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Why It Took 125 Years to Move a Mouth Graft into a Ureter, and What That Tells Us About Innovation in Surgery 1. Sapezhko in Kyiv As early as 1890, a surgeon named Kirill Mikhailovich Sapezhko, working in Kyiv, took oral mucosa from a patient’s mouth and used it to reconstruct the patient’s urethra. In 1894, he published a fuller account of this work, describing mucosa from the lip and mouth in patients with urethral disease. By the standards of the time, the operations appea

Why Surgical Training Never Really Ends 1. A Simple Procedure Early in my residency, I placed a suprapubic tube. It is a routine procedure, the sort every urologist is expected to do safely. A small incision is made above the pubic bone, a trocar is advanced into the distended bladder, and a catheter is passed. An attending appropriately supervised the case. I was neither unsupported nor unprepared. The patient died. The trocar created a small peritoneal defect. Urine leaked.

1. The Legend, the King, and the Hostile Abdomen On March 28, 1980, in a military hospital on the banks of the Nile, Michael DeBakey removed a spleen the size of a football from a dying exile. The patient was Mohammad Reza Pahlavi, the deposed Shah of Iran. The spleen weighed close to 2,000 grams, riddled with tumorous nodules from a lymphoma whose severity had been concealed from the Shah himself for years. The surgeon was the most celebrated figure in twentieth-century Amer

Or: Why the Best Surgeons Cannot Escape Variance, and What That Teaches Us About Learning in Complex Systems 1. The Ether Dome and the Statistician On October 16, 1846, William Morton administered ether to a patient in the amphitheater of Massachusetts General Hospital, and surgeon John Collins Warren removed a tumor from the patient's neck while the man slept. Warren turned to the assembled physicians and said, "Gentlemen, this is no humbug." The Ether Dome, as it came to

Intuitive wins 3 new indications for da Vinci SP system Getting energy from a fusion reactor 93 million miles away is cheaper than burning the rocks in the ground. Logarithmic axes I. There is a famous graph of the cost of solar power. It looks like a slide at a water park: an inexorable drop from "prohibitively expensive, best for space tech" in 1975 to "cheaper than coal" in 2023. If you had written a blog post about solar panels in 1990, you would have been factually cor

I let ChatGPT analyze a decade of my Apple Watch data. Then I called my doctor. https://www.msn.com/en-us/news/technology/i-let-chatgpt-analyze-a-decade-of-my-apple-watch-data-then-i-called-my-doctor/ar-AA1UZxip?utm_source=substack&utm_medium=email I. In Jorge Luis Borges’s The Library of Babel , there is a library containing every possible book. Most of them are gibberish—random sequences of letters like “mcvbn qio jkl.” But somewhere in there is the true history of your dea

When I am sitting at the robotic console during a cystectomy, the relationship between my hands and the instruments is absolute. Every movement—scaled, filtered, stabilized—originates from me. The robot does nothing independently. This is teleoperation, the model that has defined robotic surgery for more than twenty years. Despite this reality, headlines and academic discussions are increasingly filled with claims about “autonomous” surgery. For surgeons actually operating, i

A video of Elon Musk speaking with Peter Diamandis and Dave Blundin talking about the future of AGI Timeline, US vs China, Job Markets, Clean Energy & Humanoid Robots. https://youtu.be/RSNuB9pj9P8?si=HRs9v11Ae0xzK_zk&t=3775 The headline for the press: Tesla Optimus will be replacing human surgeons https://www.instagram.com/reel/DTOmP7wEpnT/ Does this kind of technology threatens the future of surgical careers? My reaction is not anxiety. It is recognition. I have seen this

I created this website to make my educational work easier to find and easier to use. Over the years, material related to my work—articles, lectures, surgical videos, presentations, and explanations of how I approach complex cases—has ended up scattered across many different places. Some of it lives on institutional websites, journals, conference recordings, and social media platforms. Individually, those resources are very useful. Collectively, they can be hard to locate. Thi