Creativity in Surgery

Tirone E. David

University of Toronto

CREATIVITY

1. Genius theory

Leonardo da Vinci 1452 - 1519

Works of Leonardo da Vinci

CREATIVITY

1. Genius theory

2. Stepwise, logical evolution of new ideas, products, operative procedures, etc…

Model of the DNA

Watson & Crick

Nature 1953; 171:737-8

Gregor Mendel 1822-1884

"Father of Genetics" Son of a farmer who became a catholic monk, conducted an experiment that involved growing thousands of pea plants, which led to the discovery of genes. His ideas were published in 1866 but went largely unrecognized until 1900.

Frederick Griffith 1881 - 1941

Virulent

Pneumococcus

Non-virulent

Pneumococcus

Heated virulent

Pneumococcus

Non-virulent +

heated virulent

Pneumococci

+

+

+

+

=

=

=

=

Death

Live

Live

DeathExperiments withPneumococcus in 1928

Oswald Avery 1877 - 1955

+

+

+

=

=

Death

Death

Experiments withPneumococcus in 1935

Non-virulent + heated virulentPneumococciNon-virulent +Virulent with destroyed lipids, ribonucleic acids, carbohydrates, and proteins

Non-virulent +Virulent withdestroyeddeoxyribonucleic acids

= Live

Erwin Chargaff 1905-2002

In 1950 he concluded that there must be as many types of DNA as there aredifferent species. The number of purinebases (adenine and guanine) was equalto the number of pyrimidine bases(cytosine and thymine). The number ofadenine bases was equal to the numberof thymine bases and the number ofguanine bases was equal the number ofcytosine bases.

Chargaff’s rule: A = T, and G = C

Linus Pauling 1901-1994

In May 1951, he described the structures of a number of proteins, including the structure of the single most important basic form of protein chain, the alpha helix (a hydrogen-bonded helical chain that is a structural component of most proteins).

James Francis Rosalind Maurice Watson Crick Franklin Wilkins 1928- 1916-2004 1920-58 1916-2004

Cavendish Laboratory Randall’s Laboratory Cambridge King’s College

Rosalind Franklin Franklin’s x-ray 1920-58 diffraction of DNA

Watson and Crick

Original Model of DNA

Nature, 1953

Nobel Prize of Physiology or Medicine 1962

Francis Crick James Watson Maurice Wilkins 1/3 prize 1/3 prize 1/3 prize

Rosalind Franklin Died in 1958 at 37 years of age of ovarian cancer

Franklin’s x-rays diffraction of DNA

1866 - Mendel

1928 - Griffith

1935 - Avery

1950 - Chargaff

1951 - Pauling

1952 - Franklin

1953 – Watson & Crick

Leonardo da Vinci

“The Paragon of Creativity”

Thomas Alva Edison 1847 - 1931

“Creativity is 1% inspiration and 99% perspiration”

Creative People

Skillful

Self-motivated

Knowledgeable

Creativity results from the interaction ofa system composed of three elements:

DomainField

Person

Domain is an area of our culture

Examples of domains: Medicine Heart valve surgery Mitral valve surgery

Field = gatekeepers of a domain

Without the assessment of competent outsiders there is no reliable way to decide whether the claims of a self-styled creative person are valid.

Person

The individual that is able to create a new idea, product, or an operation

Left Ventricular Rupture After MVR

Treasure RL et al. Chest 1974;66:511

Left Ventricular Rupture After MVR

Reconstruction of the Mitral Annulus

Reconstruction of the Base of the LV

Reconstruction of the Base of the LV

Reconstruction of the Base of the LV

Reconstruction of the Base of the LV

Reconstruction of the Base of the LV

Reconstruction of the Base of the LV

Post-Acute Myocardial Infarction VSDRepair by Infarct Exclusion

Post-Acute Myocardial Infarction VSDRepair by Infarct Exclusion

Endocardial patch for LV rupture

Reconstruction the mitral annulus

Reconstruction of the base of the heart

Reconstruction of the LV wall

Peer-reviewed publications

Left ventricular rupture after mitral valve replacement: endocardial repair with pericardial patch.David TE. J Thorac Cardiovasc Surg. 1987 Jun;93(6):935-6

Reconstruction of the mitral anulus.David TE, Feindel CM. Circulation. 1987 Sep;76(3 Pt 2):III102-

Postinfarction ventricular septal rupture: repair by endocardial patch with infarct exclusion.David TE, Dale L, Sun Z. J Thorac Cardiovasc Surg. 1995 Nov;110(5):1315-22

.... Plus 28 other publications on this topic

Surgical Creativity

• A process that unfolds during a lifetime

LV function after MV repair is better than after MVR

Gore-Tex for replacement of chordae tendineae

Techniques of MV repair in Barlow’s valves

Mitral Valve Surgery

Aortic Valve Surgery

Stentless aortic valves

Aortic Valve Surgery Aortic valve sparing operations

Creativity results from the interaction ofa system composed of three elements:

DomainFieldPerson

Surgical Creativity

Arises from the synergy of many sources andnot from the mind of a single person

Outliers:

Albert Einstein IQ 150

Christopher LanganIQ 195

Christopher LanganBorn in San Francisco, 1952

“The smartest man in America" IQ = 195 - 210

He rose to prominence in 1999 while working as a bar bouncer in Long Island

The Cognitive-Theoretic Model of the Universe

Gladwell:

“No one –not even rock stars,not professional athletes, notsoftware millionaires, and noteven geniuses – ever makesit alone”

The End of Europe’s Middle AgeFlorence, Italy – Renaissance’s Birthplace

Where do creative ideas come from?

Come from the past Come from previous knowledge and experiencesCreative works begin in continuity with the past

Surgical Creativity

Arises from the synergy of many sources andnot from the mind of a single person

“Creativity is 1% inspiration and 99% perspiration”

Thomas Edison

Thank you