 1: 11:39

It has a few applications in general surgery and laparoscopic surgery as well, but probably just not quite as important as it is, for you know the other specialties yeah yeah, and so you know I want to switch gears a little bit and I was recently reading about a researcher and I'm going to butcher this name, but the name is Mahaly Cheeksentmihai and I actually have read a couple books that talked about these studies that they did and it was in the 1970s and they would hand people pagers and they would ask them like how they're feeling at different times, and they actually, and so it wasn't, it was like less than controlled, less of a controlled environment.

Speaker 1: 12:24

So they had a, a, a journal, and they would get a page and they would say I'm feeling good here or not good here, and this is what's happening. And that's what's happening. And one of the things that they were able to find from these studies, amongst multiple interesting things, was that patients or people can enter these flow states and you know, you might think of like an athlete who's like, you know, jordan's, like hitting every shot Right, but it's it's when you're performing a complex task that kind of meets your skill set, that requires some intense focus and precision. And I would think that doing these surgeries, that you've done a lot of surgeries and so you're familiar with the surgery Do you ever feel like in the, or you kind of hit one of these flow states, like when you're doing the surgeries.

Speaker 2: 13:11

Yeah, I think that's definitely true. You know for sure. You kind of get, you know in the zone, but more so you kind of you know. It's almost just like you're so used to doing it that you're kind of disconnected from your body, but you're just in the zone, doing what you love to do and know how to do and were trained to do.

Speaker 1: 13:47

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 and you're just kind of a man working in your craft and and and you know, I would think that you kind of feel like that's where you're supposed to be in. The universe is like in the operating room doing your work.

Speaker 2: 14:08

Yeah, it's definitely our happy place, for sure, as surgeons. You know we, we see patients in the office. We see them in the hospital. You know we, we see patients in the office, we see them in the hospital.

Speaker 1: 14:17

You know we do a lot of talking, but our happy place is definitely in the operating room. Yeah, and one of the nice things I remember too is that the you know you're, you're getting calls all day and people are coming at you with all kinds of stuff and, like in the operating room, you're kind of protected from that.

Speaker 2: 14:28

Right and it's, it's.

Speaker 1: 14:29

There is some peace there.

Speaker 2: 14:30

Yeah, you're definitely protected and you kind of, for the most part, know what to expect. Yeah, and you're doing something that's important too. Yeah, very important. Yeah, for sure.

Speaker 1: 14:38

That's awesome, man. And so what's the name of your group, your surgical group, because we know some of your partners here.

Speaker 2: 14:46

Yeah, so we're actually, you know, part of the St Luke's medical group now, but we're the St Luke's surgical consultants. Yeah.

Speaker 1: 14:54

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, you know smaller surgeries that you guys do. I'm sure that's a chip shot for you guys.

Speaker 2: 15:06

Yeah, those are, those are fun and you know again, it's always, um, you know, uh nice to take care of cancer patients and to help them out.

Speaker 1: 15:15

Yeah.

Speaker 2: 15:16

Because that's definitely rewarding for us. So you know I know they love you, jason, and you know I think you're a great doc as well. But you know we appreciate everything you do and we love helping you.

Speaker 1: 15:27

You know, this is a requisite. Anybody has to come on the show. They have to, you know, say like how great.

Speaker 2: 15:31

I am, that's right.

Speaker 1: 15:40

And so I may have used this line before, but you're never as good or as bad as people say. You are All right, Nick, and how would somebody get ahold of you or your office if they wanted to talk about surgery or a?

Speaker 2: 15:45

second opinion? Sure, so you can always call our office to make an appointment. It's pretty easy. Just call us at 314-434-1211. And we'll be happy to see you in consultation in the office. You know, and I'm happy to, you know, talk things out in the office. You know, before we make any decisions about surgery, that's always an important part.

Speaker 1: 16:03

Yeah, for sure. I think I've sent you patients and 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 a surgeon's best tool is not their hands, it's their judgment.

Speaker 2: 16:16

Yeah, that's absolutely true. You know, surgery is not always the option or not always the best option, but you know that's what we're here for to make that decision.

Speaker 1: 16:25

That's why we've, you know, trained for this. Well, nick, we're glad to have a Buckeye here on the staff and I want to thank you for all the great care that you give our patients.

Speaker 2: 16:33

You bet Absolutely.