Securing Surgical Exposure – Les clés de l'excellence chirurgicale *

Prof. Dr. Pascal Probst, Spital Thurgau

La formation chirurgicale dépend entièrement de l'exposition opératoire. Le nombre de cas n'est pas un indicateur abstrait, il constitue la base de toute forme de développement en chirurgie. La compétence, la maîtrise et, en fin de compte, l'excellence ne s'acquièrent pas par l'observation, mais par la pratique. Chaque opération est un examen – et une opportunité.

Mais ces occasions risquent justement de se raréfier. Alors que les exigences administratives et la pression en matière d'efficacité augmentent, il devient de plus en plus difficile pour les jeunes médecins d'apprendre activement dans la salle d'opération. Le nombre de cas diminue – souvent de manière imperceptible et insidieuse – avec des conséquences directes sur la qualité de notre formation continue [1].

À cela s'ajoute un autre aspect : même les collègues expérimentés sont aujourd'hui soumis à une pression d'apprentissage totalement nouvelle. Pour de nombreux chirurgiens seniors, l'introduction de systèmes robotiques signifie un nouveau retour à la courbe d'apprentissage, avec toutes les incertitudes, le temps nécessaire et la concentration sur leurs propres compétences que cela implique. C'est compréhensible et cela mérite d'être reconnu. Mais cela conduit également à la suppression des opérations destinées à l'enseignement ou à leur transfert vers des niveaux hiérarchiques supérieurs. Dans ce contexte, la robotique est souvent perçue comme un ennemi par les jeunes collègues.

C'est précisément dans ces moments-là qu'il est essentiel de se rappeler la responsabilité centrale de la formation chirurgicale continue. Ceux qui maîtrisent la chirurgie peuvent et doivent enseigner. Car l'enseignement ne compromet pas la sécurité des patients, il la garantit à long terme[2]. Les nouvelles technologies ne doivent donc pas être considérées comme exclusives, mais comme intégratives : comme des outils qui facilitent la formation et ne la compliquent pas.

Un autre point concerne l'attitude envers son propre développement. Trop souvent, en chirurgie, on véhicule l'idée que l'excellence est un état, alors qu'il s'agit en réalité d'un processus. Seuls ceux qui sont prêts à se perfectionner peuvent entraîner les autres dans leur sillage. Cela implique de la planification, une orientation vers les objectifs et la création active de moments d'apprentissage. La qualité de la formation n'est pas le fruit du hasard, elle résulte de décisions conscientes.

En conclusion, on peut dire que la sécurité de l'exposition chirurgicale n'est pas une question technique. C'est une question de culture, d'attitude et d'organisation structurelle de notre quotidien. Si l'on veut atteindre l'excellence chirurgicale, il faut permettre la formation continue en chirurgie – aujourd'hui, pas demain !

Références

Grossen H et al. Future demand for visceral surgeons in Switzerland: an empirical study. Langenbecks Arch Surg. 2025 Aug 16;410(1):248.

2 Joana Rodrigues Ribeiro et al. The Influence of Surgical Teaching on Laparoscopic Cholecystectomy Outcomes: A Retrospective Propensity Score-Matched National Cohort Study. Under review.( 9.9.2025).

* Résumé de la présentation donnée le jeudi 22 mai 2025 lors du congrès SCS dans le cadre de la session intitulée « Guardians of the Scalpel: Securing excellence in surgical residency » (Les gardiens du scalpel : garantir l'excellence dans la formation chirurgicale).

BJS Session - Cultivating Excellence
A Fireside Chat with Ellen Petry Leanse and Dr. Rebecca Kraus

Recording of the «BJS Session - Cultivating Excellence» from the SCS Annual Meeting 2025.

Summary

Written by Ellen Petry Leanse and Dr. Rebecca Kraus

OPENING THE NOTHING BOX

Think about leadership – and life – and you’re actually thinking about the brain.

That theme was clear as Rebecca Kraus led a Fireside Chat with Ellen Petry Leanse, a Silicon Valley neuroscience educator and coach, at last week’s Swiss College of Surgeons Annual Meeting in Lausanne. Exploring themes like mindset, collaboration, and psychological safety, the conversation looked at ways of facing and preventing workplace conflict, harassment, hazing, and other unhealthy patterns, all through the lens of neuroscience.

“We explored how cognition is affected by emotional hijacks and the loss of psychological safety,” recalled Rebecca, President of the Swiss Society of Surgery. “Ellen showed how a sense of threat catalyzes a chemical reaction in the brain’s amygdala, reducing blood flow to the frontal regions of the cortex.

“This matters because those regions deliver some of our highest mental functions, including attention management, intentional thought, and impulse override. Clearly, these are functions every surgeon wants to reliably have available. Conditions that adversely affect emotions are always a concern. Yet in the case of surgical professions, they can actually create danger.”

Another focus of the talk was mutuality and the opportunity for people of different backgrounds, genders, or specialities to be better together. This led naturally to an exploration of the differences between female and male brains and how their different innate tendencies can lead to “better together” ways of working – in the presence, that is, of psychological safety.

That’s when Rebecca took Ellen by surprise with her own insights into neuroscience. She cited a video exploring the male brain’s gift of a “nothing box” – an allegorical term describing male brains’ ability to “shut down” into a quiet mode, a tendency Rebecca stated she wished she could access.

Ellen was quick to confirm that all healthy brains are more alike than they are different, yet acknowledged innate differences in how female and male brains prioritize and process information.

“Any healthy brain can learn and practice pretty much anything available to other brains,” she explained. “That said, the connection-oriented priorities of female brains might make a ‘Nothing Box’ less obviously available.”

Rebecca stated a wish to have easy access to a “Nothing Box,” a term used in the video to describe the male brain’s tendency to compartmentalize discrete information (in contrast to female brains’ tendency to connect information), or even to imagine what it might be like to have a quiet, still brain where “nothing” is going on.

Her perspective is consistent with comments made about the “Nothing Box” concept, including in this thoughtful piece:

“...women are never thinking about nothing. Women have anywhere from five to twenty-five thoughts going on at once, while men often have from zero to five thoughts going on at one time…men naturally compartmentalize their lives; whereas, for women, everything in their lives touches everything else.”

Excerpt from The Nothing Box, https://preengaged.com/the-nothing-box/

After exploring the “Nothing Box” concept, Ellen said, “When I viewed the video she sent and scouted the commentary around the concept, I was taken by surprise. Although I haven’t yet found research that substantiates a ‘Nothing’ state, it’s at least an excellent illustration for a significant difference in the functional orientation of female and male brains.

“Women’s brains tend to be both more connected, and connected in different ways, than male brains. That, and the functions of the more androgen-dominant left hemisphere, support a possibility that men compartmentalize information more than they interweave it, which is quite different from female brains. If only as a model for helping us understand one another better, I’m grateful to have learned about the concept from the conversation we shared.”

Rebecca added, “Sometimes it would be helpful for me – for all of us – to know how to simply sit in a chair thinking nothing, just being. Men can learn a lot from women, but women can gain a lot from practicing men´s ‘Nothing Box.’ I think all of us could benefit from this practice.”

Ellen, who has taught The Neuroscience of Creativity and Innovation at Stanford University and who leads workshops worldwide on brain-aware approaches to leadership and problem solving, has committed to writing a fuller analysis of the Nothing Box concept (and how anyone can activate it) for her LinkedIn newsletter, The Beacon.

Ellen Petry Leanse

Ellen Petry Leanse is a neuroscience educator and former Silicon Valley innovator who teaches at Stanford University, where she integrates cognitive neuroscience with leadership and innovation. Though not a medical doctor, her work significantly impacts the healthcare field by equipping professionals with tools to enhance communication, focus, and team dynamics. She was a guest at the SCS Annual Meeting 2025, and appeared in the BJS Session on Friday, May 23, highlighting her role in fostering excellence and resilience within the surgical community.

Dr. Rebecca Kraus

Dr. med. Rebecca Kraus is a prominent Swiss surgeon specializing in visceral surgery and currently serves as the President of the Swiss Society of Surgery (SGC-SSC). Since 2020, she has held the position of Deputy Chief Physician in the Department of Visceral Surgery at the Kantonsspital Graubünden in Chur . Dr. Kraus is a strong advocate for surgical education and mentorship. She initiated the Smart Surgical Forum (SSF), a monthly online educational series designed to support surgical trainees through interactive case discussions led by young surgeons and expert moderators .